FEATURE
Deschooling Medical Education in India.
hegdebm@gmail.com
“Students are schooled to mistake medical treatment for health care, social work for the improvement in community life, police protection for safety, military poise for national security, and the rat race for productive work.”
Ivan Illich
Abstract:
[Medical education in India follows the 1985 London University syllabus brought here by the East India Company with hardly any significant changes. This is irrelevant for today’s needs. Moreover, the very scientific basis of modern medicine is flawed as it still follows the linear laws of deterministic predictability in a non-linear dynamic system. The whole thing needs a relook. The earlier it is done the better. This has a lesson to other parts of the world as well lest we should all suffer from the ravages of modern medicine.]
Wise people learn from their own mistakes; wiser people from the mistakes of others. Indians being the wisest of the lot should learn from the mistakes that the western audits have discovered in our present modern medical interventions and in the scientific basis of modern medicine.1 It would be too late to learn from our own mistakes as we do not audit what we do in medicine anyway! Ever since the first three medical colleges were set up by the East India Company in 1857, based on Macaulay’s ideas, we promoted rote learning, students being taught by indifferent faculty resulting in mediocrity. There are exceptions, though. Mediocrity is competing with others, while excellence is competing with oneself, the latter being absent in our system. We punished original thinking and failed to create thinking, humane doctors. We have been pushing students into parallel coaching institutions before they get into medical schools to rote learn the premedical subjects to pass the “so called” entrance tests, again throttling their thinking capacity. Aptitude of the entrants to become healers is never tested.
The earlier this system dies the better for us as our entire education system was intended to make us rote learning robots of the western thoughts in the first place. The following extract from the speech of Thomas Babington Macaulay in the House of Commons on the 2nd February 1835 says it all. ““I have traveled across the length and breadth of India and I have not seen one person who is a beggar, who is a thief. Such wealth I have seen in this country, such high moral values, people of such calibre, that I do not think we would ever conquer this country, unless we break the very backbone of this nation, which is her spiritual and cultural heritage, and, therefore, I propose that we replace her old and ancient education system, her culture, for if the Indians think that all that is foreign and English is good and greater than their own, they will lose their self-esteem, their native self-culture and they will become what we want them, a truly dominated nation.”(Italics mine)
What ails our present medical education?hegdebm@gmail.com
“Students are schooled to mistake medical treatment for health care, social work for the improvement in community life, police protection for safety, military poise for national security, and the rat race for productive work.”
Ivan Illich
Abstract:
[Medical education in India follows the 1985 London University syllabus brought here by the East India Company with hardly any significant changes. This is irrelevant for today’s needs. Moreover, the very scientific basis of modern medicine is flawed as it still follows the linear laws of deterministic predictability in a non-linear dynamic system. The whole thing needs a relook. The earlier it is done the better. This has a lesson to other parts of the world as well lest we should all suffer from the ravages of modern medicine.]
Wise people learn from their own mistakes; wiser people from the mistakes of others. Indians being the wisest of the lot should learn from the mistakes that the western audits have discovered in our present modern medical interventions and in the scientific basis of modern medicine.1 It would be too late to learn from our own mistakes as we do not audit what we do in medicine anyway! Ever since the first three medical colleges were set up by the East India Company in 1857, based on Macaulay’s ideas, we promoted rote learning, students being taught by indifferent faculty resulting in mediocrity. There are exceptions, though. Mediocrity is competing with others, while excellence is competing with oneself, the latter being absent in our system. We punished original thinking and failed to create thinking, humane doctors. We have been pushing students into parallel coaching institutions before they get into medical schools to rote learn the premedical subjects to pass the “so called” entrance tests, again throttling their thinking capacity. Aptitude of the entrants to become healers is never tested.
