I frequently refer to one of the most famous medical quotes made in last century by a Harvard professor Dr Herbert Lay in 1969.
Five decades have gone since this observation was made by Dr Ley .Mind you ,Dr Ley is not a lay person , he was heading the same FDA which he targeted ! I guess when Dr Ley made this statement there was little commercialization in pharma Industry . Now along with it an entirely new field of medical device industry has grown to gargantuan proportions !
I wonder what Dr Herbert Ley would have to say as on 2014 !
Many modern medical professionals would shrug these views as controversial , pessimistic and negative forces of science !
Inability to think beyond self , family, private life reflects a backward and immature state of human mind
How to eradicate this backwardness we all suffer from !
I stumbled upon a book which made me wonder , whether eradication of backwardness is little to do with education ! It lies much, much deeper in our cortical thinking influenced by inheritance , evolution , culture and economy .
The stunning truth was exemplified by American political scientist Edward C. Banfield .A must read for every one who have mind for society , community and the humanity !
In this book he introduced a new term to describe this self centered thinking as “Amoral familism”
“Banfield concluded that human plight was rooted in the distrust, envy and suspicion displayed by them in relations with each other. Fellow citizens would refuse to help one another, except where one’s own personal material gain was at stake. Many attempted to hinder their neighbors from attaining success, believing that others’ good fortune would inevitably harm their own interests”
Banfield theroy and “Moral Bankruptcy in Modern medical care”
I am afraid there is a compelling link between Banfield’s observation in a remote Italian village to the current medical community mind set who care only for their patients who pay them and keep them happy !
If you think education will eradicate social backwardness ,Why ? one of the most highly educated community that form the noble profession remain backward in their thinking !
How do you explain innumerable instances of hospitals , doctors shutting doors for lesser humans even in dire emergencies ! ?
Why do many of them join hands with powers that can be detrimental to the overall health of the society ?
The stunning irony is , they do it unashamed (with pleasure at times!) in violation of the oath they take when they join the Noble profession. Shall we call it as ” Moral Bankruptcy in medical care ?
Read further
Moral Basis of a Backward Society
Highlights of this book (Text from Wikipedia)
The Moral Basis of a Backward Society is a book by Edward C. Banfield, a political scientist who visited Montegrano, Italy . He observed a self-interested, family centric society which sacrificed the public good for the sake of nepotism and the immediate family. Banfield as an American was witnessing what was to become infamous as the “mafia” or families that cared only for its own “members” at the expense of their fellow citizens. Banfield postulated that the backwardness of such a society could be explained ‘largely but not entirely’ by ‘the inability of the villagers to act together for their common good or, indeed, for any end transcending the immediate, material interest of the nuclear family’.
While our brain perceives whatever option we choose is the best for the patient , in reality it is rarely true !
The only comment I wish to make, there is nothing called standard guidelines for complex and unusual problems .We need not be obsessed with protocols !
Please remember , If you apply standard guidelines in non-standard situations 9/10 times we are going to err !
So my choice would be, to go with your gut feeling , of course your gut should be alive , up to date and periodically maintained !
If you don’t have the guts . . . don’t worry you have plenty of other options !
Unfortunately, there is a strong bias towards raw basic science when it is given in the filed of medicine.Do you know ,there is no Nobel prize exclusive for medical science ? It shares with human physiology the only field included for Nobel prize in medicine.
Evolution of human history reveals it is not the stunning scientific discoveries that impact the mankind . It is largely dependent on how we use them . It is true and natural ,invention of sub atomic particles , decoding quantum mechanics and trans-cellular signals always generate great interest than others.
In medical science, time and again we have seen problems arise in applying fruits of scientific research into practical usage in the patient domain in the bedside.
What is use of rewarding inventor of nitric oxide with a Nobel prize , when billion-dollar nitrate industry is thriving on a non existing life long indication of stable angina .
It is surprising to note , Nobel committee does give credit to wisdom & intellect while awarding prize in peace, literary or economic sciences. For some reason it lacks such a vision when it comes to medical sciences !
We have seen Nobel prize being awarded to organization that strive for peace and welfare of society and community like UN ,EU etc.The world health organization is the premier power supposed to provide and regulate the health in this planet.I do not recall any time WHO was close to considered for the Noble prize in medicine !
Nobel Ironies
Nobel committee rewards economists who point out lacunae in vital world macro and micro economics theories.
Dubious men(Heads of state ) are decorated with Noble peace prizes for preventing a war in one geographical area while doing exactly the opposite elsewhere !
In this modern millennium where scientific pursuits are contaminated and many of the research questions are misdirected or irrelevant , Nobel committee needs a through rejig in the manner in which medical Nobel prize is being awarded. We know ,Noble’s death wish was to award the brightest mind with highest scientific breakthroughs in those world . . . but
I guess Alfred Nobel if alive would have changed his rules .He wouldn’t have imagined modern science would systematically devalue common sense and reinventing it would also deserve an award equivalent to Nobel !
Some of the medical discoveries that deserve noble medical prize
States which excel in school health nutrition and other basic health programs for the downtrodden
Doctors who promote bed side clinical skills
Tobacco eradication networks
Organisations like medicine san-frontiers which strives for basic life saving medication for all
Journal houses that specialise on Medical ethics and clinical sciences
Medical professionals and institutions provide value education
Medical economists who expose the wasted financial resources that widen the gap between sick and rich
How about Nobel prize in cardiology for preventive cardiologist who successfully terminates a million statin prescription and restoring natural exercise directed lipid regulation in them ?
