FEATURE
Modern Medicine in search of its Holy Grail
Prof. B. M. Hegde,
hegdebm@gmail.com
Prof. B. M. Hegde,
hegdebm@gmail.com
The truth is something which can never be attained by scientific pursuits. Even in the hard sciences like physics, leave alone the not so perfect statistical science of medicine, the truth is an impossibility to get at. One could, at best, say that s/he has got "A truth but not The truth" at a given time. Any finding is true until it is proved to be untrue! JJ Thomson, from Cavendish Institute, got the Nobel in 1906 for showing that electrons were particles. His own son, George Thomson, got the Nobel in 1937 for showing that electrons were waves. That was the time that the de Broglie’s wave/particle duality became overwhelming and in 1932 James Chadwick gets the Nobel for that work. Erwin Schrödinger had other ideas and so on and so forth. Ultimately electrons are what they are depending on who looks at them at what time. When no one looks at them we do not know what they are like. Science can never see an electron! (John Gribbin, In search of Schrödinger’s Cat. Black Swan publication 1991) Total transparency is another unattainable goal in research.
Quantum physics is probably far removed from reality for obvious reasons as medical science is far removed from reality of what goes on in the human system with all its intangibles and imponderables. No scientist (medical included) can reach a stage where s/he could flex the muscles and say that s/he is now ready to take on ignorance and disease head on! But the real truth comes out in Werner Heisenberg’s uncertainty principle which got its Nobel belatedly after thirty one years in 1956, as many of his seniors, the leaders of the day in physics, did not believe him. The working of this world, including that of the human body, at its subtlest level, is uncertain but we, in medicine, have been predicting the unpredictable future of our hapless patients every day!
No one can possibly see an electron is now a reality, but all have been talking eloquently on the electrons, just as we in medicine talk a lot about the diseases but not about the owner of the disease, our patient at hand, who possibly could not fit into many of our known paradigms. We are yet to learn a lot about human physiology. Our RCTs and many other benchmarks can not fit all. Our bane has been the concept that one size fits all, the free size hypothesis. Any patient sitting on the hospital bed is so unique that s/he might not fit into any of our treatment algorithms. Our experience and judgment are our only saviours in such situations. That is the "art" of medicine which is dying in the midst of the cacophony of pseudo-scientific noise.
A humane doctor’s placebo effect could, at times, be more powerful than most of our chemical molecules! (Steve Silberman 2009 Wired Magazine: Med-tech: Drugs. 24th August 2009) We should never allow a humane doctor’s art of medicine to die a natural death, as is happening in many of our hi-tech teaching hospitals, lest we should all be consumed by the Promethean fire that Peter Medawar was talking about. We should allow enough leeway for the "third world" of Karl Popper to exist where we could have a near real world of our thought creation, so called thought furnitures, to help our patients. (Karl Popper: Objective knowledge: An evolutionary approach, Oxford University 1972)
Medical education should concentrate on teaching students to keep their eyes open to possibilities out with our known paradigms and not just parrot repeat the known knowledge from textbooks to get their degrees and then stop thinking about what goes on in every patient. Two patients with the same disease might not respond to the same treatment. They might not even present identically. Our teaching should stress on methodology and not just on known facts which are, at best, temporary truths. The textbooks are outdated by the time they come out of the press. Clinical research is to have a problem on the bedside and to go as far away from the bed as possible to get an answer, keeping in mind the definition of research as "organised curiosity coupled with logical skepticism."
Nobel Laureate Peter Medawar in his best book "Limits of Science" (Oxford Paperbacks, 1984) says it all: "The nature of science is such that a scientist goes on learning all his life-and must-and exults in the obligation on him to do so…..there can in science be no apodictic certainty-that is, no finally conclusive certainty beyond the reach of criticism." He also thinks that there is an unlikely "possibility of technology creating a Promethean fire which, as feared, will one day do us all in." All science starts with a hypothesis, in the words of William Whewell "happy guesses", another one of those mind’s thoughts which are being tested using the "known" parameters. They are the same as Shelly’s poetry (poesies=creation) or Samuel Johnson’s word "imagination" when he said something like this: ‘But for imagination, Sir, a man would be as happy in the hands of a chambermaid as in the hands of a duchess!" So science has its limitations although in theory one could get anything verified. A good doctor could answer some of the most difficult questions for science using his humane compassion. One such question could be "why" does one die? How one dies, science can answer very easily, I suppose but, not why does one die?
This brings us back to Charles Sherrington, another Nobel Laureate who is 1899, being appointed Professor of Physiology in Liverpool University, said in his first address to students thus: "Positive sciences can never answer the question why? They can, at best, answer questions like "how" or "how much" but not "Why". That is precisely why Coleridge declared theology to be the queen of pure sciences. "Why" can only be answered as a palliative. Truth, is probably the first casualty in medical science of today what with all the research frauds and the "games" played by the greedy industry to keep their till moving.
The Lancet, the great British medical scientific journal, started 185 years ago precisely to get the pus out of the large stinking abscess that the then modern medicine had become, using a surgical lancet. Thomas Wakley, who started this journal, was a doctor and a member of the House of Commons. He was so fed up with the system that killed thousands of patients that Wakley wanted to start a new journal to propagate good medical science and demolish the prevailing faulty but, then influential medical knowledge. Time has come to reinvent another Lancet to clear the stink today. Thomas Wakley (1795 – 1862), was an English surgeon. He became a demagogue and social reformer who campaigned against incompetence, privilege and nepotism. One glance at a recent issue of the Lancet which used three choice words to explain the industry’s maneuverings today. The words were murder, greed and corruption. These words were used with reference to a new anti-diabetic drug which must have sent a lot of people to meet their maker prematurely.
