That is true in physics as well. If you actually understood the laws of physics and how they interact, you would be able to make 2 identical snowflakes. But you are not there yet.

This was my first time posting in Neurologica as well. When an esteemed professional such as Dr Tyson makes comments as above, we physicians, in the same blogosphere, must put in our two cents worth.

As a companion piece to your comments, Viagra has taught me a lot about how important it is to assess how deeply a patient is attached to his or her given therapy. The more they own it, the more they are emotionally committed to it, the more they want the treatment to work and the more they tolerate in terms of side effects.

Heartburn and flushing can occur with both Niacin and Viagra, and yes the frequency is MUCH higher with niacin, but why have only 50% of my patients tolerated the side effect with Niacin whereas as NO ONE who suffers the side effects with Viagra ever says I won’t take this anymore?

People can insert their own joke as a punchline.

Thankfully, my practice environment is full of competant, compassionate health care professionals (docs, nurses, midlevels), so I can keep perspective. But those assertions seem to be filling some basic need that I’m not sure I’ve fully grasped (other than promoting my need for a vacation.)

Oh, and an additional thought in regards to Dr. Tyson’s thoughts and the replies regarding medical predictions:

Don’t forget other HUGE variables not mentioned….
Patient beliefs and behavior are also capable of having huge impacts on their disease process. What treatment options will they choose? Will they procrastinate, take their meds, stop drinking or smoking, look both ways crossing the street? Good luck narrowing down life expectancy too much based on “individualizing.” If there’s anything I’ve learned, getting to know someone that well is likely to take far more time than will ever be available in a realistic practice , and still subject to extreme variablility.

Ooops, sorry, this wasn’t supposed to be “my rant.”

Stay Groovy

Being a experimental physicist heavily involved in precision measurements of the standard model I can only say: Spot on!
In my (less and less humble) opinion, good physicists don’t forget to use the term “standard”.

How do I most easily convince my own GP that I am not standard? All the standard tests my GP has put me through “failed”, but still my GP does not seem to say anything else than: you look like a standard human being. I can “change my GP” but that is also tricky, because then I will find a new GP who sends me to a specialist whom I do understand, and therefore might find a problem which is imaginary.

Before we have a universal language for what being ill means, we should be afraid that we cannot solve this dilemma.

The standard candle can after my opinion only be to:
(measure, treat, measure)
What is to measure?
What is to treat?
What is to measure really?
“Patient dies in the middle of the night” could be a “small” and “reasonable” start on an interesting journey. 100,000,000 human deaths a year is quite a few.

Dr Tyson reminded us that the universe awaits … and I await his peers amazing discoveries.

But our smaller “universes” await, within all of us, and this medical universe is just as fascinating … and just as wonderfully frustrating.

I maintain that a phrase such as “inherent variability in biological systems” is code for “we do not yet understand biology well enough to predict with accuracy the causes and effects of important diseases that we diagnose.”

I’m sorry, Dr. deGrasse Tyson, but that’s just more of exactly the medical naivete I was talking about in the first place. Such thinking may take one far in physics, but it’s a lot more problematic in biology. Steve nailed many of the reasons why.

Of course, to some extent you have a point. No doubt we will “narrow those error bars,” maybe even considerably, but the level of precision in predicting prognosis that you implied is highly unlikely ever to be achieved. The reason is that the biology of, for example, cancer (my specialty) doesn’t just appear highly variable. It is highly variable. In fact, cancers of the same histological type often behave very differently. To some extent gene expression signatures are telling us a bit about the biological differences that account for that, but even tumors with similar genetic signatures can behave differently. It’s a stochastic and chaotic system. Moreover, you will never have the sheer number of “events” to observe that physicists do to hone highly “tight” statistics.

But it’s worse than that.

Even different populations of cells in the same cancer can exhibit very different behaviors. Moreover, these cells interact in numerous complex ways with the tumor microenvironment and other tumor cells, each acting on the other, and in the meantime they are evolving under selective pressures unique to the microenvironment in which the tumor arises–changing the very behavior of the tumor as an “organ system” in difficult to predict ways. Add to that the interaction with the patient as a whole and the patient’s various comorbidities, and there’s another level of complexity.

Finally, because of its unique nature as applied biology on humans, there are ethical and psychological aspects of medicine that further limit just how far we can go to narrow those error bars.

All the sciences deserve to be scrutinized over and over again ( tis the strength of science – and yes, the questions and concerns can come from all members of society ) , but with all due respect that a much accomplished man such as you deserves, medicine’s strongest critics should come from within the field as well – and it does. We debate, we research, we debate again – we evolve. Yes, it is much more difficult to control variables during human experimentation, but equating not knowing everything about a given system, such as a disease state, as “scientific ignorance” is dismissive and suggests naivety regarding the research within the science of medicine itself.

Medicine is a clinically applied science based primarily upon physiology, anatomy, biochemisty, and pharmacokinetics; psychiatry, less so, yet the field relies heavily on neurochemistry and neuroanatomy in this day and age – again, it has evolved! And yes, some diseases such as fibromyalgia, remain in it’s infancy of understanding, but others such as diabetes is deeply understood, even though debate in the field of diabetes ( such as how tightly should glucose be regulated: the recent ACCORD trial, ADVANCE trial, and STENO-2 trial ) remains hot and heavy. Again, debate is good!

Before I became a physician I was a grad student in Experimental Psychology with my primary emphasis on the physiological basis of behavior. The most important thing that I learned was general experimental design, methodology, and statistical analysis. Though I’m frustated that medical research’s variables cannot be more tightly controlled , I understand the limitations because of ethical considerations. But well done, peer reviewed, medical research is satisfactory research. Yes, this research will not yield the same depth of detail of a Hadron collider, but at least our research won’t destroy the Earth. What’s that? I sound naive? I meant to, sir. What’s your excuse Dr. Tyson?

But, overshoot is also correct, there are limits. People are not electrons. Just like we cannot predict the weather (inherently, not because of limited knowledge, but due to chaos) there will always be limits to our ability to predict interactions in a complex biological system. Imagine, for example, the possible number of permutations of 5 drugs (a conservative number for the geriatric population). Predict the interactions with every possible combination. Now throw in every possible combination of genetic variation.

Yes, the error bars will decrease inversely with our knowledge – but no matter what treatment will always have a component of trial and error.

There will also always be error bars on prognosis because you cannot predict random events. I just had a patient with a neuromuscular disease, whose life expectancy was still 20 years, die of pneumonia as a complication of his disorder. That was a random unpredictable event. That aside, prognosis involves every permutation of coexisting diseases and conditions and measures of health, as well as response to treatment. Chaos.