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David Katz, M.D.

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The Limit to What Doctors Understand

Posted: 09/08/10 08:00 AM ET

As reported August 17th in The New York Times, a fascinating study published in the Journal of Neuropathology and Experimental Neurology -- suggests that even Lou Gehrig may not have had Lou Gehrig's disease. Rather, it's possible that Gehrig had progressive, neurological deterioration mimicking amyotrophic lateral sclerosis (ALS) due to head trauma (among other things, he was hit in the head by a fastball).

The obvious implication of this report is that the head trauma to which many athletes (and soldiers, and to a lesser extent, others) are subject may have serious long-term health consequences not previously recognized. If some ALS is, in fact, due to trauma, perhaps quite a bit is. Perhaps many other conditions of the brain were caused by, or at least propagated by, injury.

This is only novel thinking up to a point. Muhammed Ali's Parkinson-like condition is widely recognized to be a consequence of his many years of suffering blows to the head. Boxers have also long been known to be subject to a form of dementia named for their trade: dementia pugilistica.

But for me, a doctor who these days specializes in the care of the hard-to-treat, the implications run much deeper. If physical trauma can cause the nervous system to fail, what else can it do? Can it cause chronic inflammation we don't know how to measure? Can it lead to chronic pain we can't detect on any scanner?

And if physical blows can take a toll we have overlooked until now, what of psychological blows? Can emotional and psychological trauma induce failures in the immune system, the endocrine system and/or the nervous system, resulting in chronic pain, chronic fatigue, fibromyalgia?

And what of low-level exposures to toxins? While many of us may be resistant to adverse effects of chemical residues, traces of pesticides or air-borne solvents, isn't it possible that some are more sensitive than others? And if so, might not this 'trauma' also exact a toll?

Each time medical knowledge and understanding advance by even a single step, it tells us something we neglect at our peril, and certainly the peril of our patients: our knowledge and understanding are incomplete. They are subject to such advances. We will know something tomorrow we simply don't know today.

Such ignorance is a potent goad to humility for anyone paying attention. How much easier it is when the source of a patient's pain or fatigue can't be traced to its origins with a blood test or MRI ... to blame the patient, rather than our own ignorance. How much easier it is to imply that it must be "all in the patient's head," rather than concede it is knowledge that isn't yet in ours! How easy, and how wrong.

In general in medicine, the term 'syndrome' is used for conditions we understand imperfectly: complex regional pain syndrome, chronic fatigue syndrome, fibromyalgia syndrome, irritable bowel syndrome, premenstrual syndrome. Alas, we tend to respect them quite imperfectly as well! The legitimacy of a condition is in question when modern technology can't elucidate its etiology, or pinpoint its pathogenesis.

But we have more and more evidence that the traumas of life -- the slings and arrows of outrageous fortune -- can cause the body to fail in ways we don't yet understand. Confronting the patients who are victims of such unkind fate with cynicism adds, in the most literal sense, insult to injury.

Good medical practice is comparably undone by such cynicism as by vapid gullibility. Our patients, and the complexities they present, warrant our most thoughtful reflection, our deepest thinking, and often, even, our open-minded skepticism. But cynicism? Blaming the victim for our own limitations? Never that. Patients who happen to have what we don't yet understand are not to blame for such precocity.

The patient deserves the benefit of any doubt, and there is ample cause for us to doubt. The inexplicable pain, headache, limp, fatigue that tempted us today to roll our eyes, may be the breakthrough reported in tomorrow's New York Times; may be the basis for next year's Nobel Prize.

Dr. David L. Katz; www.davidkatzmd.com

 

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As reported August 17th in The New York Times, a fascinating study published in the Journal of Neuropathology and Experimental Neurology -- suggests that even Lou Gehrig may not have had Lou Gehrig's ...
As reported August 17th in The New York Times, a fascinating study published in the Journal of Neuropathology and Experimental Neurology -- suggests that even Lou Gehrig may not have had Lou Gehrig's ...
 
