By:
B. M. HEGDE
MD (Lucknow), FAMS,
FACC.,
FRCP (London), FRCP
(Edinburgh), FRCP (Glasgow), FRCPI.
Professor (Visiting) of Cardiology,
University of London,
Affiliate Professor of Human Health,
University of Northern Colorado,
Professor (Visiting) Indian Institute
of Advanced Studies, Shimla,
Former Vice Chancellor, MAHE
University, Manipal,
Former Director-Professor, Principal
and Dean,
Kasturba Medical College, Mangalore,
India.
Published by:
Dr. Ajay Kumar, MD
(Patna), FRCP (Edinburgh),
Organising Secretary,
APICON 2006,
Patna, India.
Honourable Chief Minister of a very important state of
Bihar and a roundedly educated Engineer Statesman, Shri. Nitish Kumar, Dr.
Sahai, President of the API, dignitaries on the dais, my very dear Ajay Kumar,
the organizing secretary, and beloved members of the Patna State API who have a
special soft corner for me in their hearts, brothers and sisters of my
profession from India and abroad, members of the media, ladies and gentlemen.
It gives me immense pleasure to stand before you on this momentous evening and
thank God for giving me this golden opportunity to share my thoughts with you.
Although there could be much better individuals than me to shoulder this
responsibility, I remain ever grateful to Ajay and others in the Bihar API for
having placed their trust in me to do this job. I can only assure them and you
that I shall do my best, although it
might not be the best.
Association of Physicians of India is a premier body of all
qualified physicians (internists) in India; consequently, it has a moral
responsibility to see that the highest ethical standards of professional
conduct are maintained by its members in addition to helping the latter to keep
in touch with advances in their chosen fields of expertise. API should also
have the capacity to influence the powers-that-be to innovate medical education
to suit the needs of a vast country like India where the majority still live in
the far flung villages with a hand to mouth existence; many of them in inhuman
surroundings! Poverty being the mother of all illnesses, these poor Indians
attract all the worst diseases and disabilities that man is heir to. With the
majority of us overcrowding the metropolises, there are very few to cater to
the vast majority of our countrymen and women in the villages-a truly inverse care law. The Biblical saying
that “He who hath shall be given” (Mathew Law) works here as well. We also have
a duty to educate humane leaders like Nitish Kumar to help them in their
efforts to alleviate suffering, using wisdom in our field of expertise. “Snowflakes
are one of Nature’s most fragile things, but look at what they can do when they
stick together”, wrote Vesta M. Kelly. Let us stick together and make the API
strong.
We, therefore, have a greater responsibility to see that
the health of the less fortunate in society is promoted and maintained rather
than concentrating all our energies only on the quick fixes that we are trained
to use when their health fails, since doctors are primarily trained to keep the
health of the public. In fact, in the long run, health promotion, not disease
prevention, is much cheaper than disease control. “Time has come”, the Walrus
said, “to talk of many things.”…………………..”Cabbages and Kings…….,” -time has come
for us to search our conscience to see if we are going in the right path or
not.
Health Care Vs
Medical Care:
We use these words interchangeably. This is fatal. They are
poles apart. Health care in India needs only a few things which most of us are
not able to participate in and many of us are not aware of! Clean drinking water for the masses would
get rid of majority of hospital bed occupancy today. Three square meals a day for the poor, uncontaminated by human
and/or animal excreta is the next. Smoke free house in the villages where they
cook with dry leaves, twigs and cow dung cake emanating deadly carbon monoxide
into the house making women die of cancer lung and heart attacks and children
below the age of five of pneumonias, is the third. Delaying the age of marriage
for the girl would reduce fertility significantly. This could be achieved by
sending girls to school. Economically empowering village women to reduce their
risk of anxiety and depression due to their husbands drinking and coming home
empty handed resulting in their children going to bed on empty stomach. Last
but, the most important, is to have a toilet for every house in the village and
even the slums in the cities to reduce the ravages of hook worms that today
take a heavy toll of pour children’s hemoglobin and thus their immune power.1
If the governments attend to these on a war footing the
disease burden and the need for hospitals would come down drastically. Let us
advice the powers-that-be in this regard. We owe it to the common people of
this country that we, as an organization, have advised the people concerned
adequately lest we should be held morally responsible for the despicable state
of health care in this country.
