September 24, 2020

Op-ed from Marschall S. Runge, M.D., Ph.D.: A certainty of medicine is that caregivers will forever wrestle with uncertainty

Our growing certainty about the limits of the general approach we often take adds uncertainty regarding the care we are delivering

Real Clear Health newsletter graphic

In an op-ed published Sept. 23 in Real Clear Health, Medical School Dean Marschall S. Runge, M.D., Ph.D., writes about the uncertainty that caregivers face in the health care arena. He writes:

“COVID-19 has brought this into sharp relief as we confront an illness that we are just beginning to understand. Even as we make significant strides in treating the sick, a host of basic questions remain: Why does it affect the elderly far more than the young;? Why do some people who seem similar based on their age and medical histories suffer no symptoms while others remain ill for months on end? Why have a tiny handful of recovered patients become reinfected?

“Although some of the mysteries can be attributed to the sudden and unexpected emergence of this deadly virus, the questions highlight a more profound truth of modern medicine.

“An irony of our high-tech age is that even as breathtaking discoveries and wondrous machines allow us to improve care, these advances have raised almost as many questions about the human body as they have answered.

“Our growing understanding of cancer, for example, has revealed that it is not a single illness but a complex set of perhaps 200 diseases known by a single name, each of which presents its own challenges to treatment.

“Perhaps even more daunting — and inspiring — are the questions raised by the mapping of the human genome. This dramatic breakthrough has shown that even those 200 types of the cancer are just the tip of the clinical iceberg because each disease can take a slightly, or sometimes radically, different course in each unique individual.

“This discovery informs the concept of precision medicine, which combines the patient’s genome along their personal and family medical histories, social and physical environments, and lifestyle, to tailor treatments that are most effective for them.

“Precision medicine is promising, but it is still in its infancy. It remains, today, more an aspiration than a reality. This creates a Catch-22 for caregivers: We know that the most effective treatments are personalized but we don’t yet have the capacity to deliver customized medicine in the vast majority of cases. Thus our growing certainty about the limits of the general approach we often take adds uncertainty regarding the care we are delivering.

“Make no mistake, this awareness is an important advance. It is just as empowering to recognize what you do not know as what you do.”