Dr. David Newman is the Director of Clinical Research and Assistant Professor in the Department of Emergency Medicine at St. Luke’s-Roosevelt Hospital Center/Columbia University in New York City. In 2005, as a major in the army reserve, he was deployed to Iraq, where he received an Army Commendation Medal. Dr. Newman recently published the book, Hippocrates’ Shadow: Secrets from the House of Medicine. In this page-turner, Dr. Newman reviews research that refutes common and accepted medical wisdom. He cites studies that show how mammograms may cause more harm than good; why antibiotics for sore throats are virtually always unnecessary and therefore dangerous; how cough syrup is rarely more effective than a sugar pill; the power and paradox of the placebo effect; how statistics and studies themselves are frequently deceptive; and why CPR is violent, invasive — and almost always futile. In addition to his penchant for writing, Dr Newman is a dedicated teacher and passionate clinician.
Receiving: What inspired you to write Hippocrates’ Shadow?
Dr. Newman: Hippocrates’ Shadow has been burning inside of me since medical school. My sense, in fact, is that it’s a book that’s been burning inside most doctors. It gives voice to a growing reality in medicine: the deepening divide between outsider and insider. On both sides of the stethoscope we frequently misunderstand the science of medicine, and in some cases we all seem to have forgotten its purpose. The book is an attempt to reconcile those two roles through transparency, to understand the science of medicine more completely, and to find a universal thread in our dualities — science and society, doctor and patient.
Receiving: Was Hippocrates the ideal physician?
Dr. Newman: Prior to the teachings of Hippocrates, physicians on the Greek island of Kos (where Hippocrates was raised and ultimately taught medicine) practiced in the ‘Aesculapian’ tradition. This was a mystical form of healing in which patients were brought to a sacred Aesculapian temple, given ‘medicinal’ sedative substances, and upon wakening asked to recall their dreams. These dreams were felt to be the key to their recovery, carrying messages that were to guide the healing regimens that followed. Hippocrates was unique in undertaking a more scientific approach. He documented his patient encounters assiduously, categorized the illnesses he witnessed, and was fanatical about recording and learning from his empiric observations. This was new. What is fascinating about him, and what appears to have endeared him to his peers around the world, was his ability to respect the power and traditions of the mystical while championing the power of the scientific.
To put it in classic philosophical terms, in medicine we have chosen logos (measurable fact) over mythos (tradition and emotion). Given the advances in our knowledge over the last century, and tremendous strides in technology, this makes sense to us. But our nearly blind faith in science has led us, in many cases, to ignore the data that our science generates. Hippocrates’ Shadow explores areas that are difficult for physicians to reconcile with the content and tone of our education, including the surprising limits of our knowledge, the profound and proven impact of placebos and mind-body connections, and the overuse, imprecision, and inaccuracy of most x-rays, EKG’s, and other tests. To discover these areas as a physician is humbling, and empowering. Hippocrates fused these two worlds in a way that maximized benefit for his patients. His ability to do this was very much the ideal that we should be striving for.
Receiving: You are an Army Reservist, how did your time spent in Iraq influence the way you practice Emergency Medicine
Dr. Newman: Combat medicine certainly impacted my practice, and it probably will for the rest of my career. Defining that impact is tricky because it’s more mental than practical. What struck me most about the experience was the sense of how unique a physician’s position is in a combat zone. The job of healing and tending without prejudice—to any and all comers—transcends the enmity and the violence of war. That’s a special gift and a privilege, and it gave me a real respect for how special our job is.
Receiving: Your book presents convincing evidence that some routine medical screens, such as mammography, colonoscopy, and PSA level, does not improve patient outcome. Have you received any backlash for these statements?
Dr. Newman: Only those who haven’t read the book seem to object, at least so far. I try in the book to use plain language to untangle many of the statistical walls that have, I believe, made understanding data on these interventions difficult. Once these walls are gone the implications of the data become fairly clear. In the case of mammograms the existing evidence is strong, and it indicates that there is no identifiable life saving benefit to mammography as a screening tool in unselected populations. That’s something that most patients and most physicians aren’t aware of. What examples like this point out is that we have, in many cases, ignored scientific evidence in support of our science, and we continue to do so every day. The irony is hard to miss, and it’s a recurring theme in the book.
Receiving: You are the Director for Clinical Research at St-Lukes Roosevelt Hospital/Columbia University; is Emergency Medicine making a statement in medical research?
Dr. Newman: Emergency medicine is the frontier for innovative clinical research. As I point out in Hippocrates’ Shadow, the structure of our science means that on an individual level our greatest impact comes in the case of patients who are the most acutely ill, often at the earliest moments of their illness. Interventions like trauma surgery, and early goal directed therapy, and treatments for MI and cardiac arrest are all examples of how powerful our field, and research in our field, can be. The National Institutes of Health, the AHRQ, the CDC, and other major funding agencies are all beginning to catch on to this fact. As medicine begins to find itself and to value its most important resources many of the interventions with the greatest impact on human health will be developed and researched in emergency departments.
Receiving: Who is your role model?
Dr. Newman: Hippocrates, of course.
Receiving: What book are you currently reading?
Dr. Newman: ‘Sick’, by Jonathan Cohn, a brilliant, case-based chronicle of our health care system’s history and current state.
Receiving: Is a second book in the works?
Dr. Newman: I’m not sure yet. There certainly are many ideas swimming around in my head, but for now I’m going to work on getting the message of Hippocrates’ Shadow out.
Receiving: Thank you for your time.
Dr. Newman: My pleasure.
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