API-Past, Present,
and the Future:
This great organization was founded by a few thinking
physicians in Madras in the early part of the twentieth Century. The founding
President was Late Dr. Guruswamy Mudaliar, a legend in his time who taught at
the Madras Medical College. Member number two was Dr. K.S.Sanjivi, an authentic
human being and a great physician himself. Things changed later and the whole
organization was shifted to Bombay. You could draw your own conclusions as to
why this happened. From a handful of people in the beginning, API has grown
into a mighty banyan tree giving shelter to many a budding physician along with
some old bandicoots like me.
What worries me, though, is the sheer size and the unwieldy
annual conferences that we host where most, if not all, people are concerned
more with fellowship and sight seeing rather than in the scientific agenda. Too
many didactic lectures make life miserable for the minority that chooses to
savour the intellectual feast. There is ample scope to make it manageable with
less pomp and show and spending less money. I also feel that we could have
cheaper delegates’ fee for the juniors who might not be earning big money like
some in the corporate sector of the fee-for-service system. There is always a
small minority in any conference that gets lost in politicking for the future
elections and other perks that go with the offices. The next concern is about
the elections that we have these days; they would make many of our crafty
politicians look like pigmies. The Chief Minister could learn a thing or two
from medical politicians. One example would suffice.
When Dr. K.S.Sanjivi, a pioneer in NGO movement in
co-operative medical care, through his innovative VHS (Voluntary Health
Services) hospital in Adyar in Chennai and a man who resigned from Madras Govt.
Service at the fag end of his career on principles, had to contend with only a few
votes when he contested right royally for the President’s post a few decades
ago. All he wanted people to know was that he was member number two of the API.
He was a giant. Not electing Sanjivi as its President would remain the greatest
blot on the organization. API would
have honoured itself by electing such a son of India for the top post! Sanjivi’s life reminds me of the old saying
of Winston Churchill: “It is better to deserve than to get.” How true?
API must strive to put Continuing Personality Development
(CPD) on line for every member to keep updated regularly. With new knowledge
pouring in at a phenomenal rate of 7% per month (most of it is only noise), it
is imperative that a scientific organisation like the API should take the wheat from the chaff , noise from the
signal, and offer the best to the novice who is in danger when he/she, all by
himself/herself, gets into the thick jungle of medical literature of mostly
dead wood interspersed with rose and teak woods in some corners. When we look
at the future we have to keep in mind all the above points and try to change
for the better. I am not, for minute, blaming any one but the system. After all
change is life and stagnation is death. Let the API live as long as the Sun
shines on this planet, continuously changing en route. I dare not predict the
future but hope for the best, as man lives on hope, anyway.
The Quiet Art of
Medicine:
Bedside medicine, the bedrock on which most of our
generation was raised in the medical schools of our times, is fast changing
into the western system of hi-tech investigation-based euboxic medicine.2
This is sad for both thinking doctors and their patients. While sophisticated
prospective computerized studies have shown the great value of bed side
medicine and the doctor-patient relationship with the need for a placebo doctor to provoke the patient’s
immune system, we seem to go in the opposite direction. Texas Heart Institute
Journal in its November 2005 issue had an editorial on Hyposkillia –lack of bed side skills-which according to that
editorial is killing American medicine. Next editorial is on Stethoscope song originally written in
1848 by Oliver Wendell Holmes Sr., an American essayist, physician and poet.
