The Art and Science of Treating Meniere's Disease

Note: I know this needs some editing, but I'm short on time so I'll try to come back to clean it up later.  Here's my B-student mentality coming through.

Most people would consider art to be something solely based on subjective preferences and emotion, while the practice of medicine as based wholly on scientific objectivity.  While there is truth in both of these assumptions, the reality is that the two overlap more than they might appear on the surface.

In an effort to produce a desired look, a good artist understands the physical and chemical properties of their medium.  They learn how and why they must use oil or acrylic paints on canvas, while watercolors must be used on a specific type of paper.  Or that there are different types of clay to be used for sculpting and that one must choose the right one depending on what the final product is to be.  Even in understanding and using the right tools and media to produce specific types of art, not everyone will agree on the beauty of the artist's final rendering.

The practice of medicine is actually quite similar.  While the practice of medicine has evolved rapidly over the last 100 years and can now treat many previously-deadly diseases quite effectively with modern medical interventions, there are still many, many conditions for which modern science has yet to understand with enough detail as to be able to manage or cure them.  You know where, I'm going with this, right?

I have spent my entire 15-year career as a dietitian working with the sickest of the sick.  The patients I have worked with have almost exclusively been dependent on tube- or IV-nutrition or have advanced-stage cancer.  In this population, I see a lot of very malnourished patients.  Severe malnutrition creates a lot of anxiety not only for patients and their families, but also for their physicians.  Many times, a doctor will ask me what "one test" can they order to track their patient's nutrition progress.  While there are many tests that are indicators of nutrition status, there is as-yet no one reliable indicator of nutrition status.  It's safe to say that the same could be said of any other measure of health.  With most chronic diseases, it is the assessment of blood tests, physical assessment, and functional status which inform the clinician of the effectiveness of their intervention(s).  And oftentimes, it is the subjective measures which are most important to patients.  Ultimately, I tell physicians and patients alike that the assessment of nutrition status is as much an art as it is a science and that the goal is really to prevent poor nutrition from interfering with treatment of the disease at hand and/or to promote optimal quality of life within the limitations of the disease's symptoms as they relate to nutrition status.  I wish there was a better understanding of nutrition and diet and how they are related to optimal health outcomes, but the science just isn't there yet.  And sadly I don't think it ever will be.  There are just too many factors and moving targets.

If we compare the current understanding and treatments for Meniere's disease to art, I think it's safe to say we're stuck square in the Middle Ages.  The scientific understanding, at least as portrayed to us by the experts, feels entirely two-dimensional.  There are some interesting nuances that appear from time-to-time, but as a whole, if compared to art, we are long way from the 4-dimensional, Technicolor experience we all hope and wish for.

Accepting the reality of the current limitations in understanding this disease, I think many of us would appreciate a little more honest discourse from our physicians.  I am tired of the words "idiopathic" and "symptom management."  I can read all of that on-line.  I want to hear their personal and professional assessment of the latest research.  Where do they think it is heading?  What should be following in the literature?  Which scientists are doing the most interesting work?

My belief is that, just like the emergence of the Renaissance after the Middle Ages, the understanding of the cause(s) and treatment of Meniere's disease will eventually take a giant leap forward, moving us closer to that 4-dimensional, Technicolor rendering of Meniere's disease interventions and outcomes.