“Anyone who is not shocked by quantum theory has not understood it.”



Niels Bohr (1885-1962)



Biology, in general, is still in search of its Holy Grail, leave alone drinking from it! Medicine is still to go a long way. Unfortunately, most of us, both within and outwith the system, believe that we have a strong scientific foundation for our craft. When the controlled studies were first invented, knowledgeable people in the medical field thought that the last word in the history of medicine’s progress had been written. There is nothing more to worry about, they thought. In reality, we have an evidence-burdened system in place of what is popularly known as the evidence-based medicine. We go around bashing every other system of medicine as unscientific. For a change let us try and understand the science behind modern medicine, if there is any.



What we have been believing is only a mirage. When we compare two cohorts of age and sex matched human beings; we are only able to match their phenotypes, that too a microscopic part of the whole phenotype, while time evolution in human system depends on the total initial knowledge of the human being. The genotype and the, all-pervading consciousness, are beyond the reach of present day assessment. We presume that our randomization takes care of all the missing links. There is very little similarity between two individuals; even the binovular twins are not identical. When the two groups are not identical, the end result of our controlled studies would have to, per force, go wrong.1 We have been drawing wrong conclusions all along and have been predicting the future of individuals based on this faulty foundation. In short, we have been predicting the unpredictable.2 That is the main reason why every single long-term cohort comparison has thrown up surprise findings.



That apart, the human body does not work in bits and pieces. It works as a whole and in tune with the environment. Our reductionist science of studying the cell or intracellular structures and then projecting the information on to the organ and the whole body will have to go wrong, anyway! Recent studies of human physiology have brought out three rhythms in the human body-the circadian, ultradian and the infradian. The last one has a longer than 24 hours’ cycle. The one prominent rhythm that falls in this category is the menstrual cycle. Menstrual cycle is ultimately under the control of the gravitational effect of the Moon on the cortical cells that stimulate the pituitary. The latter, in turn, sends impulses to the other endocrine glands!3 Simple hormone replacement therapy could, therefore, not be harmless, as shown by more recent studies.4



Whenever we are stuck with our controlled studies, many leaders take shelter under the umbrella of statistics. Basically statistics are used in medical research to rule out the possibility of chance playing a role in the final outcome. That is the limited role of statistics in medical research. At the same time statistics could be used as the wipping boy to get out of any inconvenient research situation that might not fit in with our hypothesis, especially in drug studies. “Intention-to-treat-analysis” is one such catch that could be used to confuse the novitiates. The underlying problem is the large amount of money being sunk by drug Lords in isolating the powerful molecule in the laboratory to begin with. When found to be useful in animals they go for human studies hoping to get similar results. If the results are not to their liking, instead of writing off that huge sum, they could get enough people to explain the variance with difficult statistical jargon to confuse the medical doers. The latter are mostly ignorant of the nuances of intricate statistical jugglery.5 This applies to many of the heroic surgical feats as well. Prominent among them are the cardiac interventions6 and cancer “cure” methods. Some of these procedures are big money spinners. In short, the present day medical science seems to be guided mainly by monetary considerations rather than altruism. 7, 8



The Real Science:



Medicine was accepted as a science in the 12th century Europe and was clubbed with physics, chemistry and biology. Our research since then had been based on those three disciplines. However, in the early part of the twentieth century physics realized that the Laws of “Deterministic Predictability” did not work in reality. In truth there was no reality in this Universe. Classical example is the Nobel Prize to J.J.Thomson in the year 1907 for showing that electrons were particles. Thirty years later his own son J.G.Thomson gets his Nobel in 1937 for showing that the electrons were waves. Both were right and both were wrong! They both came from the world famous Cavendish Laboratory of the Cambridge University. Most of the physics Nobel prizes those days went to those working at the Cavendish. 9



This was the birth of the new quantum physics. Some of the great names to remember are those of Werner Heisenburg, Erwin Schrodinger, Max Planck, Niels Bohr, Paul Dirac and Born, although both Isaac Newton and Albert Einstein had contributed to the development of the new thinking indirectly. Albert Einstein, though, could not stomach the new thinking in the field till he died. He dubbed Schrodinger’s hypothesis as “some sort of a mathematical trick.”



