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Wednesday, November 14, 2012

Medical Reformation

500 years ago, Martin Luther nailed his 95 thesis on the door of the local cathedral.

What this event marked was a dramatic change in the relationship of people with the most important human institution in western Europe at the time; the catholic church. Luther's actions was preceded by key technological advances of the day, most notably the development of the printing press by Gutenburg.
Prior to the printing press, the church through the clergy controlled access to the printed word, primarily in the form of the bible. After deployment of the printing press, the holy bible, and all of the wisdom contained, was no longer was controlled by the priesthood. Then as now, he who controlled information controlled power.


Roll the clock forward to the last century. The status of physicians in the 20th century underwent a profound change. In the previous century, physicians held a status only slightly higher than barbers. With notable exceptions, most physicians has limited useful knowledge and few tools to deploy when confronted with serious medical situations. The developments of anesthesia, antisepsis, and antibiotics changed all that and by the mid portion of the 20th century, physicians held the status of gods. As Arthur C. Clark once noted, “When technology becomes sufficiently advanced, it becomes indistinguishable from magic”, and medical magic for most of the 20th century held the public is complete awe.

The continuation of awe was also facilitated by the relatively proprietary nature of the knowledge base behind which the medical magicians practiced. We held our cards close and as a rule the public was sufficiently intimidated to inquire further or question physician status.

The internet has begun to change all of this.

Like the printing press, it has taken cloistered texts and other writings out of the hands of the clergy, in this case the medical clergy, and made it available to all those who can search and read. The impact is profound and likely to become even more profound. Prior to the reformation, the catholic church firmly held to the belief that the bible and the information it contained was best controlled by the Church. So much was at stake, that being the souls and eternal fates of human beings. People simply could not be trusted with such responsibilities. Only the special priest class could be entrusted with such a role.

The arguments are being put forth by the medical priesthood. Too much as stake, and patients cannot be entrusted with their own lives. However, the genie is out of the bottle. The information is already out there and more will become available to patients every day. Some of it may be unreliable but the same can be said for what is vetted by peer review in our own fields. Furthermore, patients have an inherent advantage over their health care providers. They have much more time to invest in their own care and they have so much more skin in the game.

I saw the Medical Luthers posting their 95 theses on the door today. They are doing it everywhere. There may be health care providers who will excommunicate their Luthers. I am not sure they have much leverage. The relationship is going to be changed forever.

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