 
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07:10 PM on 09/20/2010
Thank you for writing this article. I have a propensity to stay away from medical doctors now because of the damage they did during my dx of chronic regional pain syndrome. It's not good for the patient in the short-term, but it's horrible for the long-run. Maybe someday I will stop feeling like a freak when I tell a doctor I am not interested in pills, but rather an actual remedy.
10:02 AM on 09/11/2010
How much more would we find in research, if the big pharma did not slant the studies...
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colred
08:48 AM on 09/11/2010
I am so happy someone posted what I've believed for years. That is why I'm trying to keep my system going through good nutrition, quality exercise and stress relief. Doctors don't know everything and so often are dismissive to people who have general small complaints that added together may have one cause. In addition, the lack of quality primary care physicians (due to our view of health care in this country) makes it so that the whole picture is never seen by one person in charge of putting the pieces together. That sets up lives where people are going from one specialist to another, each treating only their areas but never treating the whole person.
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vippy
Carpe Diem!
01:12 PM on 09/09/2010
I trust older doctors more than young ones for experience is very important.  I once had swollen ankles but otherwise okay and when I went to see this old doctor he said to cancel vacation plans because my appendix was about to burst.  That was taken care of and my swollen ankles were back to normal.  A younger doctor would never have known that. 
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time4truthnow
Truth about vaccinations activist
12:45 PM on 09/12/2010
I disagree. I don't trust elderly doctors. Doctors have to be re-certified to keep up but younger ones are fresh out of school & absorb the information better while older ones, I mean nearing retirement age, cannot always absorb new information or keep up with new studies. The older ones are also, many times, too brainwashed to be able to do right by you.

A perfect example is the fact vaccinations have proven to be hazardous to the health of children, if not directly afterwards causing many differing neurological disorders & gut problems, then later in life these children join the growing population of adults that become part of the many epidemics that make up this once great nation. Many doctors, not all, are still pushing the deadly toxins which are crimes against humanity. These epidemics have grown right in step with the increase through the years of the many vaccines let loose on us.

One example, among many, is the fact this government study has been out almost a year concerning the chicken pox vaccine & they are still giving them:

"Chickenpox Vaccine Linked with Shingles Epidemic"

Abstract: Pediatr Infect Dis J. 2009 Nov;28(11):954-9.
Civen R, Chaves SS, Jumaan A, Wu H, Mascola L, Gargiullo P, Seward JF.

Los Angeles County Department of Public Health, Los Angeles, CA 90011, USA. rciven@la.publichealth.gov

"The incidence and clinical characteristics of herpes zoster among children and adolescents after implementation of varicella vaccination."

http://www.herpesdoctor.com/chickenpox-vaccine-linked-shingles-epidemic
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vippy
Carpe Diem!
01:41 PM on 09/12/2010
Well, who but American Doctors push for those vaccines.  I had the very basic ones in my lifetime.
I agree, all that poison is the cause of autism and no one can convince me otherwise.  I have to say I never saw a young doctor in Europe. 
10:55 PM on 09/08/2010
One thing I find interesting after reading TXfemmom's post as well as the above article is that before
I had CFIDS, I was in a car accident which gave me head trauma and whiplash, and then I had
an awful fall/ ankle sprain that took ages to heal. The CFIDS started soon after that fall. I have
always wondered if there was some connection.
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TXfemmom
Grandma with eye on the future
08:21 PM on 09/08/2010
Finally, a voice of wisdom in the darkness.  We keep hearing physicians brand patients with things they don't understand with "syndromes" and then try to get some real treatment. 

I was an Advanced Nurse Practitioner and Certified Registered Nurse Anesthetist for almost 25 years, worked like a demon, had more energy than one can imagine, and loved my work.  Then, I was injured in an auto accident severely enough that both achilles ruptured at the heels.  Talk about pain...but I was back at work full-time in that demanding environment in six months.  Little things began to start to go wrong...I suddenly didn't sleep well, began having infections, infections which would culture as normal bacteria which shouldn't be causing an infection, no HIV infection although I had experienced a needle stick, stiffness, pain in the muscles, fatigue, when I had been the one with so much energy. 