The earlier this system dies the better for us as our entire education system was intended to make us rote learning robots of the western thoughts in the first place. The following extract from the speech of Thomas Babington Macaulay in the House of Commons on the 2nd February 1835 says it all. ““I have traveled across the length and breadth of India and I have not seen one person who is a beggar, who is a thief. Such wealth I have seen in this country, such high moral values, people of such calibre, that I do not think we would ever conquer this country, unless we break the very backbone of this nation, which is her spiritual and cultural heritage, and, therefore, I propose that we replace her old and ancient education system, her culture, for if the Indians think that all that is foreign and English is good and greater than their own, they will lose their self-esteem, their native self-culture and they will become what we want them, a truly dominated nation.”(Italics mine)
The MBBS degree that was introduced by the London University syllabus of 1857 continues even after 60 years of political independence with minor tinkering here and there. Time has come to see if this is relevant to our present day needs. Progress in science has shown us that the scientific basis of modern medicine is very shaky- more about it below. The course is overburdened with information and the student is left with very little time to study sick human beings where, in fact, the student should get all his education. Bed side medicine, the core of medical education, is all but dead in the present scenario.2 The faulty theory, based on statistical science, and not pure science, is being dinned into the students head with a top heavy curriculum which leaves much to be desired, resulting in the student having no choice but to rote learn the textbook stuff to the exclusion of real learning of medicine on the bed side. Basic doctor does not need such detailed instructions in sub-specialties that we teach now. Basic doctor needs to be a humane healer with adequate basic knowledge of the subject, mainly the fundamentals of clinical medicine for all age groups with some principles of surgery. Basic doctor also needs to know that there are possibilities to help the patient in desperate situations out with the modern medical boundaries in alternate systems that have been in existence for centuries, where there are scientifically proven healing methods. The present curriculum does not allow that laxity while in the west teaching alternate medicine is mandatory for the basic doctor.3
Deep down modern medical science is very shallow:
The conventional research in medicine is only a statistical research; there is no hard science in that area. We have been using the wrong mathematical basis for research in medicine. Whereas the human body is dynamic and follows the non-linear mathematical model, we use the linear model of deterministic predictability of Newtonian science. This has resulted in most, if not all, our data, to date, being questionable.4 We have been predicting the unpredictable future of humans by routinely screening the apparently healthy and declaring them to be unwell while time evolution in any dynamic system depends on the total initial knowledge of the organism.5 The latter, in the case of human beings, depends on their mind (consciousness), body and the genes. Routine screening, at best, could measure only a few parameters of the body. Audits now show that all kinds of screening measures have resulted in misery for mankind while helping the medical and drug industry to earn plenty of profits.6
We have been trying to medicalise the whole population. If one looks at the following data one will be convinced. Almost 90% of the population, by the age 40, will have at least one “so called” risk factor qualifying for drug therapy. With the drugs that we have for this purpose and the recent expose of the nefarious designs of the drug companies the future of mankind looks really bleak unless we quickly deschool medical education.7 Jeremy Laurance, health editor of The Independent, London wrote on the 27th February 2008 issue thus: “ The pharmaceutical industry came under assault from senior figures in medical research yesterday over its practice of withholding information to protect profits, exposing patients to drugs which could be useless or harmful.” Most drugs come under this category.
