The Real Reason Medicine and Science Cannot Give You Exact Guidelines

By Dr David Mokotoff

Retired Cardiologist, BayArea Heart founder

Human bodies are not machines; therefore, “predictable” treatments do not always yield similar results in everyone.

I grew frustrated as I prepared for another colonoscopy. Some websites said you could have eggs and white toast for breakfast the day before the procedure. My doctor’s directions said only clear liquids the whole day. 

Other sources said no nuts or seeds should be consumed for three days before the procedure. My directions said none for one week, and since my go-to breakfast is homemade granola containing nuts with Greek yogurt, this was another bother with little data to back it up.

Why can’t these “authorities” all agree on one protocol? 

The answer is that the human body is different from a machine. If a fan belt wears out in your car, provided the repair shop has the correct size, replacing it permanently fixes the problem—ditto for a bad carburetor or brakes. However, our bodies are complex and unique. And what works for one does not necessarily work for someone else.

Let me explain my perspectives based on my experience as someone who studied human body and mind.

Understanding Statistics

In determining the effectiveness of a therapy or drug for a specific condition, it’s essential to conduct clinical trials involving hundreds, sometimes even thousands, of patients.

This extensive participation helps mitigate the impact of individual differences among patients. However, it’s important to note that while statistics play a crucial role, they can sometimes be misleading for individuals without a deep understanding of the data.

For example, if you study a new drug and it reduces “your risk” of a heart attack by 20%, you would have good reason to believe if you take it, you reduce “your” risk by 20%. But this is false. The drug reduces the heart attack risk on average by 20% in the thousands of patients studied. Your risk reduction is likely not as impressive.

And if you are one of the unlucky few who get a serious side effect after a vaccine, these statistics mean little. For example, an uncommon but potentially devastating neurological complication of the COVID-19 vaccine is GBS (Gullian-Barre syndrome).

Because a neighbor and his wife hesitated to get an mRNA vaccine, they opted for JNJ’s (Johnson & Johnson) DNA vaccine. Sadly, he developed GBS and ultimately died from it. According to a large study of all these vaccines, JNJ’s vaccine had only a seven percent chance of its users developing GBS. Sadly for my neighbor, his risk was one hundred percent.

Who benefits from medical protocols?

Protocols are often created for the convenience of the providers and not necessarily the patients. One example is the rule not to give patients anything to eat by mouth after midnight on the day of a procedure.

The rationale is that if the stomach is full while you are inducing sleep with anesthesia, the patient might throw up. Acidic stomach contents and juices can flow backward into the lungs, causing “aspiration pneumonia.” This is a serious and sometimes lethal complication.

However, there is a huge difference between eating food up until the time of a big operation and having a cup of water up until two hours before a minor procedure, like a colonoscopy. Anesthesia societies have considered this and ruled that drinking water until a couple of hours before minor operations is safe.

Since the colonoscopy prep causes massive fluid losses from diarrhea, many patients show up dehydrated. This can cause low blood pressure and even fainting. I asked my nurse anesthetist about this before my procedure, and she acknowledged it was safe to drink some water after midnight. Still, it is easier for them to have everyone stop at midnight since, inevitably, schedules change, and the two-hour window for all fluids by mouth to stop could also change.

The bottom line is that everyone is different. The human body is not a machine; therefore, predictable results from an intervention, like a drug, vaccine, or operation, cannot be guaranteed with the same results. The same is true for complications. This is why medicine has been called an “art” and a “science.” No amount of artificial intelligence can account for this.

The Darkside of Human Differences

Recognition of the fact that “no two human beings are alike” unfortunately leads to our obsession with anecdotes. We search for a proximate cause and effect if something good or bad happens. The most ubiquitous one of these is what happens after a flu vaccine.

Some people react to the vaccine with symptoms that mimic but are not the same as, the flu. Since the vaccine is made from dead or deactivated viruses, it can not give you the flu. Yet, many are convinced otherwise since you can get a low-grade fever, runny nose, or muscle aches after it. These are side effects in some people.

The same is true of the false belief that “I got the flu shot but still got the flu.” Flu shots, like some vaccines, cannot one hundred percent guarantee you won’t get the flu.

However, it decreases the disease's symptoms and severity when studied in thousands of people. Yet when something good or bad happens, we tend to believe what happens to us more than scientific studies. This underlies the power and attraction of anecdotes.

Fascination with anecdotes often leads to false conclusions. Despite most scientific evidence to the contrary, people still claim that the drug Ivermectin prevents or cures COVID-19. And it’s not only one journal that reports this.

Conspiracy theorists discount all of these studies, claiming they are tainted by the sources being in the “pocket” of drug companies. Since most medical journals survive on drug company advertising, to some extent, this is true. However, this did not prevent the prestigious New England Journal of Medicine from publishing controversial data about how the CDC erred in adopting its vaccine criteria.

Unsettled Science

By its very nature, science is always evolving. I dislike descriptions like “settled” or “consensus.” I view people who have made some of the greatest scientific achievements as disrupters or non-conformists. Penicillin, for example, was discovered by accident.

In 1928, Dr. Alexander Fleming returned from a holiday to find mold growing on a Petri dish of Staphylococcus bacteria. He noticed the mold was preventing the bacteria around it from growing. He soon identified that the mold produced a self-defense chemical that could kill bacteria.

And there is the curious case of what causes stomach ulcers. Two Australian researchers were laughed out of scientific meetings for asserting that a bacteria was responsible for many stomach ulcers and, therefore, antibiotics could cure them. They were later proven correct and, in 2005, won a Nobel prize for their research.

And nowhere is science more unsettled than a new disease such as COVID-19. With the original strain of the virus, hundreds of thousands of people died in the USA alone from ARDS (acute respiratory distress syndrome) associated with the disease. Before 2020, the standard ARDS treatment was placing patients on mechanical ventilators. Ironically, with this new virus, being placed on a ventilator made the mortality worse.

And universal masking and mask mandates still are controversial. Large studies are inconclusive and difficult to control. The respected Cochrane Library is an independent organization that seeks answers to scientific controversies.

They did not support the absolute conclusion that masks help prevent the spread of this disease. What is clear is that it may have done serious harm in learning to small children who were not at large risk for serious COVID-19 complications or death.

Takeaways

Human bodies are not machines and, therefore, respond differently to illnesses, their prevention, and their treatments.

Medical statistics can be misleading as they reflect what happens when hundreds and thousands of patients become sick and are given treatments. A given percentage of “risk reduction” is an average of that large group studied and is not the same as for a given individual.

Medical and surgical protocols are designed to benefit the efficient and smooth operation of a hospital, outpatient surgery centers, doctors, and nurses. While it is true that their goal is also to foster the best patient outcomes, the two aims do not always coincide.

Because humans react differently to illnesses and treatments, anecdotes have become popular drivers of public opinion. Nowhere has this been so prevalent, as with the COVID-19 pandemic.

As the disease evolved and we learned more about it, so did the message. Mechanical ventilation did more harm than good, and the effectiveness of universal masking is still not settled.

Thank you for taking the time to read this. Your thoughts and comments are always welcome. I am a retired MD passionate about science, medicine, health, sports, and food.