American cardiologists are reminded to relearn the skills of bed side
auscultation!3,4
William Osler, in his farewell address to Johns Hopkins,
goes to say: “Cultivate, then, gentlemen, such judicious measure of obtuseness
as will enable you to meet the exigencies of practice with firmness and
courage, without, at the same time, hardening the human heart by which we
live.” What a statement of the truth? It is the human heart that we have to
retain as physicians in our daily work, which is called the art of medicine.
“Art” wrote Henry David Thoreau “is that which makes another man’s day”. Art of
medicine should be such that it should endeavour to make the patient’s day. Let
us rededicate ourselves to develop the skills needed for these qualities of
head and heart on the bed side. They are the ones that heal the patient and not
the other interventions that we embark on. Imperturbability and equanimity
(aequanimitas) are the two hall marks of a good physician according to William
Osler.5
Deep down the Medical
Science is very shallow:
The
conventional research in medical science, better called statistical science, is
all reductionist and is based purely on the bio- medical model of the human
body that runs on its electrochemistry. The future predictions based on
statistics are unpredictable, full of “butterfly effects.”6 We are trying to medicalise the whole population, if
one were to believe that almost 90% of the population, by the age 40, will have
at least one “so called” risk factor qualifying for drug intervention. With the
kind of drugs at our command the future of mankind looks really bleak!7 Intervening in symptomatic
patients is a different cup of tea altogether.
Drug
treatment of healthy people with mild hypertension, when viewed differently,
shows the darker side. The MRC trial of mild hypertension, for example, showed
that to save one person from stroke in the future we will have to treat 850
people unnecessarily with drugs!8
One could only imagine the plight of those 850 people taking antihypertensive
drugs for life. Apart from the serious long term side effects, those drugs also
make patients to lose their right to “life, liberty and pursuit of happiness.”
The
HOT study was stopped prematurely since the death rate in the treated group
outnumbered those among the controls.9
The arbitrary nature of defining “normality” of blood pressure could be seen in
the excellent book “Disease Inventors”,
by a German, Professor, Jerg Blech. The cut off point keeps dropping by the
day, naturally to net more and more people under that label. Now even the
reading 120/80 is said to be hypertension! We still refuse to believe there is
land as we see nothing but sea.
While
the physiology of organ function depends on the mean capillary pressure, we do
not know what happens to the mean capillary pressure when we reduce the
arterial pressure arbitrarily? Some times the raised pressure might even be a
compensatory mechanism. The first, and, to my knowledge, the only proof that
lowering blood pressure helps is the article published in JAMA in 1967.10 This was a placebo
controlled study. The patient numbers were small. Even among them a significant
percentage of the treated group dropped out because of side effects. Despite
this big statistical lacuna, the results were based on the intention-to-treat analysis. There has never been another placebo
controlled study for obvious reasons, as we have been selling the idea that it
is unethical to leave mild-moderate hypertensives alone with only life style
changes, although, by default, the Australian study did show that nearly 40% of
the control group did become normotensive on TLC, changed diet, cessation of
smoking and alcohol, exercise, weight reduction et cetera. 11,12
Long
term drug treated and “well controlled” hypertensives showed significantly
higher death rate compared to their normotensive cousins in society! 13 Long term follow up of
medically intervened healthy people’s group showed higher “all cause” mortality
compared to their controls.14
All these and more would prove Goethe right when he said that “ man is
absolutely certain when he knows little, with (more) knowledge doubts
increase.”. With more knowledge in human physiology we will have to embrace the
science of non-linearity and chaos. Raised cholesterol as an indication for
drug treatment in the healthy segment of the populace is another huge hoax in
medicine but, I need not go into it here as people have already done that
earlier.(www.thincs.org) A study of the elderly in France showed that those
with the highest cholesterol levels lived the longest. 15
“That,
that is is,” wrote Shakespeare in the Twelfth Night.
.