The tragedy was that medicine did not fork off to follow the less travelled route in physics. Rather, it continued to follow the Laws of Deterministic Predictability. Human body does not follow the latter rules.





2 x 3 3 x 2

(inside the human system)



because



p x q q x p.



(Heisenberg’s Uncertainty equation)



In any given situation these calculations are not really true, but in ordinary situations in the macro world, we do not realize the errors because the margin of error is very, very small as Dp and Dq are usually much larger than the Planck’s constant h ¸ 2 P , roughly of the order of 10 -27. (D is the symbol mathematicians use for minor errors)



But in the quantum level, even in the human body, these minor errors might be very serious. Even an error of one in a million might result in catastrophic end results as time evolves. The other name for this game is “butterfly effect” of Edward Lorenz. After having been crowned as the inventor of the weather prediction methods, Lorenz, a physics professor at Berkley University, was sorry that the small details of the weather predictions of the immediate future, as also the finer aspects of the predictions, rarely come correct. He exclaimed that if a butterfly were to move its wings in Beijing in China to disturb the air, after the scientists have fed all the data into their supercomputers, the air disturbance could develop into a storm in NewYork after a month!



Dynamic human body, driven continuously by food and oxygen, follows quantum physics laws. Chaos is the new science of non-linear mathematics and fractals. By measuring a few body parameters like blood pressure and blood sugar one can not predict the future outcome in a human being, based on the outdated Laws of Deterministic Predictability. Butterfly effect occurs in the human system almost always. Therefore, we have been “predicting the unpredictable”.



Be that as it may, we have gone a step further by inventing chemical compounds to control some of these “abnormal” body parameters in healthy individuals. Long-term studies have shown this effort in very poor light.5 Time evolution in a dynamic system is such that the probability of a few abnormal parameters damaging the system in the long run, is only fifty-fifty. A leading quantum physicist, Erwin Schrodinger, in his Cat Hypothesis, showed it elegantly.



Schrodinger hypothesized a closed box in which he put a live cat, a decaying atom with the half-life of half an hour, along with a phial of poison. In the deterministic predictability model when the atom decays and releases, say a proton, the latter would break the phial of poison to kill the cat. Unfortunately, the observer opening the box and looking in could only ascertain the future fate of the cat. The possibility of the cat dying was only fifty-fifty. The time of the atom decaying could not be predicted with certainty. Only the Doctrine of Probabilities of Blaise Pascal worked at the sub-atomic level of the quantum world. So does the human body, strictly following the probability laws. We are now back to the square one. New thinking has to go into this field and medical science has to change for the better. Sooner the medical scientists realize this truth, the better for mankind. The only certainty that works in the human body is uncertainty. The human body works as a whole. Reductionist science, which we follow at present, has no relevance to human physiology!



The moral of the above story is that when one is healthy and does not have any kind of trouble (totally asymptomatic), one should try and follow the simple rules of living well. Those abnormal body parameters need not perturb one. Watchful expectancy with change of mode of living would reverse the abnormality many a time. However, change of mode of living to improve the abnormality is a wise step in the right direction. Doctors could help the hapless victims by reassuring them, in the absence of any positive findings on clinical examination and routine investigations, in such situations. The doctor, however, should keep a careful watch for any new indications of trouble in the patient. This method pays rich dividends to the patient. If on repeated examinations the abnormality either gets worse or the patient starts getting symptoms, one could intervene at that stage without detriment to the final outcome.



