Caste System in Medical Care:

We all know the devastating effect of the caste system on Indian society. Similar situation obtains in the field of medical care delivery today all over the world. The practitioners of every system feel that theirs is the best and the rest have no right to exist! Be that as it may, let us look at these systems in a little more detail to unravel the mystery. All the systems of mending the broken human systems, except homeopathy, are allopathic systems.(allo=against; pathy=pathology or disease) Their methodology might be different but their aim is the same.

What we have to be careful is to see that any system that is being practised has been authenticated by the respective authority. The doctor who practises multiple systems should have enough training in each of them. Unless a doctor keeps in touch and updates his knowledge, he becomes a quack even in his own system after some years! New knowledge pours into medical field at a phenomenal pace of seven per cent per month. Anyone, modern medicine included, who does not keep updating his knowledge, becomes a dangerous quack. We must have built-in systems to help people keep updating their knowledge and skills. At the present time most practsing doctors get their postgraduate education from the drug company representatives only. Do not get a shock if I say that in the USA, the whole medical education is run with drug company money! This is brought out in a recent editorial in the prestigious medical journal The Lancet.

Re-certification could be a good idea. This could be done for doctors of modern medicine to let them practise alternative systems of medicine. There should be avenues for short-term certificate courses, say in Ayurveda, for modern doctors and vice versa. Having practised any system successfully for years there could be quite a few competent doctors who are capable of delivering the right kind of medical care using another system as well. After all at the end of the day it is the doctor's compassion for his patient that provokes the latter's immune system, the type of medicine notwithstanding. Care should be taken to see that such persons have been duly certified to do what they do. Having a revenue officer's certificate might be a dangerous law that might let quacks practise medicine.

The Science of Modern Medicine:

The lay man and even the powers-that-be, both in the government and the judiciary, have been misled by our selling the idea that only modern hi-tech medicine is very scientific and the rest are all mumbo-jumbo and witchcraft. This is not the whole truth. Modern medicine, in its present avatar, was born as mumbo-jumbo nearly five thousand years ago on the banks of river Nile and then migrated via Arabia to Greece, having been refined en route.

The science of Ayurveda is thousands of years older than the modern medical wisdom of today. I must hasten to add that, unlike modern medicine, Ayurveda did not ride piggyback on natural sciences and linear mathematics, ever since modern medicine was accepted as a science in the European Universities in the twelfth century AD. However, modern surgery had to wait for another one hundred years only as butchery, before being respected as a science. In contrast, Ayurveda and its surgery were so much advanced thousands of years earlier that the basis of most modern surgical effort could be traced to Shustruta.

The fault with Ayurveda was that it lost its support base from the ruling class during India's subjugation by alien rulers. In addition Ayurvedic scholars were under the impression that whatever is written thousands of years ago was gospel truth and does not need scrutiny using modern methods of enquiry. Anything that does not change with human wisdom can not be classed as science. This applies to all fields of human studies, modern medicine and Ayurveda included. This has to change and future research into Ayurveda should be done with new methodology.

The modern medical scientific methods also need changes to fit them into the new thinking that the human body works as a whole and not in bits and pieces, as was done so far in the organ based specialization. Reductionist science is not scientific anymore in human affairs and even the benchmark of controlled studies needs drastic changes to suit this new philosophy. The science of holism-CHAOS- is the science of the future for all systems of medicine. We should devise new methodologies in this area. This is urgent! Reductionist science and rationality have their in-built limitations when applied to the dynamic universe.

Human consciousness, which science ignored till recently, holds the key to future scientific explorations in the human domain. Earlier we understand this the better for mankind. The end results of the present modern medical science could be gauged from the recent editorial in the British Medical Journal entitled: "doctors going on strike would improve society's health." The editorial referred to the recent doctors' strike in Israel, where the death rate and morbidity were significantly reduced during the strike period. So the habit of kettle calling the pot black does not do us any good. Time has come for openness in research. The much touted cloning is also not without its skeletons in the cupboard. Our genome is not a text book map having fixed genes, as made out. The Nobel Prize winning work of Barbara McClintock has shown clearly that changing one's consciousness (mind) could change even the genes! Science has its limitations!

Society's Responsibility:

The four pillars of the so-called democracy in our country, the parliament, the bureaucracy, the judiciary and, the media need urgent education about these startling disclosures, lest they should be led up the garden path, by their time-honoured notions, to believe that it is only modern medicine that is scientific and the rest are all mumbo-jumbo, sorcery and witchcraft. Knowing the inherent defects of democracy of the type we inherited from the British in our country based on adult franchise, where the powerful few, using their money, muscle or brain power, could take the gullible common people for a ride, society should be on guard to audit what our lawmakers do. Our judiciary should be informed of the new directions in the world of science. The media could do a lot to bring about these healthy changes and to change the mindset of our officialdom. We need officials to go by the spirit of the law to help genuine people and not use the loopholes in the law to exonerate the sophisticated cheats that bleed the public.

