Why We Get Sick

Sorry for the lack of updates recently. I've been fairly busy the past two weeks with my surgery rotation (minus the 24 hours I managed to kill with BoilerPip this past weekend). Spending time with surgeons is interesting because they have a completely different approach to how they look at the patient. It's difficult to explain if you haven't experienced it personally. A gross generalization is to say medicine doctors tend to focus more on data and numbers whereas surgeons focus more on physical findings. Since I am not going into a surgery specialty I tend to think more like a medicine doc, but seeing this different view point is definitely educational and if nothing else allows me to know what types of questions to ask when thinking of referring a patient to a surgeon. As an example, if I were a medicine doc and I were doing a colonoscopy, the anatomical location of a polyp might only be of moderate importance and the histology and pathology would be most important. However, a surgeon is very interested in the anatomical location as this helps him decide if he can do a resection with an anastomosis or if a colostomy would be better. Again, this is a gross generalization and there is a lot of overlap between the thinking, but this example is exactly what I'm talking about when I say their thinking is a bit different.

While we are on the topic of different thinking, I've been meaning to discuss the book "Why We Get Sick" for a while now. The first week I was on nights last month was pretty slow and I was able to read through most of this book. The purpose of the book is to offer an evolutionary approach to illness. Unfortunately I can't give a too in-depth review without it turning into a full book report but below are some of the highlights.

Why We Get Sick

There is a quote in this book that goes like this:

A common man is impressed by the amazing. The intelligent man is impressed by the common.

I like this quote a lot and think it applies heavily to medicine. The longer I am in medicine and the more I study and more knowledge I gain, the more I am impressed by the "simple" stuff our bodies can do. I'm talking things we take for granted everyday, like sexual reproduction, bones healing after a fracture, skin healing after a laceration, stuff like that. The things our bodies can do are so complex it leaves little doubt that there is an intelligent designer out there. Yet despite our complexities, our bodies are susceptible to a host of problems, many of which have been plaguing man since the beginning of time (as far as we can tell). This book tries to answer the question "Why are we susceptible to numerous illnesses despite our complex bodies?" and uses an evolutionary approach to do so.

One of my favorite chapters is the one on sexual reproduction, which discusses topics like why we find certain types of people more attractive, and why do pregnant women get morning sickness. I think it's reasonable to ask this question. Their answer: Morning sickness occurs mostly during the period of fetal organogenesis (when most of the organs are first forming and most susceptible to injury) and was a way to detract gravid females from eating exotic foods which might harm the fetus. Is this the true answer? Who really knows? Physiologically it is due to rapid increases in estrogen and beta-hcg. But if our bodies are so smartly designed (and they are), why would these things make us sick? I think if nothing else their hypothesis is reasonable.

One of my other favorite chapters is on cancer, obviously a devastating disease which affects everyone (either directly or indirectly). Frankly, I spend most of my time in the office discussing either cardiovascular prevention or cancer prevention. It is unfortunately a common disease. This book talks about reproduction and germ cells that constantly divide (and have been really since the beginning of mankind) and other cell lineages that divide and stop dividing on cue and kind of flips the coin on the topic a bit in terms of how to look at the disease. It also discusses our aging population, how we live longer, how we are exposed to environmental toxins more rapidly than our bodies can adjust. Unfortunately, a full discussion is out of the scope of this blog. However, if this brief preview interests you I'd suggest checking the book out. It is written where no prior medical training is needed to read and understand it.

In medical school we are taught purely physiologic reasons for illness and really spent no time discussing evolutionary hypothesis. Frankly I think some of their hypothesis for illness are a bit simple, but with that being said they ask a lot of questions that honestly I never even thought about before. Their approach to illness is if nothing else thought provoking. It is definitely a different approach than what I am used to, much like how working with the surgeons is different than working with the medicine docs.