You might wonder as to why a reader needs to know this much of physics? When one understands the basis of the interventions in medicine that the doctor advises, it is better for the patient to understand the implications of those interventions. Doctors also would do well to be acquainted with the scientific basis of their art to be able to guide their patients intelligibly. None of the medical interventions, including drug therapy, is without some danger lurking in the corner. While there is no pill for every ill, in the long run, there certainly is an ill waiting to strike after every pill. One, therefore, needs to weigh the pros and cons of those interventions to become an intelligible partner in one’s own medical care. The days of doctors being paternalistic in management without taking the patient into confidence have gone. Today medicine has become a business and the consumer, the patient, has to be an informed customer lest he/she should be led up the garden path to the misty world of hi-tech medicine. One example would suffice.



If a middle aged man, in very good health and totally asymptomatic, goes for a check up, there is a possibility that the doctor might detect some elevation in his blood pressure. If the man happens to be a hypochondriac, this elevation could be very significant. I have even seen pressures of the order of 190/120 etc. in such situations that have come down to normal with tender loving care. In my opinion there is no entity called idiopathic primary hypertension.10 The latter category has some emotional and/or psychological cause for the raised pressure, which could be unraveled only by a placebo doctor who talks with (listens to) patients and, does not talk to patients in a hurry. If there is no evidence of any other abnormality either on complete clinical examination, including the fundus of the eyes or, if all the blood parameters are within normal limits, the chances of that apparent elevation of blood pressure damaging the individual in the long run is only fifty-fifty. If that individual is put on anti-hypertensive drugs there is a fifty per cent chance that the drug is not needed as the pressure might come down to normal in course of time. The other probability is that fifty per cent of the time the drug could damage the patient’s health. No one could know in advance which fifty per cent works in which patient!



By understanding the intricacies of the science of medicine, the doctor and his patient could understand the dangers of treatment as well as the benefits claimed by the drug companies. They could balance the risk-benefit ratio properly to be sensible partners in the treatment plans. No doctor could be certain of what happens to the patient (with any disease) in the future with or without treatment. The risks and dangers of non-treatment strategy are only probabilities. Prospective studies done recently, of cancer of the prostate with or without surgery, have shown that, in the long run, those who followed a watchful waiting strategy, instead of undergoing early surgery, did much better than those who had early surgery!11 Hypertension treatment, with any drug, in the long run, has been shown to have resulted in higher deaths in those treated compared to their normotensive cousins in society.12 This is the reason why the reader should understand the scientific basis of medicine.



“One of the essential qualities of a clinician is interest

in humanity, for the secret of the care of the patient

is in caring for the patient.”



Francis Weld Peabody (1881-1927)



BIBLIOGRAPHY.



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3) Editor. Cecil’s textbook of Medicine 2002 21st Edition. Page 1202.

4) Hully S, Grady D, Bush T et. Al. Randomized trial of oestrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998; 280 605-613.

5) McCormack J and Greenhalgh T. Seeing what you want to see in randomized controlled trials: versions and perversions of UKPDS data. BMJ 2000; 320: 1720-23.

6) Krumholz HM. Cardiac procedures, outcomes, and accountability. N. Engl. J. Med 1997; 336: 1522-23.

7) Angell M. Is academic medicine for sale? N. Engl. J. Med 2000; 342: 1516-8.

8) Editorial. Drug Company influence on medical education in USA. Lancet 2000; 356: 781-83.

9) Gribbin J. In search of Schrodinger’s cat. 1991. Transworld Publishers, 61-63, Uxbridge Road, London W5 5 SA.

10) Hegde BM, Shetty MA, and Shetty MR. Hypertension-Assorted Topics. Book. 1997. Bharathiya Vidya Bhavan, Bombay.

11) Holmberg L, Bill-Axelson A, Helgesen F et. Al. A randomised trial comapring radical prostatecomy with watchful witing in early prostate cancer. N. Engl. med. J 2002; 347: 781-89.

12) Andersson OK, Almgren T, Persson B et. Al. Survival in treated hypertension: follow up after two decades. BMJ 1998; 317: 167-171.