The Watchdog Bodies:

There are too many of them even to keep track. Every subject has an apex body that is there to keep a watch and see that mediocrity does not creep into these vital areas of education and medical care. Whereas the concept is very good, in practice they are the greatest hindrance for any genuine innovation to improve the systems. They do not seem to have the good of mankind at heart. They also follow the letter of the law. What weighs heavily with them are the length and breadth of the teaching rooms and not the quality and content of teaching. While they count the beds they lose sight of the excellent care that is given. In short, most of them lose sight of the beautiful woods while counting the trees. Of course, it is not for nothing that they do that. They usually have their hidden agenda. If one reads the recent Delhi High Court judgement on one of the watchdog bodies, one would lose faith in all of them. The recent Delhi High Court Judgement shows how a cunning person could misuse the watchdog body to turn it into a laughing stock.

This incident proves the futility of the safeguards against misuse in the present set up. "Man" said Shakespeare, "whether in palace or pad, castle or cottage, is governed by the same passions and emotions." How true? Adam Smith's law of stock markets had built such safeguards that it was said to be impossible for one or two individuals to upset the market. The 1984 NewYork crash and the 1990s crashes in the Indian market showed how vulnerable the system is.

The political electoral system should never be a part of selecting people to man these vital institutions. Although we do not want to put it in print, we all are aware of the devious ways in which cunning people get elected. A day may not be far off when all elected bodies might contain such people only. We could evolve a better system, but space constraints do not permit me to go into the nuts and bolts of the new system. Suffice it to say that men of straw do not misuse these very important bodies.

We have enough men of character who could easily adorn those posts and show the right direction to country. These councils could maintain the highest standards of the final product and not to look into how education should be imparted. Individual Universities should be allowed to innovate and evolve better systems. Every watchdog body shall have a university representative as a member. The councils should only assess the final product on a National scale and those who do not come up to their expectations need not be licensed to practice. In the present set up Universities have little role to play in professional education. The councils dictate even the syllabi! The university should always be above the councils. There should be only a single apex body overseeing the universities.

Healthcare Delivery :

Another fatal mistake that we generally make is to equate medical care with health care delivery. They are poles apart! Most of our politicians and even intellectuals think that doctors and hospitals maintain societal health. This is very far from the truth. Health care in India, as in many developing countries, needs the following urgently. Clean drinking water for our masses in the villages, three square meals a day with food that is uncontaminated with animal and/ or human excreta, houses with toilets to avoid hookworms sucking poor villagers' blood (70% 0f our children even today have only 50% haemoglobin), economic empowerment of the masses, and lastly a clean environment without cooking smoke getting into the house. The latter is the biggest cause of death in village women and children below the age of five. Alcohol and tobacco are the next two deadly enemies of the poor (rich also).

While there could be a few million who are ill in this world on a given day, three are billions who are well and need to be kept that way by the above methods. That, in essence, is health care delivery. Even the five-star hospitals would do well to have "wellness" clinics, in addition to their illness clinics.

Conclusions :

Medical care revolves round anxiety of two kinds. Patient anxiety of death and disability and the doctor anxiety of "have I done enough or do I do more?". If someone finds a remedy for these two anxieties all problems in that area would disappear. Modern hi-tech medicine is prohibitively expensive and could only be accessed by about 1% of the population. Universal cover with modern medicine is an impossibility even for the richest nation.

We need to innovate a future medical care delivery system that takes the best of all systems of medicine to do most good to most people most of the time. In my concept of disease classification we have the following groups. Emergency Diseases which form about 10% of the sick population needing hi-tech modern medical quick-fixes. Rest of the illnesses could all be managed using a judicious mix of alternative systems, carefully selected after due research and scrutiny.

Majority of the rest is minor illness syndromes, then we have the chronic incurable diseases, doctor-thinks-you-have a disease syndromes, patient-thinks-he-has a disease syndromes and lastly doctor/drug induced iatrogenic illnesses. All of these 90% could be managed without the expensive hi-tech stuff. Earlier we set our house in order the better. Let there be no caste system in medical care. Our aim should be to give succor to the needy using all systems; properly evaluated for their efficacy in advance. A new system of integrated medical care delivery system is the urgent need of the hour to save mankind from the ravages of medi-business controlled by drug and technology manufacturers.