MEDICAL  PHILOSOPHY

Prof  B M Hegde MD, FRCP, FRCPE, FRCPG, FRCPI, FACC.
Pro Vice Chancellor,
MAHE University,
Manipal - 576119.
India.

“No great discovery was ever made in science except by one who lifted his nose above the grindstone of details and ventured on to more comprehensive vision”
                                                                                                                                Albert Einstein.

I wonder, at times, in real life situations, if we have lost our sense of direction in modern medicine, by relying solely on the reductionist science. We have enough evidence to show that this kind of logic does not work in any dynamic system, least of all in the human being, which is much more than the organs that we are trying  “to fix.”  Each time we feel that some “things” have gone wrong with the human organs, we try and “do” something, until the patient gets better or he  dies. Death of a  patient  makes us feel, for a while, that we could be inadequate, possibly fallible, and could be wrong in our approach to the whole gamut of curing, while we should have been healing, instead.  The essence of medical teaching these days seems to be, “do it” and “fix it” attitude. Deep down, this is driven by the technological onslaught into this humane calling, the healing art.  

“Art” is defined by Henry Edward Thoreau as “ that which makes a man’s day.” Healing art is that which makes the patient’s  day. The doctor-patient relationship is akin to any other archetypal human behaviour, like that of the mother-child or husband-wife relationship. What does that mean in practical terms?  Every man brings with him to this world that innate quality of human interaction, which, basically, governs his personality. In every doctor there is the wounded patient and the healer, as there is in every patient an innate capacity to be a healer as well as a wounded sufferer. This is an ancient mythological concept, if you wish.  MahaKali was both the giver and healer of smallpox, in Indian mythology.  In Babylon, there was the story of the dog-Goddess with two names, “as Gula she was death, and as Labartu a healer.”

Unfortunately, modern medicine rarely takes a serious note of the “healer” in the patient, adopting mostly a paternalistic attitude “to cure,” which many a time fails to work, or even could work against the patient. (Iatrogenic disease). The greatest discovery of the twentieth century has been the discovery of man’s ignorance. However, this does not seem to have percolated to reductionist science and medicine in a significant way. The word `doctor’  is derived from the etymological root “to docere,” meaning “to teach.” A good teacher is one “who knows not, and knows, he knows not.”  Together with his student, curiosity should compel him to ponder over the unknown.  This is a great quality, which tries to help the student deliver the goods. Education is derived from the Greek root ( e=out., ducere=to bring out the baby). It is the student who ultimately has to bring out the child. On the same analogy, it is the patient who has to heal himself,  awakening  his `inner doctor’- the immune system.

Lewis Thomas, the former President of the Sloane Kettering Cancer Institute, in NewYork once wrote, “instead of always emphasizing what we actually know in science, it would be enormously fruitful to focus alternatively on what we do not know. For it is here that the wonders lie. To know is the domain that is safe, where risk taking is no longer necessary. To dwell in it forever is not only to never advance, it is also to promote a deceptive and false view of ourselves as knowing more than we do-of being more powerful than we really are.”

The above idea clearly diagnoses the cancer that is eating into modern medicine and its reductionist scientific basis. The latter, however, is gradually dying a natural death, weighed down by specialization and sub-specialization. There, in the distant horizon, is the rising of the new sun- the science of CHAOS and non-linear mathematics.  We can not be oblivious to this fact,  as medicine controls  the lives of millions of people who are ill, or imagine  they are ill, at a given point in time. We need a new philosophy of  wholism in medicine, in the true sense of the word.

If one observes human growth on this planet, one notices a ceaseless transformation of his intellect from the cave-dwelling forefathers’ time of the “me” concept to the “other than me” reality.  In this continuum man has grown from the “single me” to a group, then to a village, to a city, to a nation, and now  to the whole  universe!  I am happy that it is the Indian thought that has been always ahead of others  in this field.  The Vedic wisdom of Vasudai Eva Kutumbikam (this whole world is but one family) shows that our ancestors could think clearly much ahead of their times.  We urgently need such visionaries, who dare to lift medicine  from the technological-monetary-business dug up  bottomless pit, into which it has sunk!

Why does one get any disease?  It is a million-dollar question! Charles Sherrington, the famous physiologist, in the year 1899, at the age of forty-two, when he was appointed professor of physiology at the Liverpool University, said in his acceptance speech:
           The question “why” can never be answered by positive science. The latter can, at best, answer the question “how” or “how much” but never the question “why.” A physiologist could say how the heart contracts, but never say why the heart contracts; he could define death, but will never be able to define life. Ratio rei is, therefore, not reason why! How true?

