Modern Medicine in search of its Holy Grail

Professor B. M.Hegdehegdebm@gmail.com

“One can not be just if one is not humane.”

Luc de Clapier

The truth is something which can never be attained by scientific pursuits. Even in the hard sciences like physics, leave alone the not so perfect statistical science of medicine, the truth is an impossibility to get at. One could, at best, say that s/he has got “A truth but not The truth” at a given time. Any finding is true until it is proved to be untrue! JJ Thomson, from Cavendish Institute, got the Nobel in 1906 for showing that electrons were particles. His own son, JG Thomson, got the Nobel in 1937 for showing that electrons were waves. That was the time that the de Broglie’s wave/particle duality became overwhelming and in 1932 James Chadwick gets the Nobel for that work. Erwin Schrödinger had other ideas and so on and so forth. Ultimately, electrons are what they are depending on who looks at them at what time. When no one looks at them we do not know what they are like. Science can never see an electron!1 Total transparency is another unattainable goal in research.

Quantum physics is probably far removed from reality for obvious reasons as medical science is far removed from reality of what goes on in the human system with all its intangibles and imponderables. “No scientist (medical included) can reach a stage where s/he could flex the muscles and say that s/he is now ready to take on ignorance and disease head on!” But the real truth comes out in Werner Heisenberg’s uncertainty principle which got its Nobel belatedly after thirty one years in 1956, as many of his seniors, the leaders of the day in physics, did not believe him. The working of this world, including that of the human body, at its subtlest level, is uncertain but we, in medicine, have been predicting the unpredictable future of our hapless patients every day!

No one can possibly see an electron is now a reality, but all have been talking eloquently on the electrons, just as we in medicine talk a lot about the diseases but not about the owner of the disease, our patient at hand, who possibly could not fit into many of our known paradigms. We are yet to learn a lot about human physiology. There is no science of man as of now is accepted by even the Nobel scientist, Dr. Alexis Carrel. Our RCTs and many other benchmarks can not fit all. RCTs have been lately discredited.2 Our bane has been the concept that one size fits all, the free size hypothesis. Any patient sitting on the hospital bed is so unique that s/he might not fit into any of our treatment algorithms. Our experience and judgment are our only saviours in such situations. That is the “art” of medicine which is dying in the midst of the cacophony of pseudo-scientific noise.

A humane doctor’s placebo effect could, at times, be more powerful than most of our chemical molecules!3 We should never allow a humane doctor’s art of medicine to die a natural death, as is happening in many of our hi-tech teaching hospitals, lest we should all be consumed by the Promethean fire that Peter Medawar was talking about. We should allow enough leeway for the “third world” of Karl Popper to exist where we could have a near real world of our thought creation, so called thought furnitures, to help our patients.4 Hans Peter Durr’s a-duality (matter and energy are the two faces of the same coin and Fritz Albert Popp’s bio-photons now reveal the true picture that the human body is not independent of the human mind.5, 6 It is better referred to as mind-body or body mind. Rather, there is a mind in every cell of the human body. Consequently, all so called diseases are but psychosomatic!

Medical education should concentrate on teaching students to keep their eyes open to possibilities out with our known paradigms and not just parrot repeat the known knowledge from textbooks to get their degrees and then stop thinking about what goes on in every patient in the real world out there. Two identical diseases might not respond to the same treatment in two different patients; the latter might not even present identically. Our teaching should stress on methodology and not just on known facts which are, at best, temporary truths. The textbooks are outdated by the time they come out of the press. Clinical research is “to have a problem on the bedside and to go as far away from the bed as possible to get an answer,” keeping in mind the definition of research as “organised curiosity coupled with logical skepticism.”

Nobel Laureate Peter Medawar in his best book “Limits of Science” says it all: “The nature of science is such that a scientist goes on learning all his life-and must-and exults in the obligation on him to do so…..there can in science be no apodictic certainty-that is, no finally conclusive certainty beyond the reach of criticism.” He also thinks that there is an unlikely “possibility of technology creating a Promethean fire which, is feared, will one day do us all in.” 7 All science starts with a hypothesis, in the words of William Whewell “happy guesses”, another one of those mind’s thoughts which are being tested using the “known” parameters. They are the same as Shelly’s poetry (poesies=creation) or Samuel Johnson’s word “imagination” when he said something like this: ‘But for imagination, Sir, a man would be as happy in the hands of a chambermaid as in the hands of a duchess!” So science has its limitations although in theory one could get anything verified. A good doctor could answer some of the most difficult questions for science using his humane compassion. One such question could be “why” does one die? How one dies, science can answer very easily, I suppose but, not why does one die?

“Of all the anti-social vested interests the worst is the vested interest in ill-health,” wrote George Bernard Shaw. He was dead right when he wrote the above caption. In all other areas “vested interest is an interest in which there is a fixed right to present or future enjoyment.” In the medical field that comes down to simple rule that the patients do suffer and might even lose their lives because of medical arena’s vested interests; consequently, it should be condemned in very strong words. Vested interest is killing modern medical science and misleading the medical profession by various fraudulent means, the best being the pseudo-science they claim to base their opinions on. I shall cite a few glaring examples that must have resulted in millions of people suffering and a few thousands meeting their maker in heaven.

