A reasoning, self-sufficing thing, An intellectual all-in-all! — William Wordsworth.
The quote below is one of the many brilliant sayings of that great brain, Sir William Osler. “One of the first duties of the physician is to educate the masses not to take medicines.” In the 21 century, I could only echo that great sentiment as a truism, despite all the tall talk about the “so-called” evidence-based medicine. Napoleon Bonaparte went one step further, but one could argue that he was not a physician. He was at the receiving end of such a medical practice when he died. “Medicine is a collection of uncertain prescriptions the results of which, taken collectively, are more fatal than useful to mankind.” Napoleon, though, was more accurate scientifically today. The latest science says uncertainty is the only certainty in the world. This is truer in medical science. A proverb is a short sentence based on a long experience. If that were so, this one from Voltaire would take the cake: “The art of medicine consists in amusing the patient while nature cures the disease.”
Time and again, I have written in my articles elsewhere that our evidence base has been built on loose sand. (www.plosmedicine.org/annotation/listThread.action-ww.bmj.com/content/338/bmj.b1272.extract/reply) Of course, no one seems to take it seriously. They would have, if it had any financial interest behind it. The present Randomised Controlled Trials and linear relations help generate billions of dollars in chemical therapeutics even if that results in thousands dying of our efforts directly or indirectly. (search.barnesandnoble.com/Death-by- Medicine /Gary-Null/.../9781607 660026 )> A study by researchers in a respectable U.S. university of the placebo-based RCTs did show that the contents of the placebo capsule, which need not legally be made known to the regulating agencies like the FDA, were very potent substances that would show the company drug as very effective in comparison. To cite an example, anti-diabetic drugs are usually compared with sugar filled placebo capsules! Many such glaring criminal activities have come to light now in the field of “Evidence-based medicine” of today!)
What is the science base of our reductionism, organ- based specialisation and our reliance on Mendelian inheritance? Instead of trying to rehash the existing evidence base, it is better to think of a new evidence base for health and illness. Health is a state where each human body cell is in sync with other cells. Illness is when this communication breaks down. (en.wikipedia.org/wiki/Biophoton) We need a new non-linear, holistic, dynamic, scientific base for future medical research. Nature has provided a robust repair mechanism inside the human system which has been weakened by our modern lifestyle. Even though both Claude Bernard and Louis Pasteur did note that the “terrain is more important than the seed,” we have gone the whole hog on the seed, risk factors, and what have you. Modern medicine has forgotten the essence of illness care which is basically to strengthen the terrain. Ayurveda and many other complementary systems stress just that fact to strengthen one's immune system. Ayurveda has many immune boosting modalities in its armamentarium. Many simple methods which have stood the test of time are being forgotten now, thanks to the brainwashing of the masses, through mass media advertisements, with the wrong approaches to keep one healthy. The leading one among them is goading people to have a regular “health” check-up. Nothing could be more dangerous than that to apparently healthy people. When one is healthy one should NEVER ever go for a check-up! The common man will have the doubt as to how he or she could know about health. One is healthy when one has (a) enthusiasm to work and (b) enthusiasm to be compassionate. One of the ancient exercises could be the most potent modern medicine — a daily walk if one is not a physical labourer.
After 25 years follow-up of one of the largest-ever studies of risk factors (which are being sold to the gullible public day in, day out as silent killers), the MRFIT study (Multiple Risk Factor Interventional Trial) observed that: “In conclusion, we have shown that it is possible to apply an intensive long-term intervention program against three coronary risk factors, high blood pressure, cholesterol and smoking with considerable success in terms of risk factor changes. The overall results do not show a beneficial effect on CHD or total mortality from this multiple risk factors intervention trial. (Zukel, Paul and Schnaper, 1981).”
In other words, they found that changing the “risk factors” does not apparently change the risks. This necessarily means that the “risk factors” are not as important as was thought. Indeed, it should be concluded that the “risk factors” were no such thing, at least as far as this trial is concerned.
At the University Of Maryland School of Medicine, Roger Sherwin was Principal Investigator of the Baltimore Center of the Multiple Risk Factor Intervention Trial (MRFIT). He served on several national MRFIT committees and was the first chairman of the Intervention Committee responsible for the implementation of the complex intervention programme. He was disappointed that the MRFIT turned out to be only a boondoggle.
An audit by Uffe Ravnskov of the 17 leading hypertension intervention trials in the world literature showed hardly any significant difference in the outcomes in mortality between the groups whose blood pressure was tightly controlled with drugs and the groups that changed their mode of living to a healthier one.
A recent CADD study did show that very tight control of blood sugar with powerful drugs in diabetics only increased the micro-vascular complications. Most of our studies, based on which we model our treatment plans, show only a decrease in the surrogate end points like blood sugar report improvement in diabetics; they have never shown in the long run any fall in mortality. Surrogate end point research could, at times, be dangerous especially in medicine where the NNT (a statistical term denoting the number needed to treat) is prohibitively high.
One example will suffice. The large MRC study on mild to moderate hypertension treatment showed that to save possibly one stroke death in the next five years in society we will have to unnecessarily treat 850 healthy human beings with powerful anti-hypertensive drugs whose side-effects could seriously damage the health of at least 75 healthy people with some of them meeting their maker prematurely! The NNT in heart ailment drugs and cancer treatment could be much more than in hypertension.
I am sure the reader by now would have realised the significance of what William Osler's prophetic statement of 1905 meant when the great physician did not have any of these powerful drugs that we have today. Cure rarely, comfort mostly but, console always should be our motto when one is ill. Patient care simply is caring for the patient. Let me make a fervent plea for parsimony in using drugs in the healthy segment of the population, by labelling these so-called risk factors as silent killers, in the fond hope of averting major problems in the future. We simply do not have any scientific evidence for their benefit as of now.
(The writer is a former professor of cardiology, the Middlesex Hospital Medical School, University of London and former Vice-Chancellor, Manipal University. Email ID: email@example.com)