“He is wise who knows the sources of knowledge – who knows who has written and where it is to be found.”– Hodge.
“School may have been ? or still be ? boring, a killer of creativity or downright awful for you.”– Epictetus
All the wise people in charge of higher education in India today (since independence) remind me of the Chinese elephant story, wherein seven blind wise men were trying to describe the elephant! Our world( better Germanic root for the world is Wirklichkeit-in English it is acting, or changing and changing) is a wonderful wonder, where, for some unexplained reason, people only seem to understand a problem but never be able to over-stand that problem. India, with some of the best brains in the world, has contributed hardly anything to the progress of knowledge in any field since independence, what with all the infrastructural facilities developed in free India. We still stifle the thinking capacity in our students by exclusively stressing in imparting information (which we call as knowledge) even in higher education where creativity becomes a handicap. Educated people would find it easy to dwell in the known world and they fear the unknown. If one does not try to get into the unknown how can knowledge (wisdom) advance? Advance in knowledge requires us to explore the uncharted arena to demolish the many myths in every field of human understanding, using refutational research. Let us analyse the present scenario under three heads-infrastructure, content, and the container (student).
Every one is lost in the numbers game. We need more colleges, we need more universities, more doctors, and we need public-private entrepreneurship and the like. No body seems to be concerned about the quality of such infrastructure. We have higher educational institutions even in private sector that only have rooms, chairs and tables but no good quality teachers and other needed support systems. The licensing agencies could be appeased in the present corrupt atmosphere where even the highest watch dog bodies stink in malpractice. To give one recent example, one of the wise men in charge of medical education was keen on simply increasing the number of doctors in India. Little does he realise that we have a large surfeit of doctors (licensed practitioners who cater to patient needs) compared to any other country in the world. The statistics of the wise men refer only to the MBBS doctors.
That apart, a 14 country study of industrialised nations has clearly shown that in countries where there were more doctors per capita population, health was worst, longevity shorter and disease incidence much higher compared to countries where there were fewer doctors and less number of specialists! (JAMA 2000; 284: 483) Japan, with less than one percent specialists and least number of total doctors, was the best country while USA, with 99% specialists and four times the number of doctors per capita compared to Japan, was the last but one with Germany at the bottom. In addition, past experience in five countries showed that when doctors went on strike in those countries for various reasons at different times, death and disability rates fell down significantly only to go up when doctors came back to work, which resulted in an article in the BMJ entitled: “Doctors going on strike will improve society?s health”! ((BMJ 2000; 320:1561) This is not the exclusive domain of doctors; it applies equally to lawyers in society. A surfeit of lawyers in the USA has led to rise in malpractice suits against the medical profession there forcing doctors to practise defensive medicine sending medical care costs sky rocketing there. More than 70 million Americans can not afford health insurance as the premia are too high, thanks to exorbitant medical bills and hospital charges. Let us learn from their mistakes and not produce too many doctors, lawyers or for that matter any such breed. Howard Straus, a health freedom and natural cures advocate who says “The number one killer of Americans is the American medical system.”
