ARE WE BARKING UP THE WRONG TREE? “Time has come” the Walrus said, “to talk of many things-cabbages and kings…” We could now add to this list diseases and drugs, health and man, in addition. Man has been here for thousands of years in hundreds of generations; naturally diseases have been around for as long. Modern medicine must have originated nearly five thousand years ago on the banks of the River Nile in Egypt, mostly as magic, sorcery and witchcraft! It evolved through many generations and geographic areas to its present state. The latter is called modern “scientific” medicine. Ever since medicine was accepted as a scientific discipline in the European Universities in the early part of this millennium along with physics, chemistry and natural sciences, medicine has been following reductionism like all the others. Man, being dependent on nature for his very existence, is a part of
this cosmos. Consequently, he would have to depend on all other species on this planet, in
addition to working as a whole with all his organs in tandem. Reductionist science that
looks at bits and pieces to study the whole would naturally give wrong signals in human
affairs, or for that matter, in any other dynamic system.1 Quantum physics did show this truth
very elegantly. Both Schrodinger’s cat
hypothesis and Werner Heisenberger’s uncertainty
principle have brought to fore the role of the human
consciousness.2 Medicine has
to follow quantum physics in search of the truth.3
It is time to take stock of the prevailing situation and go forward to look at human
beings as a whole, both in the realm of diseases
and their management, lest medicine should continue to bark up the wrong tree.4 Diagnosis and management strategies depend on many imponderables. When
a patient sees a doctor expecting to get the right diagnosis and treatment in addition to
an accurate prognosis, the doctor is in a dilemma if he were to tell the whole truth.
Since many diseases have their own time frame, most patients get better despite the fact
that physicians have been predicting the unpredictable all these days! With the human
genome having been unfolded, doctors could get a better grip on the initial state of the
patient for better prognostication. Time
evolution in a dynamic system, like the human body, depends on the total initial state of the organism. Reductionist
science has given the medical profession a fairly good knowledge of the phenotype, what
with all the physical findings and biochemical parameters along with the scanners and
imagery. This knowledge, added to the genetic pattern that would be available for clinical
use in the near future, would sharpen the predicting capacity, although the mystery of the
human mind still would hamper “total
knowledge of the initial state” for correct predictions.5 The present scenario is quite depressing. Modern medicine has gone to
the market place riding piggyback on technology resulting in health care costs escalating
beyond the wildest imagination, making even the rich nations incapable of footing the
bill. There also is the “inverse care law” in operation. While diseases are more
common in the poorer segments resulting in the poor paying for their poverty with their
lives, medical care is mostly concentrated around the rich and powerful who do not need it
so much. The distribution of doctors also follows the same rule.6 There is a thriving business around
drugs and technology leading to ethics being sacrificed in the market place. Research data
are being faked in some cases and the surgical procedures in many areas far outnumber the
real scientific indications. Cardiac interventions stand out clearly as being overused.7 Despite the inability to predict the future correctly using the present
day phenotypic features alone, the “well” in society are not left alone. This
brings to mind the lamentations of Late Sir Robert Hutchinson: “God, give us
deliverance from not letting the well alone!” Studies have shown the futility of
routine screening procedures, many of which are not capable of predicting the future.
Medi-business in that field, however, is very fruitful. Cross sectional studies of cohorts in quantitative research many times
lead to wrong conclusions because of the inherent defects in the reductionist science.
