The Tale of the Sudden Change
It happens in biological systems from time to time that there is a sudden change of state. One day someone is fine and the next they are dead. To the observer it appears that it all happened suddenly. However, at a detailed level, the buffers of the system were slowly eroded over time until that proverbial straw that breaks the camel’s back. You can only ask so much of a system before it just gives out.
So we know that happens, the suddenly collapse of a system that from the outside looked fine until the moment of collapse. And we know that usually, when we see that situation, it really means that the system was slowly losing capacity for a long time. This is how it works in natural systems on a day to day basis. But there is another way for systems to suddenly change.
This other way, in keeping with our dropping dead model, is when an assassin kills you. In that case, you really are fine, right up until the point when someone shoots you. In healthcare, it would be that you are fine until some outside influence changes things suddenly. It could be a random event, but more often than not, that outside event is your doctor.
Imagine a 54yo man with benign prostatic hypertrophy (BPH), or enlargement of the prostate. He has symptoms that are annoying but not life threatening. At his annual exam he asks his doctor about a referral to a urologist to see if something can be done. His doctor replies that this whole thing could be cleared up with a medication specifically for his problem called dutasteride. How it works is complicated, but if you’re interested you can look it up here.
The man starts the medicine and after a few weeks notices his symptoms are less. Everything is fine.
At his next annual exam his doctor notices he’s gained some weight and his lab testing shows insulin resistance (pre-diabetes). Over the year his fasting insulin level went from a normal 5 to an elevated 12. The doctors says that these things happen and he should try to lose the weight. That will help. So the man embarks on a 2 year quest to lose weight, only being successful when he cut out carbohydrates almost entirely. His fasting insulin falls to a 4. But he’s not happy not eating carbs. It’s limiting to him and his family. He wonders why he needs to, why he suddenly became pre-diabetic all of a sudden.
So the man looks through his records. Luckily he’s a data freak and has kept an excel spreadsheet of all his labs over the years. He notices that his fasting insulin was stable for years until the change. He wonders what could have happened, so he looks back at his medical record. He notices that dutasteride started at the same time as his last normal fasting insulin level. “Huh,” he wonders, “could dutasteride cause insulin resistance?” So he does what most of you would do. He googles “dutasteride insulin resistance”.
And what did he find? The first link was a scholarly article from a few years before he was put on dustasteride. He brought the paper to his doctor who replied, “Son of a bitch! That’s fascinating.”
The key here is that there is no doctor on the planet that can keep up with everything. But doctors should have an enquiring mind that wonders why a healthy person suddenly becomes ill and enough humility to consider that the doctor might themselves be the cause. But that’s not our current system in America.
We have a system that drives short visits for algorithmically derived treatments for diagnoses that are over inclusive. We need to change that. I’m hoping I’ll be a part of that change. That’s why I’ve started Dragonsbane, a project that seeks to create a personalized solution to put individuals back in charge of their own health. Here’s the version 0.11 of the whitepaper. Contact me there or at tocdr.com if you have an interest in joining the movement.