Wednesday, October 24, 2012

The Pursuit of Truth in Medicine

The medical pond is a complex ecosystem. It's too vast in surface area, too specialized in skill sets and too uncertain in ramifications. If you are the recipient, it's also too personal. There is increased talk about alternate medicinal streams and their effectiveness or otherwise. Many seem to be singling out Allopathy (and often,  in loose reference, modern medical science), as being a dominant predator causing imbalances in an otherwise peaceful pond. So, the question often asked (and I won't answer) is : "Are you, like, Allopathy believer or Alternative medicine believer ?" Only humans are capable of these extraordinary questions, you know. They convert science into a religion and religion into science, or say something like "both are one" and confuse people, LoL.

By alternative medicine streams, I mean the whole bunch, Ayurveda, Homeopathy, Naturopathy, Siddha, Yunani, Acupuncture and so on. So, here is some of my chillar thrown into the pond, on why allopathy is not the complete picture, what's ailing alternate medicine streams and why many would find them unconvincing. It's becoming clear that my blog is for the relaxed reader, because I can't write short posts. :-) But then, it's the blog's anniversary and I haven't written since Steve Jobs, so it's the suppressed gush of a few months. :-)

Roots : To start with a very simple thing, most alternate streams of medicine rely on allopathy, their devices or the concepts for the diagnostics, even from testing the blood or measuring the BP. Allopathy itself drew some of these from ancient forms of medicine, but the original ancient forms of diagnostics aren’t even practised in their pure or correct form, and if done, too few and far between to attract reasonable attention.  Let alone being proven in favour by science in the labs and peer-reviewed journals, except for anecdotal evidence.

Research : There is probably a lean research framework for some of those alternate streams, but none of them have the research rigour, repeatability of experiments, peer disagreeability and testing techniques, of the modern era.  I am not saying alternate streams should fall in line with the western science or their research framework.  It may be that, the truths of one science cannot be validated by the framework of another science, because their underlying concepts are different. But, it’s up to the alternate medicine streams to come up with their own research and publishing  framework, where, even within their own practitioner community a certain phenomenon can be accepted, rejected, endorsed or vindicated by members of their own ecosystem. Now,  it’s all like the Mummy-Daddy kirana shop, like “Aunty got cured, I got cured, Uncle improved vastly, Try it and you’ll know, You can see it for yourself in 21 days” and so on. The "personal story" thingy, is surely an emotional and often a genuinely felt expression of a truth that happened in someone's life, it's a good thing, it's a statement of real experience. It shouldn't be discarded as imagination. But, it's one thing to share the joy and suggest it to others with fervour, another thing to start doling out suggestions based on your home-grown "expertise" and non-formal studies, another thing to conduct melas to coach people, and a totally different thing to base a science on such data.

The alternate medicine streams doesn’t have to be studied and validated by allopathy doctors, labs and journals but, at the minimum, there needs to be collation and organizing of their own anecdotal evidence. Also, if they are using Allopathy methods and devices for certain part of their work and research, like diagnosis and review, there is a need for the alternate medicine stream to evolve its own methods and devices based on its own fundamental concepts. Why would you use, Science A based principles on X, Y and Z to diagnose and then use Science B, based on principles P, Q and R to treat, particularly if you believe their principles fundamentally contradict each other ? In what sense do you think they can co-exist, whether such a co-existence has been studied and in what proportions do they mix, match or meddle ? May be some such techniques for independent diagnosis by other streams are already present, then the issue is of state support, awareness creation, publicity and wider acceptance etc. India is slightly better off in that way, in the sense that there are state-supported professional courses that support the state of native forms of medicine as an organized subject and technically qualify in those streams.

