Dr. Janet Abshire on New Ideas and Advancing Medical Practices

Put what you know aside in a safe place so that you can open your mind to something new. Scott Peck, in his best selling novel The Road Less Traveled, called this putting aside of what you know, so that you could really be open to learning new information 'Bracketing'. He also called not caring if you are right as being 'Dedicated to the Truth'. Fred Kaufman in his fabulous audio series Conscious Business, calls the same concept of not caring if your right as 'being a learner, not a knower'. For instance, if you see yourself as a learner your ego is not tied up in being right, but more in being proud of being a truth-seeker. It doesn't bother you to say, 'I could be wrong.'

New discoveries in neuroscience show how we are all limited creatures when it comes to how we decide what to do and what is real. Human limitations of perception are hilariously demonstrated in a video where the audience is instructed to count how many times the team in white clothing pass a basketball around a circle. Only a very small portion of the audience will raise their hands when asked who saw the man in the black gorilla suit stroll into view pause in the circle and leave again. When played again the audience roars with laughter. A few insist that it was a different video, but the original few that saw it refute this. We preferentially see what we are focusing on and exclude the non-essential. When we have a healthy brain we are able to filter out all unnecessary stimuli so that we can function more effectively, however we can miss important details. In addition to missing visual stimuli we also tend to hang onto what we know and exclude new ideas, so we are slow to change our minds. This occurs even when there is a preponderance of data, and seems to be worse if we are an expert in the field. This happens outside of any political and economic incentives to keep the status quo. This causes delays of progress in health care, environmental policy change, and everything else.

It helps all of us to know our limitations. I highly recommend the novel How We Decide by Jonah Lehrner. He makes a complex subject easy to understand with interesting stories. He explains the above mentioned limitations and other surprising new findings based on the science of functional brain imaging. For ages we believed that rational thought was superior to emotions, but the new science shows how sometimes rational is better, but we can be more easily duped with rational thinking, so sometimes emotional is better. Knowing when to use each is the key. When to say a certain level of proof is sufficient, and when we really do need more data. One of the most successful strategies, appealing to rationality, is to say there is not enough evidence. There may never be enough evidence if you have drastic enough standards or focus on the wrong point.

Lets take the controversial subject of statin use for lowering cholesterol. We cannot recommend Coenzyme Q 10 for people on statins because the study did not show definite improvement of muscle pain caused by a side effect of statins, despite the fact that we know that stains lower the production of this needed substance. If they can't prove that lowering the production of the substance does harm, and can't prove it helps when things go wrong, they can't recommend it, even though they know we are decreasing normal production. We know quite a bit about what it does in the body and how important a molecule it is. When does reasonableness come in to play? Also, because statins lower risk of heart attack from 2% to 1%, they can call it a 50% reduction which is helpful for marketing purposes. Some will argue that only those who have already had a heart attack should risk the side effects, as the side effects are also 1% to 2%. This however is not how it is prescribed, many disagree, and in fact they are recommending it as prevention, and for younger and younger people.

This is controversial, and as the standard of care favors the use of statins many doctors have closed their minds to looking deeper into the research. In the doctors defense, they do not have time and trust their governing board to decide. How an idea is presented makes all the difference in its acceptance, and in the boards defense, we are all vulnerable to marketing tools. The drug companies have a lot of money to put toward marketing their ideas and it works.