The battle of the clot busters is a fine example of the vested interests playing havoc with human lives. While the largest ever study, monitored by Oxford group (1000 hospitals with 46,000 patients), clearly showed that the very expensive tpA was as good as the time tested streptokinase but had the additional danger of 10% extra deaths due to cerebral haemorrhage. Peter Sleight was presenting this data when the American mafia tried to outsmart him with their tactics which ultimately led to some heads rolling there. The story in the BMJ of the Battle of clot busters and the associated article by Richard with a sensational title “What a feet?” with the photograph of the large bare feet of Professor Sleight was a collector’s delight! 8

When the Joint National Committee V report came out with the guidelines that diuretics and beta blockers should be the first line of treatment in mild to moderate hypertension, an unusual thing happened there. While JNC was supposed to be the best body to send out periodic guidelines, the Pharma lobby there was not amused. Their henchmen, the “thought leaders in the US, wrote an article suggesting that the JNC. V guidelines should not be adopted by doctors but instead the new guidelines put forward by this group should be followed.9 This has never happened in the past! See what they had to say: “As a result, health care providers should not feel compelled to regard the preferences of "official" guidelines as the best, modern, state-of-the-art therapy for an individual patient. All seven experts who are deeply involved in the daily care of patients preferred drugs other than beta-blockers and diuretics (the Joint National Committee [JNC] choices) for first-line therapy of hypertension.” Individual preferences are shown to be better than the expert committee’s advice! Modern strategies to prevent coronary sequelae and stroke in hypertensive patients differ from the JNC. V Consensus Guidelines. 10

In a Critique of Selected Aspects of the Thrombolysis in Myocardial Infarction IIB (TIMI IIB) and the Thrombolysis in Myocardial Infarction IIIB (TIMI IIIB) Trials in 1992 Roehm had shown how the vested interests twisted the truth by using the statistical numbers game against the interests of the hapless patients.11 Michael F. Oliver, a former professor and director of the Wynn Institute for Metabolic Research, London and a leading researcher in the world on the fat hypothesis was the one that tried his level best to bring some sanity to the mad rush to bring every one’s cholesterol to the lowest levels using dangerous chemicals. His article “Consensus or nonsensus conference” was an eye opener. 12 His other article in the BMJ entitled: Doubts about preventing coronary heart disease. Multiple interventions in middle aged men may do more harm than good, had been the best revelation of the fraud committed by the Pharma lobby to sell their wares. 13 In fact, a large Finnish study as also the MRFIT study had shown the futility of preventive strategy using drugs. 14 But the business in multiple drugs attacking the so called risk factors keeps earning billions for the drug companies!

A beautiful hypothesis to sell aspirin to healthy people in the fond hope of keeping them on the planet for ever has recently been slain by the ugly facts that showed that the drug could in fact do the reverse!15 I can go on and on but, vested interests alone rule the roost. We could shout from house tops and get our throats dried up but they will do their business as usual. The story is the same about many surgical procedures that keep the hospital tills moving. Cardiac revascularization efforts top the list here. Medicine can not be taken to the market place. Having taken it there we can not prevent market forces from influencing it. Ideology is good but in practice man in homo economicus, indeed.

This brings us back to Charles Sherrington, another Nobel Laureate who is 1899, being appointed Professor of Physiology in Liverpool University at the tender age of 42, said in his inaugural address to students thus: “Positive sciences can never answer the question why? They can, at best, answer questions like “how” or “how much” but not “Why”. That is precisely why Coleridge declared theology to be the queen of pure sciences. “Why” can only be answered as a palliative. Truth, is probably the first casualty in medical science of today what with all the research frauds and the “games” played by the greedy industry to keep their till moving. The humane “art” of medicine is the all time friend of the hapless patients; art being that which makes another person’s day! Long live humankind on this planet with the help of humane doctors when needed.

“To be meek, patient, tactful, modest, honorable, brave, is not to be either manly or womanly; it is to be humane.”

Jane Harrison

References

1 John Gribbin, In search of Schrödinger’s Cat. Black Swan Publications 1991. 2 Rawlins M. The Harveian Oration of 2008, De Testimonio. On the evidence for decisions about the use of therapeutic interventions. Royal College of Physicians, 2008. 3 Steve Silberman 2009 Wired Magazine: Med-tech: Drugs. 24th August 2009. 4 Karl Popper: Objective knowledge: An evolutionary approach, Oxford University 1972. 5 Durr HP. Matter is not made up of matter. 2006. www.peterrussell.com/SG/ch4.php 6 Popp FA. Biophotons-the light in our cells. www.transpersonal.de/mbischof/englisch/webbookeng.htm 7 Peter Medawar. Book “Limits of Science” Oxford Paperbacks, 1984. 8 O’Donnel M. Clot Busters. BMJ 1991; 302:1259-1261. 9 Tobian L, Brunner HR, Cohn JN, Gavras H, Laragh JH, Materson BJ, Weber MA. Am. J. Hypertension 1994 Oct; 7(10 Pt 1):859-72 10 Moser M. et. al. JNC V guidelines. Am J Hypertens. 1994: 8(5); 859-72.) 11 Rohem E. A Critique of Selected Aspects of the Thrombolysis in Myocardial Infarction IIB (TIMI IIB) and the Thrombolysis in Myocardial Infarction IIIB (TIMI IIIB) Trials. Jl. Invas. Cardio 1992: 4; 145-154. 12 Oliver MF. Consensus or nonsensus conferences on coronary heart disease. The Lancet 1985; 1: 1087-1089. 13 Oliver MF. Doubts about preventing coronary heart disease. Multiple interventions in middle aged men may do more harm than good. British Medical Journal 1992;304:393-394 14 Capewell S. Will screening individuals at high risk of cardiovascular events deliver large benefits? No. BMJ 337:doi:10.1136/bmj.a1395 15 H.J.M. Barnett, MD; M. Kaste, MD; H. Meldrum, BA M. Eliasziw, PhD. Aspirin dose in stroke prevention. Stroke. 1996: 27; 588-592. Regards to http://www.pubmedinfo.com/ where the information is taken with reference hegde sir....