As a young man, Samuel Clemens spent two years learning the lay of the Mississippi River to become a licensed riverboat pilot. No sooner had he completed his apprenticeship than he realized that the topography of the river had changed. In order to maintain his proficiency as a pilot, he would have to continue to study the waterway, which remained in a constant state of flux.
Rivers are not the only things that change over the course of time. Medical knowledge also morphs with each new piece of data that is discovered. Just when we think we’ve got it figured out, voilà—a piece of information gleaned from the latest research hints that we’re probably off the mark; and so we set off, chasing a new lead.
Consider the influenza virus. These small packets of RNA mutate every year, changing just enough to keep ahead of our immune responses. We get exposed, we become ill; and, most of the time, we recover. Yet history has shown that once in a great while a strain of virus surfaces which most of us have not encountered before. At these times influenza pandemics have the potential to wipe out large segments of the human population. Those of us who survive carry the immunity to prevent illness when next we are exposed to the same or a similar viral strain. But just because we survive doesn’t mean that we can become complacent. It’s only a matter of time until the next mutant arrives on the scene, courtesy of random genetic drift.
Thirty years ago conventional wisdom had it that peptic ulcers were produced by hyperacidity of the stomach, brought on by stress. Patients were treated with medicines designed to neutralize or decrease the production of gastric acid and advised to seek productive ways to reduce stress in their lives. Then, in 1979, Dr. Robin Warren, an Australian pathologist, discovered a type of bacteria prevalent in the lining of stomachs of patients who suffered from ulcer disease. Eventually, Warren and his colleague Dr. Barry J. Marshall were able to prove that Helicobacter pylori was the causative agent of peptic ulcer disease. Treatment plans were devised to eradicate the organism from the stomach, which led to a cure for this common malady.
So it is with medical science. Many times what we think we know for certain turns out to be nebulous at best. Still we beat on against the current of conventional wisdom, ever learning in fits and starts, never quite nailing down the truth.
Thirty years ago when I was a young student of medicine, our professors told us that fifty percent of what we were taught would ultimately turn out to be erroneous. Their dilemma of course was that they couldn’t tell us which half was wrong. We were forced to digest as much information as we could, hoping for the best. The study of medicine, like the study of a river, is a life-long process.
As a riverboat pilot, Samuel Clemens would bark orders from the bridge to periodically sound the depth of the river to avoid running aground. Soundings were taken by heaving a weighted line over the gunwale of the boat to measure the depth of the water in fathoms, indicated by knots in the line: two fathoms marked sufficient depth for safe passage.
Like riverboat pilots, we must periodically sound our medical knowledge. Sometimes we drift into shallow water and come up short; but so far the depth has been sufficient to avoid running aground.