
We Need More Doctors Who Are Scientists - johnny313
https://www.nytimes.com/2019/09/23/opinion/doctor-scientist-medical-research.html
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jedberg
What we really really need are more _dentists_ who are scientists. Dental
practice has changed a lot, but at the end of the day, we still drill holes in
our teeth and fill them up.

Most dentists spend three years in school, where 2.25 of them are spend just
learning the hand skills of dentistry. By the end of it, they are highly
motivated to _not_ want to advance dental science because it could put them
out of a job.

If someone developed a drug that would remove cavities, or a device that made
it so you didn't have to brush every day, these would be huge quality of life
improvements for people, but the people who are most expert at discovering
such things are the ones most motivated to keep the status quo.

I say this as someone who has multiple family members involved in dentistry.
Every time I even mention a new possible treatment, their immediate response
is "hmmm I'm not sure that's a good idea that's not how we usually do things".
It's something that their training has engrained in them.

~~~
aklemm
Just today my dentist, who recently took over the practice from my previous
retiring dentist, said the old guy pushed metal fillings on most patients even
though composite is a better alternative for most fillings (he did describe
for which fillings metal is still preferred).

I bet the worst medical advancement or study result for dentists would be the
one that definitively shows six-month checkups aren't better than annual.

~~~
jedberg
> I bet the worst medical advancement or study result for dentists would be
> the one that definitively shows six-month checkups aren't better than
> annual.

It depends on the person and the chemical makeup of their mouth in conjunction
with their brushing and flossing habits.

Some people can be fine even if they go years between checkups. Other people
like me need to go three times a year even though I brush and floss every day.

Gee, I wish someone would study _why_ I need to go three times a year and
maybe figure out how to change the chemical makeup of my mouth so I didn't
have to!

~~~
teslabox
> Gee, I wish someone would study why I need to go three times a year and
> maybe figure out how to change the chemical makeup of my mouth so I didn't
> have to!

People are too profitable for the system to be motivated to figure out actual
causes behind common problems.

Your quip reminds me of a comment from 2 weeks ago, where someone shared how
vitamin K supplementation helped reduce buildup on their teeth:
[https://news.ycombinator.com/item?id=20902899](https://news.ycombinator.com/item?id=20902899)

I understand that people usually get adequate Vitamin K2 from their intestinal
bacteria. Perhaps the buildup on your teeth is due to your microbiome.

I brush with salt and baking soda, but still have some plaque on my occasional
visits to the dentist. I’ll have to think about this some more.

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killjoywashere
As a board-certified specialist physician engaged in research, and now
starting to teach others how to engage in research, I predict that the road
out of this is going to be very long and hard. As research has lost support
(not just financial, but cultural), it has become increasingly difficult to
justify to department chairs. In the course of the last 8 years I was kicked
off my own project twice while in training.

So, what I predict you will see, is it will become progressively harder for a
hopeful young researcher to make the transition, not to research, but to
adding research to their already full-time+ job. It is quite likely you will
be in a department where no one has research experience and few contacts with
academics. And if you're doing research and there's even a hint of a
perception that it could interfere with any element of your clinical duties,
you can bet there are people who will be happy to burn you and your research.

The most supportive stance I got from anyone in my department during training
"Don't talk to any of us about it." That was my PI and program director.

So, the current status quo is "Toil, in addition to your other, formidable
responsibilities. Don't ask for anything. Don't ever talk about it, don't even
mutter under your breath." That does not align very well with the open-
mindedness of research.

On the flip side, if you are a PhD, the current state of medical practice in
the US is such that many medical centers are ripe for research if you can
cultivate a relationship with an MD. I know, I know the perception, which I
have been told directly by a biochemist who didn't know I was an MD "MDs
aren't knuckle-dragging idiots." But maybe, just maybe, make a friend and see
where it takes you. Which may be hard. You will probably have to go to tumor
boards and grand rounds and suffer through a bunch of people kibitzing about
things you know are 20 years behind the state of the art. Yep, that's true.
But the entrances to the mines collapsed. You will have to do the hard work of
opening your own shaft. And so it goes.

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rpedela
I agree for an additional reason: critical thinking and root cause analysis. I
am not going to go into detail but a family member had several years of
misdiagnoses because she has a lot of weird symptoms don't fit a common
disease pattern. After being correctly diagnosed with a blood test, once in
awhile she will still be told by a doctor that she has something else. Even
when shown the results of the blood test, they persist in their nonsense. A
scientist would never think they are right when there is objective evidence to
the contrary.

~~~
groby_b
Oh dear $DEITY, and please let's add reasoning about probabilities in there.
("There are virtually no problems" can mean anything from "we're just overly
cautious" to "it's a coin flip if you won't be worse off after" \- and nobody
is willing to attach a percentage, or talk about false negatives vs. false
positives)

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dlphn___xyz
we need more statisticians doing medical research.

~~~
SkyPuncher
and more training for doctors on how to read those stats. Amazing the stories
some companies can tell that are completely misleading.

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khrbrt
We need free medical school.

~~~
todipa
It is usually free for those who pursue a Phd. Just takes a bit longer...