Then, I fell in the shower, was knocked unconcious, injured my pelvis and it wiggled around and the muscles and support system didn't work.  I couldn't walk, stand or climb onto ICU beds to put patients to sleep and intubate them.  The infections went wild.  I was diagnosed with more things than one can imagine, but the sleep disorder became so bad I was told NO MORE WORKING, along with the inability to handle the physical portions of the job, the lack of restorative sleep just floored me. 

Then, I received the diagnosis of Chronic fatigue/fibromyalgia syndrome and the worst ten years of my life started.  No one gives that any respect.  I knew I had something seriously wrong and could explain things in medical terms...no one seemed to listen.  A pain med doc did some steroid injections into my spine because I had developed arthritis in it...and I ended up in the hospital with a near fatal respiratory infection.  No HIV or anything.  Then, finally I demanded they check differentials of WBC, and my B lymphocytes were so low it was scary.  I finally was diagnosed with primary humoral immunodeficiency and how I reached age 54 before the diagnosis was astounding. I should have died.  The docs can only explain it as it was genetic, I had it all my life, but sustained and repeated insults to my system finally overwhelmed it.  I pointed out to the doctors that I had treated patients branded with a "syndrome" as was I, and that "syndrome" turned out to be AIDS, and physicians need to understand how repertitive insults to the system can lead to breakdowns in neurological and immune systems. 
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Dana Ullman
Evidence Based Homeopath
08:08 PM on 09/08/2010
Homeopaths have affirmed good results using homeopathic medicines for various ailments after head injuries, and some research has confirmed these good clinical experiences (Chapman, 1999). A randomized, double-blind, placebo-controlled trial of 60 patients, with a four-month follow-up (N = 50), was conducted at Spaulding Rehabilitation Hospital (SRH), a teaching hospital for Harvard Medical School.

Patients with persistent mild traumatic brain injury (MTBI) (mean 2.93 years since injury, SD 3.1) were randomly assigned to receive a homeopathic medicine or placebo. The primary outcome measure was the subject-rated SRH-MBTI Functional Assessment, composed of three subtests: a Difficulty with Situations Scale (DSS), a Symptom Rating Scale (SRS), and a Participation in Daily Activities Scale (PDAS). The SRH Cognitive-Linguistic Test Battery was used as the secondary measure.

Analysis of covariance demonstrated that the homeopathic treatment was the only significant or near-significant predictor of improvement on DSS subtests (P =.009; 95% CI -.895 to -.15), SRS (P =.058; 95% CI -.548 to.01) and the Ten Most Common Symptoms of MTBI (P =.027; 95% CI -.766 to -.048). These results indicate a significant improvement from the homeopathic treatment versus the control and translate into clinically significant outcomes. This study suggests that homeopathy may have a role in treating persistent MTBI.

Reference: Chapman, E, Weintraub, R, Milburn, M, et al., Homeopathic Treatment of Mild Traumatic Brain Injury: A Randomized, Double-blind, Placebo-controlled Trial, Journal of Head Trauma Rehabilitation, 14,6, Dec, 1999, 521-542.
11:47 PM on 09/08/2010
The study you are quoting is a pilot study, and only has 50 patients in it in total. This is not proof of anything. It simply suggests that homeopathy "might" have benefit but would need to be confirmed by a larger study.

