Monday, September 9, 2013

Evidence

We have been reading a lot of POEMs in school... don't get excited, I haven't been getting in touch with my feeling or learning to express myself in rhyme.  It turns out that POEMs means Patient Oriented Evidence that Matters... which means mostly reading about clinical trials (and they almost never rhyme).  

Back in my chemist days, I never really put much thought into the fact that all the chemistry knowledge that I tried so hard to obtain over 5 years of undergraduate and graduate education had nothing to with the work that I actually ended up doing as a chemist... I mean, other than thinking "this sucks, this job has nothing to do with what I learned in school."  

Now that I am seeing how pharmacists practice in the "real world" with "people that could die" I am seeing that a lot of the theories and pharmacology that I loved learning about actually breaks down or are completely irrelevant.  Over the first few weeks a question like "why do they treat a person with systolic heart failure with metoprolol?" would prompt a response "it decreases the workload on the heart by slowing it down as well as increases their left ventricular ejection fraction by blocking the remodeling,  both are mediated by the adrenergic system as the body responds to the heart's increasing inability to move blood throughout the body" but now I know that the real answer is "because there's evidence that less people die when they have heart failure and take it." 

Ok, I get it... hospitals aren't built for science projects. Someone informed me recently that they are built to keep people alive, which is probably more important.  Similarly, someone once told me that ink factories aren't built for science, they are built for making ink (well, actually the ink factory that I worked at was built to be a warehouse for plumbing company but it eventually turned into a building that makes ink). I remember at the old job, the Plant Manager adopted a thing called "lean manufacturing." It involved making smaller quantities more often instead of big quantities all at once.  He said dozens of times: "It don't sound like it should work better, but it does, so we do it (and then he would throw up his hands and roll his eyes)." So I guess that it is a universally applied rule whether it be with medicine or making ink that goes on cardboard. You go with what works.

Unrelated, on radiolab they talked about how the color blue never came up in any of Homer's works or in the bible or anything really from the B.C.E.  There is no question that the Greeks were able to see the color blue (we have been able to see colors since before humans evolved from apes) but their explanation was that they hadn't "discovered" the color blue yet.  Looking back through history they found that most cultures first acknowledged the color red, followed by green and then yellow.  The color blue is the most difficult to create with dyes (I can vouch for that) and red forms naturally as iron oxidizes (usually forming rust) so they thought maybe that was why the same civilization that built the Parthenon hadn't bothered to acknowledge one of the primary colors. If something as fundamental as the color blue was not acknowledged by the Greeks, I am left to wonder what we are not seeing today that will be flagrantly obvious in 2000 years.    


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