The question why could only be answered in teleology, but never in biology.
Let us now examine the new concept in teleology. The Universal consciousness would want this world to go on uninterrupted, or at least, without much damage to its components. Naturally, all bad people, who could be a nuisance to society will, eventually, have to be eliminated or, at least, immobilized, to avoid unnecessary trouble for the good people in the world. People who are angry, jealous, proud, hostile, and greedy are a menace to society. Recent studies have thrown up every one of the above devils to be important risk factors for all the dangerous and fatal degenerative illnesses.
Dawson Churchill writes:
                        “From the global perspective it may be very valuable that such an individual be unhealthy. This limits his scope of working mischief! If he were well, his ability to project these destructive emotions into disruptive action would be enhanced. Illness may thus be something of a planetary defense mechanism, a reaction against baneful inner states which human beings have nurtured within themselves.”

Although I may not agree with his views in toto, they look very logical and holistic. This is in fact the global wellness concept,  that  I have been developing over the years. Nothing in this universe could be viewed in isolation. This concept tries to marry biology to teleology, answering both the questions why and how.

On the other side is the enormous “progress” that we have made in the medical technological field. We live in an age of heart transplants, artificial hearts and kidneys, genetic engineering, and even cloning. We daily wage a surgical and chemical warfare on diseases and the bill for all that is skyrocketing.  Star-performers in the field are attracting all the limelight; and the price tags keep going up keeping pace with those stars  charges. Writing an editorial in the New England Journal of Medicine, Professor Krumholtz, a leading cardiologist at the Yale University, wrote about  the business going on in the field of the most expensive of interventions, the bypassing of the coronary heart vessels by surgery. He felt that bypass surgery is done more often to fill the coffers of the hospitals and the surgeons, rather than to help patients. Many studies in this field are being twisted, using all sorts of statistics, to show benefit to the patient while, in essence, the procedures are only helping the doctors and the industry. Corporate business houses are jumping into the arena of “hospital industry” in the fond hope of making large profits, without much headache from labour unions or raw material suppliers.  This goes against all canons of medical ethics, if there are any left, of Hippocrates: “never try to make money in the sick room.”   Did he say that you should do free service?  Far from it, very far! What he meant was that medicine is a calling, which is very noble, and should never be debased to that of a moneymaking business.

Running parallel to this development is the burgeoning undercurrent of mistrust and loss of faith in the medical profession, noticed by the galloping law suits against doctors in the West, which is, sadly, making a foray into our country as well. This doctor-distrust would make medicine very expensive, in that every doctor, under all circumstances, would want to use every available technological test,  to allay his own anxiety, to  protect  himself against a future potential threat of legal action.  This is where we stand today.

With this background, it is time for us to have a relook at what we are doing in modern medicine; the latter being based mainly on the old Newtonian physics and linear mathematics. In this century, beginning with the Einstein’s theory of special effects in 1905, and later his Theory of Relativity, followed by further developments in quantum physics of time, space, energy, and matter, the scientific world started coming nearer to the ancient wisdom of the East, which looks at this world as a whole, including the observer’s consciousness.   Werner Heisenberg’s Uncertainty Principle ultimately brought modern science very  close  to Adi Shankara’s philosophy of the uncertainty principle of matter, energy, and the maya.

Technological, market-force driven, modern medicine has to change to keep pace with man’s wisdom, driving him slowly towards the Ultimate Truth.  Modern Medicine, said of the Sloane Kettering Cancer Institute, in NewYork once wrote, “instead of always emphasizing what we actually know in science, it would be enormously fruitful to focus alternatively on what we do not know. For it is here that the wonders lie. To know is the domain that is safe, where risk taking is no longer necessary. To dwell in it forever is not only to never advance, it is also to promote a deceptive and false view of ourselves as knowing more than we do-of being more powerful than we really are.”

The above idea clearly diagnoses the cancer that is eating into modern medicine and its reductionist science. The latter, however, is gradually dying a natural death, weighed down by specialization and sub-specialization. There, in the distant horizon, is the rising of the new sun- the science of CHAOS and non-linear mathematics.  We can not be oblivious to this fact in medicine, as medicine controls the lives of millions of people who are ill, or imagine they are ill, at a given point in time. We need a new philosophy of wholism in medicine, in the true sense of the word.

If one observes mankind’s growth on this planet, one understands how he has been growing intellectually from our cave-dwelling forefathers’ time of the “me” concept to the “other than me” concept. In this concept man has grown from the “single me” to a group, then to a village, to a city, to a nation, and now to the whole universe!  The Indian thought that has been always ahead of others in this field.  The Vedic wisdom of Vasudai Eva Kutumbikam (this whole world is, but one family) shows that our ancestors could think clearly much ahead of their times.  We urgently need such visionaries, who dare to lift medicine from the technological-monetary-business oriented bottomless pit, into which it has sunk!

