I was surprised to read the article “Modern medicine has given illness care a miss” (The Hindu, Open Page, February 19, 2012) by Professor B. M. Hegde in which he makes a fervent plea to avoid drugs in the healthy segment of the population. Literally he may be correct, but what is the definition of health? If a person's biochemical values (e.g., sugar or cholesterol) are abnormal, but with no complaints, he cannot be considered healthy and he needs drugs to prevent further catastrophic events secondary to the abnormalities.

The interpretation of Sir William Osler's (1840-1919) statement (Osler was the first professor of medicine in Johns Hopkins University, Baltimore, U.S., in the 1870s) is misleading. Osler's remark that “one of the first duties of the physician is to educate the masses, not to take medicines” does not mean that he advocated rejection of medicines. One has to think about the era in which Osler lived (latter part of the 19th century), a time when there were no antibiotics, hypotensives, statins, chemotherapeutic and antiviral agents — the only treatments available were elixirs, enemas, lotions and massages. Osler gave equal importance to patients' education as well as medicine administration (whatever was available then).

Quoting Napolean , who died in captivity, is also out of context. His statement that “medicine is a collection of uncertain prescriptions, the results are more fatal than useful to mankind” is correct because Napolean died due to stomach cancer what with the facilities available in that era when there was nothing except prayers and porridge.

Similarly, Voltaire's statement that “the art of medicine consists in amusing the patient while nature cures the disease” is hypocritical. A renowned French crusader against bigotry and cruelty (1694-1778), Voltaire is known for his characteristic wit and satire. He was not only a playwright, he used to write copiously on philosophical and moral problems and hence Voltaire's statement can be taken only in a sporting spirit.

Randomised controlled trials (RCT) are criticised in the article, especially about risk factor preventions. I do agree that different trials may yield different controversial results but that does not mean that these clinical trials are not beneficial. These trials give the practising physicians an insight into the pros and cons of various chemotherapeutic agents. It takes at least five to seven years to get FDA permission in the U.S. to market a drug after submitting experimental details in animals, pharmacodynamics and pharmokinetics of the drug in human volunteers. And the final Phase III trials in patients. The scrutiny by FDA is very stringent, meticulous and time-consuming. One example is the non-approval of the drug thalidomide in the U.S. in 1960 when thousands of children were born with congenital limb defects in Europe and Australia. Ms. Frances Oldham Kelsy, a pharmacologist working in FDA, U. S., then objected to the approval for sale of thalidomide in the U.S. and the application was rejected. She was honoured by President Kennedy in 1962 for her bold and brave decision.

Dr. Hegde's article would create an erroneous impression among the public that unless you are symptomatic, no drug should be taken. I have a few comments on this dangerous plea:

Is it not true that reduction of blood cholesterol and blood pressure would reduce the incidence of heart attack, even when the patient has no signs or symptoms?

Is it not also true that lifestyle modification would reduce the risk of developing Type 2 Diabetes Mellitus in patients who are at risk (obesity, family history, etc.)?

Is it not beneficial for cancer patients to undergo certain tests to exclude metastasis even if they are asymptomatic, thus avoiding unnecessary radical surgery?

Is it not better for diabetic patients to undergo a Treadmill test even if they have no chest pain because in diabetic patients heart attacks are usually silent?

I can enumerate many universally accepted international trials like DCCT, UKPDS, 4S, PROGRESS, ADVANCE, DECODE, APOLLO, LEVEIN, 1,2 and VADT which have yielded extremely beneficial results to save cardiac, diabetic, and stroke patients from the clutches of death by countermanding the risk factors.

(The writer is Emeritus Professor of Medicine, SUT Academy of Medical Sciences and Chief Physician, SUT Hospital, Thiruvananthapuram.

His email is simulupaul@gmail.com)

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