“The art of progress is to preserve order amid change, and to preserve change amid order.”

…Alfred North Whitehead.







“Time has come” the Walrus said, “to talk of many things-cabbages and kings….” Time, really, has come to talk of an urgent need for a paradigm shift in the medical establishment’s thinking and philosophy, if there is one in place already. Walrus, of course, had his next meal in mind when he was saying this to the crabs, but the present dialogue has anything but altruism as its inspiration!



The present thinking and teaching in medicine is that doctors are trained to cure illnesses, as also to prevent diseases by detecting them in their early asymptomatic stage and then try to correct the presumed “abnormalities”, with the assistance of drugs and technology that we have at our command. In the bargain if one could make money that much better. More money one makes the merrier. Doctoring has never been taught as a discipline to keep the health of the public. Sadly, health as a concept has not been fully understood in the modern medical thinking, since health is not a reductionist concept. Health needs the preservation of physical, psychological, emotional, spiritual, social, economic, and altruistic wellbeing. Health, therefore, is holistic, could never be a reductionist concept.



Reductionist science makes it easy for us to divide the human body into smaller and smaller bits-organs, cells, molecules, chromosomes and genes and then try to find out the defects in them to be fixed. These quick-fixes have eventually led to the belief that setting the genes right would set the man right. Consequently, it heightens the expectations that stem cell research would solve most, if not all, problems of mankind. I wish it were true. The cloning experiment itself has not been successful so far. Even the trial of genetically modified gene therapy in the first three children has resulted in unexpected cancers in them! Genetically modified drugs generally have met with similar fate.



Many of the surgical and other non-invasive interventions have never been audited before being let lose on the gullible public. Most of them have fallen by the wayside after the ravages caused by them were brought to light. Many an intervention has been abandoned. The story of the multitude of drugs-derived again by studying their molecules, either chemical or herbal, checked by the double blind controlled methods, touted as the most scientific method of drug evaluation, is not also very encouraging. The truth, however, is that the medical profession has been blind to the after effects of these double blind studies. In addition, no drug to date has been studied in combination with other drugs to be administered together in a given patient. In real life situations poly-pharmacy is the rule and not an exception. All the controlled studies are done on single drugs, in ideal experimental set ups, that are far removed from the ground realities of the real life situations in individual patient care.



Statistics, used liberally in these studies, have a limited role in that they probably work in large cohorts of men and women, the higher the number the better, but they do not seem to have any bearing on the individual patients that doctors are called upon to treat in their practice. Extrapolating such statistical significance to patient care could have limited role. Human beings could never be put into watertight compartments. Two human beings are never alike. Even the uni-ovular twins have their genetic differences and, if brought up separately, have many other differences in their physiology. How, then, could we compare two age, sex and body mass index matched, groups as identical for controlled studies? Most, if not all, controlled studies have observed, even those mismatched cohorts, for not more than a maximum of five years. But those drugs after going through the controlled studies are usually administered to apparently healthy people, with abnormal bio-chemical profiles, like raised blood sugar, cholesterol and blood pressure over very long periods of time, sometimes for the rest of the person’s life. Many of those drugs, on retrospective audits, have given rise to serious side effects. Almost every fourth patient on prescription drugs, in the long run, has had serious side effects. Those drugs make life feel longer for the patient, but most of those patients have met their maker faster!



If one tries to overstand the medical scenario from outwith the compound wall of secrecy that doctors have built around themselves, one would soon realize that doctors probably have not done enough to preserve health of the public. In the bargain they have, unwittingly, contributed to higher intervention rates in society, resulting in unwanted deaths and disability as the inevitable fall out of those interventions. Health preservation requires a strong political will in any country. The basic needs to preserve health are clean drinking water, empowerment of the public with knowledge and money, providing them with three square meals a day and a roof on their heads. It is also necessary to give basic sanitary facilities like toilets in every house and avoid deadly cooking smoke from coming into the house in villages.



Poverty is not only the womb of all ills, it is also a double-edged sword in that it makes the victim poorer during his illness period, robbing him/her of the capacity to work and earn. Of course, one sees the inverse care law working in these areas as well. Whereas there are surfeit of doctors in metropolitan cities where they are not needed that much, there are very few in the remote villages where their need is the greatest. So be it. A recent audit did show that more doctors in a place do not make the public healthier anyway. Israeli cities did have a remarkable fall in death rate when doctors went on strike for three months in the year 2000, only to come back to the previous level when doctors returned to work!