Why does one get any disease?  It is a million-dollar question! Charles Sherrington, the famous physiologist, in the year 1899, at the age of forty-two, when he was appointed professor of physiology at the Liverpool University, said in his acceptance speech:
                     The question “why” can never be answered by positive science. The latter can, at best, answer the question “how” or “how much” but never the question “why.” A physiologist could say how the heart contracts, but never say why the heart contracts; he could define death, but will never be able to define life. Ratio rei is, therefore, not reason why! How true. The question “why” could only be answered in Teleology, but never in biology.

Let us now examine the new concept in teleology. The Universal consciousness would want this world to go on uninterrupted, or at least, without much damage to its components. Naturally, all bad people, who could be a nuisance to society will, eventually have to be eliminated, or at least immobilized, to avoid unnecessary trouble for the good people in the world. People who are angry (negative energy directed outwards), jealous, proud, hostile, and the greedy, (negative energies directed inwards) are a menace to society. Recent studies have thrown up every one of the above devils to be important risk factors for most of the dangerous illnesses.

Dawson Church writes: ^1,2
                  “From the global perspective it may be very valuable that such an individual be unhealthy. This limits his scope of working mischief! If he were well, his ability to project these destructive emotions into disruptive action would be enhanced. Illness may thus be something of a planetary defense mechanism, a reaction against baneful inner states which human beings have nurtured within themselves.”³

Although I may not agree with his views in toto, they look very logical and holistic. This is in fact the global wellness concept that I have been developing over the years. Nothing in this universe could be viewed in isolation. This concept tries to marry biology to teleology, answering both the questions why and how.⁴

On the other side is the enormous “progress” that we have made in the medical technological field. We live in an age of heart transplants, artificial hearts and kidneys, genetic engineering, and even cloning. Daily we wage surgical and chemical warfare on diseases and the bill is mounting almost to the skies.  Star-performers in the field are attracting all the limelight, especially in the fee-for-service system of the USA; and the price tags keep going up, keeping pace with the stars' charges. Corporate business houses are jumping into the arena of “hospital industry” in the fond hope of making large profits, without many headaches.   This goes against all canons of medical ethics, if there are any left, of Hippocrates “never try and make money in the sick room.”   Did he say that you should do free service?  Far from it, very far! What he meant was that medicine is a calling, which is very noble, and should never be debased to that of a moneymaking business.

Running parallel to this development is the burgeoning undercurrent of mistrust and loss of faith in the medical profession, noticed by the galloping law suits against doctors in the West, which is, sadly, making a foray into the developing countries as well.  This doctor-distrust would make medicine very expensive. All the doctors, under any circumstance, would want to use every available technological test, to allay their own anxiety and to protect against future potential threats of legal action.

With this background, it is time for us to have a relook at what we are doing in modern medicine; the latter being based mainly on the old Newtonian physics and linear mathematics. In this century, beginning with the Einstein’s theory of special effects in 1905, and later his Theory of Relativity, followed by further developments in quantum physics of time, space, energy, and matter, the scientific world started coming nearer to the ancient wisdom of the East, which looks at this world as a whole, including the observer’s consciousness.   Werner Heisenberg’s Uncertainty Principle ultimately brought modern science very close to Adi Shankara’s philosophy of the uncertainty principle of matter, energy, and the maya.

Technological, market-force driven, modern medicine has to change, to keep pace with man’s wisdom, driving him slowly towards the Ultimate Truth.  Modern Medicine, said Prince Charles, heir to the British Throne, “with all its breathtaking progress, is like the Tower of Pisa, slightly off balance.”  I could not agree more!  Doctors, like others in all walks of life, should have their swadharma.(societal obligations).  The following Indian oath of the physician is worth noting in this context.

·        You must be chaste and abstemious,  speak the truth, not eat meat; 

·        Care for the good of all living beings; devote yourself to the healing of the sick even if your life were lost by your work.

·        Do the sick no harm; not, even in thought, seek another’s wife or goods; be simply clothed and drink no intoxicant; speak clearly, gently, truly, and properly; consider time and place; always seek to grow in knowledge.

·        Treat women except their men be present; never take a gift from a women without her husband’s consent.

·        When the physician enters a house accompanied by a man suitable to introduce him there; he must pay attention to all the rules of behaviour in dress, deportment and attitude.

·        Once  with his patient, he must in word and thought attend to anything but his patient’s case and what concerns it.  What happens in the house must not be mentioned outside, nor must he speak of possible death to his patients, if such a speech is liable to injure him or anyone else.

·        In the face of Gods and man you can take upon yourself these vows; may all the Gods aid you if you abide thereby; otherwise  may all the Gods and the sacra, before which we stand, be against you;

And the pupil should consent to this, saying,
                                  "So be it"