“Of the terrible doubt of appearances,
Of the uncertainty after all - that we may be deluded!”
— Walt Whitman
This morphologically young woman in her early 50s, let us call her Gita, called me the other day in great hurry and she was palpably agitated, to say the least. She was not even coherent. “I am truly down and feeling so low that I feel I have a serious problem. I feel very low after my evening walk.” I asked her “what happened?” She shot back, “My doctor told me my pressure is way high at 160/100. She immediately asked me to take a tablet, which I took.”
“You must be feeling fine now,” I interrupted her. “No, No, No. I am feeling worse now. My doctor told me a couple of days later that my pressure is still way above normal at 130/80. She gave me a new tablet and asked me to swallow it right there as she wanted the pressure down to 110/70 as fast as possible.” In addition, my doctor asked me to urgently see a cardiologist to have a complete work up.”
“What happened then? I asked. “My doctor's last advice put me off and I thought I better talk to you.” I could see her almost in tears. To cut the long story short, I had to talk to her at length to counsel and convince her that the blood pressure reading that she was worried about was all in her mind! The reader might think it is very easy. It is easier said than done. I can assure you that it would have been easier to give birth to a baby had I been pregnant than to successfully counsel an agitated 50-year-old postmenopausal, morphologically young lady to cool her down on the phone.
Let us look at Gita in toto to know her better. “Know your patient better than his disease,” wrote Hippocrates. He was dead right. Gita was educated in the U.S. Her husband, a brilliant and capable scientist was the one who put together one of the most successful business groups in India. She had two beautiful and intelligent kids. She also had a cushy job on hand. Theirs was a happy & perfect family. But fate willed otherwise. Her handsome, intelligent husband died one sad morning due to what doctors called heart attack. Gita was devastated and shattered. One could understand. She came out of that reactive depression slowly but steadily and still does her job very successfully. She brought up the children like a true Indian mother and now both are successfully placed in society. Her families on either side were a great help and so were her colleagues and her husband's former colleagues.
Turning 50, Gita felt lousy. An informed woman, she was worried about her menopause. That needed counselling again. Right then both her children went abroad in search of greener pastures and higher education. Gita was outwardly ecstatic but subconsciously she was feeling lonely and forlorn. That mind of Gita was somatising as “her feeling very low” which took her to her a “good” doctor in the first place, more due to family pressure. The rest is history.
This sad story is all but lost on our modern medical business that tries to attack the palpable abnormal body parameter, which is mistaken for a disease to be drugged ruthlessly. Twenty-four hours after her traumatic experience, Gita was back to her usual confident self, with an on-top-of-the-world feeling, back on her job. The drugs are in the waste basket as she had to survive. “Thank you, Dr. Hegde, I feel fine. All in the mind — yes, yes, I now believe you.”
Let us examine the science behind this misadventure. A thinking American professor, a rarity in that country these days, Mary Tinnetti, had this to say about our obsession with a firm diagnosis and our disease concept. “The time has come to abandon disease as the focus of medical care. The changed spectrum of health, the complex interplay of biological and non-biological factors, the aging population, and the inter-individual variability in health priorities render medical care that is centred on the diagnosis and treatment of individual diseases at best out of date and at worst harmful. A primary focus on disease may inadvertently lead to undertreatment, overtreatment, or mistreatment.”
The drugs are being pushed irrationally and the gullible doctors who depend on drug companies for their continued education believe their advice a hundred per cent. The pharma lobby even gets research data manipulated. (JAMA 2010; 303(20): 2058-64.) “Speaking of Big Pharma's big, bad influence, here's more proof they're not interested in playing on a level field. It turns out a controversial and dangerous hormone therapy that was all the rage a few years back was pushed in medical journals by writers who were paid by Big Pharma,” according to court papers found in August 2009 by The New York Times.
The paper also found that “in one case that seemed typical, the drug company paid around $25,000 to a third-party medical writing firm to generate one of these reports. That might sound like a lot of money to you or me, but it's money well-spent for Big Pharma. In fact, these shady reports helped hormone treatments generate $2 billion in sales in 2001, just before that money train was derailed.”
The whole thing looks like a stage-managed effort to keep the best treatment method, change of mode of living, for chronic diseases like raised sugar, blood pressure and cholesterol from practising doctors as the pharma company profits from life-long drug treatments could be mind-boggling.
This reminds me of the infamous Tuskegee experiment where 400 African-Americans suffering from syphilis were observed from 1932 through 1972 withholding penicillin treatment just to record the natural history, symptoms and complications of the disease without their consent. Sir George Pickering, a doyen in hypertension research, had this to say: “More people make a living off hypertension than dying of it.” This was written in the 1950s when there were hardly a couple of crude drugs for hypertension. What would he have said about our situation today? God only knows!