I have been writing about many other drugs with shadier past compared to the ones referred to in The Lancet for the last forty years but no one took notice. Now the Lancet has seen the writing on the wall. Wake up physicians and sleep not till the mess is cleared. Medical education is for life and should not be through industry sponsored textbooks, leaflets and medical meetings with sumptuous food and drinks to follow, not to speak of the freebees and foreign trips thrown in large measure. Remember that it is the hapless patient who picks up the tag at the end of the day! God save mankind! God also save the King(s) in charge of the watchdog bodies that let these dangerous chemical molecules cleared for human use in the first place.
Quantum physics is probably far removed from reality for obvious reasons as medical science is far removed from reality of what goes on in the human system with all its intangibles and imponderables. No scientist (medical included) can reach a stage where s/he could flex the muscles and say that s/he is now ready to take on ignorance and disease head on! But the real truth comes out in Werner Heisenberg’s uncertainty principle which got its Nobel belatedly after thirty one years in 1956, as many of his seniors, the leaders of the day in physics, did not believe him. The working of this world, including that of the human body, at its subtlest level, is uncertain but we, in medicine, have been predicting the unpredictable future of our hapless patients every day!
No one can possibly see an electron is now a reality, but all have been talking eloquently on the electrons, just as we in medicine talk a lot about the diseases but not about the owner of the disease, our patient at hand, who possibly could not fit into many of our known paradigms. We are yet to learn a lot about human physiology. Our RCTs and many other benchmarks can not fit all. Our bane has been the concept that one size fits all, the free size hypothesis. Any patient sitting on the hospital bed is so unique that s/he might not fit into any of our treatment algorithms. Our experience and judgment are our only saviours in such situations. That is the "art" of medicine which is dying in the midst of the cacophony of pseudo-scientific noise.
A humane doctor’s placebo effect could, at times, be more powerful than most of our chemical molecules! (Steve Silberman 2009 Wired Magazine: Med-tech: Drugs. 24th August 2009) We should never allow a humane doctor’s art of medicine to die a natural death, as is happening in many of our hi-tech teaching hospitals, lest we should all be consumed by the Promethean fire that Peter Medawar was talking about. We should allow enough leeway for the "third world" of Karl Popper to exist where we could have a near real world of our thought creation, so called thought furnitures, to help our patients. (Karl Popper: Objective knowledge: An evolutionary approach, Oxford University 1972)
Medical education should concentrate on teaching students to keep their eyes open to possibilities out with our known paradigms and not just parrot repeat the known knowledge from textbooks to get their degrees and then stop thinking about what goes on in every patient. Two patients with the same disease might not respond to the same treatment. They might not even present identically. Our teaching should stress on methodology and not just on known facts which are, at best, temporary truths. The textbooks are outdated by the time they come out of the press. Clinical research is to have a problem on the bedside and to go as far away from the bed as possible to get an answer, keeping in mind the definition of research as "organised curiosity coupled with logical skepticism."
Nobel Laureate Peter Medawar in his best book "Limits of Science" (Oxford Paperbacks, 1984) says it all: "The nature of science is such that a scientist goes on learning all his life-and must-and exults in the obligation on him to do so…..there can in science be no apodictic certainty-that is, no finally conclusive certainty beyond the reach of criticism." He also thinks that there is an unlikely "possibility of technology creating a Promethean fire which, as feared, will one day do us all in." All science starts with a hypothesis, in the words of William Whewell "happy guesses", another one of those mind’s thoughts which are being tested using the "known" parameters. They are the same as Shelly’s poetry (poesies=creation) or Samuel Johnson’s word "imagination" when he said something like this: ‘But for imagination, Sir, a man would be as happy in the hands of a chambermaid as in the hands of a duchess!" So science has its limitations although in theory one could get anything verified. A good doctor could answer some of the most difficult questions for science using his humane compassion. One such question could be "why" does one die? How one dies, science can answer very easily, I suppose but, not why does one die?
This brings us back to Charles Sherrington, another Nobel Laureate who is 1899, being appointed Professor of Physiology in Liverpool University, said in his first address to students thus: "Positive sciences can never answer the question why? They can, at best, answer questions like "how" or "how much" but not "Why". That is precisely why Coleridge declared theology to be the queen of pure sciences. "Why" can only be answered as a palliative. Truth, is probably the first casualty in medical science of today what with all the research frauds and the "games" played by the greedy industry to keep their till moving.
The Lancet, the great British medical scientific journal, started 185 years ago precisely to get the pus out of the large stinking abscess that the then modern medicine had become, using a surgical lancet. Thomas Wakley, who started this journal, was a doctor and a member of the House of Commons. He was so fed up with the system that killed thousands of patients that Wakley wanted to start a new journal to propagate good medical science and demolish the prevailing faulty but, then influential medical knowledge. Time has come to reinvent another Lancet to clear the stink today. Thomas Wakley (1795 – 1862), was an English surgeon. He became a demagogue and social reformer who campaigned against incompetence, privilege and nepotism. One glance at a recent issue of the Lancet which used three choice words to explain the industry’s maneuverings today. The words were murder, greed and corruption. These words were used with reference to a new anti-diabetic drug which must have sent a lot of people to meet their maker prematurely.
I have been writing about many other drugs with shadier past compared to the ones referred to in The Lancet for the last forty years but no one took notice. Now the Lancet has seen the writing on the wall. Wake up physicians and sleep not till the mess is cleared. Medical education is for life and should not be through industry sponsored textbooks, leaflets and medical meetings with sumptuous food and drinks to follow, not to speak of the freebees and foreign trips thrown in large measure. Remember that it is the hapless patient who picks up the tag at the end of the day! God save mankind! God also save the King(s) in charge of the watchdog bodies that let these dangerous chemical molecules cleared for human use in the first place.
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