Posts Tagged ‘medical ethics’
Peer reviewed perils: Medical science is still far away from true democracy !
Posted in Uncategorized, tagged acc aha esc guidelines, clinical cardiology, drsvenkatesan venkat quotes, medical editors, medical ethics, nstemi, peer reviewed journal, stemi on September 12, 2020|
Time to tweak the definition of “Professional incompetence” in medical practice.
Posted in Uncategorized, tagged artificial intelligence, dr s venkatesan, dr venkatesan sangareddi, future of medical ethics, gene therapy, hippocrates, journal of medical ethics, lown foundation, madras medical college, medical ethics, medical quotes, nano medicine, nejm bmj lancet, noble profession, principles of practice of medicine, quotes medical ethics best, sir william osler on January 28, 2020|
Who is the “Real master” in Master health check up clinics ?
Posted in Uncategorized, tagged master health check up, medical ethics on September 17, 2019|
Master health checks* , superficially look like a perfect modality to practice the greatest medical concept ie “Prevention is better then cure” .Let us detect all human diseases early , prevent its progression, regress it or completely cure it . Absolute bliss is it not?
Why then articles such as this one should ever get published, that too in one of the prestigious journal of medicine?
*Master health check .( Also referred to as annual General health checks.)
While the title itself is provocative, it adds a tag line which is still more a shocker.
There are specific well-researched reasons for this preventive health check fiasco.The masters, who were originally the guardians of health soon became disease mongers.In the process, the primary aim of propagating the doctrine of “prevention is better than cure”, could not reach its desired goals. Instead of ignoring and reassuring the minor deviation of biological data and Imagery generated, they became a perfect feed for the hunters who are after the trivial and non-existing illness.
Final message
Good intentioned health checks are always welcome in selected high-risk population say pregnant women/children of developing a world (As in endemic countries of rheumatic fever) Also cancer , CAD , screening in people with a positive family history can be critical.
However, when these masters of health deviated and started making a living out of apparently healthy people. ( The side effects reached monstrous proportions hiking global health cost in a meaningless way).People, especially in counties with poor resources, are the ultimate sufferers, as the cost and efforts are diverted, to fix the health of healthy, while people with true illness continue to struggle.
Will the WHO* wake up and intervene against this skewed practice of routine master health checks in healthy, that are rampant in both rich and poor countries. Ideally, doctors should order preventive health assessment for those who may need it.
There are enough grounds for public Initiated periodic walk-in health checks to be banned (or at least restricted)
*WHO is world health organization
Found the secret of successful medical practice … in just three seconds !
Posted in cardiology-ethics, Quotes, Science and Religion, Uncategorized, tagged best medical quotes, briany quotes, dr venkatesan quotes, hippocrates quotes, madras medical college dr s venkatesan chennai, medical ethics, medical quotes, sir william osler, william osler on April 29, 2019|
*When I tried to condense three decades of my learning into the medical profession in three lines, I scribbled this. Sorry folks, if It doesn’t sound scientific for some of you!
By the way, What is successful medical practice? Success for the Doctor, patient or both? The answer to this question is never simple.
Random thoughts: If extreme poverty is a disease . . . what about uncontrolled affluence ?
Posted in bio ethics, medical quotes, tagged affluence as a disease, medical ethics, mitosis of money, modern medical care, money and life, oncological aspects of money multiplication, principles of life on March 8, 2019| 2 Comments »
Poverty is a cruelest disease of mankind , the infective vector is not any deadly HINI or retro virus , but mostly the fellow humans themselves ! This is why WHO has included poverty in the ICD code (Z59.5 ) as a disease .
I used to wonder , as a member of Noble profession , should we fight against this disease or be happy to spend my entire life time cleaning the coronary arteries of affluent human-beings and earn few bucks !
Can growth of money eliminate poverty ?
We may think so . . . but it doesn’t most times .Of course , affluence bring more jobs to the poor , logically it should alleviate poverty. But , we know the reality. Its not that easy concept to understand . However we have robust evidence for the opposite ie affluence can aggregate poverty .
If poverty is a disease & if mindless affluence is an Indirect cause for it , then affluence also becomes a potential disease , Is in’t ? Will WHO include it in ICD listing ?
May I propose Z59.5A to be called Uncontrolled & manic desire for affluence ? Since it is made at the cost of fellow humans , it should be clubbed along with poverty as a worrisome disease. Once its included in the ICD manual , I guess it will be unethical to ignore this disease.
We all aim for growth in life .Nothing wrong in that .There are many facets of life that requires growth. Unfortunately , for most homo-sapiens , growth is synonymous with multiplication of money . . . nothing else seems to matter ! Money when it grows unregulated , begins to control you and hijack your body and mind .
One more issue to comprehend is , rapid growth of money is possible only at the cost of something (or someone) else – Akin to cancer cachexia ,it depletes the body (Earth ) of it’s resources ( Nature abuse , extreme poverty , inequality , Third world exploitation , wars, etc ) For the medical professionals it is all the more important that growth shouldn’t mean money , as it has a direct and conflicting impact on some one else’s life !