Suggesting that this study is conclusive is misleading.
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Halsey
"There is a price to pay for speaking the truth. T
08:04 PM on 09/08/2010
What an honest piece from an M.D.! Thank you Dr. Katz. (yes I have a sob story). Shortly after a very bad head on collision I was bitten by a tick (strange but true). I started tripping over my own feet, couldn't think and knew I was going crazy. Doc's and psychiatrist through so many drugs at me (since CT showed a concussion but no bleeding). Seroquel, friggin TOPOMAX, Zoloft, a cornacopia of horrid drugs. I awoke with a huge fevor and somehow got on internet to find an immunologist I could walk to (since driving was out of the question). He tested me for everything from syphillus (sp?) to HIV, West Nile and yes LYME!...I'd been walking around with friggin LYME disease for over 6 months before a 14 day regimen of doxicycline cured it..voila!. (and I remember BEGGING my internist to just test for West Nile as I remembered a "bite"..he just laughed..literally. It was not West Nile, but a test for this would have shown the bacteria of lyme and I would not have ended up committing myself to the looney bin for three days (what a snake pit). Finding a doctor that will listen is very hard; but OMG don't give up!
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JewellB
Organic gardening - healthy land & people
07:30 PM on 09/08/2010
Talk to your doctor like you talk to a close family member or one of your best friends. Then the doctor cannot help but respond in a helpful and caring way; the doctor is human also, not a God. So don't talk to the doctor like he is a God! Many of us out here have had wonderful doctors who actually sometimes say, "I don't know, but let's try this first." I adore doctors who are conservative and start with simple treatments instead of recommending some high powered expensive treatment at the get-go, which is like killing a nat with a baseball bat. Hopefully ethics, technology, and the internet come together soon so patients can rate the doctors and all the people who have had disappointing experiences will be able to find the outstanding doctors.
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WoodsideCraig
Author of the blog "The Weiler Psi"
03:42 PM on 09/08/2010
Wow, that was a very good article. In general, I don't trust doctors or their pills and that has served me well for almost 50 years. I choose instead to take care of my body and not let it get diseased and hurt rather than trust them to fix it.

Doctors are insanely expensive and there is very often very little bang for the buck. There are some things they do very well, and in those areas I trust them, but they are not particularly good with hard problems most of the time.
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ChloeW
02:51 PM on 09/08/2010
I had a baffling array of symptoms..extreme weight gain, depression, panic attacks, insomnia. Spent $60,000.00 in tests and doc visits looking for answers. Saw the best Los Angeles has to offer, and kept being told it was all in my head. I should have some psych drugs to calm me down, and start exercising.

Well, they were right.....it WAS all in my head. I had a brain tumor!! I finally found a most lovely, wonderful, and life saving Endocrinologist. He sees patients only Tuesday nites and does research studies full-time. He studied these very rare brain tumors for 15 yrs at the NIH.

I walked into his office, he looked me up and down, asked me a few questions and said "I think you might have Cushings". After many MRI's, and gallons of bodily fluids donated to the cause.....I was diagnosed.

He's the smartest doctor I've ever known....and I've known ALOT!!!!! Yet, when I first saw him and asked what the odds were he'd be able to help me he said "about 80%". What a lovely and honest answer!!!! He did get me diagnosed, and I had the tumor removed and I'm well on my way to being me again!