David Eddy, a professor of cardiac surgery at Stanford converted mathematician, has now come up with a soft ware encompassing 10,000 differential equations (non-linear mathematics) by name archimedesmodel, which is a virtual human body with all its physiology, where one could test to audit interventions of any kind.8 This has thrown up shocking data that most of what we have been doing has done more harm to mankind than good. Medical science needs to change from its time honored reliance on conventional science of linearity to that of the new science based on consciousness, non-linearity and CHAOS, a futuristic science in the making.9 I have been working on the non linear functioning of the heart for the last three decades and have come up with excellent data about a very good new diagnostic and prognostic test in HRV (heart rate variability) which will eliminate most of the common mistakes that are made on the surface ECG where scalar measures are used to derive vector analysis!10
Sad demise of humane bedside medicine:
Medicine had been practised on the bed side, with emphasis on the art of medicine, from time immemorial up until the birth of the first clinic: then came the hospital.11 It is only in the last 50 odd years that medicine started riding piggyback on technology which has now resulted in medicalising the whole population. Doctors have succeeded in schooling the population to believe that health depends on medical intervention alone; while the truth is that the health of the society does not depend on doctors and hospitals. In fact, recent audits have shown, in a fourteen industrialized countries study, that those countries with a higher doctor-patient ratio and bigger bed strength had worse health status of the population and shorter life expectancy!12 While trillions of dollars had been spent in the last quarter of a century in the west for medical intervention only 3% of the life expectancy increase has been attributed to medical interventions including vaccinations. Rest of the improvement came from nutrition, sanitation, education, better mode of living and affluence.13
Time honored doctor-patient relationship, on which depended relief from illnesses in the past, has all but vanished what with doctors practising medicine based on the array of scopes, shadows and laboratory reports rather than on the suffering human being’s bedside. This scenario has brought American medicine to its nadir. The recent movie SICKO by the celebrated US film maker, Michael Moore, and an editorial in a recent issue of the Texas Heart Institute Journal entitled Hyposkillia, document all that there is for the common man to know about the sad state of the medical world in that country.14
Future medical education scenario:
Medical education in the future must be totally changed for the good of patients and doctors as well. Change is life and change is the heart of true science. Science could be defined as “making models, mostly mathematical constructs, which with verbal jargon are supposed to work.” In that case the mathematical basis of medicine must be strong and it should naturally come from non-linear mathematics. With the understanding of consciousness in physics, medicine could take advantage to scientifically fathom the mind, which does not reside in the brain alone but, does so in every human body cell at its sub-atomic level. With the understanding of the mind better patient care could be planned. 15
Mind is at the root of most, if not all, diseases from common cold to cancer. Healing also needs the help of the mind of the hapless victims of illnesses. With the recent discovery of the most powerful expectation effect (EE) the role played by the doctor on the bedside assumes greater significance. It is the strong expectation effect that boosts the immune system of the body that alone helps healing.16 EE depends, to a great extent, on the faith and confidence that the patient has in his/her doctor. Consequently, future medical education should revolve round this summit where two human beings meet; one with an illness or an imaginary illness and, the other in whom the first has confidence. All teaching and learning should be on the bedside and clinical research should replace laboratory research to a great extent. Clinical research is simply having a problem on the bed side and going as far away from the bed as one could to get an answer. The latter could include all the laboratories and research facilities including the library. Unfortunately, in the present system research goes in the opposite direction, where laboratory results are thrust on the patient and the interventions are based on those results rather than on clinical indications! With the governmental funds drying up, medical research now depends more and more on pharmaceutical and technology company funds.17 “Experts criticised the stranglehold exerted by multinational companies over clinical trials, which has led to biased results, under-reporting of negative findings and selective publication driven by the market, which was worth £10.1bn in the UK in 2006, amounting to 11 per cent of total NHS costs” notes a report in the Independent, London, on its February 27th, 2008 issue.
Medical education of the future must have two clear cut compartments-first four year course, after class 12, to train a basic family physician, the only breed that has been shown to be useful to society in recent studies. And another slot of four years for those that expect to specialize after the first course. The second slot comes after a couple of years of practice as a family doctor preferably in a remote village. One does not become a specialist at the end of second four year course, though. S/he gets his license to be trained as a specialist after the second four year certification based mostly on, an on going on the job evaluation but not based on an end year examination of rote learning and information recall. Real skill is learnt after one gets a license to be a specialist. Learning stops only at the grave for any specialist. A good surgeon is one who knows how to operate, a better surgeon is one who knows when to operate and the best is the one that knows when NOT to operate. At that last stage only one becomes a true specialist, rest of them are only impersonators.18We have been trying to medicalise the whole population. If one looks at the following data one will be convinced. Almost 90% of the population, by the age 40, will have at least one “so called” risk factor qualifying for drug therapy. With the drugs that we have for this purpose and the recent expose of the nefarious designs of the drug companies the future of mankind looks really bleak unless we quickly deschool medical education.7 Jeremy Laurance, health editor of The Independent, London wrote on the 27th February 2008 issue thus: “ The pharmaceutical industry came under assault from senior figures in medical research yesterday over its practice of withholding information to protect profits, exposing patients to drugs which could be useless or harmful.” Most drugs come under this category.
