Sunday, November 18, 2012

The Evils of Common Sense

“I can walk on it, so I know it’s not broken.”

It turns out that the fibula, one of two bones in the lower leg, doesn’t bear weight. You walk on your tibia.

“I can move it, so I know it’s not broken.” You may know, but I’m not so sure.

Patients yearn to understand their problem. In the absence of evidence, they use common sense which turns out to be a terrible way to get at the truth. In fact, it’s a good rule that any common sense explanation of a medical problem is wrong. Here are others that I hear all the time.

“I have to let this run its course…”

Seeing smoke pour out of your car’s exhaust, no one explains that the engine is repairing itself by expelling bad things. Yet plenty of patients believe their vomiting or diarrhea is the body’s attempt to cleanse itself. In fact, it’s a simple malfunction. It’s OK to treat it although exceptions exist for a few serious diseases.

“Fever is your body’s way of fighting an infection.”

This may not be wrong (scientists still debate this), but it leads to many sensible beliefs that, being sensible, are wrong.

Google “does fever treatment help” for an avalanche of praise for fever's healing properties from doctors and medical sites as well as laymen. Don’t believe it.

Here’s the truth. Your body generates fever in response to viral and bacterial infections. It’s an immune response. Enthusiasts regularly quote studies showing certain germs that grow at 98.6 don’t grow as rapidly at 102. Common sense teaches that you shouldn’t interfere. But you already know my opinion of common sense.

Here are questions that you might ask.

1. In what specific infections is lowering the fever harmful? I can’t think of any.

2. What infections do doctors treat by giving patients a fever?  The answer is none (a note to nitpickers: I know medical history – I’m talking about doctors today).

3. Every day, across the world, a hundred million people take medicine for fever. How many end up at the doctor who explains that this made the problem worse?

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