The future discoveries in medicine will require a combination of hard work, a fair amount of luck, and large doses of critical, creative thinking. As Kahneman observes, we often have a tendency to become overly reliant on our intuition, which leads us to activate System 1 instead of System 2. Think slow, not fast.
The results of the studies described above have broad implications for our community. Can we manipulate the microbiome to our advantage when treating rheumatic diseases? Can we do so without resorting to using a colonoscope or feeding patients worms? Will vaccine therapies for selected autoimmune diseases ever become a reality? Does the cancer metastases model data translate to RA? In some patients, do RANKL and the SNS play similar roles in translating emotional stress into disease flares?
The “sex life of the screw worm” was one of many federally funded studies that was attacked as being frivolous by the late U.S. senator from Wisconsin, William Proxmire. From 1975 to 1988, his Golden Fleece Awards highlighted what he considered to be government waste in support of dubious science. But a $250,000 study of this pest, which is lethal to livestock, has, over time, saved the U.S. cattle industry more than $20 billion. Think grateful, that our tax dollars are being used wisely. And keep thinking different.
Dr. Helfgott is physician editor of The Rheumatologist and associate professor of medicine in the division of rheumatology, immunology, and allergy at Harvard Medical School in Boston.
References
- Kahneman D. Thinking, Fast and Slow. New York, N.Y.: Farrar, Straus & Giroux; 2011.
- Scher JU, Abramson, SB. The microbiome: A voyage to (our inner) Lilliput. The Rheumatologist. 2011;5(11):1, 32-35.
- Me, myself, us. The Economist. August 18, 2012.
- Velasquez-Manoff M. An immune disorder at the root of autism. New York Times. August 26, 2012: SR1.
- Summers RW, Elliott DE, Urban JF Jr, Thompson R, Weinstock JV. Trichuris suis therapy in Crohn’s disease. Gut. 2005;54:87-90.
- Brandt LJ, Aroniadis OC, Mellow M, et al. Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection. Am J Gastroenterol. 2012;107:1079-1087.
- Faustman DL, Wang L, Okubo Y, et al. Proof-of-concept, randomized, controlled clinical trial of bacillus-calmette-guerin for treatment of long-term type 1 diabetes. PLoS One. 2012;7:e41756.
- Campbell JP, Karolak MR, Ma Y, et al. Stimulation of host bone marrow stromal cells by sympathetic nerves promotes breast cancer bone metastasis in mice. PLoS Biol. 2012;10:e1001363.
- Melhem-Bertrandt A, Chavez-Macgregor M, Lei X, et al. Beta-blocker use is associated with improved relapse-free survival in patients with triple-negative breast cancer. J Clin Oncol. 2011;29:2645-2652.
