Lessons learned from ignorance: the curriculum on medical (and other) ignorance

What lessons can be learned from ignorance and particularly from medical ignorance? Lewis Thomas's novel idea for a course on medical ignorance struck a responsive chord. As an example, consider the state of ignorance about AIDS. After more than twenty-five years of fundamental discoveries, multiple clinical drug trials, and frustrating efforts at prevention, there has been little dent in the burgeoning global pandemic, and the prospect of effective vaccine development remains elusive. While much has been learned about AIDS, we still suffer from our ignorance. Perhaps an admission of ignorance, symbolized by a few blank pages in the section on AIDS in medical textbooks, might stimulate young minds to pursue new paths of investigation. The same approach holds for solid organ cancers, such as of the brain and the pancreas, where blank pages might more accurately reflect how little can be done practically to arrest tumor growth. Even artificial hearts and organ transplants, the miracles of modern surgery and biomedical engineering, attest to the fundamental ignorance of heart disease and other organ dysfunction. Indeed, surgery itself as a discipline is the ultimate medical exercise in ignorance-removing organs and "mutilating" the body. As the legendary surgeon John Hunter summed up several centuries ago: "It [operation] is like an armed savage who attempts to get that by force which a civilized man would get by stratagem."1 Although an operation is often the best treatment currently available for many ailments, it is at the same time a stark testimonial to a basic lack of understanding- namely, ignorance-of the underlying disease process and an inability to prevent or arrest its progression by "natural" means. In this setting, we reasoned that courses on medical ignorance would not only enhance medical education but also be a potent stimulus for new ideas and fundamental research. As the Curriculum on Medical (and Other) Ignorance (CMI) evolved, the power and reach of the "ignorance paradigm" has progressively revealed itself.2.