VERY NEAR, YET SO FAR!

When a doctor arrives at a diagnosis, is it the final say ? I am not trying to doubt the credibility of the doctors’ skills which he has acquired after a massive effort. I am trying to raise a very basic question. Do doctors know everything today ? Have the doctor- scientists discovered all possible factors that can disrupt or even influence the normal functioning of the human body?
The obvious answer is a big NO. What makes me write this blog is that the not very uncommon repetition of the statement ‘ the exact mechanism behind this is still not known’, in books that are considered bibles of the basics of medical school. It makes me ponder about so many possible outcomes of an impossible disease, promising treatments for the unknown ailments. What I mean by unknown ailments is that we might be treating a disease say X assuming it to be Y by a drug say Z, as Z is the most precise treatment for Y, not because of our inability to diagnose X, but because we have not discovered it yet.
At times we may not get the desired therapeutic effect of a particular drug or a procedure. Resistance or tolerance to the chemical, genetic polymorphisms in the mechanisms that might eliminate it, the severity of the disease is high, the dose is insufficient, the surgery did not remove it completely, these are some of the common interpretations and possibilities that we ponder upon. I wonder why is it that we don’t think of a possibility of it not being known yet.
Another reason why I am writing this is because I’ve seen and observed closely, a patient who presented with a giant cell tumor in the mandible, was operated and a bone graft from the fibula was done not once but twice and it recurred for the third time. With the little knowledge of what I’ve acquired so far, I do understand that it is very rare in the mandible and recurrence is its speciality. What boggles even the top medical professionals in the field Is that the graft from the fibula being affected again and again.
When the pathologists say it’s a squamous cell carcinoma of the lung, when the biochemists say it’s obstructive jaundice, when the microbiologists say it’s hepatitis B, is it done ? Isn’t there a possibility of something closely relevant but slightly different? Isn’t there a possibility of there being a small gap which we don’t know, could mean a huge leap if it is known? I’m sure we are here today only because of such giant leaps. From what was called a mass to a swelling to a cancer, today we think of it being either benign or malignant, adenocarcinoma or squamous cell carcinoma, CIS or invasive, congenital or acquired, germ-line or sporadic and so on. I know that we have come a long way, but we cannot afford to deny the fact that we have miles to go and I’m not sure if we can ever sleep, for these miles have no numbers or limits to unravel the mysteries of God’s creation.
A person who has a high blood sugar level, may belong to type 1 or type 2 diabetes according to the present system. Tomorrow, it might be type 19 or type 34. Today, we might read in books that Alzheimer’s disease is caused due to ‘tau’ deposits, tomorrow it might be said that it is due to ‘Sai’ deposits. In a nutshell, more and more efforts, funding and encouragement must go into research, in par with that which goes into diagnostics and treatment facilities, the former makes the latter simpler. In my view, I think genetics opens up a huge window to unravel various mysteries and answer quite a few questions.

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