Near the end of his life Dr. Albert Schweitzer was asked, “Dr. Schweitzer, what do you feel is the most serious problem in the world today?”

The illustrious physician paused for a moment and then responded, “The greatest problem in the world today is that men simply don’t think.” (Lest any ladies reading this article cheer in agreement, he was using “men” in the all-inclusive sense, prior to the time when such usage became politically incorrect.)

Dr. Schweitzer’s assessment was most astute. Rational thought is one of the main characteristics that sets us apart from animals, which operate primarily from instinct. Our ability to think has enabled us to fly higher than eagles, travel faster than cheetahs, and deliver stings more deadly than cobras. It has enabled us to survive in climates as hot as a tropical jungle or as cold as the Arctic tundra. Failure to think is the greatest problem in the world today, for it is only by thinking that other problems can be solved.

I cannot attest to the amount of thinking being done in the areas of law, industry or finance, but I can state that, in my experience, physicians spend very little time immersed in deep thought. The practice of medicine in the United States has become standardized to the degree that thinking is not only optional; it is actively discouraged.

Diagnosis, the process of attaching a name to a group of symptoms, physical findings, and laboratory abnormalities, has become the heart of American medicine. It is impossible to order a test, schedule a procedure, or bill for a service unless a diagnosis has been made and recorded. Many people are given a diagnosis before all of the facts are in and long before they have been analyzed. Unfortunately, once a diagnosis exists further investigation and contemplation often appear superfluous and unnecessary.

This has not always been the case. As a young physician I was confronted with a dilemma. A woman had presented in the Emergency Room of the hospital with symptoms for which I could not find a cause. I sat at the desk feeling puzzled and uncertain as to how to proceed.

A seasoned colleague happened to pass by. Seeing the bewilderment on my face he stopped and asked what was wrong. I explained that I was trying to decide how to deal with a situation in which I sensed that a serious health challenge was present, but was at a loss to explain why.

“You’ll experience that from time to time,” he observed. “I’ve found in those situations that it’s best to admit the patient to the hospital and observe them closely. Something serious will almost always appear within the next 24 to 48 hours, and there may not be time for the person to get back to the hospital when it does.”

He was right. His sage advice served me well, and I mourned the arrival of the era in which such prudence was no longer allowed.

If diagnosis has become the heart of American medicine, pharmaceutical treatment has become its soul. It has become nearly impossible to leave a physician’s office without one or more prescriptions in hand. Little or no thought is given to how they will affect the overall well-being of the individual. It is enough to know the diagnosis, for this specifies which drugs are indicated based on the results of double-blinded, placebo-controlled, crossover studies.

Two realizations changed my approach to sickness irrevocably. The first was that I had been trained to ask the wrong question when confronted with signs and symptoms of illness. I had been taught to ask the question, “What is this?” – to “Make a diagnosis.”

The correct question, as I pointed out in the June 2002 issue is not what, but why.

The second was that clinical studies are fraught with error and are not the only source of creditable information.

Many people mistakenly believe that scientific studies provide conclusive and definitive answers regarding how to manage health challenges. This is simply not the case. Well-designed studies do provide valuable information, but in reality they play a relatively small role in medical decision-making.

While clinical studies provide the basis for FDA approval of drugs and appliances, they do not govern their subsequent use. Drugs are prescribed for “off-label” (not supported by enough evidence to gain FDA approval) use more frequently than they are prescribed for approved indications. Very few surgical procedures or therapeutic techniques have been subjected to controlled scientific investigation.

It is therefore more than a little hypocritical when nutritional supplements, bioenergetic devices, and manipulative treatments are dismissed as quackery because they have not been evaluated by a sufficient number of placebo-controlled studies to be approved for use by the FDA. Supporting the body’s ability to function properly with substances whose mechanism of action is clearly understood is not only logical; the practice is scientifically sound.

The condition called fibromyalgia is an excellent example of the limitation of double-blinded, placebo-controlled, crossover studies. Fibromyalgia is characterized by the presence symmetrical tender points in multiple locations. Although hundreds of studies have been conducted seeking an effective treatment, no consistently effective regimen has emerged. While the symptoms wax and wane, the condition is considered irreversible.

Logic, on the other hand, dictates that there must an identifiable cause or causes for the muscle tenderness that is present, and that when the cause is identified and corrected the pain will no longer be present. Following this approach, seven distinct causes have emerged: toxicity, mineral deficiencies, hormonal imbalances, sleep disturbances, spinal stenosis, energetic disturbances, and chronic viral infections. When each of these conditions is approached individually and proper supports are given the condition either improves dramatically or resolves completely in a relatively short period of time.

Similar examples could be given for nearly every chronic disease state. When one begins to think, to reason logically, the root cause of the condition becomes evident and a corrective regimen emerges.

We are capable of resolving the United States health care crisis. We will not achieve this goal by waiting for the result of the next double blind study, however. We will see dramatic declines in sickness and premature death only if we follow Dr. Schweitzer’s sage advice. We simply must think.