This article is a rebuttal to the article Modern Medicine Has Given Illness Care a Miss by Dr. B.M. Hegde in the Open Page of The Hindu, dated February 18th, 2012. (The piece is in fact recycled from this almost identical piece by him from November 2010.)
Dr. Hegde begins his article with some quotations by famous people, and offers them as evidence that medicine in the past was better than it is today:
The quote below is one of the many brilliant sayings of that great brain, Sir William Osler. ‘One of the first duties of the physician is to educate the masses not to take medicines.’
Dr. Hegde, I guess you forgot to mention that this was intended for the quacks who call their wares “medicine”. I challenge you to never take any medicines. Also, William Osler has also said this: “The greater the ignorance the greater the dogmatism.”
In the 21 century, I could only echo that great sentiment as a truism, despite all the tall talk about the “so-called” evidence-based medicine. Napoleon Bonaparte went one step further, but one could argue that he was not a physician. He was at the receiving end of such a medical practice when he died. “Medicine is a collection of uncertain prescriptions the results of which, taken collectively, are more fatal than useful to mankind.” Napoleon, though, was more accurate scientifically today.
The thing to remember is the time when these people made those alleged comments. What was medicine then? It was not what we have today! There was not much useful or factual there in “Medicine” in those days. It involved primitive practices like Leeching, Blood letting, Purging, etc. No wonder people tried to come up with all kinds of “alternatives”. Evidence Based Scientific Medicine (EBSM) has marched on tremendously in the past 100 years to be entirely different from what these gentlemen knew at their times as “medicine”. If I could point out a proverb in Tamil, “Aayiram paerai konnaathaan, ara vaithiyan!” (it’s only when you kill a thousand people that one can become even half a doctor) – that was medicine for you in those days. Trial and error; no proper scientific methodology. That was the basis of your “ancient medicine”.
The latest science says uncertainty is the only certainty in the world. This is truer in medical science.
Really? Is there any uncertainty about what causes Malaria? Or Tuberculosis? Or what is the reason for Down’s syndrome or the fact that Rickets is caused by Vitamin D deficiency, or that Nyctalopia (Night blindnesss) is caused by Vitamin A deficiency? I wonder which “medical science” you are talking about. I am sure you are referring to the medical “science” of S.C.A.M.s (So-called Complementary & Alternative Medicines) and not Evidence Based Scientific Medicine (EBSM).
A proverb is a short sentence based on a long experience. If that were so, this one from Voltaire would take the cake: “The art of medicine consists in amusing the patient while nature cures the disease.”
Again, just imagine what was the level of advancement of “medicine” during Voltaire’s times, viz. the 18th century. That would explain why the great man said that. The same Voltaire has also said, “A witty saying proves nothing!”.
Time and again, I have written in my articles elsewhere that our evidence base has been built on loose sand.
Have you provided any good evidence for this allegation? Even assuming it is built on loose sand, that doesn’t mean you start questioning its basic principles. Our endeavour must be to strengthen the foundation, to tighten that “loose sand”. The evidence base is the ONLY way to a better system. And as with everything scientific, the “evidence base” is not any infallible and unquestionable dogma! The quest for betterment is a never-ending process that is constantly scrutinized rigorously and in the process ironing out the flaws, accepting newer evidence and discarding proven false or spurious evidence. Perhaps you can read about Barry Marshall to find out how important it is to provide evidence before your hypothesis is taken seriously.
Of course, no one seems to take it seriously.
They would have, if it had any financial interest behind it.
I knew this was coming! 🙂
The present Randomised Controlled Trials and linear relations help generate billions of dollars in chemical therapeutics even if that results in thousands dying of our efforts directly or indirectly. A study by researchers in a respectable U.S. university of the placebo-based RCTs did show that the contents of the placebo capsule, which need not legally be made known to the regulating agencies like the FDA, were very potent substances that would show the company drug as very effective in comparison. To cite an example, anti-diabetic drugs are usually compared with sugar filled placebo capsules! Many such glaring criminal activities have come to light now in the field of “Evidence-based medicine” of today!
