EVIDENCE BASED OR EVIDENCE BURDENED MEDICINE?
Posted by bmhegde on 1
Modern medicine, with all its hi-tech and claptrap, is still following the outdated linear mathematics. Human body is dynamic and is never linear. Continuously run by food and oxygen, the body follows only non-linear rules.1(hegdebm chaos, a new science) Normality, defining normal human beings, is another imprecise exercise in present day medicine. Statistical definition of normal is the mean+-2 Standard Deviation in a Gaussian distribution. This would automatically declare 5 per cent of the normal population as abnormal-the so-called false positives.2 (Smith Richard The Screening Industry BMJ) This number (5%) goes up to 15-25% when we try to apply disease statistics to healthy people! This is very frightening when one takes the present hi-tech diagnostic gadgets into consideration. Let us look at the total body scanner that measures up to five hundred body parameters at a given time.
Well Man:
When we check one hundred normal people using the total body scanner, therefore, two thousand five hundred abnormalities would be detected in those hundred normal people, even without their having any illness whatsoever. This would make us all abnormal in some sense or the other. There will be no “well” human beings at all if one follows the modern medical evidence. A well man would be one who does not see any doctor. When he goes to see a doctor to get investigated he becomes a patient. Rarely ever does he have a chance to become well again. 3 (hegdebm who is a well man)
Reductionist Science:
Medicine still follows reductionist science. We study organs through the study of the function of their cells. This is then projected on to the organ and finally we assume that the human body follows all our rules of deterministic predictability on the lines of Newtonian thinking. This has been the bane of medicine ever since modern medicine was accepted as science by the European Universities in the twelfth century. Although physics took the right route to unravel the mysteries of nature with the advent of quantum physics, modern medicine did not take notice.4 (medicine and physics Lancet) It is still mired in the time-honored Cartesian logic of reductionism. Modern science, including physics, has reached a stage where it needs to be rewritten with the discovery of human consciousness as the basis to try to understand nature. Everything is in the eye of the beholder. Almost all our studies so far have been flawed. Let us look at them in greater detail as we go along. Suffice it to say, at this stage, that we need to go back to the age old wisdom of holism followed both by the west before Rene Descartes, and by Indian and Chinese sciences for thousands of years. Deterministic predictability is a myth. The doctrine of probabilities, first enunciated by Blaise Pascal, a parish priest, when called to arbitrate in a game of dice, comes closer to truth even today.
Holistic Science:
Human body works as a whole. The different organs do not function independently. They are all connected together and are under the influence of the most dominant rhythm of breathing. This concept is called “mode-locking” in physics. For example the heart rate varies according to the phases of respiration-heart rate variability.5 (HRV-KMJ)
The cardiac rhythm probably originates in the brain and not in the heart as was thought in the past.6(Solomon victor’s work)
Newer specialties of neuro-cardiology and the like are coming up. Time evolution-what happens to a given man days, months, or years later-depends only on the total knowledge of that man initially. Modern medicine today is not in a position to assess a man completely as man is only thirty per cent phenotype (body features), another thirty per cent depends on his genes and the remaining forty per cent depends on the mind (consciousness). We are able to, may be, to asses a small fraction of the phenotype only at the present state of knowledge. In that background doctors have been predicting the unpredictable future of mankind all through the history of modern medicine.7(Firth WJ BMJ 1991) This nullifies almost all of our statistical projections on to the population of our controlled studies for drug effectiveness or even the long term outcome of elective prophylactic surgical procedures like coronary bypass etc. Controlled studies are further flawed because we are comparing a few body parameters of the two cohorts to match them while they have millions of other variables that we can not assess at all with our present knowledge. No two individuals are alike, even twins have their variations!8 (hegdebm controlled studies JAPI)
Drug Studies:
All our drug studies, that we swear by, have major errors. Firstly at the drug discovery phase there are a couple of problems. A chemical molecule is discovered in the laboratory and then this is checked for its potency, toxicity, and other dynamic features usually using an animal model. The animal data is then extrapolated to man and preliminary studies are done on volunteers. If all these are uneventful the final phase of drug development, the controlled study is mounted. We have looked at the problems besetting these studies. In addition, all the controlled studies are done for not longer than five years before the drug is let lose on the gullible public. Occasionally the last step is even given a go by before letting patients have the drug with disastrous consequences.8 (promise study)Many of the unforeseen side effects occur only after five years when the drug has been given to millions of people.9, 10, 11 (BP,Sugar,pain killers,anti-arrhthmics) Similar is the fate of surgical interventions and many other medical interventions.12, 13(Swan-ganz and CABG studies)
Sexed-up Studies:
Research funds drying up from independent sources more and more studies are done with industry sponsorship. Most of them have strings attached. Positive reports have better chance of publication, the sponsors many times indulge in data dredging in addition, occasionally companies get doctors to create diseases to sell drugs. It is a multibillion dollar business anyway and market forces influence research in this area very significantly. 14, 15, 16. Academic medicine seems to be on sale these days with doctors and researchers being offered lavish gifts by the companies. Even the textbooks are written with drug company money! 17, 18. (ac.med.sale.gift horse) Final bow comes from researchers trying to confuse the doctors with complicated statistical methods when the data are not convenient to their mentors.19 (latest BMJ aspirin)
Evidence burdened Medicine:
For a conscientious doctor it is very difficult to practice medicine with the evidence produced. If he does not do that he would be liable to be sued for malpractice. If he follows every single data pouring into the field at the Medline figures of seven per cent per month, I am sure, any practicing doctor would be in a serious dilemma. One glaring example is the area of hypertension treatment. Whereas there are more than six guidelines inn the world for doctors to follow, if all of them are computed together the inclusion criteria add up to only 39% of patients.20(hegdebm to do not to do) The majority of 61% do not have guidelines at all. Similarly there are as many studies eulogizing coronary interventions as there are which show the former in very bad light.21(hegdebmrcpe)
In conclusion, one wonders as to how we have not taken note of all these glaring loopholes in the present system of medical science to rectify the same using better holistic methods of medical care. Modern medicine has become mandatory form emergency use anyway, but in the long term most of our interventions have been shown in very poor light. Another area of confusion is in understanding the words health care and medical care. The two are not synonymous. They are complementary. Health care needs basic amenities for the people and the quick-fix medical care interventions described above are for the minority that are ill and not fit for those who are well. The present effort is to use medical care methods for all, resulting in much misery and estrogenic problems. Recently studies did show that when interventions come down death rate in the population falls down significantly.22 Israel) Time has come for right thinking doctors to wake up from their deep slumber and their brainwashing by the industry to do most good to most people most of the time. A good doctor can never be dispensed with. He is then placebo for the human immune system to help heal the sick. May their tribe increase.
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