Has biology, the mother of modern medicine, found its Holy Grail, leave alone drinking from it? As a medical student at the Stanley Medical College, Madras, I got the impression that what I was taught was the whole truth and nothing but the truth. That was long time ago, in fact, in the last century, to be precise in 1956 AD. Since then a lot of water has flowed down the Cooam Bridge on the Marina Beach. Unfortunately, nothing much has changed in our thinking in the medical field in the last half a century although lots of new technology that I did not even hear about during my student days have come into the picture and some of them have been since abandoned as they produced more suffering in their wake compared to the relief that they gave. Lot more new drugs have come and gone and are making media news almost everyday of a breakthrough or of a life saving drug.
Shaken to my bones by some of the events in my medical life since then, I have tried to unlearn what I had learnt as an examination going student, almost for a decade from the time I entered the medical school, only to relearn the realities in the field sans the claptrap. It has not been an easy task, an uphill task at that, at great risk to my career even. But now after more than half a century I feel it has been time well spent. I deem it my duty to share my arduous journey with the newer breed of doctors, trained in the present five-star, hi-tech atmosphere under the glare of an array of scopes and scanners and breathtaking heroic (the hapless patient as the hero) surgical feats. I would like to share my joys and sorrows with them lest they should also go through the same process that I went through and waste their time.
Medical literature today is like a thick jungle, what with 7.5 % new information pouring into biology through, well over forty thousand bio-medical journals all over the world, every month, the novice would find it difficult to separate the wheat from the chaff. In fact, that is the job of an ideal teacher to guide the novice in this thick jungle of mostly dead wood to the real useful rose wood or the teak for his/her benefit. Otherwise, the novice would not reach the real stuff and might get lost in the jungle for ever. I wish to share that with the readers through these columns. David Eddy, a former professor of cardiovascular surgery at the Stanford, changed his profession after having gone deep into the realities (or otherwise) of medical science and trained to be a mathematics teacher at the Dukes University after his Ph.D in mathematics! I did not do that as I found it difficult to study advanced mathematics. I tried to swim along and see how we could change things if we can or bear with things that need no change and also to have the wisdom to know the difference. I do not know if I have reached my goal and that is why I consider myself a medical student even today.
Human body does not follow the linear rules of conventional mathematics and time evolution in man depends on the whole man (his genes, phenotype as well as his consciousness) and not on a few parameters of the phenotype. This is where our predicting man?s (patient?s) future rarely comes true. We have been predicting the unpredictable and intervening unnecessarily in apparently healthy people. This is precisely the reason for death and disability rates to plummet in Israel recently when doctors struck work for three months. Similar experience was reported from Saskatchewan in Canada twenty years ago and from Los Angeles country ten years ago when doctors went on strike. There has been hardly any difference in the per capita deaths due to chronic myeloid leukemia at the Christy?s Hospital, Manchester, during the two time slots, 1900-1940 and 1950-1990, although there were sea changes in our approach during the latter period.
The basic tenet to understand is that our body cells, of which there are about one hundred thousand billion in all, love one another so much that they would like to work as one whole. Even the cells of all sentient beings do the same. But for evolution (nature) developing the most powerful immune system all living things (humans included) would have been one large mass of a cell syncitium. Thank God for that. With that background in view, our organ based specialties and therapeutic measures would have to have problems on a long term basis. While modern medical quick fixes could be useful in an emergency, they would come to grief on long term use.
Another bane of modern medical thinking is the definition of normality. In a bell shaped Gaussian graph of any measure in the human system, normal human beings are those who fall within the mean+- two SD (standard deviations). This automatically brings in the issue of false positives. In every parameter thus measured, 5% of normal population would, per force, be declared abnormal (false positives). This five per cent suffers the long term consequences of our interventions, anyway. Be that as it may, now with the new Total Body Scanner, threatening to invade India in a big way in the near future, one shudders to think of the future of Indians. Total body scanners would measure five-hundred body parameters in one sitting. Now think of the mind boggling 5% of the five hundred measures making a total of 2500 false positive measures for every one hundred people that go for a routine screening! Any one that sees the doctor for a check up when apparently healthy, after the TBS, would have, on an average, 2.5 abnormal reports. There will be no NORMAL HUMAN BEING AT ALL. Although it is a very good business proposition, it is bad for mankind. Even at the present day it takes one thousand healthy women to be screened for cervical smear for forty long years to save one woman from cancer cervix! A sizeable per cent of those women would have lost their organs for no fault of theirs, as nearly 75 women in this group would have had abnormal smears with normal cervix and so on. Similar is the story of prostate, breast and many other cancers. The MRC study of mild-moderate hypertension showed that it takes 850 innocent normal people to be drugged for a period of five years to, probably, save one stroke.
So read on to know the other hidden face of the moon (medical science) bereft of all the dressings and frills in medical science, and, in the bargain, get a glimpse of the new science in the horizon of holism (in place of reductionism), CHAOS and fractals, without any heavy dose of mathematics that we doctors generally are not good at (I am talking for myself). Happy reading folks!
Author: Dr. B. M. Hegde- India