I’ve heard it said that medicine is as much an art as it is a science, where expert opinion and experience is the basis for treatments. This was true especially 50 years ago and was still common as late as the 1970s (and probably well beyond). For example, my wife and I were both referred to a Dallas-area endodontist who was famous in the dental community for his knowledge. He also taught at a local dental school. He had a variety of rules of thumb he had learned from years of experience. His techniques were second to none. He had a reputation for being able to save infected teeth when no other endodontist could. He would use antibiotics for certain infections but not for others, or on certain teeth but not others. He had many other techniques you probably won’t find in textbooks. If you ever mentioned his name to a dentist trained in the Dallas area, they invariably said something like, “Oh my God, he taught my endodontics class at Baylor. Nobody knows how’s he’s so good at what he does. It’s scary!”
The now deceased legendary endodontist had spent years observing patients and what made them get better. He shared his knowledge with students, but disseminating knowledge that way is slow. The goal of evidence-based medicine is to gather evidence (like the endodontist) from successful treatments and standardized therapies. Increasingly, medicine is being dragged – kicking and screaming – from an art where individual doctors have their own methods to a science where every doctor follows the same procedures. The following is from an article in The Conversation:
The practice of medicine has undergone an incredible, albeit incomplete, transformation over the past 50 years, moving steadily from a field informed primarily by expert opinion and the anecdotal experience of individual clinicians toward a formal scientific discipline.
Evidence-based medicine began to emerge as a way to bring together the latest scientific knowledge and make it available for all physicians to use instead of relying on their own gut instincts or experiences that could take years to acquire.
The bedrock of evidence-based medicine is a hierarchy of evidence quality that determines what kinds of information clinicians should rely on most heavily to make treatment decisions.
In the future patients will increasingly be treated with customized, personalized medicine. This is sometimes referred to as precision medicine.
The advent of evidence-based medicine meant clinicians identified the most effective treatment options for their patients based on quality evaluations of the latest research. Now, precision medicine is enabling providers to use a patient’s individual genetic, environmental and clinical information to further personalize their care.This map of the human genome enabled scientists to discover genes linked to thousands of rare diseases, understand why people respond differently to the same drug, and identify mutations in tumors that can be targeted with specific treatments. Increasingly, clinicians are analyzing a patient’s DNA to identify genetic variations that inform their care.
The advent of precision medicine requires reams of data and huge computational power. The work involves not just doctors and biology science but also computer scientists. Researchers are beginning to use artificial intelligence (AI) tools to analyze data and develop treatment plans specific to individual patients. Research on the relationship between the human genome and individual diseases and conditions allows a level of precision not possible in the past.
There is credible evidence that endodontics is not safe, that leaving dead teeth in the mouth leads to hidden infections that can eventually harm the heart and other organs. The relationship between mouth and heart at least is widely accepted now. Tooth transplants do not run these risks, but endodontics is still a huge business and remains standard of care.