How about Noble prize for a noble physician sitting in corporate hospital infested with all commercial ingredients who could resist and argue successfully against inappropriate tonsillectomies and appendectomies ?
I am sure , such a man will be a laughing stock for most of us !
An appeal to Nobel committee
It is a wish , Noble prize in medicine is to be included for people who do yeomen services in preventive and clinical care and professional who carry forward the legacy of caring for the sick with clinical application of available scientific wisdom !
In this scientifically obsessed world , It will be a new beginning in the way future medical research will be directed and nurtured ! Only then the true power of Noble prize in medicine will be realised !
Tree of life : When professional morality suffers a mortality . . . human health becomes a causality !
Greatest threat to the future of human health is . . .
Not from exotic infectious agents , bird flu or mosquito fevers
Not from epidemic of cardio vascular disease
Not from thousands of published diseases in ICD code
Not from aging population and failing vital organs
Not from lack of availability of life saving drugs and devices
Not from lack of hospital beds.
Not from good sanitation
Not from hunger and poverty
Not from lack of para medical workers
Not from lack of health awareness and education
But from . . .
The way health care is administered in this planet .
The way noble professionals are created .
The way trivial health issues prevail over major health crises that wallop the health budgets.
The way by which medical morality is systematically destroyed
The way “concept of health” is sold as a buyable commodity by insurance companies.
The way medical journals churns out junk articles in the name of research.
The way corporates indulge in delirious pursuit to increase bed occupancy rate of their patient ware houses (Also called Hospitals)
The way greedy drug companies aim to increase the per capita drug consumption of ill informed homo-sapiens by discovering pseudo drugs for pseudo illness
The way health insurance policies are misused
The way rich spend billions for reconstructive cosmetic surgery while the poor die for want of basic medicines !
Following are revered facts . . . among the “Guardians of Cardiology” !
When false truths are synthesized to conceal a true myth . . . where will the poor myth complain ?Following are revered facts . . . among the “Guardians of Cardiology” !
Primary PCI is a greatest innovation in modern day cardiology .Without this modality most STEMI patients will buy Instant tickets to grave yard !
A cardiologist who intends to thrombolyse a STEMI is considered as a low quality cardiologist .
Streptokinase should have no place in the crash carts of modern coronary care units.
There is nothing called “Time window” for rescue angioplasty.
VVI pacemaker will convert an electrical problem of heart block into a mechanical one by depressing LV function .
Digoxin is an obsolete drug even in well established cardiac failure with dilated heart.
Beta blockers not only fail to control blood pressure smoothly , it often converts a hypertensive individual into a unhealthy one by it’s prohibitive side effects !
In one of my meetings , I told a small gathering , that regular exercise can shrink atherosclerotic plaquesand regress CAD. I also quoted , a recent large study which has proven this fact convincingly !
I concluded, simple exercise and other life style changes,risk factor correction may convert a 90% lesion to 70 or even 50 % . I stressed the importance of this study and asked my colleagues to avoid misuse of Angioplasties .
When many seemed to agree with me , one angry Interventional cardiologist questioned me, and asked the name of the study, and in which journal it came , What was quality of the paper ?
I told him , It is an Imaginary studydone in my back yard . It never got published in print. You may call it as E-journal* , not exactly though.It is not available in any websites , but located in the biological servers, and neuronal circuits as digital imprints in learned brains !
*Journal of experience
You may call it , a scientific forgery , to quote a non-existent study,
“But this study benefits whole lot of my patients”.
He was amused , and became agitated !
He told over the mike , “You are making foolish statement. . . don’t corrupt young minds” !
May be , he is true !
I asked him to be calm and requested to listen to another study which I was about to quote . . .
He couldn’t sit any more and rushed out of the hall !
Final message
We are ready to believe all those rubbish stories about a fourth generation self disappearing BVS that is able to scaffold a coronary artery and maintain a MLD by 2.5mm and TVR by 20 % and prevent near MAZE at 30 days by 9 % and improve long term survival by 6 months at the cost of 100, 000 Rs per month .Only to realise, it may be a farce . . . 5 years down the lane !
How to cleanse the darkened face of science ?
When falsehoods come with evidence and harm people , Good deeds can be preached without evidence to save our fellow human beings !
The doctrine of modern medicine goes something like this . . .
For most medical problems , there would be a solution. Keep trying . . . till you get it !
*But , just make sure that problem on hand deserves a solution in the first place !
Modern medicine continues to remind us every day , the much hyped solutions often end up in new problems and many times worse than the original problem !
Oh ! what a great a quote ! When I was boasting myself . . . My wife reminded me , this is just plagiarized version of a 2000 year old Hippocratic thought !
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Five decades have gone since this observation was made by Dr Ley .Mind you ,Dr Ley is not a lay person , he was heading the same FDA which he targeted ! I guess when Dr Ley made this statement there was little commercialization in pharma Industry . Now along with it an entirely new field of medical device industry has grown to gargantuan proportions !
Dr.S.Venkatesan MD 