The Remainder Is the Patient
A commentary on “The Vanishing Human Presence” by A Midwestern Doctor (Substack – The Forgotten Side of Medicine, October 8, 2026)
ยท @Thomas Lee Abshier, ND
What the article argues
A Midwestern Doctor’s latest essay begins with a small observation: a couple of pop songs from around 2000, heard on the radio, sounded more alive than most of what is produced today. From there he builds a single argument across music, film, video games, dating, artificial intelligence, and medicine. The argument is that technology first enlarged human expression and then, once it became cheap and dominant, began replacing it. Pitch correction, quantized drums, loudness compression, franchise formulas, and clinical protocols all remove the small irregularities that reveal a real person behind the work. What remains is technically flawless and strangely empty.
He offers one test that carries the whole essay, and I think it is the most useful: does a given technology make the human being more present, or less? Production is not the enemy. A heavily produced record can still leave the singer unmistakably there. The question is whether the tool serves the person or stands in for him.
I agree with most of the essay, and I want to explain why from a naturopathic medicine standpoint. I also want to press a few points where I think the argument needs qualification or could go further.
Where naturopathic medicine already stands
The essay’s medical section describes, almost exactly, the founding concerns of naturopathic practice. Two of our oldest principles are to treat the whole person and to treat the cause rather than suppress the symptom. Both assume that the patient in front of you is not the statistical average of a clinical trial. He has a particular constitution, history, sensitivity, and set of circumstances, and treatment has to fit him, not the other way around.
The author cites a 2015 commentary in Nature reporting that the ten best-selling drugs in the United States help somewhere between one in four and one in twenty-five of the people who take them. That figure deserves to be read slowly. It does not mean those drugs are useless. It means that for most of the people taking them, the drug is doing nothing useful while still carrying its risks, and the protocol that prescribed it had no way to tell the responders from the rest in advance. That is the clinical version of snapping every note to the grid.
The author also borrows an idea from Mattias Desmet that I think belongs at the center of medicine: every rational model of a natural thing leaves an unexplained remainder, and that remainder is not noise but the essence of the thing itself. In clinical terms, the remainder is the patient. The diagnosis code captures what this patient shares with others who carry the same label. What it leaves out is often where the real problem lives, and where real healing must happen. A physician who trains himself to see only the code trains himself not to see the person.
Comfort, stress, and the body
The essay quotes an older woman who told the author, when he was young, that comfort makes you weak. This is not only folk wisdom. It is physiology. Muscle, bone, the cardiovascular system, the immune system, and the cell’s stress-response machinery all strengthen with an appropriate dose of challenge and weaken in its absence. The technical name is hormesis. Exercise, heat, cold, fasting, and many traditional hydrotherapy practices work this way. The dose matters; too much stress injures rather than builds. But a life engineered to remove all demand leaves the body without the signal it needs to maintain itself.
The author draws the right distinction here between rest and comfort. Rest is the recovery phase of a cycle that includes effort. Comfort, as it is sold to us, removes the effort, so there is nothing to recover from and nothing gets built. I would add that the nervous system follows the same rule. A nervous system that is constantly spiked and soothed by engineered stimulation loses the capacity to register anything subtle, which is the author’s closing point and, I think, his most important one.
The pill as a supernormal stimulus
The essay introduces Niko Tinbergen’s supernormal stimuli: imitations that exaggerate the cues an instinct responds to, pulling harder than the real thing. The author applies the idea to processed food, pornography, engineered entertainment, and AI companionship. I want to extend it one step further, into the pharmacy.
Much of conventional prescribing works by producing the cue of recovery without the process of recovery. Acid suppression quiets the burning without asking why digestion failed. A sleep medication produces unconsciousness, not restorative sleep. A stimulant produces the feeling of focus without restoring the capacity for it. In each case, the symptom, the body’s signal that something needs attention, is silenced, and both the patient and the physician experience that silence as success. Like Tinbergen’s plaster eggs, the drug can be more immediately satisfying than the slower work of restoring function, and so it wins on instinct.
