The myth of the average man
Carl Wunderlich, the medical director of the hospital at the University of Leipzig in the 1850s, is credited with establishing that most fundamental of medical standards—the normal human body temperature. To do this, Wunderlich examined over 25,000 patients in the hospital and concluded that the normal temperature of the human body is 98.6 degrees Fahrenheit. Ever since then, the number 98.6 has been used as a primary indicator of physical health, any variation being seen as evidence that the body is fighting a disease.
As a matter of fact, this is not the normal human body temperature. A more recent study indicates that no more than 8% of humans have a normal temperature of 98.6 degrees Fahrenheit and, if we have to take an average, 98.2 is probably closer to the mean. But even that is not conclusive as body temperature varies depending on the time of day, the age of the person and many other factors. Temperature is just one of the many approximations on which modern medicine is based. Almost all the other standard measures—blood pressure, blood saturation, liver function—are based on the assumption of an average man.
As we now know, there is no such thing.
No human being is like another and while we may appear, outwardly, to be the same, we all have a myriad tiny abnormalities that make us different.
Our bodies have found ways to cope with these aberrations, making minor compensations to the way individual organs and systems operate in order to keep the body, as a whole, functioning. But as a result, it is virtually impossible for any set of medical parameters to be deemed to be the human norm. Yet, for hundreds of years, medical science has based itself on the image of the average human being.
Take, for example, the drugs we use to treat disease. Before a new medicine can be certified as being fit for prescription, it has to pass a rigorous approval process designed to both establish medical efficacy as well as identify any side effects that may exist. Drugs that have harmful side-effects are either prohibited or only required to be prescribed only to treat severe illnesses where the potential benefit outweighs the risk of their side-effects.
These trials are carried out on a small sample of patients on the assumption that the performance of the drug on that sample can be extrapolated across all of humankind. Implicit in this process is the assumption that there is a sameness to us all that, as we have seen above, does not exist. This is why we each react slightly differently to the drugs we consume, experiencing side-effects in certain cases and lower treatment efficacy in others. What’s more, doctors prescribe these drugs based on a quick consultation but have no way in which to measure how our body reacts to the medicines or to calibrate the dosage based on a patient’s individual response. As a result, medication is almost never as effective as it ought to be. Ideally, medical treatment should be customized for each individual, designed to specifically treat us based on variations from our personal baselines. Drugs that we have been prescribed should be monitored in real time so that dosages can be re-calibrated based on the specific response of the human. This type of personalization requires long-term, continuous monitoring to detect marginal variations—something that is impossible when medical advice is dispensed from the consultation room of an outpatient department.
All this is about to change. Thanks to improvements in wearable technologies, we have monitors today that are capable of continuously monitoring personal parameters such as blood sugar. These devices can be used to both establish individual baselines and detect variations as they occur, be it from something as simple as a change in diet or as serious as the onset of a major disease. These devices have the potential of re-shaping the way medicine is practiced, allowing us to customize treatment for each patient using treatments specifically calibrated based on the effect they have on our bodies.
All of this will force us to think about health differently, allowing us to calibrate treatment finely based on marginal responses, changing the approach from being responsive to symptoms to pro-actively heading off disease before they become untreatable. Eventually this will force us to re-think medical regulation itself, forcing us to change our drug approval process from extrapolating health effects across the population to relying on more personalized analyses of their effects. It will impact our laws on insurance and medical liability both of which evaluate incidents against standard protocols that doctors are expected to perform but which will need instead to base their inquiry on individual baselines.
Most importantly, we will need to implement a host of positive regulations to make this future a reality.
Rahul Matthan is a partner at Trilegal.
Ex Machina is a column on technology, law and everything in between.
His Twitter handle is @matthan.