Time
and again studies have shown that time evolution in a dynamic human system does
not depend on minor changes in the phenotype alone. Doctors have been
predicting the unpredictable future of the hapless patients using these
screening techniques that have become a big business these days. Death can
never be predicted with any degree of certainty even in seriously ill patients;
leave alone by screening for any thing. Cancer biology also tells us that some
cancers could kill themselves as time evolves. But the scare and the dread of
knowing the screening result, be it true or false positive, could kill the
victim!16
Evidence Based or Evidence Burdened
Medicine?
“They
are ill discoverers that think there is no land, when they see nothing but
sea."
Sir
Francis Bacon
The
oft repeated statement that the incidence of coronary artery disease is going
up exponentially in the immigrant population (as also in others) needs further
scrutiny. Is it just a statistical anomaly or a real increase needs to be seen?17 In our reductionist
bio-medical model of diseases we use coronary artery blocks and coronary artery
disease synonymously. Many people could have blocks in the epicardial vessels
without any evidence of coronary artery disease; elegantly shown in the studies
of Vietnam and Korean War casualties!18
Many of those that have innocent blocks could be provoked to have coronary artery
disease by our precocious labeling them. Evidence based medicine can not assess
the gravity of frightening patients about fatal diseases and doctors predicting
their unpredictable future course. Many of these youngsters could eventually
suffer the ravages of the Ulysses" syndrome.19
“Evidence-based
medicine (EBM) has been defined as the "conscientious, explicit, and
judicious use of current best evidence in making decisions about the care of
individual patients. The practice of evidence-based medicine means integrating
individual clinical expertise with the best available external clinical
evidence from systematic research." Intuition and individual clinical
experience are deemphasized and decision-making based on evidence is stressed.
Although there have been some concerns about whether there is sufficient
evidence to guide many of our clinical decisions, about what represents the
best available evidence, and about the authoritarian voices of the EBM
movement, it should be our goal to make the most informed medical decisions on
behalf of patients.” writes Howard Bauchner.20 With newer studies showing the mind as the major
player in the causation of coronary artery disease, one wonders why the authors
are still harping only on the time honored “risk factor hypotheses” of fat,
blood pressure, diabetes etc.21
The latter could all be the genetic clusters in such individuals rather than
being the cause of one another! The conventional fat hypothesis has led to the
burgeoning business in anti-cholesterol drugs that seems to have only changed
the label in the death certificates without changing the date!22, 23, 24 Too much drugging
for lowering patient’s blood sugar and blood pressure have both been
counterproductive to say the least.25,
26
The
economic status could also be contributing to the incidence of coronary
disease. Coronary artery disease also follows the rule that poverty is the
mother of most ills. Barker’s hypothesis could be working in those precocious
CAD patients that were born to abject poverty. Therefore, if future studies are
being planned to study the reasons why precocious coronary disease occurs, if
at all it does, the above mentioned suggestions could be incorporated there to
make it more evidence based and authentic. We seem to be absolutely certain
about the risk factors in coronary disease as we know very little about its
causation.27 “Man is
absolutely certain when he knows very little, with knowledge doubts increase”
said Goethe. Recent evidence points to the role of life style modifications
with a special stress on tranquility of mind as the best insurance against
precocious coronary disease as also in the management of established CAD. That
needs to be incorporated in the evidence based management strategies of CAD.28, 29, 30
"Facts
do not cease to exist because they are ignored."
Aldous
Huxley.
Pills Thrill but Could Kill!
All
our drug studies have major flaws. Firstly, a chemical molecule is discovered
in the laboratory and then this is checked for its potency, toxicity, and other
dynamic features using an animal model. The animal data is then extrapolated to
man and preliminary studies are done on volunteers. If all these are
uneventful, the final phase of drug development, the controlled study is
mounted. In addition, all the controlled studies are done for not longer than
five years before the drug is let lose on the gullible public. Usually one
single drug at a time is tested under ideal settings, while in real life
situations a single drug is rarely ever, if ever, prescribed. The ideal
situation obtaining in controlled studies is rarely seen in patient care
setting. Occasionally, the last step is even given a go by before letting
patients have the drug with disastrous consequences as had happened in the case
of Milrinone.
