Do Not Expect Too Much from Medicine; Learn to Live With Disease

There are many Grade-A tertiary hospitals near my home, and several are the first choice of out-of-town patients coming to Beijing. My whole family carries Beijing medical insurance, and we used to feel we enjoyed medical benefits that many out-of-town patients could not. But recently we reviewed our own family’s experiences — and those of an old classmate and his family who live nearby — at a famous tertiary hospital around here, and found that fewer than one in five of our problems were actually solved by the hospital; most of the time it was repeated misdiagnosis and outright ineffectiveness.

This surprised and disappointed me. Asking myself, I suspect that among the patients from all over the country who turn to me, I too may help relatively few effectively. Ever since I began studying medicine, I have often doubted what medicine can do. Not only are non-self-limiting diseases like cancer hard to cure; the great majority of self-limiting diseases are also hard for medicine to solve. At any rate, many of my own problems have been relieved by rest; where rest did not relieve them, over time I adapted to the diseases and learned to coexist with them.

I do not think this phenomenon exists only in developing countries like ours. Through the patients I know, I have some sense of the medical situations in developed countries like the United States, Germany and Japan. Some patients I know well who went to developed countries for treatment actually did worse overall than at home. Not only was their cancer not well resolved, but a host of common clinical symptoms they developed went unrelieved. By contrast, when treated at home, because there was no language barrier between them and the medical staff, the results were better.

This is not to say that no lucky patient’s disease is ever cured by doctors. It is to say that, in reality, too many patients remain in a state of ineffective treatment. Spending money to see a doctor without the disease being cured is the normal state of real life. Probably the great majority of people over forty need to coexist long-term with one or more chronic diseases and adapt to living with disease. I myself have coexisted with several chronic diseases for many years; although I still keep studying medicine, there remain health problems of my own that I cannot solve.

Whether modern or traditional medicine, its greatest contribution is probably nothing more than symptomatic supportive treatment. Symptomatic support, plainly put, is only a set of temporary means of relieving the patient’s suffering. Relieving suffering is not the same as curing the disease. We often say that treating the root is better than treating the branch — but, honestly, a medicine that reliably treats the root has not yet arrived. What truly treats the root is nature itself.

The immune system and self-recovery capacity we formed in evolution can help us root out a small number of diseases; these may count as treating the root. Such self-recovering diseases we habitually call self-limiting diseases; their recovery is the optimal solution nature evolved in us. But there are many diseases that even nature cannot solve; these are what we call non-self-limiting diseases. Patients who contract such diseases essentially end up coexisting with them long-term; it is already good if medicine can ease their suffering at the worst moments. In this sense, medicine is not without effect — its effect is simply far smaller than we expect.

So I now study medicine with a much more realistic frame of mind. I honestly learn some techniques of symptomatic supportive treatment and do not crave cure. What cures self-limiting diseases is the law of nature, not medical technology; the great majority of non-self-limiting diseases cannot be cured at all, and every non-self-limiting patient who is cured is a lucky one — their cure has the same luck factor as winning a lottery, and the doctor’s role in it is negligible. I especially like a remark by a Korean doctor: “It is God who cures the patient; the doctor merely builds a bridge between the patient and God.”

I am now also especially wary of patients and families who come to me full of hope for a cure. Patients often ask me, what is your success rate in curing cancer? I tell them it is infinitesimally close to zero. I never feel that the occasional patient I cure was really cured by me — besides, their lives are still long, and whether the disease recurs in future is unknowable. From the physician’s standpoint, the more scientific and rational attitude is to speak cautiously of cure. We encourage patients to be positive and optimistic and to hope for miracles, but we must not exaggerate or mislead them.

More importantly, rationally recognizing that we ourselves can only live with disease — striving to prolong survival and improve quality of life, and learning to adapt to the illness — saves patients and families from blind decision-making. In fact this also benefits patients to the greatest degree. When someone is ill, rather than giving false comfort, give rational guidance. Letting the patient face reality and learn to coexist with disease prolongs survival to the greatest degree, eases bodily pain and mental anguish, and saves them from wasting a great deal of money. Healthcare is a bottomless pit; who knows how many people have poured their entire fortune into it only to lose both person and money.

There is a book whose Chinese title translates as Survival of the Sickest: How Living with Diseases Makes Us Live Longer (English title: Survival of the Sickest). I often recommend patients and friends read it. Its authors are Sharon Moalem, an American doctor of neurogenetics and evolutionary medicine, and Jonathan Prince, a senior adviser at the White House. The book looks at disease from the perspective of evolutionary medicine. Although reading it cannot help us cure our diseases, it can teach us how to coexist with those that cannot be cured. Compared with seeking cure, learning to live with disease is both more realistic and far more useful. Diseases that drugs cannot cure indeed need to be treated with the help of thought.