David Eddy, a professor of cardiac surgery at Stanford converted mathematician, has now come up with a soft ware encompassing 10,000 differential equations (non-linear mathematics) by name archimedesmodel, which is a virtual human body with all its physiology, where one could test to audit interventions of any kind.8 This has thrown up shocking data that most of what we have been doing has done more harm to mankind than good. Medical science needs to change from its time honored reliance on conventional science of linearity to that of the new science based on consciousness, non-linearity and CHAOS, a futuristic science in the making.9 I have been working on the non linear functioning of the heart for the last three decades and have come up with excellent data about a very good new diagnostic and prognostic test in HRV (heart rate variability) which will eliminate most of the common mistakes that are made on the surface ECG where scalar measures are used to derive vector analysis!10
Sad demise of humane bedside medicine:
Medicine had been practised on the bed side, with emphasis on the art of medicine, from time immemorial up until the birth of the first clinic: then came the hospital.11 It is only in the last 50 odd years that medicine started riding piggyback on technology which has now resulted in medicalising the whole population. Doctors have succeeded in schooling the population to believe that health depends on medical intervention alone; while the truth is that the health of the society does not depend on doctors and hospitals. In fact, recent audits have shown, in a fourteen industrialized countries study, that those countries with a higher doctor-patient ratio and bigger bed strength had worse health status of the population and shorter life expectancy!12 While trillions of dollars had been spent in the last quarter of a century in the west for medical intervention only 3% of the life expectancy increase has been attributed to medical interventions including vaccinations. Rest of the improvement came from nutrition, sanitation, education, better mode of living and affluence.13
Time honored doctor-patient relationship, on which depended relief from illnesses in the past, has all but vanished what with doctors practising medicine based on the array of scopes, shadows and laboratory reports rather than on the suffering human being’s bedside. This scenario has brought American medicine to its nadir. The recent movie SICKO by the celebrated US film maker, Michael Moore, and an editorial in a recent issue of the Texas Heart Institute Journal entitled Hyposkillia, document all that there is for the common man to know about the sad state of the medical world in that country.14
Future medical education scenario:
Medical education in the future must be totally changed for the good of patients and doctors as well. Change is life and change is the heart of true science. Science could be defined as “making models, mostly mathematical constructs, which with verbal jargon are supposed to work.” In that case the mathematical basis of medicine must be strong and it should naturally come from non-linear mathematics. With the understanding of consciousness in physics, medicine could take advantage to scientifically fathom the mind, which does not reside in the brain alone but, does so in every human body cell at its sub-atomic level. With the understanding of the mind better patient care could be planned. 15
Mind is at the root of most, if not all, diseases from common cold to cancer. Healing also needs the help of the mind of the hapless victims of illnesses. With the recent discovery of the most powerful expectation effect (EE) the role played by the doctor on the bedside assumes greater significance. It is the strong expectation effect that boosts the immune system of the body that alone helps healing.16 EE depends, to a great extent, on the faith and confidence that the patient has in his/her doctor. Consequently, future medical education should revolve round this summit where two human beings meet; one with an illness or an imaginary illness and, the other in whom the first has confidence. All teaching and learning should be on the bedside and clinical research should replace laboratory research to a great extent. Clinical research is simply having a problem on the bed side and going as far away from the bed as one could to get an answer. The latter could include all the laboratories and research facilities including the library. Unfortunately, in the present system research goes in the opposite direction, where laboratory results are thrust on the patient and the interventions are based on those results rather than on clinical indications! With the governmental funds drying up, medical research now depends more and more on pharmaceutical and technology company funds.17 “Experts criticised the stranglehold exerted by multinational companies over clinical trials, which has led to biased results, under-reporting of negative findings and selective publication driven by the market, which was worth £10.1bn in the UK in 2006, amounting to 11 per cent of total NHS costs” notes a report in the Independent, London, on its February 27th, 2008 issue.
to be contd....in next issue
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