Many
of the unforeseen side effects occur only after five years when the drug has
been given to millions of people. Similar is the fate of surgical interventions
and many other medical interventions. Swan-Ganz catheter, that used to be
routinely used in the intensive care set up, was found to have resulted in at
least 100,000 deaths in the American hospitals in one year! 31
Sexed-up Studies:
Research
funds drying up from independent sources more and more studies are done with
industry sponsorship. Most of them have strings attached, the new breed of CROs
in the third world is another cause for anxiety. Positive reports having better
chance of publication, the sponsors, many times, indulge in data dredging, in
addition. Occasionally, companies get doctors to create diseases to sell drugs.
It is a multibillion dollar business anyway and market forces influence
research in this area very significantly. Academic medicine seems to be on sale
these days with doctors and researchers being offered lavish gifts by the companies.
Even the textbooks are written with drug company money! Final blow comes from
researchers trying to confuse the doctors with complicated statistical methods
when the data are not convenient to their mentors. One only has to read the
editorial in the Lancet on the influence of drug company money in medical
education in the US as also the one in the New England Journal same year 2000
entitled “Is Academic Medicine for Sale?”32,
33 John Cleland systematically deciphers the long term effects of
small dose aspirin in healthy people in the British Medical Journal in 2002, to
show how the good effects sold to the public are the result of sexing up the
real data. 34
The present scenario:
SSRIs
and Cox2 inhibitiors are not the only culprits in making man miserable. Let us
survey the other common diseases and their drugs. Type 2 diabetes has been a
history of failures, while the drugs lower the glucose levels complications set
in, sometimes more vigorously in the tightly controlled sugar status. In a
paper entitled-Treatment and Mistreatment of Type 2 diabetes- Prof. Leif Groop
stated that no treatment thus far has been able to change the inevitable course
of this disease; diabetes is far more heterogeneous than thus far thought of,
therefore treatment should be custom built for the individual patient, a sagely
advised followed for “time out of mind” in Indian Ayurveda. Unfortunately, in
the reductionist science that we follow the individual patient does not exist.
Only bits and pieces exist.
Rheumatoid
arthritis drugs, present controversy notwithstanding, lower the pain, yet
mortality and morbidity remain frightening. Pincus discusses this and says
"RA trials paint a rosy short term picture, while patients’ status deteriorates
over the long term." Anderson et. al have shown that while
anti-hypertensive drugs lower blood pressures, yet survival and mortality rates
worsen compared to non-hypertensives. Recent IOM report in America showed that
modern medicine is the leading cause of death in that country followed by
cancer and heart attacks. Most conventional medical treatments are not helping
the majority of people taking those most of the time! Many Americans are
seriously harmed by modern medicine while more than 200,000 die annually
because of modern medical interventions, drugs and all.
Aaron
Wildavsky in 1977 said: “Most of the bad things that happen to people are at
present beyond the reach of medicine.” In the same book Lewis Thomas questioned
concerning the major issues like cancer, heart attack, hypertension, stroke,
diabetes, arthritis and peptic ulcer, the following: “For many of these
illnesses, do we possess a decisively effective technology for cure or
prevention, directed at a central agent or mechanism, comparable to the
treatment, say, of pneumococcal lobar pneumonia with penicillin?” His answer
was that “It does not look like the record of a completed job, or even of a job
more than half begun, when you run through the list,” In essence a reflection
of failure. The story seems to be veering round to Heinemann’s thinking that
drugs in large doses seem to cause diseases that they are supposed to control.
