But Why Is It So Difficult To Think Of It Again?

It being the "it" of the Goethe quote referenced in "Acne Vulgaris, Probiotics and the Gut-Brain-Skin Axis — Back to the Future?" : "everything has been thought of before, but the difficulty is to think of it again".

Of late there has been considerable debate about a perceived stagnation in medicine. Advances came fast and furious in the first few decades of the 20th century (think antibiotics, the pill, the Salk vaccine, etc). Nowadays advances are few and what few there are seem little more than nibbles around the edges e.g. news of a treatment extending the life expectancy of patients with advanced pancreatic cancer from 24 weeks to 27 weeks made its way to the front page of the newspaper a while back. What happened to progress? Has all the low hanging fruit already been picked? Why aren’t the drug companies discovering wonder drugs? Are none left to be found?

It’s an old temptation that makes people think they understand the world and how it works. In 1874 Max Planck’s physics professor told the future father of quantum theory not to bother with a career in physics saying "in this field, almost everything is already discovered …". Ooops.

The peril, as Thomas Kuhn described it in "The Structure of Scientific Revolutions", is that researchers tend to get trapped within a worldview, a paradigm, that blinds them to possibilities beyond the perceived realities that they’ve spent their lives trying to comprehend. It’s not until a scientific discipline is in crisis, a state brought about by a once elegant theory being turned into a Rube Goldberg contraption from the numerous tweaks made to explain away embarrassing inconsistencies, that blinders come off. It’s only then that new ideas, or as Goethe might put it old ones thought of again, are tried.

And that, I think, is where we are today – In the middle of a crisis of medicine. The old deterministic model on which the small molecule pharma model was built i.e. add what’s lacking, deplete what’s in overabundance, turn off what shouldn’t be on and turn on what shouldn’t be off, doesn’t work beyond a few now obvious exceptions.

So what old ideas are being reconsidered anew? Read the (ungated) paper on acne vulgaris referenced above. Seventy years ago a few people thought that the bacteria which live in our guts and on our skin (and maybe elsewhere) could explain the strange association between gastrointestinal illness, depression and acne vulgaris. They also thought that reforming the microbiota (terra-forming the gut or ile-forming) with different bacteria might ameliorate or even cure such complex disorders. Now there are lots of researchers opening their eyes to the possibility that most diseases are emergent phenomena far too complex to be dealt with one molecule at a time yet ones that might yield to complex cocktails of multiple drugs or, more complex yet, cocktails of bacteria, probiotics, to fight fire with fire.

If the past is any guide we’re not in an era of stagnation in medicine; we’re on the verge of a new age of discovery.