The new paradigm looks at the human body as a whole, working in tune with nature. The cheapest and the safest way to remain healthy is to preserve the wellness that man is heir to right from birth. Minimum intervention, if inevitable, should be the motto. Ayurveda, the great Indian medical wisdom of yore, has the ideal prescription for preserving health.



Swasthashya swastha rakshitham

(Keep the well healthy)



This should be the new paradigm not only to keep people healthy as long as they live, but also to save them from the ravages of the screening-intervention-iatrogenesis loop. When one gets into that loop it is impossible to come out of that. Man, a well man, becomes a patient the minute he sees a doctor. He, rarely ever, if ever, becomes a well man again! In the modern medical paradigm a well man is one who has not been completely and properly evaluated. This has become an economic necessity in medicine, as the initial cost of having a set up for screening and intervention is prohibitively expensive. Recently an American hospital, Tenet Hospital in Reading in Northern California, was closed as the FBI found them intervening most of the time even without indications. The cardiac interventions top the list since they are the biggest money spinners, netting billions of dollars in cash as also prestige to the doctors, hospitals and, the instrument manufacturers.



Reductionist statistics would never work in a dynamic system like the human body. The human body works as a whole. The various organs work in tandem and are all mode-locked to the most dominant rhythm, breathing. If one learns to breathe properly he/she would be able to control most of the problems. The next pre-requisite for good health is regular physical exercise. One needs to remind people that heavy exercise is not only not needed for remaining healthy. Heavy exercise could be detrimental in the long run. Healthy food, preferably vegetarian, taken in moderation, with four helpings of fresh fruit daily would ensure good health. Adequate water intake is a must. Alcohol and tobacco should be kept as far away as possible. The myth that small quantities of alcohol, especially wine, would promote health is a fraud on the public. Repeated good studies, both prospective and retrospective, have shown NO BENEFIT from alcohol as far as health is concerned.



The key element in the new paradigm is the important role played by the human mind in human health. Diseases originate in the mind. Destructive emotions and negative thoughts like anger, jealousy, pride, hatred, and depression are the main killers. The educational system should change to inculcate positive thoughts of love, compassion, camaraderie, co-operation, and altruism early in life. Latest scientific findings show that these positive and negative emotions stimulate different parts of the human brain.



Mind does not just reside in the brain, though. Even creatures, which do not have brains, do have emotions. Single cell amoeba knows where to get its food as also to move in that direction. Ants and termites do not have brains. They are blind as well. They still have a collective consciousness that makes them do wonders like building multi-storeyed anthills. Every cell in the human body has the mind, the consciousness, which in turn is a part of the Universal consciousness. Memory “T” cell in different organs is a good example.



The idea of curing diseases in the present thinking is anything but impossible. The word “cure” connotes the capacity to bring back to the original level. Nothing in the human body could be made normal again even after a minor illness, like common cold. Many of the cells in the nasal mucous membrane in common cold are destroyed permanently. The new paradigm talks of healing. Healing is pregnant with meaning. The concept tries to make a “whole” of the sick human being. This is possible. The present teaching seems to have forgotten the advice given by Hippocrates, the father of modern medicine: “to cure rarely, comfort mostly, but console always.” Healing, though, requires a physician who is compassionate and understanding. He should be able to talk with patients and not talk to patients. He should never try to make money in the sick room his motto. Medical education should aim at preserving the health of the public and not at trying to confine himself to making a sophisticated diagnosis and intervening at any cost for monetary gains.



The latest craze in this direction is the introduction of the whole body scanner in America. The company is trying to sell those scanners with a vengeance. These machines are supposed to allay anxiety. In reality, they only add anxiety to the whole society since no one will come out of those without something somewhere falling outside the defined “normality.” In fact, allaying anxiety is the main goal of the medical establishment-patient anxiety of death and disability and the doctor anxiety of having done enough or not for the patient. Whole body scanner of the conventional school of thought is not the answer. In the new paradigm a placebo doctor is the answer to the whole riddle. May mankind be happy. Long live doctoring for the good of mankind.



“There is a time for departure even when there’s no certain place to go.”



…Tennessee Williams.