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Myth: doctors can do a lot these days

Myth: doctors can do a lot these days

Photographer:Fotograaf: Joey Roberts

Myth busters

When prof. Harald Schmidt was a student, many lecturers and students raved about the holistic approach in medicine. Schmidt did not want to have anything to do with that “woolly babble”. He felt that if someone had a heart problem, you should look at his or her heart, and not at the person as a whole. In the meantime, he has changed his mind. The latest molecular genetic insights actually support holism.

Schmidt then rises and goes over to a poster in his study, which has the impressive title The network of all human diseases. He points at a dozen coloured dots, representing diseases with connecting lines between them. “The fact that all cancers have lot in common with each other and form a cluster, is not so strange, but look at this: Alzheimer, asthma, obesity, and diabetes are all connected on a molecular genetic level. This is also apparent in consultations: Alzheimer patients, relatively speaking, often also suffer from heart problems. Arthritis, Crohn's disease and rheumatism often occur together. This is not a coincidence; indeed, these diseases most likely have a common source. Maybe these diseases are merely symptoms of one and the same disorder.”

If this is true, then nothing is certain, says Schmidt. “At the moment, medicinal education and professions are classified by organ: heart diseases, brain diseases, et cetera. In the light of the latest insights, this is rather a 19th-century practice. Diseases don't appear to limit themselves to a particular organ. When I was a student, it was all about lung cancer, brain tumours, liver cancer. That is no longer the case, today it is about what is happening at the cell level in a particular patient, rather than where the tumour presents itself. It also means that we have to set up our hospitals differently. At the moment, Alzheimer patients suffering from asthma are sent from the neurologist to the lung specialist. That is far from useful.”

These new insights are a real turning point for pharmacology: in about forty years’ time, all present medication will have been dumped, says Schmidt. “Which, in a sense, is not such a terrible loss, because a lot of medicines don't do much more than treat symptoms. “High blood pressure is my favourite example. We give patients a drug that widens the blood vessels, and that at least prevents a heart attack or a stroke, but in 95 per cent of the cases we have absolutely no idea what the cause is. Compare it to a car in which something goes wrong with the petrol supply and it drives way to fast. The pharmacologists' solution is to put a brick on the brake. It helps, but at the same time it is silly. By the way, I am not pointing a recriminative finger at anyone, but it is good to realise where we stand. There is little reason for self-satisfaction.”

Pharmacologists work with NNT figures, where NNT stands for ‘numbers needed to treat’. It is a measure for the effectiveness of a medicine, says Schmidt. To illustrate: the medicine for high cholesterol has an NNT figure of 300. “In other words, 300 patients need to be treated with that medicine in order to prevent one death. So, 299 people don't benefit from it at all.”

The first examples of ‘repurposing’, as it is called, have been implemented. In this case, existing medication is being used for related diseases. Diabetes medication, for example, is currently being tested for heart diseases and antidepressants for obesity and fibromyalgia.

Mythbusters is a series in which academics shoot down popular myths on complex topics

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