Right-thinking people in the medical profession have a tough job on hand to try and get at the truth, which in itself is a daunting task, and then cross a greater hurdle to deschool society of its firm belief that modern medicine is a true science and there is a pill or surgery for every illness! The truth is that while there is certainly no pill for every illness, every pill is followed by a definite illness. Pills might thrill but could even kill. Change of mode of living — diet, exercise, mental tranquillity in the midst of this maddening world running after the mirage called money, universal compassion and simple nature-given immune boosters in vegetables and fruits should set right most transitory parameters. It is too late in the day to start deschooling society to reverse the trend and help hapless patients like Gita.
(The writer is a former professor of cardiology, Middlesex Hospital Medical School, University of London, and retired Vice-Chancellor, Manipal University. Email: hegdebm@gmail.com)
Keywords: illness, blood pressure, health concern
In this age, where humans consider themselves as machines and try to find answers to every question they have and believe in the answers for generations, I think we have lost the sense of touch with nature. We have forgotten to accept things as they are and we live in our own egos.
Pharma companies are a necessary evil, and in total more good comes out of them than evil.But it is the physician, who has to make a learned,independent choice,using his judgement, without falling into the traps laid by the pharma companies and keeping in mind his obligation to the patient who depends totally on his skills. I wish that every common man reads the last paragraph twice to understand, what the writer wants to convey.
Although modern medicine has made a huge contribution to human health, it has also left some scars behind,the doubtful and dubious role played by the pharmaceutical industry world wide is under question and yes all ailments have a psychosomatic aspect to them.
A very good article indeed!
It is very difficult to change the mind set of people in India and other parts of the world regarding the evil effects of modern medicines. The industry exists to make money and is not its concern if a person dies sooner or later after taking medication. Fortunately or unfortunately, both modern medicine and man are hard to please. Be it from urban or rural sector everyone is spending millions of rupees on medicines. They are completely oblivious to the fact that nature has provided them with better options of healthy living. We have completely given up our Vedic living life style.
Nothing can be truer than the averments made by Prof Hegde in this very learned article about over drugging patients without corresponding cure or relief. These days, even for a simple cold, about seven different pills and syrups are prescribed in one single prescription (from my own experience). One can well imagine the magnitude of the callousness that could come into play by vested interests in the case of hypertension and such serious illnesses. The exercise of relentless drugging will go on and on, despite articles by profound scholars.
Treat the man, not the scan -- was a famous caveat issued to neurologists exceedingly relying on CT scans and not even talking to patients properly. Differential diagnosis --a better tool to unravel a patient's mind-- has been vociferously sidelined as well. Coming to drugs, I'm reminded of a rather unusual case of a pill having a positive side effect. Avastin (of the pharma major, Genentech) helps inhibit formation of blood vessels that supply vital nutrients to tumors - thereby limiting metastasis of several cancers. Surprisingly the same inhibition helps prevent abnormal growth of blood vessels on the lining of retina at the back of the eye. This abnormal growth is common in a form of vision-related problems in the age called macular degeneration. Genentech, realizing this "miraculous" benefit, did not go ahead with getting approval for Avastin to be used in vision treatments; but came out with other drugs. We have to plainly understand that no altruism drives pharma majors, but pure money-spinning profit-generating motives. That's the truth. It is up to the patients to be properly educated themselves about persisting problems with their mind and body. But I'm saddened by this clause about American profs: A thinking American professor, a rarity in that country these days. No, America still produces a great number of fine illuminating professors. In the disciplines I'm interested in, Mathematics and Neuroscience, there have been great many "thinking" minds: Laszlo Lovasz, Peter Erdi, Joe LeDoux, Steve Kossylyn, and many more at MIT. It is in India that hardly anyone thinks -- of course, we are smart enough to offload that responsibility on textbook reasoning, MCQs, etc. But are not intelligent and wise enough to get to the depth of things with intensity. Don't exclude me from this "Indian" club as well -- the only difference being that I'm ready to accept this offending truth!
India with a population of over one billion is a lucrative market for both drug makers and prescribers. It is both a boon as well as a bane. With some serious efforts and use of technology we can be leaders in this field. There will always be a threat of business lobby when it comes to research. But we as medical fraternity what have we done? We firmly believe in the protocols and guidelines , standards of western care. Why can't we modify to suit ourselves? Its time we stood up to the challenge of health care in the country or we'll be facing a health crisis in the years to come.
Thought provoking piece. However the insult about the rarity of thinking American professors was gratuitous.
Dr. Hegde is the doctors' doctor and one listens to him with respect. I wish he dwelt on the undue stress placed on some of these expensive tests, on the decline of clinical diagnosis and the role of internal medicine. May be, he would do so, in a follow-up article.
This happened in my wife's case. A lady who never had visited a doctor for 49 years, got upset when she had moodswings due to menopausal symptoms. The doctors at Cochin prescribed 12 tabs which she consumed and later a all-body-scan and a series of biopsies.Now that skinny lady is heavy-weight. Lucky, she refused doctors' suggestion to pluck out the uterus. Finally, she visited a Namboodiri Math in Kerala.They guided her that menopause is not a disease.Now she is worried about her extra fat.
