Positive sciences do not answer the question, "why?" They could, at best, answer "how" or "how much". One could explain how a patient died, in great detail. We enjoy the famous CPC's so much that we lose sight of the fact that under similar circumstances another human being might not have died! One young man at thirty five could drop down dead instantaneously of a massive myocardial infarction, while another seventy year old man/woman could have similar infarct and go on to recover and live a full life! Why did the first one die? When people survive doctors claim credit. Medical business also would want to believe that medical interventions keep people alive. On the contrary, a recent strike by doctors in Israel, where they refused to interfere except in dire emergencies, mortality and morbidity came down significantly. Even in emergencies, the scenario was not very much different. The war casualties of Vietnam and Falklands were audited in a recent study. Whereas Vietnam had the best of emergency facilities with helicopters and a hi-tech base hospital in Saigon, the wounded soldiers in Falklands were left to the vagaries of the cold snow for want of facilities for even up to 6-12 hours without intervention. However, the per capita mortality was decidedly in favor of Falklands!



I have been in this business for nearly half a century, studying human health and disease from the first day of my joining the Stanley Medical College in Madras in 1956 and am still a student of human health and ill health. What amazes me is the lack of thinking researchers in the field. Most of us seem to go with the flow. All most all of us are swept off our feet by the hi-tech hurricane originating on either side of the Atlantic Ocean. We are made to believe that there is "NE plus ultra"-no more beyond-the hi-tech world. It also makes good business sense! Medical establishment which, originated as an altruistic noble calling, has now tuned into the biggest money spinner industry, attracting the big multinational sharks to get into five star hospitals business. “Never make money in the sick room,” wrote Hippocrates, the founding father of modern medicine. Medical establishment probably is the biggest single headache free industrial enterprise these days. Egged on by moneylenders, it also helps the unscrupulous to launder their black money in this business. There is no harm if all this is done to help people. To cap it, we have the new class of man eating sharks who live on sale of human organs.



There is another face to all these claptrap. People who get involved in this business, the doers, get lot of publicity and patronage by the powers-that-be. On the sidelines are the greater and richer players in the drama. They are the technology manufacturers and the drug barons. They have been shown to even invent new diseases lately to sell their wares, aided and abetted by the greedy 'doctors'. One of the most recent new diseases is the female impotence invented to sell sildenafil (Viagra). Male population being less than the female and most elderly males having contraindications for Viagra, the company that made a net profit of $11.2 billion last year thinks that if females, especially those who are young, were induced to take it the profit might be ten times more! Epidemiologists are another class who cause epidemics by frightening healthy people and making them fall into the drug company nets. We have a lot of them predicting the unpredictable epidemics of diabetes, high blood pressure, and vascular diseases, while the truth is that there has not been even one per cent absolute increase in the incidence of vascular diseases in the last one century! Larger populations, people living to middle ages and beyond because of the decrease in killer infections in childhood, increased disease awareness, the diagnostic wrong labeling of the apparently healthy, and the ageing population that naturally qualifies for degenerative diseases cause the apparent increase. Fear in the minds of the public increases their sugar level, fat level, as also their blood pressures. Thus they fall into the "doctor-thinks-you-have-a-disease" label basket. This kind of routine screening of apparently healthy people has been shown to be dangerous! Who cares as long as it makes our tills move?



Divine interventionalists, another menace to healthy people in society, claim that they intervene early to prevent a future catastrophe. The truth, though, is different. No one could predict the future of a dynamic human system. Audits have shown most of these interventions in very poor light. The big seller, coronary bypass surgery, as also its close cousin angioplasty, have benefited only a small percentage of recipients, especially those with intractable symptoms. Even early surgery for certain cancers has been shown not to have helped the poor victims! Some of these interventions have attracted more dangerous and even fatal complications. Early bypass surgery immediately after a heart attack has been shown to have increased four fold the stroke incidence in those patients within the next six months, and most of these strokes had been fatal!



The expensive drugs for chronic “doctor-thinks-you-have diseases”, like high blood pressure, asymptomatic hyperglycemia and blood vessel and joint diseases have all increased total mortality when followed up beyond five years! Hormone replacement therapy (HRT) after menopause, oral calcium to prevent osteoporosis, and long term use of vitamins instead of natural sources of these vital amines, fruits and vegetables, have all come to grief on long-term audits!



