PLEA FOR A PARADIGM SHIFT IN THE SCIENCE OF MEDICINE
Posted by bmhegde on 1
Dear Sir,
I am so much impressed by the response of Dr. Herman Jeggles from South Africa that I thought I should write more elaborately on our problems in modern medicine because we use reductionist science. There is an urgent need for a paradigm shift in medicine if society has to really bebefit from us. I was so happy that a young man is thinking like me and is asking for a pardigm shift. Many years ago, an article of mine in the Proceedings of the Royal College of Physicians of Edinburgh did have the same caption-need for a paradigm shift, but there were no takers!
In emergency care we have no other choice than to follow the modern medical quick fixes, although there are warning signals that all is not well even in that area. In all chronic illnesses, I feel, our treatment does more harm than good, if one carefully audits the outcomes. Many a divine intervention in the apparently healthy population have similar outcomes. A good example is the Philadelphia-Ontario bypass audit in the immediate post Myocardial infarction period. This is not surprising at all, as time evolution in a dynamic system is not dependent on minor changes in the initial state in the human body. Correcting those changes need not (will not) result in better outcomes in the long run. "Butterfly effect" of Edward Lorenz takes over. The altered state (lowered BP or Sugar) might result in catastrophic changes elsewhere, if one understands non-linear mathematics that the human body follows.
Aristotle wrote that “truth can influence only half a score of men in a century while falsehood and mystery would drag millions by the nose.” This is more than true in the case of modern medicine. Plato, in his celebrated book, The Republic, refers to his teacher Socrates’ efforts to change society when, at that time in Greece, injustice was justice and justice was the convenience of the powerful. Socrates did not succeed, though. I am only trying to indicate the inherent drawbacks in our system lest people should be taken for a costly ride!
Lucien Leape of the Harvard Medical School in his excellent article, Errors in Medicine, published in 1994 in the prestigious Journal of the American Medical Association (Vol 272; page 1851-1857) gives a very graphic description of all the errors that we have been committing. This has been updated recently by Barbara Starfield in her excellent article in the same journal in the year 2000 (JAMA 2000;284:483-485) which reiterates the same, adding many more glaring dangers to the list already given by Leape. To date, I have been able to trace more than seven thousand articles showing the mistakes of modern medicine in the best western journals.
Nearly 225,000 people have died in one year in the US alone due to iatrogenic diseases. Of these 140,000 has been exclusively due to adverse drug reactions. In addition, an equal number died during out patient management of Adverse Drug Reactions that cost the buyer a total of $ 79 billion in prescription bills in one year. There have been three million injuries due to medical interventions in a year with 44,000 to 98,000 deaths annually. Nosocomial infections alone caused 80,000 deaths in one year in hospitals. One hundred million people suffer from chronic debilitating illnesses partly due to medical interventions. These figures look horrible if one takes into consideration the relatively small population of US. The sad story does not include the escalating costs of modern medicine.
One of the reasons why this sordid drama unfolds in that country is the heavy advertisement about screening the apparently healthy people for all kinds of abnormalities. However, all the audits of screening efforts have shown that screening healthy people could be one of the most dangerous activities in society. Time evolution in the human system does not follow linear laws of predictability. The screening industry is the biggest money spinner in medicine. A very recent editorial by Richard Smith in the prestigious British Medical Journal entitled “The Screening Industry” bares the true picture in all its ramifications. Screening probably is the main source of the above sickening numbers mentioned earlier. If doctors confined themselves to cure the sick rarely, comfort them mostly, but to console always, they would be doing a great service to the public. When doctors try and intervene in healthy segments of society problems start. Sir William Osler, a celebrated brain in medicine in the last century, was right when he said: “patient doing well do not interfere.”
Modern medicine is slowly becoming unpopular in the west. In the year 1997 alone 629 million people took treatment from alternative systems of medicine in the west paying from their own pockets. This is more than the number of people that saw their family doctors in the same year, according to a survey done by Eisenberg and colleagues in 1998. India should take note of this as we have one of the best systems of health care in Ayurveda, especially for chronic illness syndromes. If this could be judiciously clubbed with the emergency care methods of modern medicine complementing each other we could bring down the costs of medical care to almost one tenth of its present level with less danger to the public as a bonus.
The future lies in emphasizing promotive health. We should change the present teaching in medical schools to that of patient-centred education from the present disease-centred education. We should use statistics sparingly in medical research. One of the drawbacks of applying disease statistics to the healthy population is that the latter throws up a very high percentage of false positives, resulting in epidemiologists predicting the unpredictable resulting in epidemics. The fear of an illness could help the illness to take a firm root in a healthy person. Modern medicine has realized that the human mind plays a vital role in disease causation as well as its control. Hence there is a need for doctors to train themselves in human psychology and behavioral sciences. Health is one’s birth right. Diseases are only accidents. If one follows the correct rules of healthy life style, accidents (diseases) will be rare indeed!Unexplained symptoms also fall into place in this new scenario.
Yours ever,
bmhegde
Competing interests: None declared