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" To Know How To Grow Old
is the Master-Work of Wisdom "
Henri
Amiel.
I wish I had known the
above saying early in life to keep quiet when I grow
older, rather than try to correct the wrongs in society.
Now it is too late and the bad habit has stuck so hard
that it is difficult to keep quiet when things do not
seem to be in order, nor are done for the good of
humanity at large. The common feature of all human
efforts in society seem to be guided solely by the
selfish motives of a few. There is a tendency for change
in every walk of life. Change is a must and is the key to
life itself, but the change must be for the good of
humanity is not debatable.
Every institution seems to be heading for fragmentation.
Let us take stock of the political scene in our country.
We daily see the smaller groups of people perceiving the
advantages of fragmenting the country for their benefit,
into smaller and smaller bits as if we have not had
enough of the already existing states in the country.
What with all the administrative machinery eating up most
of the country’s annual budget, leaving very little
for any developmental works, we still want more
administrators and expensive ministers in the newer
states. Political parties are another good example.
Almost every day a new party is born only to die a
natural death after making enough money. Larger parties
are breaking up every day into all sorts of smaller
fragments, named after individuals. This will certainly
destroy our democracy in the long run.
Take the example of the human body for our analysis. It
is very good in functioning as an organism for nearly
seventy odd years if in good shape. If any of the tissues
declare independence, in the long run, the whole system
will disintegrate and get destroyed. No part of the human
body could function in total isolation. The only saving
grace for the future is a holistic approach to man’s
ills. The latter is not being appreciated, nor is being
taught to the young students in the medical schools. This
philosophy is not conducive to the new ethos of
specialisation and further fragmentation into
subspecialties.(1) The key word in the medical field is
that of fragmentation of medical knowledge in trying to
know more and more about less and less.
Man, in the new set up, is perceived as his body which we
see, with all its details of height, weight, body mass
index, fat pad thickness, blood chemistry measurements,
and many other details that we could measure with our
present knowledge. This is called his phenotype (form or
shape), which accounts for only 30% of his make up. In
addition he has his genome, the genetic make up, forming
about 40-60%, and the rest is made up of his
consciousness or mind. In our present set up we try to
study man (and screen him) by only knowing less than 30%
of his make up. Then we take pride in predicting his
future based purely on these parameters. Naturally the
future predictions go wrong; they should, as they do not
know the total initial state of the organism. Time
evolution in the dynamic human organism does not follow
the linear equations that we use in medicine.(2) For
better use of future predictions we must view the body as
a whole with, when possible, the knowledge of the genome
and the mind.
Take the hospitals of yore for example. Hospitals,
derived from the word hospitality, were very good for the
sick, but they soon changed to specialist clinics and
later became superspecialist in their attitude and have
disintegrated in the West. Do we learn our lessons from
others’ mistakes ? Never! As we are very clever we
want to go through our own mistakes and learn. In the
West new hospices have sprung up in place of the old
hospitals, again to look after the dying and give dignity
to death as well, because death is inevitable, despite
the hi-tech medicine that we think we are practising.
American hospitals are empty, British hospitals are
closing down, the French are opting for the Chinese
system of medicine, but we, the proud Indians, are going
in for five-star hospitals and try and fragment medical
practice into specialties and sub-specialties
(superspecialties in Indian English ).
Smaller groups of individuals, calling themselves
specialists, try to see the advantages in becoming
independent of the previously unified set up, put forward
arguments to fragment the system. They claim to do better
patient care and give hi-tech specialised service to the
specialised sick, belonging to their microspecialty. They
forget to look at the whole, and in the bargain, never
get the wisdom of keeping the organisation as a whole for
the good of the suffering humanity. Human body is never
to be seen and corrected in bits and pieces. Let us take
the example of one small subspecialty of cancer.
A cancer specialist thinks that the whole of the
organisation needs to be his for better patient care. He
puts forward arguments to say that cancer treatment and
cancer detection are the key to keep man alive on this
planet. He fails to see the writing on the wall. Despite
all the efforts death rate in cancer has not shown a
tendency to go down, although in some small subsection
they have achieved some success. Cancer screening is a
different story. Mammographic screening of breast cancers
in young women is of uncertain effectiveness. (3 & 4)
It is still not clear as to which screening method is
good enough for ovarian cancer. (5) With these and many
other studies about other screening methods, the National
Health Service in the UK refuses to invest money in this
kind of procedures; but the direct money spinning
American hospitals still encourage cancer screening and
we, of course, have to follow the Americans. !
The cancer of fragmentation is slowly spreading to
graduate medical schools as well, definitely to the
detriment of undergraduate teaching. A novice in the
field of health care, the innocent undergraduate medical
student, does not get the true message of the unity of
the human body, and its incapacity to work in bits and
pieces. In the new scenario of the plethora of
specialties, the novice gets the wrong message, what with
the halo around the sub (super) specialist in the
teaching hospitals the young graduate student wants to
ape him, but naturally. This brings on the dangerous very
early subspecialisation craze, not knowing and
understanding the human being as a whole. I have seen
this adversely affect the basic tenet of the medical
profession of "curing rarely, comforting mostly, but
consoling always".
Professor Eisenberg, in the USA went through the present
medical course, once again at the age of fifty. He
resigned his job and took the entry test to the medical
school and went through the course in the right royal
way. He has been totally disillusioned about the way the
young medico is taught the tricks of the trade in the
present day hospital set up. One or two American
Universities, led by the Minneapolis University, have set
up new reorganized departments of general medicine and
general surgery to oversee patient care and graduate
teaching.
The best bet for the common man in the present set up is
to have a good family doctor as his friend, philosopher,
and guide. Every one should be guided by his family
doctor in matters of health and illness. The specialists
should be consulted only when advised by the family
doctor. If followed, this method might cut down on the
incidence of a new disease called, the Ulysses Syndrome.
The latter is due either to diagnostic or therapeutic
misadventure. The present day heroic surgeries and other
modes of treatment are all fine as long as the
hero’s role is played by the poor patient who
subjects himself to the procedure.
We must be careful about this new trend for
fragmentation. Fragmentation is ultimately inevitable and
will destroy any organism or organisation. This is not
speculation or bad thinking. It is the rule or a law,
called the First Law of Thermodynamics. It is frightening
to know the future prospects of the health care industry
with the First Law of Thermodynamics in operation.
Physics is the king of sciences and the laws of Physics
cannot go wrong. I have given the warning. Beware !
Bibliography.
- Hegde BM, Holistic
Living. Book 1992. Bharathiya Vidya Bhavan,
Bombay.
- Hegde BM, Chaos- A
new concept in Medicine. Jr. Assos. Physi.
India 1996, April ( in Press)
- Forrest AP &
Alexander FE, A question that will not go away-
at what age should mammographic examination
begin? Jr. Natl. Cancer Inst. 1995; 87:
1195-7.
- Evans DER, Fentiman
IS, Mc Pherson K, et al. Familial breast cancer.Br.
Med. Jr. 1994; 308:183-7.
- Philips J. Is
screening for ovarian cancer worthwhile? Jr.
Med. Screening 1994;1:206-7.
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