Wednesday, February 1, 2017

Micro Shifts

I'm at the Winter Conference on Brain Research (WCBR) which is full of very complicated talks about brain functioning and the underpinning mechanisms and mediators. It's Kuhn's "Normal Science" writ large. But since Kuhn focused on physics and it was 50 years ago how could he have imagined such a huge effort focused on such a small (comparatively) problem? 

Were he to be at this conference, perhaps he would have identified "Micro-Paradigm Shifts" that follow the same pattern but are limited to a smaller field. As an example genetics is slowly challenging the Bipolar Disorder I/Schizoaffective/Schizophrenia rubric and imply they are all the same. Most people say it's bunk and others simply carry along with DSM-V and ignore the debate and implications. But if these diagnostic categories are wrong then the entire field of psychiatry has been traveling down the wrong path (and misdiagnosing patients and potentially mistreating them) for eons. Certainly that would qualify for a paradigm shift.

Similarly there is probably some finding at this conference which is "upsetting" to some attendees and challenges the known order. Perhaps what we really need is a way to identify the early stages of shift where/when someone challenges "normal science."

In terms of medical student training we might look for evidence of unease. For example, the emphasis of the "new" topics (economics, big data, data analysis, communication, coordination) isn't really causing any unease. Annoyance, frustration and perhaps irritation for some, but certainly not unease. So this is still "normal science" of medical education. It's just adding topics already to crowded curriculum (which lacks coherency, recognition of unsustainability, or relevance to the actual practice of medicine - but I digress.)

In contrast arguments that medical school should be reduced to 3 years (which I find compelling) have been greeted with unease. So any challenge to the "medical school takes 4 years" paradigm [Duke's replacement of one year with a research year seems a sneaky way of implementing change without causing unease] would seems to be evidence that a shift is happening. The actual shift may not be to 3 years. It may be to an entirely new approach (distance learning, individualized curricula, varying lengths?) to medical school training. But to me identifying unease is the key to identifying potential shifts, and changes to the 4 year plan are about the only change that I see that causes unease.


  1. With the new tech age it makes sense for medicine and the way that it is taught to also advance. I like that your blog and your page are geared towards medical students that are learning. Like the new discoveries above where you were talking about Bipolar, Schizoaffective, & Schizophrenia being the same thing. I found a similar link that talks about how a brain disorder makes someone an addict and not a behavior issue. I found it interesting and wanted to share this with you. is

    1. Addiction is indeed a brain disorder, a problem with the reward circuitry. We all have things that make us feel good. And we do them more and more. Drugs hijack this system for folks who are genetically susceptible. Hopefully we will be able unravel who is more susceptible and to what drug (alcohol, nicotine, opioids, cocaine). Until then the best solution is keep one's brain away from all of them. The excessive prescribing of opioids is a case in point. As we prescribe them more we find the percentage of people whose brain is susceptible to opioids and they in turn enter the struggle against opioid addiction.