Do you realize what you have just said? I hope you are blaming the individual trials and not the method. If it’s the former, then you are entitled and even upright about it; but in case you are trying to deride the method itself then I am afraid that your argument is a weak one. http://www.bmj.com/content/316/7126/201.full
Perhaps you didn’t notice this: Even this information bringing to light the despicable act of manipulating trials to show the desired end results, was a result of another study which was again scientific! I would like to point out once again that SCIENCE IS SELF-CORRECTING. There is nothing dogmatic about science. That is the beauty of “Evidence Based” science. Even the fact that there were some unscrupulous practices going on was found out because of the rigorous, unyielding and unbiased methods of science.
Recently, I had a message from one of my students, who is a leading dermatologist in India doing innovative research. “I always wondered when I used to listen to you during my student days and respected your views all along. In dermatology evidence is found only in 28 per cent of published studies. All molecular biology companies come with an offer to give authorship if we buy their equipment for our laboratory! Doesn’t that mean that most molecular biology studies are prototype and try to find out how what is known fits into their study?”
So what? Really, so what? How can that equate to “Evidence Based Scientific Medicine is flawed”? The evidence in this case is bad. And let me reassure you that the inherent, self-correcting methods of science will iron out the flaws in due course of time. Haven’t you heard of drugs being recalled, for example? There is a regulatory body, and perhaps there may be evil, corrupt individuals in those. But all of them are accountable and they eventually get found out, sooner rather than later.
The foundations of our evidence in modern medicine like the statistical risk calculations, (especially the relative risk reductions in place of absolute risk reductions that are sold to gullible doctors in most of the “scientific” articles without mentioning the NNT figures) and, the RCTs, which have no true science base, are very shaky, indeed.
Now are you accusing the foundation itself to be flawed? I agree that the “Big, Evil” Pharma companies might indulge in these kinds of shady activities. But have you ever wondered why they still keep talking in terms of RCTs, etc? That is because these are the only methods to assess efficacy accurately. Can you envision any other more valid method?
But when a Professor like you doesn’t understand it, how can we expect the general crowd to? The key remains not in deriding the method but in educating the doctors and the consumers about how to assess claims and analyze the research methodologies. A dose of skepticism is what we need to prescribe. I suggest you read the book “Bad Science” by Dr. Ben Goldacre. In fact, if I could, I would make this book a compulsory subject for all school students!
We need to have a new science of man, which is sadly missing in this whole bargain.
New science? What’s that? It is either science or it is nonsense, period. There is nothing like ancient science, medieval science, modern science, Indian science, Chinese science, Islamic science, voodoo science, or occult science. Anything that follows the scientific method is science. The rest is mere pretence.
Let us continue:
Physics changed in 1925 and there is no more physics, but we still use the same old physics laws for our statistics.
Again, so what? General relativity may have superceded Newtonian physics, BUT for basic purposes and practical ease, Newtonian physics is still good enough unless you want to pick on the nitty gritties. Don’t tell me it is totally useless. Not at all! It still gives fairly good understanding for all basic purposes. And your point that the “same old physical laws” are being used for our statistics is a non sequitur. Things won’t change much if we use the newer methods. It’s not that if we apply the latest, cutting edge physical laws, then automatically all the S.C.A.M.s will be validated while EBSM will be discredited. But hey, why don’t you try it?
Matter is not made up of matter. Matter and energy are interchangeable. (journalofcosmology.com/QuantumConsciousness106.html) Human molecules communicate with one another which can now be documented through the photon lights emitted from each DNA.
Woo, and more woo. Notions of “quantum consciousness” have been debunked. Let’s restate what you have said, shall we? “Human molecules communicate with one another which can now be documented through the photon lights emitted from each DNA.”
What?! How can molecules communicate with one another? Then what about the molecules in an inanimate object? Are they any different from those in lifeforms? You are credulous to the core, and I hope you learn some critical thinking skills.
What is the science base of our reductionism, organ based specialisation and our reliance on Mendelian inheritance?
