Medical mind 1 ; The Master Healer; Regression to mean

The Master Healer; Regression to mean 

Try this question. Who in the history of mankind has healed more wounds, cured more diseases and relieved more ailments than any one? Not only is there a definite answer to this question but also  a lot of daylight is there between this master healer and the next in line.

The origin of medicine, its growth and present omnipresence owe a lot to this simple fact; a good portion of human ailments; physical and mental, regresses to the mean.

Ok, whats this regression to the mean?

Its simple, most events over a period of time will have a mean like value or state. We usually know this state by the name " normal" . When we say we had a normal day, an uneventful journey or an average performance, we are evoking this mean value.

Now lets imagine a not so normal day, a bad day for instance. By saying this we are meaning the day had few things that were beyond normal in a bad way, isn't it?  Its no surprise that all the following days wont be like that or in other words in most circumstances the day following the " bad day" is going to be a "normal day " . So it has regressed to mean.

But why bother about it?

When we don't understand this regression of mean happening, we end up attributing causes to why things happen when in reality there is no such relation. One classical example is corporal punishment. When someone does something thats deserving of a punishment it means his or her action was way beyond the normal variation. What it also means is in most cases that action is not going to be repeated in immediate future. Now if punishment immediately follows the act, one might feel like corporal punishment has worked as the person's behaviour seems to have improved immediately after it

The same mechanism is in action when a skilled surgeon who had a tough case on a day attributes meticulous planning and work up to why his next cases went smoothly.

Whats its relevance in medicine? 

Its easy to see how regression to mean works in quack medicine . We call it by the name " placebo effect" . Imagine having a common cold for instance, a self limiting disease. It will be at its distressing worst u when you decide to consult the "doctor”. The self limiting disease must be near its peak effect when u take the so called medicine or medicinal advice. And in days following it, you start getting better.  So the credit that has to go to regression to the mean goes to your "doctor"

Modern medicine and regression to the mean

Whats interesting though is how much so called modern medicine is indebted to ROTM. For major part of modern medicine's history, actually till about a century ago, medicine did more harm than good. With bloodletting & putting holes in skull with absolutely no idea of asepsis and  anaesthesia, a modern medicine doctor of 19th century definitely was a person to avoid if u were sick. But, still physicians and doctors were not only consulted and revered, but also made fantastic cures!  Actually they were just snatching off the credit from ROTM.

Even today the story isn't much different!

Yeah! Its a fact. Though modern medicine has made some giant leaps in fields like asepsis, anaesthesia, immunisation etc, its still owes a lot to ROTM.

Try this fact. One would expect the life expectancy changes brought on by modern medicine to be most evident in western societies. Now, the life expectancy of a child born in 1900 in US was about 45 yrs. today its close to 75 yrs. a gain of 30 yrs. but, the life expectancy of a 50 yr old was 22 yrs in 1900, and is 29 yrs today. Just a gain of 7 yrs.

What does this say? Its reasonable to assume that in last 100 yrs we have achieved some remarkable things in mother and child health care. Interestingly this where asepsis, anaesthesia, immunisation all intersects. But what it also says is in regards to adult health our achievements have being less than spectacular to say the least.

So a 50 plus year old in 2012 with back pain, knee pain or on a cocktail on medications for hypertension, anti coagulants, anti anxiety drugs, anti oxidants, etc etc is not getting dramatically better management than his counterpart  a century back. Thank god for ROTM! Patients still believe visit to GP is doing wonders and gets cured too!!