Don't ever let docs tell you it's "all in your head". It just means they are too stupid, or lazy, or know-it-all to figure out what's really going on".
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TXfemmom
Grandma with eye on the future
08:22 PM on 09/08/2010
I am so pleased that you finally got the right care. 
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ChloeW
10:23 PM on 09/08/2010
Thank you! :)
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Daphydd
Lets play some music
02:29 PM on 09/08/2010
After many years of searching I finally found a GP who possesses a wonderful combination of preferences which match mine: 1) He assumes I am intelligent and receptive to straight talk, including admissions on his part that he really doesn't have a solution, 2) the tendency to avoid prescribing drugs of any kind, and a keen awareness of drug side effects, 3) a brief presentation of what is known by the medical community, 4) a frank assessment of the relative risk of action on his part versus inaction. Other doctors I've had displayed a tendency toward condescension which always annoyed me, sometimes to the point of arguing with the doctor. I was once told by a doctor that asking a question of her was a misuse of resources. I responded by explaining that it was part of her job to give me facts, since she was presumably authoritative. I soon dropped her and moved on to another.
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Ohio5470
03:15 PM on 09/08/2010
I had a GP like her. He would not answer my questions or even consider my description of my symptoms. If he couldn't identify any thing abnormal he would merely send me for a test. The tests were very general and showed nothing. Eventually, after 2 and half months he told me he didn't know what was wrong with me and asked me if I wanted to see a surgeon. He ASKED me! He didn't even have the sense to even explain why he was asking me. I saw a surgeon and in 5 minutes he diagnosed a hernia. I had to wait 2 and a half months for such a simple diagnosis. It destroyed my summer and interrupted my schooling and cost me hundreds in salary. I have dropped him since.
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ChloeW
10:28 PM on 09/08/2010
Sounds like you have a wonderful doc. I have a GP like that. Sometimes she's a bit know-it-all, but mostly just a straight-shooter. She doesn't like drugs and won't prescribe them unless very necessary. She is willing to have an intelligent conversation about symptoms and such. She is also open to alternative medicine ideas, and has a Chineese Herbal doc in her office! If she doesn't know the answer she'll tell you. That's the best part! Then you can move on to someone else if need be.
nothingchanges
too soon old, too late smart
02:27 PM on 09/08/2010
First and foremost, Doctors are people, subject to the same human frailties and personality faults as the rest of us. In my personal opinion, there are too many "Doctors" practicing today whose principal motivation is economic. After all, the medical field holds several occupations noted as "the best jobs in America" primarily due to the fact that they pay extremely well.

How much of the failure to consider all options, is simply an assembly line mentality. The faster you move your patients through the doors, the more money you make.

There are difficult patients, and quite frankly some with mental disorders (recognized or not), but that is part of a Doctors practice and supposedly they have been trained to deal with these contingencies.

IMHO, much like in the political arena, a great many problems in medicine could be obviated by the removal of monetary gain from the equation. The quotation "Physician heal thyself" has been used repeatedly for over 2000 years. Perhaps someday it may come to pass. Greed may be the most destructive disease of our age. I doubt a cure will ever be found.
Dharma kate
Monty Python wrote my bio.
01:59 PM on 09/08/2010
The sword cuts both ways. Doctors don't know everything. Neither do patients. A lot of the cynical comments on this board exemplify that very principle. Too many people abdicate their 'health' to a physician and then hid behind a variety of conspiracy theories when things don't turned out as planned. Doctors make for very convenient scapegoats.

I always find it interesting that I have really good experiences with physicians. Perhaps it goes with the fact that I approach my encounters with them from a level of respect for their training and their experience. I find them to be very open to questions. Why do you recommend this test? What piece of information will this test provide to you over alternative means? What is the standard of treatment in these matters? Here's why I think my case deviates from the protocol ... and then being able to back it up with data. At the same time, he's not a miracle worker and he's not responsible for my lack of compliance with his advice.

Lastly, I'm going to die. So is my doctor. Regardless of how skilled he is in the art and science of medicine, I'm still going to die. And that is a hard reality for many people to accept.
07:53 PM on 09/08/2010
Agree.

Health literacy is a huge barrier to physician-patient interaction and communication, and patients need to empower themselves by educating themselves in health and wellness or whatever ails them.
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ChloeW
10:41 PM on 09/08/2010
Yes, but if you have no idea what's wrong that is difficult to do as a lay person.

Even digging around on the internet for answers can take yrs until you are finally convinced of the disease you think you might have!! Then you have to convince the docs of it. It's not always an easy task.

I can walk into most Endocrinologists office right now, and more effectively diagnose a Cushings patient than the Endo. I know that people with cortisol levels in a "normal range" mean very little for a Cushings patient. I know that Cushings ACTH production can be cyclical. Sometimes the tumor suppresses production and then the patient feels horrible but you don't get high cortisol readings. Alot of docs don't even believe that's possible. Well, I'm living proof they are wrong!!!!I

Forget a GP.....they just try to put you on psych drugs if you walk into their office with symptoms of Cushings.