That said, let us try and understand human health and healthy existence on this planet using the existing knowledge in the field of science. Medical science, like many other conventional reductionist sciences, is a game of uncertainties. Newer quantum mechanics has shown that the sub-atomic particles do what they do only when we look at them. When we are not looking at them only God knows what they do. Despite knowing the half-life of the decaying atom in Erwin Schrödinger’s cat hypothesis experiment, the reality of the cat being alive or dead inside the closed box, depended ultimately on the observer looking into the box to find out. The chance of the cat dying as per the predictions was only fifty-fifty. We are now back one full circle to the beginning of the doctrine of probabilities of Blaise Pascal. So everything in the realm of science is in the eye of the beholder. If one changes the tinted statistical scientific glasses in the field of human illness and wellness, one would quickly realize our fallacies. It is not a wonder that in one year, three hundred thousand people died in the US due to medical mistakes alone. A good quarter of the hospital admissions there were due to iatrogenic diseases!



Teleologically, man is built to last. Nature has provided enough inbuilt safely measures and even repair mechanisms to keep the organism going on for a full life span. Of course, ageing would catch up as time passes and death, the only certainty, genetically programmed into each one of us, is the final outcome. The only risk factor for death is life. Nature does not intend that we become immortal. If people do not die where is the place on this planet for all of us? Even, the exaggerated claims of egoistic scientists claiming to clone man have received a big blow when a sobered down Ian Wilmot had to euthanase 'Dolly" his first creation to send her to meet Wilmot’s maker!



Man never had any illnesses in the sustenance economies of yore. This was shown in a scientific study of the Iannus in an island off the coast of Saskachiwan in Canada. Monetary economy with its greed, hatred, jealousy and, the killer competitive ethos, changed all that. To cap it we have changed the symbiotic relationships between all the creatures in Nature and have spoiled, in addition, the environment to make it more conducive to create human illnesses. Recent studies have shown that even small amounts (declared safe by scientists) of background radiation could be dangerous to human health. Despite all that our built-in repair systems, the autonomic nervous system and the immune shield, help us to overcome diseases most of the time. Only when they fail, man suffers pain and other symptoms of disease. If one studies the microscopic world of heart muscle cells after an infarct one wonders at the marvel of nature in trying to remodel the ventricle. Rarely when this process fails, we doctors could help and hope to get temporary reprieve for the victim. Earlier interventions, using drugs that block either of the above protective systems, have been shown to be dangerous. This is also true after grave injury as shown in the Falklands war study.



In conclusion, the existing wisdom (not knowledge) in science in general and medical science in particular would convince any thinking student of human health that doctors, drugs and technology should only be used to assist Nature when it fails (that is when patient manifests symptoms) to cure rarely, comfort mostly, but to console always. Doctors should stop playing God. Doctors should not deceive themselves by the industrial claptrap to think that every human ill has a pill and they have the power to intervene in healthy people to keep them here for ever. Only a philosophic teleological outlook in the medical field would be a boon to mankind. Before you want my blood for writing this, stop and think. Even intercessory prayer has been shown in elegant experiments to help heart attack patients! If one treats Nature as our mother she would nourish us, if abused she would kick us.







Further Reading:



1) Siegel-Itzkovich J. Doctors’ strike in Israel may be good health. BMJ 2000; 320:1561.

2) Moynihan R, Heath I, Henry D. Selling Sickness: the pharmaceutical industry and disease mongering. BMJ 2002; 324: 886-891.

3) Stehabens W.

4) Stewart Brown S and Farmer A. Screening could seriously damage your health. BMJ 1997; 314: 533-534

5) Hux JE and Naylor CD. In the eye of the beholder. Arch Intern Med. 1995; 155: 2277-2280.

6)

7) Josefson D. Early bypass surgery increases the risk of stroke. BMJ 2001; 323: 185.

8) Beral V, Banks E, Reeves G. Evidence from randomised trials on the long term effects of hormone replacement therapy. Lancet 2002; 360: 942-944.

9) Gribbin J. In Search of the Schrodinger’s cat.

10) Hegde BM. God Forgotten- Man Sleighted. Lancet 2003 (In Press).