Just Imagine , if the all the car companies combine together , aim for a dramatic growth from the current 4 % to 25 % by 2030 and manage to achieve it by any means ! . . . This planet will sink in the combined weight of automobile Junk !
It is obvious , uncontrolled growth in any form requires vigorous regulation and Intervention and will eventually require a radical surgery if the growth goes unabated !
Counter point
It is foolish to link growing money and wealth equivalent to cancer. Unlike cancer cells , money multiplied can be put into use for those in need .It is the principle of charity .But the reality is , human beings who are rabidly after money rarely have this mind set.In contrary the haven’ts have it in plenty. In my opinion, excess money has a dubious capacity to contaminate human values ! (Why should some rich and elite opposes affordable health care to poor ?)
Let us amass wealth and help others . Microsoft is able to do it. Apple may do it later. What is the need for big companies social responsibility and philanthropy ? If the business worlds motive and end product promotes equality and goodness , sans exploitation , the question of charity at a later date never arises.
Final message
If extreme poverty is a disease , forces that Initiates or sustains poverty cycle can not be a bliss. In this context , the manic affluence (& the urge for it) should be included as a communicable disease since it seems to be most contagious as well.
In health care delivery “affluent and modern care” may also connote a sinister meaning. Poor people might think they are deprived of good care because they cant afford it. But ,truth hides deep. True sustainable caring is little to do with affordability+ , since most of the modern health care expenditure is jacked up with junk.
I know in my country people sell their life time assets for what they think as crucial health care .(Of course universal health care insurance is just beginning to come in. Here again insurance based health care has inflated the actual costs and threatening to impose inappropriate therapies .
As a medical professional we should aim for the cheapest and best form* of treatment to our patients . Artificially inflating the cost of therapy by worthless drugs, devices, procedures and disseminating them invariably leads to pathological growth of science.
*If any one thinks “cheap and quality” doesn’t go together in medical care it is ignorance ! Most problems has simple and effective solution.
Post-amble
* I object this statement -Modern health is nothing to do with affordability.
We need to go to the basics then .What is true health ? Forget about transplants, Organ Assists, Five star critical care .They seem to work in a minority , but drain the world economy. Its Impact on global health is at best minuscule. One Important analysis say 90% health care cost is wasted in prolonging the last 30 days of life of homo-sapiens.(Will get the reference for it )
Please note
Diseases that occur to affluent population is entirely different topic . Can be found elsewhere
I am sorry , I hate Hippocratic oath !
Posted in Ethics in Medicine, tagged doctor's manual, general medical council guidelines for doctors, hippocrates, medical ethics on July 30, 2017| 1 Comment »
Hippocrates is bestowed with the Immortal tag “Father of Medicine”, not because he invented any miraculous gene therapy or a modern virtual imaging of human organs, nor did he found any magic drugs .He didn’t receive a single award even from his local village, forget about any Nobel prize to him !
Mind you , he lived before Christ ,2ooo years ago , there was nothing in the hands of noble professionals, not even a piece of paper and pencil to note down patient’s symptom .They didn’t even know what organs human body contained no basic medical tests . They just had a pair of hand, working brain with six senses , strong will to work hard and most importantly a caring mind and a constant search for answers to lingering scientific queries .
Yes, Hippocrates is still holding the post of father of medicine because he was the first human to propagate thought that human diseases are not evil forces beyond our control, it may have scientific basis , every disease has a specific cause that arise from derangement of body function.
More important than this , he formulated a way to practice this profession in a dignified manner. He also predicted common sense may prevail over science in innumerable instances. Going through his quotes , one could wonder , he probably predicted technology might hijack human Intellect as well !
Now,we have every thing. Students read medicine in animated 3D class rooms , physicians get a deluge of body system data & images beamed straight into their ipad . One can perform complex interventions with ease in almost every organ or even replace it , if it doesn’t work .
Still , as on 2017 ,there is something huge , that is missing in the Noble profession when compared to ancient days (2 millenniums before!) when people thronged Hippocrates clinic in the remote Koss Island of Greece, where he used to sit with almost nothing , but was able to offer definite cure for many .
What is that missing link ? Without realizing what it is, we enter the Noble profession and fervently take the customary Hipocratic oath . For many (or most ?) of us it is amusing to read and practice that. Life has moved in fast lane since then. It is a tragic truth , Hippocratic oath have become redundant , obsolete .or outright humiliating for few !
Final message
Whatever you say, still Iam compelled to feel sorry for that “Good old man” who miscalculated the Integrity modern day Noble professional , (I would say, Mr H failed to realise doctors are also made from ordinary human beings ! )
It’s ok . . . here is a “Doctor’s life maintenance” manual : Keep reading it periodically !
British General medial council , has done a wonderful job . It has published a practical life maintenance and behavioral guide for doctors which I feel is most important text to be read periodically and of course followed !
What ails modern medicine ? When “Nonsense” masquerade as scientific data . . . should “sense” has to leave quietly by back door ?!