Claims: Another issue is, the often “fantastic but untrue” claims of “I have cure for Cancer”, “I have cure for AIDS”. Quacks are present in every stream including allopathy, so it's not about them. But, even among the technically qualified professionals in the alternate streams, such claims are not uncommon. Okay, assume such claims are not "claims" but, valid instances, the genuineness of which the world is refusing to see. Even for the good and qualified practicioners, it is quite common for practitioners in alternate medicine, to “give up on their patients in the last minute and rush them to the hospital”, after the situation has worsened beyond remedy. Even an intelligent modern CEO like Steve Jobs had to fall a victim of this trap, when it came to choosing a medicinal stream for his pancreatic cancer. For terminal illnesses, or for illnesses that can get fatal in advanced stages and require surgical intervention,  the alternate medicinal streams get absolutely clueless on what is to be done. They can “manage the show” for sometime and “make you feel good” for a little more time, but they fizzle out once the symptoms become advanced. Then, allopathy finally takes over, intervenes. Say, for some reason, because of the complexity and uncertainty, they are unable to figure out what's happening. At the time too, the alternate theorists might sit by the sidelines and comment on what the surgeons are doing wrong and how they can do stuff in a jiffy, but thats pretty useless unless you have a more complete alternative to handle the situation. Unless we have a complete alternate system, (or atleast as complete as it gets, as much as allopathy), the comments don't take the form of organised study.

Tradition: For streams like Ayurveda and Siddha in India, there is the argument “These were all told by our ancestors which these other guys are all exploiting today or ignoring today.”  There is surely an element of truth to it, but part of this argument is emotional, “my country”, “my mummy” thingy. Like the Steve Jobs analogy I used above.  There are a few things mangled here, their validity in terms of effectiveness, an establishment of such validity, then awareness and communication, genuineness in practice,  and then, last,  “my country ka science tha”, that brimming pride in the gleaming eyes. It's true that some ancient texts like the Siddha medicinal texts in poetry form, are not discovered, not studied enough and not publicised, but that's an access and awareness issue. I would only say, it’s an open world,  to every citizen his own country is the darling, so in a global world, let the Medicine Stream A fight it out with Medicine Stream B. Whichever works , gets accepted. Which we’ll know in a few centuries after we have messed up the whole thing, LoL. We shouldn't mix up our passion for our country with the pursuit of Truth. Brilliant minds from every land have pursued the truths in every field and struck upon original insights that aid in that pursuit. After all, till Louis Pasteur discovered what fermented beet sugar, the world was just watching people die. May be we are the pooja room of the world, but  Saraswathi Kataksham is global, LoL.

Lifestyle : Most alternate medicinal streams tend to explain their unreliability, with “lifestyle” choices of the patient. “It doesn’t work because it’s all tied to your lifestyle”, they would say. This is true, and hugely significant, and such significance is often undermined by sheer ignorance, even among the otherwise literate crowds. Unfortunately, health awareness, is like personal finance literacy. How-many-ever times people tell you the right thing and educate you on risk and return, you foolishly believe what you want to believe and go put your money in a chit fund first thing in the morning, LoL. Like the potato chips pack I devoured just now.   But the "lifestyle kills it" argument, is not true only for alternate medicine, it’s true for allopathy too. It’s common nowadays, in the light of modern research trends, for allopathy doctors to suggest lifestyle changes before medical management, and also to suggest Meditation, natural foods, diet and exercise changes etc wherever found to be relevant and helpful, but only upto a stage where these things can manage the show. So it’s not like, allopathy ignores lifestyle management. To be fair, the alternate streams should be credited for creating greater awareness in allopathy research by pointing their significance and relevance. Again, while most doctors suggest meditation where relevant, Yoga is suggested only with caution. Because, as much as Yoga done in the right way can have its benefits, Yoga done the wrong way can land the patient into fresh issues, over which again the doctor has no control, like lifestyle.

Subjectivity : Because the major part of the problem is the lifestyle, or so they believe, the problem is also prone to a lot of "customised" explanations. This is fine. But this also becomes an escape hatch, for things that you are not able to explain. If a doctor looks at two patients with a similar symptom, he may decide that their causes are different. But if two doctors look at the same patient, they might still decide that, the cause, according to their views, is different. This gap in subjectivity is better closed, by a framework that allows a peer to challenge your study and to find patterns among all the subjectivity. Given a patient, and assuming the doctors are equally qualified in their streams, two doctors from Allopathy are likely to agree on the broad causes better, rather than two doctors from an alternate stream. Now, which one is the whole truth, which stream and which of the two doctors in that stream ? Is it subjective based on the patient's condition or subjective based on the doctor's study of it ?

