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The Three-Fold Cord of Rheumatology
by Kelly Young
Proverbs endure because they assert eternal truths. One such saying from an ancient Hebrew book has been frequently quoted by Christian, Jewish, and worldly authors for centuries. There seem to be endless applications of it, which only serve to substantiate its veracity.
“And if one can overpower him who is alone, two can resist him. A cord of three strands is not quickly torn apart.”—Ecclesiastes 4:12.
Examples of the proverbial “three-fold cord” in literature, religion, and life seem unlimited: the Christian Trinity; the Hebrew Patriarchs; the three American branches of government; the Three Musketeers; J.K. Rowling’s Harry, Hermione, and Ron; mind, body, and spirit; Pascal’s triangle; id, ego, and superego. There are even books about the importance of threes, rules of three, and the rule of thirds.
According to the proverb, an individual is not very powerful because he is easily overwhelmed by an opponent. Together, two can begin to resist an adversary. However, three become a force to be reckoned with. Let us consider how the proverbial three-fold cord applies to rheumatology.
The First Thread: The Rheumatologist
Rheumatologists select a challenging profession which is noble if only because of the daunting nature of the diseases they treat. Rheumatologists are the doctors who have committed to not flee through Sir William Osler’s notorious “back door” when people come to call with cruel conditions that involve arthritic symptoms.1 Rheumatologists have chosen to treat some of the most difficult-to-treat diseases that humanity faces.
For most of its history, rheumatology had an impossible task: soothe the suffering from ruthless incurable diseases like rheumatoid arthritis, lupus, and ankylosing spondylitis.
The Second Thread: Technology, Tools, and Treatments
Increasingly, resources have emerged to allow rheumatologists to actually begin to fight these diseases. With newer therapies and tools, rheumatologists are now able to offer patients hope of managing, or at least curbing, rheumatic diseases to some degree. This second thread strengthens the position of rheumatology. As the ancient proverb suggests: “two can resist.” Increasing and improving the resources in the hands of rheumatologists is an obvious way to improve care and outcomes in rheumatology. Funding for research must be increased, therapies must be improved, and the unwavering objective must be innovation. Collectively, these make “resisting” rheumatic diseases more achievable.
Adding a Third Thread: Patients
Patients are the third thread to create an unbreakable cord in rheumatology. Certainly, there have always been patients in rheumatology as objects of study or care. However, patients are also participants in advancing rheumatology care and research. The notion of patients as a collective resource has gained prominence in various specialties over the last few years. “Shared decision making” is also more common as individual patients now partner with their medical caregivers.
As participatory medicine gains footing across the globe, medicine can advance more rapidly. Recently, Katherine Leon and a handful of other women with Spontaneous Coronary Artery Dissection (SCAD) initiated the first study of their disease through Mayo Clinic.2 This model of collaboration has also been successful in cancer research.3
In the United Arab Emirates, people living with rheumatoid arthritis participated in numerous meetings of the Emirates Society for Rheumatology (ESR) in 2011.4 According to Al Maini, MD, “This scheme is part of our new medical education program that means whenever ESR meets we will make a slot available for patients to interact with rheumatologists.”
Charting a Course of Patient Contribution
Research can be accelerated by direct patient input as patients can contribute essential information; no one knows the specific details of a condition more intimately than a person who lives with it. Second, there is no more powerful force for strengthening the second thread of technology than those who can benefit from the breakthroughs; the patient voice advocates most effectively for innovation. Patients also share knowledge with one another about what is effective in management of rheumatic diseases. Patients want to do all they can to help strengthen the cord.
Dr. Osler also said, “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” While Dr. Osler confessed that he longed for a back door, he carried on. He charted a course for us to consider.
Kelly Young is author of the RA Warrior website and a founding board member of Patient Insights, LLC, and the Rheumatoid Patient Foundation.
- Saleh A. Rheumatoid arthritis: Novel strategies for an old problem. Available at www.naama.com/pdf/rheumatoid-arthritis-strategies-assil-saleh-md.pdf. Accessed March 16, 2012.
- Torrey T. The SCAD ladies—Where patient empowerment meets rare diseases. Available at http://patients.about.com/b/2011/10/17/the-scad-ladies-where-patient-empowerment-meets-rare-diseases.htm. Published October 17, 2011, Accessed March 16, 2012.
- Camporesi S, Marsico G. Cancer Contribution: An innovative example of participatory medicine in cancer. Available at www.ecancermedicalscience.com/comment-editors-views-article.asp?doi=10.3332/ecancer/editorial9. Published July 4, 2011. Accessed March 16, 2012.
- Pfizer. Patients teach doctors about arthritis under new medical education initiative. Available at www.zawya.com/story.cfm/sidZAWYA20110523063432. Published May 23, 2011. Accessed March 16, 2012.