Physicians of the Medical Frontier Manifesto (Know Thy Enemy)

Sun Tzu says in the Art of War “If you know the enemy and know yourself, you need not fear the result of a hundred battles.” This is the wisdom that will make it possible for us to prevent and reverse the chronic diseases associated with aging and civilization.

We, the doctors of the future, must know ourselves. We must be aware of our emotions and thoughts and effectively regulate them with self-discipline, loving-kindness, and wisdom.

We must also know our enemies, our enemies being the pandemic of chronic diseases that are decimating humanity more and more every day. To strive for this, we must thoroughly learn the medical and premedical curricula so that we can understand the context of our enemies. But while that is necessary, it is not enough.

We must go beyond becoming experts at USMLE material; we must strike out boldly into the great frontiers of medicine. We must read the literature. We must teach ourselves what’s been discovered since the last time the USMLE curriculum was updated.

The problem is that it’s extremely time-consuming to read the literature. Yet, we must do so even though it is extremely difficult and painful, even though it is a sacrifice that is not expected of us and is not reasonable to make, even though our current healthcare system demands immense sacrifices and heavily incentivizes doing the same thing over and over.

We must study the literature on top of the USMLE content because we have a duty not just to execute the current standard of care, but to improve the standard of care until all chronic diseases can be prevented and reversed with the same reasonable level of safety and efficacy with which we can currently treat most acute infectious diseases with antibiotics.

We must push forward the standard of care because it is our God-given duty.  We owe it to ourselves and to everyone we know who suffers from a chronic disease that medicine currently considers incurable. If your experience is anything like mine, that includes you, everyone you care about, and most of everyone you’ve ever met. It is our duty to push back against the chronic diseases of aging and civilization, and that is why I have given my life to become a physician.

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Carrying forward the current standard of care while also improving it may seem like a lofty goal, but the truth is that the basic and translational medical science communities have spent decades mapping out the mechanisms and pathogenesis of all the chronic diseases, identifying the novel therapeutic targets, blowing up those targets in animals and small cohorts of humans, and demonstrating the improved safety and efficacy that many of these novel treatments offer us.

To improve the standard of care of complex chronic diseases like cardiovascular diseases, diabetes, obesity, depression, and cancers, we must select the highest-impact therapeutic targets in their pathogenesis, and hit them with the best of every standard and novel therapeutic we’ve got. You can’t take down a cancer or even something as seemingly simple as an eosinophilia-induced atopy (my own chronic disease) by targeting a single step in the pathogenesis. You must attack the enemy at every step in its pathogenesis. Cut it off at the root, the stem, the flower, and salt the earth. This is what the combined power of the current medical curriculum and the literature is making more and more possible every day.

We must also honor the fact that the specific pathology of every person is unique with personalized medicine. The same “disease” may be caused by several different etiologies and may progress via different pathogeneses in different people. We must use current and emerging biomarkers and instruments to diagnose the specific mechanisms of each person’s unique pathology, not simply rely on the one-size fits all textbook description. Advances in the literature also make this possible.

The path to preventing and reversing the chronic diseases is arduous and full of obstacles. The goal will not be achieved in a single lifetime. Personally, I will consider myself blessed if I am able to contribute a small sliver towards this greater goal by devoting of my life’s work to the cause. There are others like me, and one day when I’m old, I will pass down this mission to the next generation. We will get there eventually if we will it. We must say to every obstacle, “We will not yield; we shall overcome”.

We must know ourselves, we must come to know our enemies as students of the USMLE and the literature, and we must use this hard-won knowledge to target our enemy with existing and novel therapeutics at every point along the pathogenesis. We must continue to learn, to experiment, and to innovate until all the chronic diseases are destroyed as safely and efficaciously as most bacterial infections are today.

This may sound like a dream, but so did antibiotics before the invention of penicillin. It is possible, and what’s more, we’re already well on our way.

Join the fight to prevent, reverse, and cure the chronic diseases of aging and civilization today. All you have to do is go to Google Scholar and type in keywords for the disease that you yearn to cure the most right now (maybe your own or that of a loved one) and learn. Then share the most important therapeutics targets and novel treatments that you find with the world.

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