The proof lies in the pudding. These concepts have been proven to be working.
Instead of trying to rehash the existing evidence base, it is better to think of a new evidence base for health and illness.
Well, nothing wrong with that. All the progress everywhere is exactly because of this. And, this is in fact a key feature of science! A new evidence base that you are advocating is indeed worthwhile. But rest assured that unless the current concepts are “DIS”proved, they will remain. The aim is not in formulating dogmatic theories and sticking obdurately to them, but in better understanding of medical science. Newer evidence is always welcome. In fact, any newer evidence that might contradict the existing concepts will be thoroughly investigated and gladly accepted if it stands up to rigorous scrutiny. So, if you really have some ‘new evidence base for health and illness’ then please put them forward for peer review. Let’s see how they stack up to current knowledge.
Health is a state where each human body cell is in sync with other cells. Illness is when this communication breaks down. (en.wikipedia.org/wiki/Biophoton)
This is no different from the concept of the “Ancient Wisdom” (this term itself is a fallacy- something ancient need not necessarily be wise) involving the “phlegms”, “biles”, “imbalances” and various other fanciful words. You have merely rehashed those ancient concepts of biles and phlegms into a new-age version of “communication and sync between molecules”.
Now, that’s an assertion and a statement… if you can back it up with evidence and how it can be falsified, then it will be useful. Thank you.
We need a new non-linear, holistic, dynamic, scientific base for future medical research.
Only the Scientific part is essential. It will definitely encompass useful contributions (if any) from the other mentioned parts.
Nature has provided a robust repair mechanism inside the human system –
May be robust, but not ALWAYS satisfactorily complete. And for your kind information, cancer is “natural” too.
– which has been weakened by our modern lifestyle.
So, blame the modern lifestyle. Don’t blame the science. And in fact, even this information is a result of a SCIENTIFIC inquiry.
Even though both Claude Bernard and Louis Pasteur did note that the “terrain is more important than the seed” we have gone the whole hog on the seed, risk factors, and what have you. Modern medicine has forgotten the essence of illness care which is basically strengthening the terrain.
More bunk! Where exactly has ‘modern medicine’ forgotten the essence of illness care and strengthening the terrain? I hope you are aware and have not forgotten about the field called “Preventive & Social Medicine”. It is an elementary subject in medicine and one cannot become a doctor without studying it.
Our ancient wisdom Indian Ayurveda and many other complementary systems stress just that fact to strengthen one’s immune system. Ayurveda has many immune boosting modalities in its armamentarium.
I was wondering when this would come up. The various S.C.A.M.s (including Ayurveda) might talk about “strengthening the immune system” but what do they offer? What exactly does “strengthening the immune system” mean? It’s easy to say such things, but what is their understanding of the immune system? It’s zilch! They knew nothing about illnesses! All that they had was a defunct concept involving such chimerical entities such as Vata, Pita & Kapha! Do you have any literature of the so called “Ancient Wisdom” that actually explains the immune system of the body and methods to strengthen it?
Many simple methods which have stood the test of time are being forgotten now, thanks to the brainwashing of the masses through mass media advertisements about the wrong approaches to keep one healthy.
For example? Can you name just one? These ancient systems may not entirely be useless. Let us point out that, it is a simple equation… If there is a way these ancient systems can help then it is by pointing out these “simple methods” that the ancient systems may have found out by trial and error, so that science can analyze it scientifically, identify the exact component of the concoction that is effective in alleviating the symptoms, the therapeutic characteristics, the adverse effects, ceiling dose, antidote in case of over dosage, and any safer alternative for the effective individual component including a synthetic form.
The leading one among them is goading people to have a regular “health” check-up.
Having a regular health check up is not a crime! What exactly in this practice do you find is bad? Let’s say someone is willing to sponsor a regular health checkup, will you suggest to decline it? Why?
Nothing could be more dangerous than that to apparently healthy people.
