The mythology of modern medicine--I. Scienstition.ML Kothari, LA Mehta
Keywords: Human, Medicine,
Ostensibly scientific medicine and mythology seem contradiction in terms. Eugene Garfield, famed for Current Contents and all that, declared that his organisation ISI (institute for Scientific Information) was a compelling communicational necessity to help every medical Tom, Dick and Harrieta keep pace with the ceaselessly advancing medical scene. An American medical journalist described the USA as "a country in which medical breakthroughs occur with dizzying regularity." Modern medicine, so it would seem, never has had it so good. So, where is the mythology?
Mythology is also a state of the art reality wherein you see what is not there and proclaim what is nowhere around. In Vedantic parlance, the term mithya is basic to the Vedantic idea that you, and the world, are NOT what you think they are. So, in modern medicine, no matter how sophisticated or latest, from Harvard or Harley Street, there are a number of concepts and actions that are NOT what the doctors think they are and their patients think they ought to be, and hence constitute its Mithya-tatva, its mythology. Under such circumstances, what is passed as science is superstition of a kind, a sort of scienstition.
Fresh from the medical frying pan is a journal BioMed-Magazine for Medical Update. The editorial is pollyannaistic: "The specialisation in modern medicine is growing very fast... BIO-MED is a multi-faculty medical update magazine, the first of its kind in India which will keep your knowledge updated about the rapidly changing medical scenario, may it be in the field of diagnostic technology, laboratory equipment, treatment procedures or conceptual changes in the rehabilitation process. The aim is simple, keep you in touch with medical progress." The gloss and the advertisements are enough to tell the discerning eye that the journal will help sell yet more gadgets, more tests, more procedures, more bankruptcies through medical bills. Sir Wilfred Trotter, England's surgeon-philosopher, used to marvel at the mysterious viability of the false. BioMed is but an example of prosperous medical mythology, a blanket term for the mysterious viability, nay prosperity, of many a patent medical falsehood, as detailed below:
1. Modern medicine is held synonymous with allopathy, a term and concept founded in 1842 by its arch rival Hahnemann to connote a mode of therapy that cures one disease by causing another. Rob Paul to pay Peter.
2. By modern, allopathic admission, in 9 out of 10 problems, modern medicine is symptomatic, palliative achieving this by suppressing this enzyme here or that chemical there, unleashing in its wake a whole new science of latrogeny, more truly latral Medicine. Peter may feel eased for a while but Paul, ipso facto, must feel dis-eased.
3. Yet, modern medicine's mania for mastering mankind's maladies marches merrily, monetarily, menacingly. Hence the plethora of anti-drugs inbluding, as examples, anticancer, antiarthritic, antidiabetic. Each anticancer drug began as procancer in the animal, and, in the human body, it is anti-every-dividing-cell but never anticancer. An antiarthrtic is antistomach, anti bone- marrow, antiskin but not antiarthritis. All antidiabetics are -hypoglycemic agents, nowhere antidiabetic, and at best, glucostatic agents. Many a therapy -allopathic, homeopathic or Unani - is a doctor's knee-jerk response to a patient's complaint, the anti - prefix being the epitome of this reflex response.
4. Harris popularised the transectbnal phrase I'm OK, YOU're OK, by his famous book so titled. But in the patient-doctor interaction, the all-too-common assertion by the seemingly learned is I'm OK, You're NOT. In this battle of the learned versus the lay, the dontrast between the mere information of the former versus the direct experience of the latter is lost sight of. A medical man in the USA, Chad Calland, underwent kidney transplants, to experience this interactional lopsidedness: "Patients on dialysis are accustomed to being told by the doctor, 'You are doing fine' - usually after the latest measurements of electrolytes and creatinine. The patient then thinks to himself, 'if I'm doing fine, why do 1 feel so rotten?' After undergoing correction of several days' accumulation of metabolites in a few hours, who could feel well with the resultant cerebral edema? Who, with a hematocrit of 17 per cent feels well enough to function when he cannot climb his own stairway because of dyspnea?
After a number of such visits to the doctor, the patient beglins to think that perhaps his very real symptoms of fatigue, dyspnea, muscle weakness and so forth are products of a deranged mind, so that he begins to conceal them because he is ashamed. Eventually, the time comes when the patient complains of nothing, and the doctor is thus wholly unaware of these symptoms, just as he is unaware of the other (marital, financial and social) difficulties that the patient is experiencing.
Patient on hemodialysis know these facts better than the physician does, because the patient alone experiences them - often in isolation. Is it any wonder that the patient feels less valuable than any healthy person and doubts the worth of his struggle? Is it necessary to postulate psychiatric disorders to understand the self-evident?"
5. The medical arena was overcrowded with books and journals. To add to this cacophony have now arrived audio-cassettes, video-cassettes, and on-line computers to help the desperately busy medical student/resident/teacher/practitioner/researcher have ready, capsulated access to the latest, the best. All work and no play, no reflection, no repose makes the medical Jack a dull boy.
The literary vanity of file medical mind is exemplified by the way Current ContentsR is propagated: "What is Current Content? CC is your only personal library of over 1,180 of the world's most important journals contents of the latest journal issues published and saves your valuable time locating information vital to your professional needs. The compact weekly editions can be carried with you everywhere and read whenever you have a minute to spare. The easy to scan format helps you to keep on top of more than 231,000 journal and book articles published every year in life sciences. Each CCR issue contains these weekly features... ISI offers fast, efficient document delivery service." As an outline computer service, ISI also offers CC SearchTM and CC ConnectionTM.
Some phrases in the foregoing have been italicized to expose the mythology of the too busy a doctor. The superscripted CC by R and CCS and CCC by TM betray the colossal business-sense behind these seemingly scientific ventures. This American spirit of free enterprise is advancing its stronghold on the Indian psyche, that by itself is oblivious of a comment that Time magazine made sometime ago: "Free enterprise can be free of all restraints."
Waiter Alvarez, the pioneer gastroenterologist at the Mayo Clinic wrote his autobiography in which he described the saddest moment of his tenure at the Mayo Clinic. One would have thought it was his day of retirement. Yes, it was, but for another reason. That day, he happened to go the Mayo Clinic Library and accidentally picked up Oster's Aequanimitas, only to discover that the book had not been cut by any member in the preceding 10 years. No wonder, Sir John Apley lamented that we medicos are overeducated philistines.
The typical successful American physician is supposed to be too busy for his family and hence the divorce rates are so high. What price medical busy-ness! We are all brought up on a diet of enormous medical trash that effectively elbows out philosophy, religion, Shakespeare and Vinoba Bhave out of our lives. We end up being - the overeducated, nay, the overinformed robots, the shallow philistines. Physician, Heal thyself!