How effective is diagnosis?

The Cracked Road Bridge Problem

Diagnosis is the only method used for tackling sickness and disease. But how effective is it?

Isn’t it true that for chronic conditions the doctor only uses diagnosis to name the disease, in order to decide on treatment? And even with the best treatments for say, diabetes, rheumatoid arthritis or multiple sclerosis - sickness continues to get worse - and usually leads to complications?

So let’s put diagnosis to the test. Let’s compare it to the common sense approach to solving problems and see which method actually solves them.

Engineers are scientists who apply practical problem solving (common sense) every day. Let’s say engineer Frank Jackson is called in to assess, repair or restore an unsafe road bridge where cracks have appeared in the bitumen surface.

The medical diagnose-then-treat approach

Engineer Jackson would focus on the symptoms - the cracks in the bitumen. If Jackson had never seen this problem before he might name it ‘bitumen crack disease’. (He may later even publish a paper on it and eventually be hailed for his contribution to engineering by having the syndrome named after him, Jackson’s bitumenosis.)

Then he would prescribe treatment to alleviate the symptoms - say, weekly applications of fresh bitumen to the cracks as they re-open and become deeper. However, because the underlying cause has not been addressed the bridge continues to fail - and is at risk of collapse.

Common sense (scientific) search-for-the-cause approach

Engineer Jackson observes carefully, looking beyond the obvious fissures in the bitumen - searches for possible causes. After a thorough and detailed examination of the design documents, speaking with engineers - and conducting his own testing - eventually he finds ad investigates some hairline cracks in one of the supporting girders. With further testing he discovers this particular girder has been made with the wrong steel.

Over the course of a three week project he has the faulty girder replaced with a new steel beam. He then arranges independent stress testing in situ. Finally, satisfied the repairs as are sturdy - he arranges to have the road surface resealed. He has found the cause of the problem, rebuilt and restored it - thereby solving the issue for the long term.

The ailing racehorse problem

A horse is a herbivore (eats only plants) - you can tell by looking at its teeth. but if a naïve owner tried to fortify his racehorse’s diet by adding milk powder and ground beefsteak in the hope she would gallop faster - the horse would become extremely ill and may even die. That would be slow poisoning for the horse.

Most of us know intrinsically that horses don’t have the physiological equipment to digest cows’ milk or meat.

The medical diagnose-then-treat approach

A veterinary doctor is called in and works hard to give a diagnosis, focussing on the horse’s symptoms. But a firm diagnosis cannot be given. Perhaps - out of frustration the vet might dub the condition ‘equine idiopathic gastritis’ , (horse stomach inflammation of unknown cause). If a bacterial infection was found via testing, that would be blamed - and antibiotics would be prescribed. But if the horse’s diet was never examined she would continue to suffer despite the antibiotics. The sickness would be progressive (because the poisoning would continue) and she would likely suffer subsequent infections and undergo repeated treatments. Her racing career would be over and she would be retired early.

At some stage on the same diet she would suffer organ damage - putting her life at risk.

Common sense (scientific) search-for-the-cause approach

As the horse has suddenly become ill - the vet checks her all over for any injury, festering sore or parasites. Finding nothing, he turns to her diet. Analysis of her feed and stomach contents soon identifies the problem. He provides new food for the horse - and leaves instructions for the owner on how to feed her appropriately. He reports the case to the local animal protection authority for follow-up. A week later the vet returns and finds the horse is much better.

The moral of the stories

Sickness is just like any other problem in the universe - it always has a cause. We just have to apply regular garden-type common sense - and all will be revealed.

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