My father who started as a doctor in the 1940s liked to talk of medicine as an art rather than a science. To an extent that still applies in fields like general practice, geriatrics and psychiatry. Doctors now work in an era of evidence based medicine, and so it was refreshing to read the editorial below, which bears the hallmark of one of the most eminent cardiologists on the world stage.
Randomised controlled trials remain the cornerstone of good practice, but weighing the evidence and applying the data, in individual risk assessment, is challenging. Genetic profiling seems likely to provide the next piece of the puzzle.
And the art of medicine? Best read the editorial, simply stated and elegant, with a whiff of grapeshot.
I love the fact that personalised care allows for a more ‘human’ element; if the initial grounding is in clinical trials and evidence based medicine,then this approach should serve to enhance the patient experience. It certainly allows for more individuality to be applied in deciding upon a care pathway.
Good article Oyster, certainly added to my understanding, and also good to read some differing opinions on scoring.
I can't be the only one however, who worries about the future of genetic profiling, whilst it might add to our specific knowledge in circumstances such as anti-cogualation for AF, the other ramifications of genetic discrimination remain very high.
We can’t put the genie back in the bottle Ian. Genetic profiling will always be available somewhere in the world, for as long as it remains commercially viable.
Interesting article.I was considered to be CHAD1 by my GP,as female.I do have hypertension,so really should have been a 2.I also have strong family history.I saw a consulant for my high cholesterol,who wrote to my GP advising anticoagulation.He again said I was a 1,and no need for anticoag....Not knowning better,I agreed.2 weeks later I had a TIA...and the rest is history..on Apixaban,Flecanaide and awaiting ablation.Previously just Bisoprolol and blood pressure tablets.
I agree,one size scoring system doesnt seem to work for AF,using judgement based on family history,patient history and lifestyle,including type of employment,couldhave more impact then just referring to a list!
Sleuthed out the followinga number of weeks ago. file:///C:/Users/C/Documents/Genetic%20testing.html. Have been researching for over a year; promising for me and my children, most especially my son who--like I--had a 'rare' and bizarre adverse reaction to his first 'significant' Rx at 18 months. Closer to my 'soon-to-be' new home base is Duke University, another source. Also have the first genetic 'go' next week to determine best approach for visual impairment treatment. Hopeful.
I would like to have known your father. My treasured mentor for 20+ years was a D.O. (a former boxing and wrestling champion from Ireland) who was schooled in England. That history and his Doctorate of Divinity made for some interesting conversations. I was encouraged to view the human body as a 'work of art' to be cared for and 'revered,' rather than treated like 'an amusement park.' Sound advice.
Good to see you again. Do you have a web link, or is that it above?
Thanks for your comment about my father, I learned a lot from him about perseverance in the face of adversity. My parents, being young adults in second world war England, had a different perspective to the golden generation of the 60s. He was a good man.
I like your turn of phrase, treated like an amusement park, you made me laugh!
The intent of the 'botched' link was to refer to Mayo Clinic's Center for Individualized Medicine, Personalized Medicine and Pharmacogenomics.
If it's relative, my older brother had his third successful ablation at age 80 (his first was mid-50's after SVT since his teens).
Can relate to your parents. Adolescent years spent during WW-II in a vulnerable southern USA coastal town, replete with black outs, air raids, evacuation drills and submarine watches from a town-center 'crow's nest,' didn't exactly foster a placid childhood.
Thanks for the heads up on the Mayo Clinic. I had no idea, what a fantastic resource, do you have any idea on costs? The link below goes to the About page
I must look in to the possibility of something similar in the UK, not for me but for my family.
Sorry, Joseph, no idea on cost. My last attempt to get more info from Mayo was on 2/24. That yielded the telephone number for the Medical Genetics Department: 507-284-8198. Since I do not even have a name for the test I'm seeking, I decided to wait until I did.
In the interim, my daughter bought a retirement home in North Carolina and I will have closer access to three research hospitals (Duke, University of NC and Wake Forest) all of which are pursuing Pharmacogenomic research.
I should know more March 13th after an appointment with a 'genetic consultant' with whom I am working in the hopes of improving the visual impairment.
Will keep you posted by PM if I may. Otherwise, when the planets align again :), I'll do a short post.
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