More research is needed—but what type?

Dear Fiona,

The caption comes from the 1854 book, Walden, by Henry David
Thoreau, which shows why we love our conventional research
so much even in 2010.

Science is making models, mostly mathematical constructs,
which with verbal explanations are supposed to work! That
was the opinion of one of the great brains in science, John
von Neumann. Western science is lost in this mess and is
searching for a better model for future research. A leading
western scientist, Douglas C Wallace, writing in the famous
Genetics Journal, has shown that the non-linear model of
Asian medical systems like Ayurveda is more useful to human
physiology and recommends those methods for future research!
The mathematical base of modern medical research is linear
while the human body is non-linear. All the research we have
been doing has come to grief. First, human diseases
affecting a wide range of organs could result from systemic
defects in energy metabolism and, second, hereditary human
diseases could result from mutations in the non-Mendelian
mtDNA. Consequently, mitochondrial biology and genetics
become excellent candidates for expanding the anatomical and
Mendelian paradigms to address the complexities of the age-
related diseases, ageing, and cancer, wrote Wallace.
(Genetics 2008; 179: 727)

It was in the year 127 AD that a great teacher of
medicine, Galen, wrote that the liver pumps blood around the
system. For the next 1500 years all teachers and students
everywhere wrote their research papers based on this
premise. It was only in the year 1628 AD a thinking family
physician in London, William Harvey, observing a fire
hydrant working, thought that the heart pumps blood.
Knowledge advanced after 1500 years. I ask the same question
today. Is the heart a simple muscular pump? The answer is
probably-NO. But who cares? If one reads my article in an
indexed journal entitled is the human heart a simple
muscular pump one would be shocked to know how far away from
the target are we hitting.
(medind.nic.in/jac/t10/i1/jact10i1p16.pdf) Many such wrong
ideas are being taught and followed.

All that I wish to convey through this response is that many
good THINKERS among students could do good research. No law
will make any one a thinker!! If doctors confined themselves
to curing the sick rarely, comforting them mostly, but to
consoling them always, they would be doing a great service
to the public. Good teachers and researchers are as
important to a medical school as are good bedside
clinicians. These two breeds, combined with a few thinkers
who could do genuine research to take knowledge forwards,
would be an ideal combination in medical schools to motivate
students with different skills and interests. It will be
foolhardy to expect all these three in one individual except
very, very rarely.

Modern medicine is becoming unpopular in the west. In the
year 1997 alone 629 million people took treatment from
alternative systems of medicine in the west paying from
their own pockets. This is more than the number of people
that saw their family doctors in the same year, according to
a survey done by Eisenberg and colleagues in 1998. (JAMA
1998; 280: 1569) India should take note of this as we have
one of the best systems of health care in Ayurveda,
especially for chronic illness syndromes. If this could be
judiciously clubbed with the emergency care methods of
modern hi-tech medicine, complementing each other, we could
bring down the costs of medical care to almost one tenth of
its present level with less ADRs as a bonus.

The future lies in emphasizing promotive health. We should
change the present teaching in medical schools from the
disease-centred education to that of patient-centred
community based education. We should use statistics
sparingly in medical research. One of the drawbacks of
applying disease statistics to the healthy population is
that the latter throws up a very high percentage of false
positives, resulting in epidemiologists predicting the
unpredictable, resulting in epidemics. The fear of an
illness could help the illness to take a strong footing in a
healthy person. Modern medicine has realized that the human
mind plays a vital role in disease causation as well as its
control. Hence there is a need for doctors to train
themselves in human psychology and behavioral sciences.
Health is our birth right. Diseases are only accidents. If
one follows the correct rules of healthy life style,
accidents (diseases) will be rare indeed!

If we are interested in getting better medical scientists in
the future we should see that every medical school has a
department of medical research with a decent budget, headed
by some one who has done real good refutative research work
published. S/he must be adequately compensated lest the
person should look elsewhere for succor. The departmental
work must be subjected to strict periodic auditing. Such
teachers alone could motivate brilliant young students to do
good research. Drug studies are NOT research in the true
sense. Even if such studies are needed they should NEVER be
funded by drug companies as is the case at the moment.

While good research is refutative, all kinds of repetitive
research must be shunned. Karl Popper once wrote that
knowledge advances not by repeating known facts but only by
refuting false dogmas, of which there are plenty in modern
medicine today. The medical school should be proud of such a
research department and should include that as a selling
point in the brochure for prospective students. If this is
genuinely pursued, a time will come when we will get a few
good researchers in the world. They would make us proud.
Outstanding research is only serendipitous. One can not plan
such work in advance. That said I must warn that serendipity
helps only those with prepared minds receptive to creative
thinking. Let us work to get more prepared minds in the
country and not legislate to have the usual IMRAD
(introduction, material methods, results, and discussion
type) research papers most of which are not even worth the
weight of the paper on which they are written.
Sadly even in 2010 we do not have a correct science of man.
Great minds in western science, from the time of Galileo,
were happy working on models for inanimate objects like in
Physics and chemistry. Even biology does not have a model of
its own. Human physiology is far, far away from reality with
its linear model of the inanimate sciences applied to a
dynamic human system with its all pervading consciousness.
Man is but his mind, says Indian Ayurveda which has human
beings classified into many gentico-constitutional types
which take into consideration human consciousness as well.
These classes could then be used for better RCTs; the latter
at the moment compares only a small fraction of the
phenotype of cohorts! One size fits all is foolishness in
our present research. Individualised medicine has gone out
of the window. Peer review is the enemy of progress as the
peers can only deal with the known and if a refutative
researcher wants to publish an out of the box thinking paper
that would promptly go to the waste paper basket.

Let us think out of the box rather than use more complicated
Latin words for new research with the same flawed science of
man. Intellectual integrity made it quite impossible for me
to accept the myths and dogmas of even very great
scientists, more particularly of the belligerent and so-
called advanced nations. Indeed, those intellectuals who
accepted them were abdicating their functions for the joy of
feeling themselves at one with the herd.(Bertrand Russell-
1872-1969)

Yours ever,
bmhegde

Competing interests:
None declared