Any human being who is kind and compassionate and has the permission to practise as a medical doctor could be as effective as the highest degree holding specialist as far as the sick population is concerned. Latest science in medicine shows the best curative tool in sickness care is the faith the patient has in her/his doctor- the placebo effect-which has been proven beyond doubt to be both scientifically true as also to be more effective than most of our hi-tech interventions. Some argue that such “half baked” doctors might do more harm than good. Evidence is now showing that the modern medical establishment, even in the USA, is the leading cause of death and disability followed by cancer and heart attack in that order, despite our tall claim that we are evidence based! The evidence base in modern medicine is shown to be built on a foundation of lose sand. (Controlled Clinical Trials-an analysis-1991. Project Cure, Washington DC)
All our chemical molecules, the so called therapeutic drugs, have been shown to be damaging the human body cells as they are all dextrorotatory while body molecules are levorotatory. Eastern herbal drugs are shown to be not only levorotatory but harmless to our body cells. The so called “first pass effect” that every medical student learns by heart for the pharmacology examination should tell him and his teacher that the body tries to reject every chemical molecule in the first place. Our pharmacology has resulted in the exponential growth of Adverse Drug Reactions (ADRs) as the leading cause of death inside the medical establishment. An old WHO study in Bangkok did show that all the five systems of medicine being practised there at that time had an equal effect on society. The systems ranged from pure western medicine to the Samoa system where there is hardly anything “scientific”. All doctors, if they are humane, could provoke the placebo effect in the human immune system which, ultimately, cures anyway. Except for corrective surgery and trauma care, modern medicine has very little advantage over other systems! So our doctor-patient ratio is the best and we need not dilute that in a hurry by the newer suggestions by the wise men.
Contents of higher education:
Modern medicine needs to look to set its own house in order. To start with we have no science of man; we only use the inanimate science of physics and chemistry as our base for an animate, dynamic system that works as a mind-body whole, with its consciousness in the driving seat. Modern medicine has not understood the driver yet. Same holds good for science in general. While physics, whose job is to study matter has ceased to exist independently almost since 1925. Matter is not made out of matter. Matter and energy are the two faces of the same coin (E=M) but we do not teach that in school or college and still hang on to the coat tails of Albert Einstein. Since medicine has no science base we need to have all sciences and humanities in every university for knowledge to advance. Here in India for political expediency we are encouraging a retrograde step of setting up single subject universities, an anethema to the concept of universality. Nano science, born with the Sol-Gel technique of Late Professor Rustum Roy in 1954, has made chemistry totally different. We do not teach that but hang on to the old chemical analysis and proclaim to the world that homeopathy is not science as their medicines have no chemicals in them. We are not aware that all of them are in either nano or piko forms. Nobel Laureate, Luc Montaigner, had to flee France to avoid intellectual terrorism there because he again showed that water has a structure and that it is not just H2O. He is setting up a laboratory in China to further his research. Many decades earlier Late Professor Rustum Roy had shown water structure and devised many new therapeutic tools.
Even Ayurveda, a great science, is not being taught in our medical schools; while the US medical schools teach six months in their four year course the basics of all complementary systems of medicine. How a thinker could do research in medicine without the help of modern physics, chemistry or mathematics as also humanities? How could lawyers study jurisprudence without medical jurisprudence? How can a physicist learn physics without chemistry and mathematics? That was the very reason why the concept of universities was thought of in the past, first in India when Europeans were still hunter-gatherers roaming the forests (Voltaire), in Nalanda, Taxashila, and Banaras etc. Today?s wise men want to reverse that trend!
I could cite similar experiences for all other subjects at the higher education level. Take economics for example. While we teach students the work of Vernon Smith and David Kahnman (2002 Nobel) that all men are altruistic, the truth of that statement is questioned by the same “Dictator Experiment” by another professor in the same department of economics at Chicago University. John List found out that “men are all homo-economicus and NOT homo altruisticus.” No man is humane today, but the student does not get to see that truth hidden in the lie that got the Nobel. See the reality in the world ?all Indians in power are corrupt and our education did nothing to make them humane! This is the naked truth. If one looks at the content of our higher education, one could easily infer the quality of the container as it comes out of the portals of our sacred temples of higher learning. Result is that the world is becoming greedier with the poor people suffering. This is one of the fall outs of this kind of elite education. While India shines in the share market, two thirds of Indians do not have food to eat. 67 million children suffer from a disease-Nutritional Immune Deficiency Syndrome-which does not even find a place in medical textbooks. However, AIDS, which is an illusion of a disease, is known even to lay people! Poor pay for their poverty with their lives; while the rich couldn?t care less while engaged in vulgar display of their wealth. True education must make the student go in search of the truth. Medical education should stress more on that aspect. All our lives are in the hands of the doctors trained in this faulty system. Will the wise men in charge of higher education remove their blind folds please and listen to saner voices in society who ultimately are at the receiving end?
