The vernacular of the medical doctor is rife with words of conflict. Diseases are incursions by alien forces which must be fought off and destroyed by the benevolent immune system. Physicians speak of a war on cancer in similar terms to a military campaign, even with concepts such as acceptable causalities involving healthy cells that die in chemotherapy treatment. Each patient is a battleground where medicines are employed as weapons against our own mortality.
This concept of war for the physician has important consequences for treatment. The philosophy is: hit it as hard and as fast as you can. Yet, this philosophy, quite prevalent since the early days of earnest medical science, has necessary detrimental consequences.
There are some wars that we simply cannot win. The physician, over the long-term, is not going to defeat bacteria; it is an arms race in which we cannot afford to participate. As we employ more and more antibiotics for mundane or even serious bacterial challenges, evolutionary pressure will select for the resistant section of the herd rendering our antibiotic now useless. There is no manner in which medical science can possibly keep discovering new antibiotics to defeat these intruders as bacterial weapons, multi-drug resistant proteins, have more power than our feeble antibiotics.
It seems that a new metaphor is in order to effectively describe the relation between physician, patient and illness. This should be predicated on the idea that the medical doctor exists to correct abnormality through adjustment, not through warmongering. A recent article by Dr. Gary Reisfield in the Journal of Clinical Oncology found that the use of military metaphors and consequent assumptions could lead to less effective treatment.
Reisfield stated that often the metaphor of war indicates that one needs to simply fight harder to overcome the cancer when alternative therapy may be a better route. Further, the illusion of battle often misleads one about basic aspects of biology.
Biological timing plays an important role in the body's interaction with the environment. It has been known for decades that toxic insult is tolerated differently depending on the time of insult in relation to the circadian rhythm. In fact, chemotherapy and no doubt a number of other toxic therapies are no different. This brings to bear the idea of chronopharmacology or the study of changes in living animals by chemical substances with regard to biological rhythms, such as the light-dark cycle. This should be a consideration in future trials of chemotherapy agents as this element of time could be an important factor in survival.
Clearly, the metaphor of war is an outdated concept that needs to be revised for more effective treatment. It is the duty of clinicians to evaluate not only the therapies used, but also the metaphors that are employed to describe those therapies. In the end, clinicians must be careful in the metaphors chosen to describe their patients and diseases to ensure effective treatment.
Michael can be reached at michaelmcduffie@cavalierdaily.com
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