Yesterday I wrote how Alexandra Carmichael’s headache story illustrated a large and awful truth about modern healthcare: It happily provides expensive relief of symptoms while ignoring investigation of underlying causes. If we understood underlying causes (e.g., causes of migraines), prevention would be easy. Let people get sick so that we can make money from them. There should be a name for this scam. In law enforcement, it’s called entrapment.
Sensible prevention research would start small. Not by trying to prevent breast cancer, or heart disease, or something like that: They take many years to develop and therefore are hard to study. Sensible prevention research would focus on things that are easy to measure and happen soon after their causative agents. One example is migraines. Migraines happen hours after exposure. The fact that Chemical X causes migraines means it is likely that Chemical X is bad for us, even if it doesn’t cause migraines in everyone. This is the canary-in-a-coal-mine idea. Migraines are the canary.
Acne is another canary. Acne is easy to measure. Figuring out how to prevent it would be a good way to begin prevention research. To prevent acne would be to take the first steps toward preventing many more diseases. A high-school student could do ground-breaking research — research that would improve the lives of hundreds of millions of people — about how to prevent acne but somehow this never happens. In spite of this possibility, grand-prize-winning high-school science projects, from the most brilliant students in the whole country, are always about trivia.
A just-published review in The Lancet reveals once again the unfortunate perspective of medical school professors. The abstract ends with this:
New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.
Actually, finding out what causes acne is all that’s needed.
To figure out what causes acne (and thereby how to prevent it) three things are necessary: (a) study of environmental causes, such as diet, (b) starting with n=1, and (c) willingness to test many ideas that might be wrong (because it’s far from obvious how to prevent acne). All three of these things are exactly what the current healthcare research system opposes. It opposes prevention research because drug companies don’t fund it. It opposes n=1 studies because they are small and cheap, which is low-status. To do such a study would be like driving a Corolla. It opposes studies that could take indefinitely long because such studies are bad for a researcher’s career. Researchers need a steady stream of publications.
High school students, who aren’t worried about status or number of publications, could make a real contribution here. You don’t need fancy equipment to measure acne.
Thanks to Michael Constans.