Recently a member of our class unearthed and shared an article published in the August 5, 2012 issue of Nature Medicine. In this study, the authors show that the treatment regimen for a particular type of prostate cancer actually results in the release of a molecule from the damaged surrounding tissue that promotes the growth of the very cancer it was designed to treat.1 This is disturbing not only because of the patients who may have been inadvertently harmed, but also because something about which we had felt so sure turned out to be false. How could we not know? How many other things are we getting wrong?
The idea that a therapy commonly used for years can actually have the opposite effect than that which was intended is a little bit unnerving. This is not, however, an experience that is new to medicine. The extreme examples are of times past, when it was thought that improperly balanced “humors” resulted in ailments of the body, or that contours of the skull determined temperament and health. I’m sure that, if pressed, most people could easily recall a medical truth that has within recent history been proven to be false (the harmlessness of cigarettes springs to mind). It appears that we cannot be as sure of the things we know as we would like; in fact half of what we know now will be obsolete or irrelevant in 45 years. This is an issue of special significance in the field of medical education. The facts we are learning now are supposed to form a base from which we make decisions with patients later. As students, what can we do to ensure that as we move forward, we keep abreast of the correct information? Are we learning not just facts, but how to learn?
Fortunately, this is an item of interest in our curriculum. While we have textbook chapters assigned as pre-reading for almost all lecture sessions, there are more often than not pertinent scientific articles assigned as well. We are encouraged to consult the literature via PubMed, AccessMedicine, or Clinical Key as opposed to just the textbook when studying and preparing talks. This emphasis on accruing our own information from the most current and reliable sources has resulted in a general skepticism toward using only one source to understand a topic. When I hear from M3’s, M4’s, and even residents that they find themselves utilizing many resources to adequately prepare for their time in the hospital, I am thankful that I am learning how to do that now. While it may be the case that many of the facts I have committed to memory now will prove to be false or irrelevant in the not-so-distant future, I don’t worry about it interfering with my patient care. The habits of investigation we are developing now as students will help us keep up with the changes our medical knowledge will undergo in the coming years.
1 Sun Y., et al. Treatment induced damage to the tumor microenvironment promotes prostate cancer therapy resistance through WNT16B. Nature Medicine; 18 1359-1368, 5 August 2012. http://www.themarknews.com/articles/the-half-life-of-facts/
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