Small cohorts many times give favourable results, while larger number of patients included
in the study could reverse the outcome.8
Drug trials are another area where short term follow up data in small groups of patients
could be belied in long term prospective studies of larger numbers.9 Qualitative research involving many
of the non-quantifiable data has been shown to be useful in certain areas.10 Routine labelling has resulted in
over diagnosis and a distorted view of epidemics of degenerative diseases. While
epidemiology has been useful in unraveling the mysteries of communicable diseases, the
same does not hold good in the field of chronic degenerative diseases, where at times
“epidemiologists could cause epidemics.”11
Using mortality statistics and false labelling of dangerous diseases spurious increases in
the incidence of certain diseases like vascular diseases are being projected. This
frightens the public and enhances anxiety levels in society.12 Philosophically the major role of medicine is to allay anxiety, patient
anxiety of disability and death and doctor anxiety of having done enough or not. On the
contrary modern medical predictions, especially in the realm of chronic diseases, makes
man more anxious.13 Lots of educated
people die everyday worrying about the possibility of falling a prey to one of the killer
diseases and do not enjoy living at all. Happiness is living dangerously. If one wants
everything to be absolutely safe life would become miserable. Present day regular check
ups leave very little time for any one to enjoy life to the full. In one sense there are
no well persons in society at all. Well man would be the one who has not been properly
investigated!14 Long-term follow up of large cohorts of people has upturned most of our
predictions about the risk factors and their management. More and more studies throw up
various negative attitudes like hatred, depression, anger and jealousy as powerful risk
factors for major killer diseases like cancer, stroke, and heart attacks.15 All is not well with the risk factor
hypotheses. Modern technology has replaced the time-honoured skill of listening to the
patient. Doctors have no time to “waste” listening to the woes of their
patients. They have to get on with their scanners and x-ray images, forgetting that the
shadow is not the man. “If you listen to your patient long enough, he will tell you
what is wrong with him” was the strong conviction of a great physician of yester
years, Lord Platt. Some students of Lord Platt investigated this statement recently using
modern technology. They showed that the statement holds good even today.16 Listening adds the missing third
dimension to the organisms initial state of health, the human mind. "Diseases present
through the personality of the patient.” wrote Sir James Spence. In the midst of all this confusion there seems to be a ray of hope in
the distance horizon. The new science of non-linear mathematics and chaos has opened up
new avenues in human health and illness. Using this science and assessing the patient more
intimately probing his mind one could get a better grip on the situation. In addition,
prediction becomes more accurate as time evolution follows non-linear mathematics. All the
organs in the human body are interconnected and “mode-locked” to one another.
The system with the most dominant rhythm controls other organs. Breathing is the most
dominant rhythm in the body. Ancient Indian system of medicine, Ayurveda, stressed this
very much using the Vedic non-linear mathematics. Recent studies using modern technology
has shown how proper breathing techniques could even change tissue oxygenation in-patients
with intractable heart failure. Heart rate variability is another parameter that follows
non-linearity and gives much better assessment of cardiac function at a given time. Newer
patterns of HRV, using computerized “wavelet analysis” of the surface ECG
recorded continuously over a period of fifteen minutes, gives much better and detailed
analysis of the myocardial state at that point in time. Since it is non-linear this has a
better predictability.17 A healthy child has marked heart rate variability with breathing, sinus
arrhythmia. The variability gradually decreases as age advances or as the heart muscle
gets damaged. Keeping a child’s heart even in old age is one way of keeping oneself
fit. Breathing exercises originally perfected in the Yoga system of Ayurveda helps keep
healthy HRV for a long time even in elderly people.18 Another area that needs change is the present preoccupation with quick
fixes for every minor deviation from the so-called normal range. There could not be any
parameter that is constant in a dynamic system like the human body. All biochemical parameters have to, per force,
keep fluctuating. Loss of this constant fluctuation gives better indication of the state
of health rather than a given measure falling within a narrow range at a particular point
in time. This applies to blood pressures, blood cholesterol and many others. Experience
has clearly shown that long term prospective studies did not show significant benefit by
our efforts to lower any of these parameters to the expected normal ranges, although short
term benefits in symptomatic patients deserves our attention. Better prediction of future
trouble could be assessed by studying the above parameters over a longer period of time
keeping a watch on the rate of variability of the levels similar to the HRV discussed
above. Many of the quick fix drugs have also shown disappointing results.
Comparing the antioxidant vitamin combinations of AC and E given to postmenopausal women
in Canada compared to a similar cohort of matched controls given extra fruits and
vegetables over a period of five years showed the futility of those quick fixes in
preventing cancer and heart diseases. On the contrary the incidence was significantly less
in the fruit and vegetable-eating group.19
Be that as it may, the cohort studies of matched controls are flawed
from its beginning. Control studies, claimed to be the best way to study drug effects and
many other areas in medicine, do not reflect the real future events. As discussed earlier
time evolution being dependent on the complete organism-genotype, phenotype and
consciousness, controlled studies only match the phenotype. Many of those studies, if not
all of them, have given wrong signals.20 BIBLIOGRAPHY
|