I am not saying these drugs are never appropriate. Sometimes the symptom itself is doing harm and must be stopped. But the naturopathic question is always whether the intervention supports the body’s own capacity to heal or substitutes for it. That is the author’s test, applied to medicine: does the treatment make the patient’s own healing more present, or less?
Where I would add a qualification
I think the essay is strongest where it stays proportionate, and a careful reader should hold the conclusions a little more loosely in a few places.
Protocols were not invented by villains. Clinical guidelines arose in part to protect patients from idiosyncratic physicians, whose “art” was sometimes simply habit or error that no one checked. An individualized practice without discipline is not art; it is opinion. In my view, the right relationship is that a sound protocol sets the floor, and judgment is the craft built above it. The author’s own test captures this well: a protocol that extends the physician’s ability to perceive the patient is a good tool; one that overrides that perception is not. The problem he describes is real, but it is the problem of the floor becoming the ceiling.
Some of the evidence is illustrative rather than decisive. The German study of analog versus digital listening involved about fifty people and does not appear to have been replicated. Dr. Kory’s comparison of testing and survival across his ICU colleagues is a single service over eighteen months. The musical observation also has a selection effect that the author partly acknowledges: the songs we still hear from 1999 are the ones that survived, while the forgettable ones from that year are forgotten. None of this makes his conclusions wrong. It means they rest on the overall pattern and on what an attentive person can perceive, more than on any single study. I think that is an honest basis for an argument, and it should be named as such.
The AI finding cuts in two directions. The author cites a 2024 randomized trial in which GPT-4 working alone outperformed physicians on diagnostic reasoning for complex cases. He reads this as showing that physicians who reduced themselves to protocols made themselves replaceable. That is part of it. But the same result also says something uncomfortable about how much unaided diagnostic reasoning has already eroded, and how poorly many physicians integrate a new tool even when it is in front of them. I use AI tools daily in my own research and writing. The test I apply is the same one the author proposes: do they help me see the person or the problem in front of me, or do they do the seeing for me? The tool does not settle that question. The person using it does.
The question underneath
The essay ends where it should, with the question of what a human life is for, and with Pascal’s remark that our troubles come from being unable to sit quietly alone in a room. The author’s practical conclusion is that restoring nervous-system health is the first step, because only a nervous system no longer depleted can perceive the subtle and the real, and only then can a person sit still long enough for the question to arise.
I agree, and I would go one step further. A restored nervous system makes room for the question; it does not answer it. The question of meaning is ultimately spiritual, and the same principle the author applies to art and medicine holds there too. What is real in a person cannot be manufactured or standardized, nor supplied by a substitute. It has to be met. Healing the body, in this sense, is not the goal but the preparation: it gives a person back the capacity to meet what is real, including the One who made him.
For the reader
If this essay describes something you recognize in your own life, a few practical steps follow from it, none of them dramatic:
- Let some silence back in. Take a walk without headphones, eat a meal without a screen, and spend a few minutes each day with nothing demanding your attention. The nervous system slowly recovers its sensitivity, and only when the spikes stop.
- Reintroduce appropriate challenge. Physical work, regular exercise, and time outdoors in heat and cold are the oldest forms of hormetic medicine. If you have a health condition, work out the right dose with a practitioner who knows you.
- Choose a practitioner who examines you. A physician who listens, asks, touches, and adjusts is practicing the part of medicine that cannot be automated. That is worth seeking out.
- Ask what your treatments are doing. For each medication or intervention, ask whether it is restoring a function or covering a signal. Both may be appropriate at times, but you should know which one you are getting.
- Prefer real people. A phone call over a text, a visit over a call, an imperfect friend over an agreeable machine. The friction is where the relationship forms.
The Midwestern Doctor’s essay is worth reading in full. Its central test, whether a technology makes a person more present or less, is one I intend to keep using in the clinic and beyond.