Adoption: One question that still remains and pertinent is : "Have you tried ? Try and then speak." . While this is a valid question, it can also take wrong directions for the uninformed. Most people, would like to have an answer to another question that arises before this : "Is it worth a try? If yes, why ?". The answer for this is either not clear, or not clearly communicated, or unconvincing, or incomplete except for the passionate appeals. The appeals are like the shouts on the Marina : "He is the only REDEEMER", kind of thing, okay for suddenly waking up from slumber, but not convincing for long-term adoption. If we don't pause to ask the question "Is it worth a try" before trying, we might as well be trying anything that anyone says, the seller of panacea with a mike on the pavement who supplies mysterious potions in minisule portions. There is always the answer :"You'll try when you feel the pinch". This is true, but it doesn't answer the question still. May be we all will turn to alternate medicine after getting frustrated with allopathy and its side-effects, just like some who do the converse.Oh, by the time, we won't have any money left, and by then, alternate medicine also would have got commercialized, so we won't even be able to shift loyalties. :-) :-)

Whatever may be said about the research, the passion of some promoters of alternate medicine is amazing and is born of a genuine concern for wholesome health of their fellowmen. Their approach is different, but the fervour with which they learn and update their study of the subject is unquestionable. Some of it, arises out of what they see as the public being misguided by the marketing giants, who mask the truth of things or the basic causes of a disease lying untreated while the symptoms are dressed up and covered up with a pill mania. The "misguidance" theory works both ways. The alternate streams believe, pharma companies are misguiding, pause them for a moment and go to the other camp, you'll hear Allopathy saying that the alternate streams are misguiding. If you are too baffled, I think it's easier for you to become a doctor yourself and not go to one. But, Oh God, medical education is costly and you'll end up misguiding others, gathering a lot more sin, because of which you will be born as a patient once again in the next birth, and the cycle continues. LoL. Not without reason it is said, 'Iha samsaare bahu dustare'.

Commerce: Of course, Allopathy and western medical science today have got entangled into a lot of other issues and maladies. Legality, insurance, Big Pharma, side effects, over-cautious and aggressive medication, trial medication under uncertainty, suppression of facts, greed, blatant promotion and mindless marketing, camouflaging of bad practices as good ones and then deep and deliberate over-commercialization. Some back-end parts of the muck is not different from organized crime. It ain't Healing that is paramount any more. It's some money, and then some healing, if it happens that is.  As I wrote earlier, Pharmaceutical research has got mangled with money, law and governance, so much so that the "intention to cure" has become an also-ran motive, rather than the primary one. But I guess, these are present in  various other streams of human life, no point singling out Medicine. As a race, we are generally doomed in many ways, and specifically “extra doomed” in few ways, LoL. I also expect these negative phenomena to happen in alternate medicinal streams whenever they hit the threshold level of wider acceptance and practice. If you are Windows, you have viruses. It's like saying, adopt other streams because Allopathy has issues. As those alternate streams grow in size and acceptance, you'll have the same maladies because the malady is there in the mind of Man, not in the tools you choose.

Effectiveness: That said, we can't say alternate medicine streams are all ineffective. It's just that, their effectiveness is not part of meticulous, unambiguous documentation and framework, that can be independently studied by others  in comparable environments, under controlled conditions and across cultures and geographies. It’s more like the beneficial effects of home remedies, native wisdom, meditation, yoga etc, effective indeed in pockets based on context, particularly in prevention and consciously healthy lifestyles, some of them supported by occasional  research, but not all and not all the time.