A treatise to read! Congratulations to Prof.B.M.Hegde. Commerce has taken over the morals in all fields. Sickness is encashable - health is not! Drugs are made, prescribed, sold to maintain sickness and to create market for other new drugs.
Unless we learn to live with changes in our life with grace and certain amount of confidence, we may come across many experiences like those of Mrs Gita in this article. Secondly, the doctors today are increasingly dependent on pathology and other lab reports and less dependent on their experience and gut feeling. It is going to be more and more difficult for ordinary people unless the patients themselves show good restraint and avoid going to the specialists for minor health problems.
Thank you for the article. It is really a good regimen for better health. Modern society is encumbered with a lot of problems, mainly arising out of anxieties of too much information about health. Information, misinformation, and disinformation through print and visual media and the belief that there is a pill/treatment for every variation in functional parameters being probed by devices. Adding to the problems of health, is the absence of experienced good physicians and presence of specialists in various branches. Health is related to social environment--an environment of peaceful living. Peace obtained from our mental state of being healthy physically.
How true! I am a victim of the modern medicine men who promise the sky and fail to deliver. My random sugar level was 240 so I could not have an extraction. The three monthly glycated sugar level is 6.1 but since the fasting blood sugar level is 160, I can't have the extraction. A new dosage of medicine is to be taken after each meal; that is the new recipe that is supposed to "cure me" of the ailment. Three months ago I had an extraction done with the same level of blood glucose with no secondary complications. So I sit and wonder about the wonderland called MEDICINE.
Absolutely right. It is very rare to see true doctors in India now. The usual refrain is that we have to cater to what the patient wants! No. Doctors are supposed to be leaders leading the patient to good health. I do not know if that will be possible at all in India. The trajectory now does not bode well. It will change only when hospitals and doctors consider the people/patients walking into their facilities as such rather than as customers.
Very well-balanced and extremely accurately articulated article. Thank You Doctor!
An excellent article which must be read by a large number of people who are in the same category as Geeta. The Big Pharma lobby is becoming more and more powerful and doctors must be weaned from them. Patients should also become more sensible and avoid going to doctors for every ailment - mostly imaginary.
A very thoughtful and convincing article.
Dr Hegde's voice of moderation and wisdom is a voice crying in the wilderness of commercial (often masquerading as scientific) medicine. In poorer countries like India, potentially millions of lives can be lost when scarce resources are diverted from simple inexpensive interventions to more recently developed, expensive treatments and investigations with little or no additional advantage. Ironically, the wealthier countries are now becoming more careful by developing guidelines for the more common diseases. It is imperative that similar guidelines, appropriate for India, be developed independent of the pharmaceutical industry. It is also necessary to establish a mechanism to ensure that such guidelines are followed. I hope more people like Dr Hegde join together for this endeavour. But then "knowledge comes to many, wisdom only to a few."
Great!. Hope this writer succeeds in awakening the minds of those who feel that today's doctors are gods and medicines they prescribe take precendnce over preferred diet. It is time we reconsider the concept of family physician instead of narrow focussed specialists.
Such observations from people in the business will enormously force the medical industry to do some navel-gazing. The writer has succinctly put that it is time the society is deschooled from the belief that modern medicine is science and there is a pill or surgery for every illness.
Very interesting-not just what he says, but also the fact that people don't seem to know this already! Our lifestyle and the way we see ourselves in relation to nature and other fellow human beings is what creates most of our problems- not just the medical ones...
There is a rush of doctors behind making money. They do not believe in counselling but in extracting their patients. Now, who holds this medical professionals as 'god', who considers them 'vaidya', who holds them in a high 'esteem'? The professionalism has taken its place so strongly in the lives of every individual that they forget "What is their purpose ethically?" So, the doctors should not take their patients as a new sorce of money and suck them as parasites but try to behave as a human and COUNSEL them, to make them to realise the very fact that 'they themselves can act as a pill to the so called illness of theirs'. There are no 'material pills' for each and every illness.
I don't completely agree with what has been said. I don't deny the fact that there is over treatment nor the fact that there have been instances of influence on research by pharma companies for their benefits. But not all research is influenced nor every patient is over-medicated. There is also a fact that a vast majority of physicians recognise the ill effects of over medication. As well, there is an emerging consensus to recognize mental wellbeing as an essential aspect of care to be looked after by the physician and not only concentrate on the physical complain. I agree that diet, exercise, etc. are essential components for staying healthy but at the same time a physician's intervention is as much essential in case of some disease. What you described in the article about anxiety of the patient was more created by lack of knowledge of the physician. Hence it would not be appropriate to generalise the trend of business governing drug prescription to the whole medical community, when physicians who still work for providing best healthcare of the patients exist.
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