Don't blame it on the patients. The docs need to get a clue that they DON'T know everything. The correct thing to do with someone you can't diagnose is tell them you don't know what is wrong!!!!!!!!!!!!!!!!!! Not put them on psych drugs and tell them it's all in their heads.
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TXfemmom
Grandma with eye on the future
08:28 PM on 09/08/2010
Believe me, as an Advanced Nurse Practitioner, I did not abdicate my care to any physician.  It still took me years, and almost dying, to finally get a diagnosis and I had to come up with the research and the idea to demand that the appropriate testing and things be done.

One doctor told me that the testing was useless because I could not have reached the age I had reached and worked in the hospital around all those infectious things and not have died, but I demanded the testing, and he discovered I have primary humoral immunodeficiency and my B lymphocytes were in the tank and didn't budge with stimulation.  I had been having infections with cultures which didn't make sense for years, and had been tested for HIV from having a needle stick ten years before, and then just ignored.  Finally, a near fatal respiratory infection just infuriated me and I demanded all this further testing.  I had seen 10 different doctors in the hospital and I made certain that all ten of them knew what was found.  Just because they may not have seen it before, doesn't rule it out as a possibility.
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ChloeW
10:48 PM on 09/08/2010
I'm glad you finally got diagnosed, are you feeling better now? Sure hope so. :)

I don't blame docs for not knowing everything. My goodness these bodies are terribly tricky and complicated sometimes! One person can only know so much. What I find so despicable is when they are not compassionate, talk to you in a condescending manner, and tell you there is nothing wrong since they can't find anything!! Like they are the final word on all things medical. Ugghhhh........

My current Endo (who diagnosed me) is so cool. I go see him 3-4 times a yr, and I tell him what tests I want him to do and why, and he says fine. Sometimes he thinks it's unnecessary.....fair enough!! But he always backs me up on what I want. He works with me as a team member. It's very nice.
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alongst
too often denied to speak
11:29 AM on 09/09/2010
And if the patient is misdiagnosed by an Advanced Nurse Practitioner?
Seen it lots of times.
01:40 PM on 09/08/2010
this maybe a synpathetic place to comment about
CNN from huffpost link "The end of the autism/vaccine debate?"

a more correct understanding is that healthy habits ' consciousness ' saves life ; strictly speaking it is not correct but very profitable to say vaccines saves lives

unless one also says vitmain C saves lives anti-oxidents saves lives ; undamaged organic ecology saves lives , stresslessness saves lives

inother words vaccines are a unfortunate need of a shortcut to boosting th e immune function becaus eof neglect of consciousness of healthy habits and because of degradation of habitat

the one sure way of reducing infections is to reduce commercial meat consumption to less than 25% of platefull ideally less than 5%

{ also reduce alcohol consumption but all this is in the 2 words healthy habits ]

in connection with my previous comment consciousness is best enlivened at its foundation by Maharishi vedic medicine as explained in detail BY Robert Schneider MD FACC
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HighInfoVoter
06:57 PM on 09/08/2010
No.

First, there is no causal link between autism and vaccines. PERIOD. The factual debate is over.

Jenny McCarthy and other advocates for the return of smallpox, measles, typhoid, polio, et al, may claim whatever they want, but the facts do not support their allegations.

While some bacterial and environmentally borne diseases can be prevented through better hygiene and more healthful diets, these measure cannot eliminate the need for efficacious vaccines. Polio actually became a problem because better hygiene reduced the low-level exposure that had created the immunity in earlier generations. We learned how to create that and other immune responses that protect us from deadly and debilitating diseases that plagued humanity for millennia.

A modified lifestyle may increase one's resistance to certain vectors of disease, but it cannot prepare the body for every pathogen we may encounter.

You refer to vaccines as a shortcut. In a manner that is correct. However, what it is a shortcut toward you have missed. It is a shortcut past virulent diseases that we have not already evolved natural immunities to. Rather than wait many millennia, and allowing billions to die needlessly, while we evolve inborn immunity, we choose to use the technology we have to eliminate these threats now.