The content of our higher education needs a thorough overhauling. It is safer to teach methodology in place of facts. The latter change so fast that the textbooks today become outdated by the time they are out of the press. Future textbooks would be loose leaf ones to be regularly updated. Information (knowledge) is at the finger tips these days for students to get to know by the flick of a button in their computer. Why should we have fixed curricula? We should let students learn for themselves and a teacher should only help them to do so. Examinations could also be very creative with open books to refer to, if the student wants. Corruption in the examination system could also be avoided thus. Very soon a new technology of a hand held tablet could enable a student in minutes to down load any book from anywhere for study. That will replace the laptop and computers. We need to reform the system by the following three points, 1) encourage the students to study for themselves, 2) provide them with all the infrastructural facilities, and 3) protect the present lot of students from the present lot of teachers, what with their fossilized brains. Future teachers that come up in the new system will have learnt their lessons, anyway.
I still remember my words some years ago when the CHEA, Council for Higher Education Accreditation of the USA, wanted me to go to Phoenix to talk to their wise men about ethical higher education there. Robert Glidden, the then President, was very keen that I go there. I asked the wise gathering one simple question. What is education if it does not make a human being human and humane? What do we see today? Every one, especially with some power to wield, has become corrupt, arrogant and inhuman to the needs of others to the exclusion of one?s own proclivity for comfort and greed. Education must teach the student about himself and also the purpose of all education. Education is to train a human being to act “justly, skillfully, and magnanimously, under all circumstances of peace and war.” Dr. Eliot?s now famous “five-foot book shelf, has Milton?s “Areopagitica” and “Tractate on Education”. Our wise men, in charge of education, would do well to glance through those for the good of India?s future generation. Life is not just to live and enjoy. Life has to be useful, to be compassionate, and to be authentic and should touch other lives to show that not only one has lived well but has let others to live well in the bargain.
The container, the student, should also be trained to have that enthusiasm to know the unknown-the only way to progress. The word Upanishad says it all. Upa=near, shad=sit down; and Ni=vacuum that one takes to the feet of the teacher to fill with wisdom. Our present system of schooling closes that vacuum completely leaving the student with no place to fill the wisdom. On the contrary, our edu-care tries to fill the student?s brain with what we want him to learn. True edu-cere is to bring the best out of the student. The latter is born a genius; “only to be converted into an idiot in school.” (Dr. Alexis Carrel) More creative work right from day one with creative project work for students, allaying the fear of the Damocles sword of the end year parrot repeating examination that curtails all curiosity in the learner, on going teacher and peer review of student performance coupled with a teacher that encourages his/her student to learn for himself/herself rather than stuffing useless information into the student?s head, should be the future system. The teacher must be a true midwife trying to help the student to deliver at the end.
To change medical education one needs to revamp it totally taking it away from the hi-tech five star corporate hospital background to living communities where one sees human illnesses naked. Only a small percentage of filtered terminal incurable illnesses reach teaching hospitals. A student trained in that setting comes out with the stunted view of the total spectrum of illness as that he/she had seen in the teaching hospital. To cap it, we have an array of mind boggling scopes, scanners, and shadows which take away to joy of “understanding” the patient in his/her totality. The latter simply is trying to understand the mind of the patient. If we listen to some thinkers in this area things will clarify a bit more. Lord Platt, a great teacher in the last century, had said in 1949:” If you listen to your patient long enough s/he will tell you what is wrong with her/him.” Lord Platt?s students, who are the present pillars of medicine in England today, did a triple blind, computerized, prospective, study of out patients in London teaching hospitals using even the positron emission tomography but came to the same conclusion that “80% of the final accurate diagnosis could be arrived at the end of listening to the patient which can only be refined 4% more by all the examinations and 8% more by all the tests, including PET! In addition, 100% of the management strategies could be arrived at, at the end of listening to the patient.” () If this is adopted in medical teaching our doctors could practice high standard medicine even in remote villages. All that they have to take with them is their trained mind that could listen to patients.
