Yes, yes…long time, no see.
I may have mentioned that over the years several, ‘many’ depending on how you want to define that, several people have asked me to write a book about my approach to medicine.
Well one of those who asked year after year when I was going to write a book and finally realized I wasn’t going to decided he would in my stead.
You don’t even need to hyphenate the two words ‘ghost’ and ‘writer’ as they have passed unmolested into the vocabulary as a single word; that is how common the employment of ghostwriters has become.
Now, I have one!
I wind up spending hours and hours working with this most pleasant of men and he is making me do the work a writer needs to do anyway; that is, think about what he wants to communicate.
As Hamlet would say, did say: “Aye, there’s the rub.” I communicate best with graphs, concepts, guidance, conveying my care for my patients in non-verbal ways, iterative testing, diligent reading of the research literature, all the while experientially jaundiced about the pollution level in medical literature and advice and thus skeptical enough to dig deeper than headlines for the guidance I offer my patients. I hope, more than know, that there are other docs out there of whom all of that could also be said.
In any event only now am I being forced to organize in words how my work proceeds.
I want to introduce some of the schemata I use to examine and incorporate protocols into my practice and advice.
When I developed the software program I use in my practice, now dubbed KumarEHR (this title derives from the work Kumar, my associate, went through to get our system certified with one of the national labs) my main almost metatheoretic idea was that in biological systems trends were more important than single time-point numbers; thus the software was a graphing system where various lab variables could be put side-by-side to check for correlations, to probe for causative links and to make visible trend effects of behavior changes.
OK, ‘trends’ matter more than single numbers. Seems obvious but conventional medical practice pays only lip service to this idea.
Next was that you could assess biological age, much more important than chronological age, by understanding the nexus within a matrix of local, regional, systemic effects on plumbing, wiring and chemistry.
Simple: wiring=nerves, plumbing=vascular system, chemistry=hormones, neurotransmitters, interleukins and the like.
‘Local’ is nanometer to millimeter scale, ‘regional’ is millimeter to centimeter scale and ‘systemic’ is centimeter to meter scale.
Now you can easily guess why I need someone else to write the book; already this seems too abstruse to be of use. Still with this schemata in my head I can read, scan and use or reject tons of basic science and clinical level science and incorporate it within my medical practice in an ongoing manner.
It helps me not get carried away with treatments that are only assessed at the local level, beta-blockers are a good example of how following my assessment principles led me away from this terrible class of drugs decades before they were recognized as suspect by the profession. The concept led me to know there was no such thing as a local injury, the beginning of an atheroma, ‘heart blockage,’ for example and that there had to be systemic signals; now known as BNP, CRP, IL-6, etc. and so on.
Unfortunately I could go on and on about how this technique led me to my exercise protocols, dietary guidelines, the value of spiritual discipline, massage and relaxation and the harm of almost all supplements.
Yes, I did say ‘unfortunately,’ because that ‘going on and on’ is what I would do if I were to write the book, but the brave good man who is writing it has an editor’s eye and a gift for levity that I lack. You will love the book. When I have his permission he will no longer be a ghostwriter but a writer in full.
Just an update.
Smile, Have Fun and God Speed,
PS The title of the book is “Renewal.”