Posted in bio ethics, Cardiology quotes, Cardiology research topics, Cardiology Risk assesment, medical quotes, Two line sermons in cardiology, tagged Lown Institute, medical ethics, what is scientific data on October 16, 2016| Leave a Comment »
Bedside wisdom
We have been using unfractioned Heparin for long , and its is better than any other anticoagulants in ACS . . .
Our observation shows that Streptokinase has distinct advanatge over Tenektepelase as it works longer duration . . .
My experience says Diuretic and beta blockers are still good as first line therapy for Hypertension . . .
Mind you , there are infinite number of such wisdom in every sub specialty of medical field.
However , the typical response from any modern scientific intellect would be . . .
Stop it . . . Its old stuff folk , What does the current data say ?
Common uttering in scientific forums,
Is there data backing up your treatment modality ?
Is there sufficient data ?
Come’on , grow up , don’t talk about experience in a scientific forum . . . come out with data man !
No one seem to care the quality of the data . Every one bothers about the quality of the Author and Journal instead . if its X Y Z its ok If its A B C no its not acceptable data.
Probably , Data is most misused word in medical science.
In scientific world, “unpublished sense” goes straightway to dustbin ,while we have so many avenues for the published nonsense to be celebrated (Still, bulk of guidelines in cardiology is backed up by Level C evidence which means experience of experts !)
By the way what do we mean by data ?
Its organised collection of genuine scientific information , that’s post processed , follow it up with sound inference and faithful questioning and debate that should ultimately end up as “clinical application” in patient domain for consumption.(No prizes for guessing , whats happening in real world !)
OMG, give us back that elusive Common sense . . . which I think we lost some time at the turn of this millennium !
Wrong or useless data : Who will recall ?
Once applied to patient , these data is to be scrutinized and monitored . If we find a study conclusion and reality does not match , we need to stall the data from adversely exploding .Every stake holder should have the power to do it. There have been instances a treatment modality got banished in one country is legally permitted in other country knowing fully well the futility.
Final message
Modern scientific Data* is not God sent. Its created , synthesised and disseminated in various mind factories. All you require is , backing up with some pioneering journal publication with huge impact factor.It’s not really blasphemy to question things which doesn’t make sense .Unfortunately , wrong data can be tackled only with further data .(There is no other means I guess !)
When does “good common sense” become hard data and evidence ?
Its the act of publication , so please guys whenever you find some contamination in so-called scientific data please post here. To begin with I am registering a new Journal “Commonsense journal in cardiology”
*Please note, data is not a bad word as this write-up seem to suggest.Naturally occurring , epidemiological and observational data about diseases are the foundations for medical science .The issue become murky when few motivated humans play brutal games at the sensitive interface between science and truth.
It should be acknowledged , there is a distinct risk of this fight against falsehood end up in blocking true progress of science . Still , Homo sapiens are (believed to be !) intelligent enough to differentiate good from bad , that’s the reason God gave us the sixth sense !
Link to Lown Institute (Started by Cardiologist and Nobel peace prize Laurate Dr Lown who strives hard to pursue this goal)
Further reading : Scientific Reversals in cardiology
Is misinterpreting scientific papers an Academic crime ? No, its not, I do it often !
Posted in bio ethics, Medical ethics, medical quotes, medical satistics, tagged fraud in medical research, hippocrates oath modern science, how to interpret a study, how to read a scientific paper, jokes in science, medical ethics, medical research errors, medical statistics on June 28, 2016| Leave a Comment »
Medical Ignorance : Just Ignore it . . . move on , lets live the moment !
Posted in Medical ethics, tagged ethics of ignorance, medical ethics on June 9, 2015| 1 Comment »
It is believed (assumed ?), medical science is propelled by constant quest for knowledge and improvement in basic and clinical science that eventually would transform into better patient care and favorably impact global health standards. We know the field of medicine is growing in an unimaginable pace.It’s obvious any growth if uncontrolled or not properly guided is at risk of deviation from the main goal and ultimately turn malignant and destroy the system which it’s supposed to guard.
How many times we realise the current treatment we administer would soon become obsolete and even become dangerous ? What is the point in replacing treatment A by B , and then B is pulled over by C or D and suddenly finding A is better than either C or D (and still we hesitate to fall back on A because its an oldie!)
Still ,this is what we call as practicing ” State of the art medicine” How about a person who defies state of the art , and able to fore- see the futility which is threatening to be the norm in modern medicine. Then,who is really Ignorant ?
I stumbled upon this wonderful writing on this issue by ex BMJ editor by Richard Smith. Mind you , this was published way back in 1992, when the boom of futile ” Human Health shopping” was just about to explode !
Link to The ethics of Ignorance
Post-amble
Don’t get confused .Noble professionals are licensed to practice with whatever is published as science as long as their intentions are deemed to be genuine .Harm arising out of practicing what’s considered best as on today is acceptable in the court of law.
Meanwhile , its a tragic truth, If you do not follow the herd , you are at risk of being punished even for goodness committed by you. Wisdom and conscience can never win a legal battle ! If you have the courage try practice them !
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Dr.S.Venkatesan MD 