Recent reports about one of the beta-blockers in the long run causing higher
strokes in hypertensives, and pain killers causing heart failures comes close
to this thinking. Incidentally, the name pain killer is very apt; while it
removes the pain it could kill the patient.35
The
moral of the story is that we seem to have built our modern medical buildings
on quick sand using the bricks of reductionism and linear mathematics both of
which do not have any relevance to human dynamic system. Our controlled studies
are seriously flawed, to say the least. No one wants drug companies to close
shop; on the contrary, the powerful drug companies could listen to sane advice
and try and mend their ways and be more transparent for the common good of
mankind. Medical science should learn from quantum physics and try and take the
right road to success. Change is a part of life and change is science. Blind
faith in our methods is close to being unscientific.
Need for a paradigm shift:
There
is an urgent need for a paradigm shift in medicine if society has to really
benefit from us. Many years ago, an
article of mine in the Proceedings of the Royal College of Physicians of
Edinburgh did have the same caption-need for a paradigm shift, but there were
no takers!1 In emergency
care we have no other choice than to follow the modern medical quick fixes,
although there are warning signals that all is not well even in that area. In
all chronic illnesses, I feel, our treatment does more harm than good, if one
carefully audits the outcomes. Many a divine intervention in the apparently
healthy population has similar outcomes.
A
good example is the Philadelphia-Ontario bypass audit in the immediate post
myocardial infarction period. This is not surprising at all, as time evolution
in a dynamic system is not dependent on minor changes in the initial state in
the human body. Correcting those changes need not (will not) result in better
outcomes in the long run. "Butterfly effect" of Edward Lorenz takes
over. The altered state (lowered BP or Sugar) might result in catastrophic
changes elsewhere, if one understands non-linear mathematics that the human
body follows. Aristotle wrote that “truth can influence only half a score of
men in a century while falsehood and mystery would drag millions by the nose.”
This is more than true in the case of modern medicine. Plato, in his celebrated
book, The Republic, refers to his teacher Socrates’ efforts to change society
when, at that time in Greece, injustice was justice and justice was the
convenience of the powerful. Socrates did not succeed, though. I am only trying
to indicate the inherent drawbacks in our system lest people should be taken
for a costly ride!
Lucien
Leape of the Harvard Medical School in his excellent article, Errors in Medicine, published in 1994 in
the prestigious Journal of the American Medical Association,36 gives a very graphic description
of all the errors that we have been committing. This has been updated recently
by Barbara Starfield in her excellent article in the same journal in the year
2000, which reiterates the same, adding many more glaring dangers to the list
already given by Leape.37
To date; I have been able to trace more than seven thousand articles showing
the mistakes of modern medicine in the best western journals.
Nearly
2,25,000 people have died in one year in the US alone due to iatrogenic
diseases. Of these 1,40,000 has been exclusively due to adverse drug reactions.
In addition, 79 million people had to be treated on out patient basis for
serious drug reactions costing a total of $80 billion in doctor and
prescription bills in one year. There have been three million injuries due to
medical interventions in a year with 44,000 to 98,000 deaths annually.
Nosocomial infections alone caused 80,000 deaths in one year in hospitals. One
hundred million people suffer from chronic debilitating illnesses partly due to
medical interventions. These figures look horrible if one takes into
consideration the relatively small population of US. The sad story does not
include the escalating costs of modern medicine.
One
of the reasons why this sordid drama unfolds in that country is the heavy
advertisement for screening the apparently healthy people for all kinds of
abnormalities. However, all the audits of screening efforts have shown that
screening healthy people could be one of the most dangerous activities in
society. Time evolution in the human system does not follow linear laws of
predictability. The screening industry is the biggest money spinner in
medicine. A very recent editorial by Richard Smith in the prestigious British Medical Journal entitled “The
Screening Industry” bares the true picture in all its ramifications. Screening
probably is the main source of the above sickening numbers mentioned earlier.38 If doctors confined
themselves to cure the sick rarely, comfort them mostly, but to console always,
they would be doing a great service to the public. When doctors try and
intervene in healthy segments of society problems start. Sir William Osler, a
celebrated brain in medicine in the last century, was right when he said:
“patient doing well do not interfere.”