That is a statement that is condescendingly nonsensical. I urge you to re-read it and correct it forthwith. NOT getting a regular health checkup is definitely more dangerous than getting one regularly. Every single time! Just imagine yourself with a tumor or a brain aneurysm waiting to burst! Or perhaps a glaucoma?
And, I wonder how we can know if someone is healthy or not, without taking recourse to some scientific method?
When one is healthy one should NEVER ever go for a check up!
Nothing could be further from the truth.
The common man will have the doubt as to how he/she could know about health. One is healthy when one has a) enthusiasm to work and b) enthusiasm for being compassionate. One of the ancient exercises could be the most potent modern medicine, a daily walk if one is not a physical labourer. Universal love is another life-giving elixir.
After 25 years follow-up of one of the largest-ever studies of risk factors (which are being sold to the gullible public day in, day out as silent killers), the MRFIT study (Multiple Risk Factor Interventional Trial) observed that: “In conclusion, we have shown that it is possible to apply an intensive long-term intervention program against three coronary risk factors, high blood pressure, cholesterol and smoking with considerable success in terms of risk factor changes. The overall results do not show a beneficial effect on CHD or total mortality from this multiple risk factors intervention trial. (Zukel, Paul and Schnaper, 1981).”
In other words, they found that changing the “risk factors” does not apparently change the risks. This necessarily means that the “risk factors” are not as important as was thought. Indeed, it should be concluded that the “risk factors” were no such thing, at least as far as this trial is concerned.
Did you even realize that what you are saying here is also a part of the scientific method? EBSM involves precisely this. Everything follows the scientific method. Okay, now that you are sure that changing the “risk factors” does not apparently change the risks, I challenge you to indulge in smoking, high cholesterol food and avoiding any kind of measure against high blood pressure including anti-hypertensives if you may be taking any!
hardly any significant difference in the outcomes in mortality between the groups whose blood pressure was tightly controlled with drugs and the groups that changed their mode of living to a healthier one.
Again I repeat, where exactly in the annals of EBSM is it stated unambiguously that only medications need to be taken and no change to a healthy lifestyle must be undertaken? Your research methodology needs a lot of work here. Variables must always be separated! Let’s see a group that takes only medications and no change to a healthier lifestyle and compare that with a similar group that takes no medications and refuses to change to a healthier lifestyle. What do you think would the result be? Any guesses, sir?
Surrogate end point research could, at times, be dangerous especially in medicine where the NNT (a statistical term denoting the number needed to treat) is prohibitively high.
Well, what exactly do you propose as an alternative to the medications in such cases? If you are going to harp about lifestyle modification, then I wish to point out that lifestyle modification need not be considered as something alien to EBSM. These studies that you are citing are part and parcel of the scientific method that EBSM espouses. If we do a study and find that something is not that effective, then we try to modify it or abandon it and move on in the search for better modalities and interventions. Simple. (Aside – I hope you are aware of orphan drugs?)
I am sure the reader by now would have realised the significance of what William Osler’s prophetic statement of 1905 meant when the great physician did not have any of these powerful drugs that we have today.
Well sir, you have yourself admitted that they did not have the powerful drugs (and the investigation tools, and most importantly the knowledge) that we have today.
Cure rarely, comfort mostly but, console always should be our motto when one is ill.
I prefer this: Cure every time (if a cure is available); comfort every time (this is certainly possible); console always.
Patient care simply is caring for the patient.
Well, you are playing to the gallery now. You didn’t care much for humanity when you made such loose statements such as, “When one is healthy one should NEVER ever go for a check up”.
Let me make a fervent plea for parsimony in using drugs in the healthy segment of the population, by labelling these so-called risk factors as silent killers, in the fond hope of averting major problems in the future.
Well, even I am not averse to parsimony in using drugs in the healthy segment of the population, by labelling these so-called risk factors as silent killers, in the fond hope of averting major problems in the future. But let us apply that same parsimony to unproven, unscientific systems of S.C.A.M.s which are far more dangerous and useless.
We simply do not have any scientific evidence for their benefit as of now.
Thank you for finally using the words “scientific evidence”. That is the key point of this extended rebuttal of your claptrap.