My teacher, Nobel Laureate Bernard Lown at Harvard, a great cardiologist and the man who invented the Lown Defrillator, had this to say about our present standing in modern medicine: “We believe the modern medical model has become increasingly reductionist: human beings are seen as repositories of malfunctioning organs that need repair. This view results in an onslaught of tests and uncertainty. Doctors often take refuge behind technology because it is easier and less time-consuming than talking with a complex human being who is their patient.” [The New Yorker 5/17/99]. Another great thinker, a professor of medicine at Yale University, Mary Tinnetti, said: “The time has come to abandon disease as the focus of medical care. The changed spectrum of health, the complex interplay of biological and non-biological factors, the ageing population, and the inter-individual variability in health priorities render medical care that is centered on the diagnosis and treatment of individual diseases at best out of date and at worst harmful. A primary focus on disease may inadvertently lead to under-treatment, overtreatment, or mistreatment.” (Amer. J Med. 2004; 116: 179) Much more insight can be gained from the following extensive study of modern medicine by researchers led by Gary Null, entitled “Death by Medicine.”
Doctors should be trained to keep the health of the public and not just to treat sick individuals. Today?s medical education does not teach anything about the need for keeping the health of the well segment of the population, the Bija Mantra of Ayurveda. UNIDO report recently stated that India needs the following simple measures to keep her people healthy, viz: clean drinking water for all, three meals a day uncontaminated by animal and/or human excreta, sanitary facilities with a toilet for every house, a roof on top for the poor, in place of the star lit sky at night, avoidance of cooking smoke, having deadly carbon monoxide, coming into the house using a smokeless choola, education of girl child at least up to twenty years to bring down the fertility rate and economic empowerment of poor women. Does our present curriculum contain any of these?
Higher education in India is crying for urgent modernising if ever we want to compete with the world in all fields of human endeavour. Our outmoded and outdated Macaulay type of education, doling out BA, B.Sc, MBBS, BE, should change for a more dynamic living educational system that is both contemporary and creative at the same time. The recipient of a higher degree should be bold enough to stand on his own legs should the need arise and not dependent only on some cushy job. Concurrently, there should be a revision of the school curricula which is a prerequisite for a changed scenario in higher education. Education should be viewed in its entirety and not in bits and pieces.
While we need improved infrastructure to cope with the millions of young men and women looking for higher education in the near future it is not enough if we simply mindlessly encourage mushrooming of infrastructural facilities. Numbers do not count as long as they are not of expected quality. Care must be taken to see that the private entrepreneurship in education does not become another money spinning machine like the growth in the telecommunication facilities. We will have bigger scams in this area with greater damage to the future generation. The signs are seen even now with limited private public partnership. That does not absolve the tax payer?s money spinners in the field of higher education. Some of them really suck!
“It is important that students bring a certain ragamuffin, barefoot, irreverence to their studies; they are not here to worship what is known, but to question it.”– Jacob Chanowski
MD, FRCP, FRCPE, FRCPG, FRCPI, FACC, FAMS, is editor-in-chief of The Journal of the Science of Healing Outcomes; chairman, State Health Society?s Expert Committee, Govt. of Bihar, India, Visiting Prof. Cardiology at The Middlesex Hospital Medical School – University of London, Affiliate Prof. of Human Health – Northern Colorado University, Visiting Prof. Indian Institute of Advanced Studies – Shimla, Retd. Vice Chancellor, MAHE University – Manipal. Prof Hedge regularly gives talks on AIR, Doordarshan, BBC and Zee TV, London.
Author: Dr. B. M. Hegde- India