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Mindful EM

Faith in the One Percent

Hazan, Alberto MD; Haber, Jordana MD

doi: 10.1097/01.EEM.0000499527.04370.98
Mindful EM

Dr. Hazanis an emergency physician in Las Vegas and the author of the medical thriller Dr. Vigilante and the preteen urban fantasy series The League of Freaks. Find out more about his novels athttp://amzn.to/1Dug0iG. He is also a board member withwww.givingmore.com. Follow him on Twitter @Dr_Vigilante. Dr. Haberis an emergency physician at University Medical Center in Las Vegas. She has a master's degree in medical education. Follow her on Twitter @JoJoHaber. Read their past articles athttp://emn.online/1UiG4a2.

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By some accounts, Thomas Edison may not have been a very nice guy.

The story of Topsy the elephant is a controversial one. Some historians assert that Edison once electrocuted an elephant to prove that his direct current (DC) was superior to Nikola Tesla's alternating current (AC) electricity supply system. Others point out that evidence connecting Edison with this cruel act is insubstantial and that he was not physically present at Luna Park during Topsy's execution.

Edison's involvement in that infamous demonstration at Coney Island during the War of Currents remains in question, but nobody can deny that he was a genius. He developed the light bulb, the phonograph, and the motion picture camera. He had more than a thousand patents, and is credited with establishing the first industrial research laboratory, largely through his efforts in integrating teamwork and mass production to the creative process. Edison's inventions had a huge impact on the industrial world. He established mass communication and brought electricity to millions of homes and businesses.

Edison's long career also afforded him much wisdom. He was undeniably a passionate inventor who knew the meaning of hard work, as shown by some of his more famous quotes:

“I have not failed. I've just found 10,000 ways that won't work.”

“Many of life's failures are people who did not realize how close they were to success when they gave up.”

“Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.”

But arguably his most famous quote relates to how little knowledge humans have in general, which may seem odd coming from a man who discovered so much, who furthered our knowledge, and who revolutionized mass communication and industrialization:

“We don't know a millionth of one percent about anything.”

As hyperbolic as this statement may seem, it rings true, especially in medicine. Consider that hundreds of medical practices are overturned every year. Our standard of care is constantly being challenged, replaced, revamped, and disproven. New discoveries continue to baffle our understanding of how our bodies function or how disease ravages the human body.

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Criticized Then Feted

The discovery of prions is a case in point. When Stanley Prusiner, MD, a neurologist at the University of California, San Francisco, was searching for a causative agent of kuru, the deadly disease that causes psychosis in residents of New Guinea, he was sure it was prions, which are infectious proteins. Nobody else did. And why not? The idea that a protein can by itself “reproduce” and lead to other proteins causing disease through replication without evidence of having DNA, RNA, or any form of nucleic acid was considered unfathomable. In fact, Dr. Prusiner received scathing criticism and was on the verge of being ousted by the scientific community when he was able to prove his theory and then receive a Nobel Prize. Now, prions are thought to cause a wide variety of diseases, including Alzheimer's and Parkinson's.

Consider the following thought experiment: Let's say giant beings from outer space were looking at humans under a microscope. The caveat is that these microscopes only allowed x-ray inspection. What do you think we would look like to these guys? We would be a bunch of white sticks and a ball moving in a seemingly random way. These beings would miss that we have brains and organs and are covered by skin. They would miss that we make art and music, that we engage in sports, that we have careers. That we treat patients.

Are proteins just like that? Can they all be considered to be “living beings” just like prions because we only see just one aspect of them?

This is just one example of the limits of our knowledge. If Edison is right that our accumulated knowledge doesn't amount to a millionth of one percent, what does that say about us? Are we just lost? Is our knowledge that lacking?

This notion certainly raises questions, but it should actually be extremely reassuring. The fact that we may not know a millionth of one percent means that any of us can make a huge discovery. The playing field is wide open for anyone to take charge, especially for a physician working in an emergency department. After all, if anyone is going to see correlations that will lead to major discoveries, it's going to be one of us: We see thousands of patients a year, we see disease processes at every stage, and we can see correlations where nobody else can if we ask the right questions.

We have to pursue truth actively, remain engaged, ask questions, and do our research. When we finally have a working theory, we have to have the courage to write about it and expose others to our ideas without fear of being ostracized or Semmelweised. (ALiEM.com; “Getting Semmelweised: An Essay on Fear and Medical Education;” http://bit.ly/29TdERF.)

We need to think big, challenge our modern thinking, and question every theory out there. We need another major discovery turning our modern thinking upside down: something akin to the theory of relativity or Copernican heliocentrism.

Even if you don't believe in Edison's estimation and you think we know a million times more than what he thought we knew, that still leaves us at only one percent. If we really know so little about medicine, then any amateur emergency physician can set up shop in his living room with a microscope and make huge discoveries. And it means that little things can actually make a big difference. So challenge yourself, and don't be silenced by authority. The next major revolution in medicine may be in your hands.

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