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EDITOR'S CHOICE: Rajendra Kale About children . . . and more BMJ 2007; 334: 0 [Full text]

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Is modern medical science immoral?

BM Hegde   (9 June 2007)

Depth and width of analysis

Krishnaswami Natarajan   (10 June 2007)

Is modern medical science immoral? 9 June 2007
BM Hegde, Retd. Vice Chancellor Mangalore, India Send response to journal: Re: Is modern medical science immoral?	Dear Editor, Both the editorials today are thought provoking, to say the least. Children doing CPR sounds great. Recent studies, however, have indicated that immediate re-perfusion and oxygenation of the lungs after a heart attack could damage the heart muscle cells much more and cause real death of the heart cells. Newer techniques of resuscitation are being worked out to avoid immediate reperfusion injury viz: hypothermia, heart lung machine use to reestablish circulation after hypothermia to give the muscle time to remodel on its own instead of immediately flooding the ischaemic cells with plenty of oxygen through effective CPR. The newer methods might improve the number of people saved from sudden arrhythmic deaths. The heart muscle cells are seen to survive for many hours after an arrest unless damaged by immediate oxygen supply. We have been using phenobaritone for epilepsy for decades with success. But newer drugs have their patrons that push them using the controlled studies as their “scientific” tool. More about the latter below. “Saying that predicting risk from genetics (is) not an exact science yet and could result in unfair discrimination.” This sentence in the US editor’s note is worth its weight in gold. Predicting the future from any of the other known “risk factors” is also not exact science but is only a statistical science. Much harm could come from predicting the future based on this kind of statistical science of deterministic predictability in the apparently healthy section of the population. Time evolution in the dynamic human system being non-linear,unless one knows all about the human being at a given point in time one could never “scientifically” predict the future. Isaac Newton himself felt this difficulty in physics. If the exact position (and perhaps its velocity) of each and every particle in this universe could be known at a given point in time, one would be able to predict the future correctly, he felt. No one could do that even to this day! In that sense hypertension, hyperglycaemia, hypercholesterolemia etc. in the asymptomatic apparently healthy population could only be “risk factors” having very limited role in predicting the future. Therefore, they are not to be treated as “diseases” as we do now. The correct science in that area could be our advice to change the individuals “mode of living” in the true sense of the word. If we try to change those “risk factors” by intervention-drugs or surgery- there is no scientific method to show that the interventions help in the long run. Cancer screening methods also fall into the same category. Similar “science” is being used in the so-called gold standard for most medical research-randomised controlled studies. We compare a few of the phenotypic parameters of individuals to group them for comparison! The groups have very little in common. Unless we get all the details of those individuals, impossible with our present knowledge of human physiology, we are predicting the unpredictable in this area as well. True comparison is possible only with cross over studies where the same individual becomes his/her control. I would have liked a holistic approach to these problems instead of our nibbling at bits and pieces. Let us move from the reductionistic medical science to the holistic healing science.In that sense, is modern medical science immoral if not unethical? Yours ever, Bmhegde Competing interests: None declared
Depth and width of analysis 10 June 2007
Krishnaswami Natarajan, President,Flower Growers Assn of India 600004 Send response to journal: Re: Depth and width of analysis	The article is well researched. We are in a universe with no boundaries. Unfortunately, most of the research work is today with a prescribed defined goal for commercial success. If those researches continue to be there and the conclusions are arrived at after a throrough debate- internal / external, atleast we may inch towards truth! Competing interests: No competing Interest