Published on May 19th, 2016 | from CAMH
Patient vs Participant
By Dr. Sarita Sharma, MD, Research Volunteer, Research Imaging Center, Campbell Family Mental Health Research Institute
“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.” – Hippocratic Oath
The Hippocratic Oath is a pledge that is taken by new physicians, whereby they promise to uphold all ethical principles in the practice of medicine. I chose to include this particular segment of the oath because it represents my belief that medicine and science, though they are very different, cannot function properly without each other.
Medical school has always been my goal and the field of psychiatry was the ultimate target. I have always been intrigued by the human brain. What makes us feel the emotions we do? What can I do to help one remove negative thoughts and replace them with positive ones? I believe this stemmed from being exposed to doctor visits and overnight hospital stays with my sister, who is a paraplegic and diagnosed with Spina Bifida Meningomyelocele at birth. She has had multiple surgeries throughout her life and experienced numerous complications, which ultimately led her into a deep depression. I was determined to help her feel emotionally stable so that she could lead a happy and fulfilling life. It had become clear to me that I wanted to pursue a career that allowed me to think, feel, and relate to others in a genuine and meaningful way and psychiatry was the obvious choice.
Now, as a recent medical graduate, before applying to a psychiatry residency program, I took a year off to explore clinical research in psychiatry. I have had the pleasure to volunteer with Dr. Jeffrey Meyer’s research team here at CAMH. Through this experience, I have gained some insight into the differences between research and medicine. I have noticed that physicians and scientists tackle problems very differently and I would like to share my perspective as a medical student.
In medical school, besides learning how to read in your sleep, we are taught to treat the patient and not the disease. As physicians, we have the power to directly impact our patients’ lives on a personal/one-on-one level. We are trained to come up with differential diagnoses based on the patient’s physical and historical findings. This is a very efficient and well-organized approach to treat the patient and every so often a complete picture is not even needed since this problem-solving method is based on probabilities. Our mandate is to follow the well-known rule of thumb “if it is not broken, do not fix it” and that is why majority of our focus is put on preventative measures. We have to work to stop of the illness from happening in the first place.
In clinical research, the primary goal is to understand the disease and not the patient/participant. Scientists use logic to look at a problem in the abstract form. They form a hypothesis or question and use different methods to solve it by breaking it apart individually. This method is more time consuming and detailed than the physicians’ approach. However, if the correct hypotheses are modeled, this can contribute to a greater understanding of the illness. This can not only directly help the participant but also generate new knowledge that can be applicable to other diseases and reach a far greater population. As a whole, the result would be the ultimate solution because it takes into account the most information.
Now you are probably wondering, what if we combine the two? When researchers work closely with psychiatrists there is the greatest opportunity for diagnosis and management in relation to patient care, but also to gain understanding of the illness. There are many such collaborations at CAMH and I have had the pleasure of working with Dr. Jeffrey Meyer, who is a psychiatrist and a scientist, in his research using brain imaging to understand the biochemistry of depression. We are working on a study in which we use a brain scan to measure brain inflammation. Inflammation is the body’s response to injury but it can be excessive in some people, leading to the body fighting itself when it doesn’t need to. In a previous study, we found that at least a subset of people with clinical depression have brain inflammation. Now, we want to see if treatments with anti-inflammatories can help reduce symptoms of depression. We hope that our study will improve the understanding of clinical depression and other diseases and lead to the development of better treatments.
If we do not fully understand the mechanism of action of psychiatric illness then a drug is rendered less effective because it is not targeting the correct source of the problem. That is why it is so important to remember that there is art to medicine as well as science and the two must work together. Given the high prevalence of mental illness, discovery and innovation in clinical psychiatric research will have a profound impact in medicine, science and society. Let’s do this together!
To learn more about this study or other research at CAMH, please visit “Find a CAMH Study” (use the keyword MDD Brain Imaging Study).