The term doctor was first applied in the 14th century to prominent theologians. Later in the century, it was expanded to include physicians and academics. The word comes from docere, which means “to teach” in Latin. When Cicero coined the term in 55 BC, he wrote that it means to provide truth through rational argument and statement of fact. I learned this history in medical school more than 30 years ago and began my career fully intending to teach my patients a rational approach to care, based on evidence and facts. It didn't take me long to realize that much of my learning would come from the people I treat.
I studied biology, pathology, pharmacology, and disease mechanisms in medical school, but my patients have shown me how their diseases affect their quality of life, helped me understand the spectrum of symptoms, and described the effectiveness and toxicities of treatments I've prescribed. My mantra, which I share with residents, fellows, and students, is “The patient is telling us what is wrong—we just need to listen.”
The listening process is how we translate what our patients tell us into more effective treatments and potential cures. We can turn patient-doctor interactions into questions that we can test in the laboratory and in clinical trials. Patients have more to teach us about their disease than laboratory animals (as important as they are). In this special supplement, we look at the ways the doctor-patient relationship has influenced treatments for myasthenia gravis, a rare disease in which the immune system attacks the junction between nerves and muscles, resulting in weakness and fatigue.
Over the last five years, the U.S. Food and Drug Administration (FDA) has approved three innovative medications—with more approvals expected soon—that have transformed the care of people with myasthenia gravis. And participating in MG clinical trials is now easier as most studies allow people to continue with their current treatments. This doctor-patient collaboration helps improve the quality of life of individuals as well as the community of people with a specific disease.
I hope our feature about clinical trials will inspire readers to find a study that's right for them. For anyone with myasthenia gravis whose symptoms are poorly controlled or whose disease is resistant to treatment, clinical trials promise a brighter future. This is also true for people diagnosed with other diseases. People with multiple sclerosis, for example, now have 25 FDA-approved therapies from which to choose, with many clinical trials ongoing. In April 2023, the FDA approved toferson (Qalsody), a potentially transformative therapy for a rare form of amyotrophic lateral sclerosis.
Our patients are not only telling us what is wrong, they are teaching us how to fix it.
A. Gordon Smith, MD, FAAN, Issue Editor