Completeness : There is a view that while Allopathy has its merits and relevance on the surface (diagnosis, treatment), it is hugely incomplete in its study of the roots and causes, there are entire sets of insights that it is refusing to acknowledge. Many alternate streams, (some bordering on healing techniques and not exactly Science) insist on a strong mind-body connection, and then, a spirit-mind-body connection to disease. Allopathy might appreciate it "kinda broadly", but we should credit the alternate streams for highlighting the connection, that the root of disease lies in our thoughts, foods and lifestyles, in that order. Some border work between Allopathy and alternate streams have definitely resulted in new learning for Allopathy. A Mahesh Yogi volunteering to be medically studied under trance during Meditation or Carl Jung's focussed study on Man's Consciousness have, later found relevance and attention from mainstream research, even though viewed with suspicion in early stages. Good scientists are humble when they see technical merits even if they are outside their domain of study. This has led to "Holistic" medicine. But the problem with the term is, each stream claiming it is more holistic than the other. Holisticker than thou, LoL. But the complete truth is better pursued, by each stream, acknowledging the areas where a stream is clearing lacking and adopting insights from other streams, with a honesty in approach and healing as the objective.

It’s also possible, that we are all living in a Matrix-like illusory haze, all “falsely” believing in Allopathy, where, in fact, that’s the villain. Evolved believers of alternate medicine are mocking at our balloon, filled with the gas called research, waiting for it to be pricked. We’ll tumble in a free fall, and land in their hands, and they’ll then take care of all of us with affection and succour :-) .  Then, you should know, anything like this blog post, which “clearly” re-assured the balloon is safe,  is actually warning you, that it might not be. I mean, otherwise, why would someone go to great lengths to reassure you repeatedly :-) ? Like the analysts and officials who always said, “everything is fine”, till the bubble burst on the sub-prime housing crisis. The Truth will set you on fire, and then it will set you free.

Three specific disclaimers, in addition to the general ones at the blog footer :
1.    I have no knowledge about any medicinal science. My knowledge of medicine is lesser than my knowledge of music, which is documented earlier here.  It's an unresearched post on the importance of research, LoL.  I am just an intellectual patient, with exactly 2 cents in my pen and pocket, LoL, with which I can’t substantiate any of these claims, including your medico-legal one.

2.    I am willing to be corrected. Expect an update five years from now, when I have transformed and converted to the alternate evangelists, err... I mean, of medicine. Some of my passionate friends have already "moderated" my views on this post, a few more strokes, and they may have their way, LoL. By now, it’s well-known that  I usually adopt late, particularly when it comes to the good things of life. The more virtuous it is, the more time I take to adopt. :-) :-) Not exactly the satsang you want to be in.

3.    And please, I haven’t seen Aamir Khan’s TV episode on medicine, LoL.

1 comment:

  1. Why are there multiple healthcare systems...'
    Is it like multiple cultures, languages, sports, dramas and movies... each one catering to different groups of people/situations?

    On the SSSIHMS-WFD inauguration day, 19 January 2001, Baba said: “In life, health is the greatest wealth. Since ancient times, yogis, sages, and seers made penetrating investigations into the means to keep good health. They were of the view that man could work for the peace and security of the world only when he is in good health. In modern times, many people are inclined to place complete faith in allopathic medicine. Others feel that Ayurvedic principles are essential. Allopathy only gives temporary relief; it does not permanently cure diseases. But Ayurveda can provide such permanent cures...."

    In SSSGH, patients have heard about Dr. Ghooi. The doctor explains how she mixes the medical treatment methods..

    Dr. Iyer of SSSIHMS also explains a lot on ayurveda

    We have also heard that body heals by itself and that the healthcare system aids in that process. Probably that why we have many variations and approaches with influences from the other!

    The practitioner of one can appreciate the benefits of other while trying to set the stage for patient's cure...


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THANK YOU: These reflections draw sometimes from readers and friends who initiate ideas, build up discussions, post comments and mention interesting links, some online and some over a cup of coffee or during a riverside walk. Thank you.

Disclaimer: Views expressed in this blog are the blogger's personal opinions and made in his individual capacity, sometimes have a story-type approach, mixing facts with imagination and should not be construed as arising from a professional position or a counselling intention.