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EDITOR'S CHOICE: Jane Smith Finding meanings BMJ 2008; 336: 0 [Full text]

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Who are we fooling?

BM Hegde   (10 March 2008)

Prof Hegde is right!

Sumithra Josepha   (13 March 2008)

Who are we fooling? 10 March 2008
BM Hegde, Retd. Vice Chancellor Mangalore-575 004 Send response to journal: Re: Who are we fooling?	Dear Editor, This week's BMJ makes very interesting reading. Let me first take up the article on primary care, Alma Ata declaration etcetera. What are we talking about? Are we talking about medical care for all by 2000 or health care? Health care, in the true sense, has very little to do with medical care, be it primary or tertiary care. Health care for the majority in this world boils down to supply of clean drinking water, uncontaminated three meals a day, a roof on their head instead of the starlit sky, toilet facilities and other sanitary amenities, economic empowerment of poor women, education for all, especially for the girl child to avoid child marriages in many parts of the world, family welfare, nutritional care of pregnant mothers to have a future generation with adequate organ development, employment for the able bodied, and education about the hazards of alcohol and tobacco. What is the role of hospitals, primary care deliverers or other doctors, in this area? I remember a well known British thinker once saying that the idea that hospitals and doctors keep society healthy is plain rubbish! Poverty and malnutrition are our biggest enemies of health of all, not by 2000 AD but even by the next century. While 40 million AIDS sufferers prick our conscience so much that we bend over backwards to sell costly drugs to kill that evanescent virus, we are not concerned about millions of children all over the globe, especially in the poorer countries, suffering from NIDS (nutritional immune deficiency syndrome) who die of multiple causes unsung and unwept by the medical scientific community and the media! These poor children having NIDS are generously given all kinds of vaccines (we are even having NGOs doing that) without realizing that the vaccine needs serum proteins to build adequate antibody levels against the deadly disease that we think we are trying to prevent. Live virus vaccines are the ones that need more care about the prior nutritional status of the recipients. It is not that we do not have the resources, but the latter are held by a handful of people in the world while the millions go to bed hungry every night! There is enough in this world for man's need but not for man's greed! Caring is only sharing. We are trying to make money out of people's misery by selling costly drugs to poorest of the poor in this world who have the highest incidence of all diseases from cancer to common cold. Health for all needs empowerment for all. Let there be a new Alma Ata declaration and let the world leaders cross their hearts and pledge that they are committed to that. Doctors who claim to be leaders in the community have a great responsibility to educate society about the real need for health care. The rich also will benefit by having a healthy society around them. Mental aberrations like terrorism, robberies, crimes of all kinds and social unrest begin with oppression, suppression and denial in the first place. It is, therefore, in their own interest that the rich better look after the poor. Let us not beat about the bush by our reductionist idea that primary care will deliver health for all. While doctors and hospitals are absolutely necessary while one is ill they are a nemesis when we are well. If a "well" person today goes for a check up, s/he has no chance of coming back as a "well" person. Our definition of normal is so badly skewed that if all the known parameters are tested in all of us on a routine basis, while we are still apparently healthy, we will all be declared fit for intervention of one kind or the other! Good business for the medical industry. Humanism, as defined by Goethe, should guide us. Goethe wrote in the second part of the Faust: "Reach towards the highest form of existence by the dint of uninterrupted effort. Humanism lays the foundations of individual and collective morality; it establishes law and creates an economy; it produces a political system; it nourishes art and literature." May I add health care to that? The area of anti-depressants is still more puzzling. RCTs and epidemiological studies are a gimmick to fool the public and the medical community that does not seem to go deep into the shallow science of reductionism in human affairs. While the human body is a dynamic whole that follows the non linear mathematical rules, science is simply making models, which are mathematical constructs. These models are supposed to work with our capacity to sell them using statistics. Medical science of today is just a statistical science and not true hard science. Have we not treated SMON as a slow virus disease till it was discovered to be an ADR? Did we not treat pellagra and beri beri as infectious diseases for a long time with dangerous arsenicals etc? Did we not teach that liver pumps blood around the body for centuries? To dwell in the field of the known is not progress. To dare to get into the dark allays of the unknown is true scientific adventure. Werner Forssmann would have been a simple German country doctor if he did not dare to push the urinary catheter into his own heart to get a Nobel. Progress is refutative research. While even physics has come to grips with consciousness, medicine that deals basically with the human mind, does not take consciousness into consideration in research. The "expectation effect", recently discovered, knocks off the very foundation of RCTs. In the realm of emotional abnormalities like depression same reductionist laws state that depression "is a lack of nor-adrenaline transfer from a brain cell to another. To increase the transfer by any means should cure depression" is making a mockery of true scientific principles. In reality, starting from the monoamine oxidase inhibitors through tri and tetra cyclics to SSIs, it has been a long and sorry saga which has, at best, benefitted a microscopic minority. Now that the cat is out of the bag, we have any number of players trying to show that anti-depressants are not that bad after all! God, if there is one, should help mankind as man has failed mankind. God always gives and forgives while man gets and forgets! yours ever, bmhegde Competing interests: None declared
Prof Hegde is right! 13 March 2008
Sumithra Josepha, Doctor, PHC,JKUndubelala,Kuttikole 670541 Send response to journal: Re: Prof Hegde is right!	Prof B M Hegde is 100% correct.What we need is proper preventive measures than treating disease.But for the medical industry to go on we need sick people from which we make money. My dad an agricultarist lived up to the age 90, I never remember having any disease.He lived n an era where he ate home made vegetables,worked everyday in feild and had clean drinking water from the well from home.Though he did not enjoy modern facilities like tv etc he lived a very happy life till his death. Now I live in an era where I get vegetables with pesticides, water which is tretaed with chlorine and air which is polluted.I have all moden day amenities but my lfie is filled with uncertanities and tension.I am sure I am going to die slowly of HYpertension,Diabetes,IHD and renal failure. Competing interests: None declared