Modern
medicine is slowly 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. 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 medicine,
complementing each other, we could bring down the costs of medical care to
almost one tenth of its present level with less danger to the public as a bonus
and offer an excellent new integrated system of medical care.39
The
future lies in emphasizing promotive health. We should change the present
teaching in medical schools to that of patient-centred education from the
present disease-centred education. We should use statistics sparingly in
medical research.40, 41
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 epidemics. The fear
of an illness could help the illness to take a firm root in a healthy person.42 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 one’s birth right. Diseases are
only accidents. If one follows the correct rules of healthy life style,
accidents (diseases) will be rare indeed! Unexplained symptoms also fall into
place in this new scenario.43
Afterword:
Our
war against disease and death is anything but won. World goes on, the medical
fraternity notwithstanding. More than 80% of this world population does not
have any touch with modern medicine! They live all the same. If things have
changed in the affluent part of the globe
for better it is now known to be due to better hygiene, better
nutrition, health education, decreased smoking and alcohol intake, better
housing, cleaner atmosphere, less crime, and not due to doctors and hospitals.
In fact, recent data clearly shows that in the US, where the healthy life style
changes have been the best among the fourteen industrialized countries, the
disease and death statistics are the worst. US is the last but one in the list
of 14 developed countries in medical
care outcome! Countries with more doctors per capita and more specialists have
done badly compared to countries with less doctors and significantly less
specialists and sub-specialists! Japan gets the first rank for all these
reasons with the best medical care outcome.36
When doctors went on strike recently in Israel asking for more money, health
status improved in the public and death and disability rates fell precipitously
only to come back to the normal levels when doctors came back to work!44
Our
wise Chief Minister could take these lessons home to change the face of this
great State of Bihar, which at one time was the leader not just of India but of
the whole world. The Athenian race in Greece is said to have migrated from
Athoni in Bihar. The whole European wisdom, according to this study by a Greek
scholar, Edward C Pococke done in 1832 AD, came from Bihar. Our war against
diseases reminds me of the American war in Vietnam and Iraq. Both of us are
stuck with it for ever. But both are being fought with ulterior motives!
American wars are fought to reap the oil wealth and for hegemony, our wars are
fought to get more money for the drug and the technology industry.45 Today the pharma lobby is
three times bigger than the oil lobby in Washington! Our efforts have been
aimed at medicalising the whole population with total body scanners that
measure 500 body parameters at a time.46
Imagine with 5% false positives for every parameter measured, there is no
chance for a “well human being” to exist. A very good proposition indeed! That
exactly is the reason why large corporates want to get into hospital
“business”, in a Nobel profession whose motto; according to the father of
modern medicine, Hippocrates, “is not to make money in the sick room”!
Conclusions:
“Fear not! Life still
Leaves human effort scope.
But, since life teems with ill,
Nurse no extravagant hope;
Because thou must not dream, thou
need not then despair!
Mathew Arnold, in Empedocles on Etna.
This
poem, in short, is the long and short of my talk today which I hope has taken
you through a long journey of the life of a physician giving the two sides of
the same coin, one the real side and the other the ideal. Although humans could
never be perfect, they should strive towards that goal, anyway. Jesus Christ
did extort men: “Let perfection be thy aim”.
Now I deem it an honour to declare this 61st APICON 2006
duly inaugurated on this day in this historic venue, where great events have
occurred in the past. May the year 2006 be peaceful, happy and healthy for all
the members? Let us also wish the best of everything for everyone in our vast
nation as also in all the corners of the world. “Sarve Janaah Sukhino Bhavatu.” I hope and pray that we resolve in
this New Year 2006 to try and do most good to most people most of the time. API
has to rise like a monolith to be in the forefront of human kind’s struggle
against squalor, oppression, suppression, denial, ignorance, and illness. Long
live human kind on this planet with physicians assisting them to live well.
“One doesn’t
discover new lands without consenting to lose sight of the shore for a very
long time.”
Andre Gide.
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