Cure rarely, comfort mostly but, console always should be our motto when one is ill. Patient care simply is caring for the patient

“A reasoning, self-sufficing thing, an intellectual all-in-all!”— William Wordsworth

The quote below is one of the many brilliant sayings of that great brain, Sir William Osler. “One of the first duties of the physician is to educate the masses not to take medicines.” In the twenty-first century, I could only echo that great sentiment as a truism, despite all the tall talk about the “so called” evidence based medicine. Napoleon Bonaparte went one step further, but one could argue that as he was not a physician. Napoleon was at the receiving end of such a medical practice in Persia where he died. “Medicine is a collection of uncertain prescriptions the results of which, taken collectively, are more fatal than useful to mankind." Napoleon, though, was more accurate scientifically today. Latest science says that uncertainty is the only certainty in the world. This is truer in medical science, if there is one. A proverb is a short sentence based on long experience. If that were so, this one from Voltaire takes the cake: “The art of medicine consists in amusing the patient while nature cures the disease.” 

Time and again I had written in my articles elsewhere that our evidence base has been built on loose sand. (www.plosmedicine.org/annotation/listThread.action-ww.bmj.com/content/338/bmj.b1272.extract/reply)  Of course, no one seems to take it seriously. They would have, if it had any financial interest behind it. The present Randomised Controlled Trials (RCTs) and linear relations help generate billions of dollars in chemical therapeutics even if that results in thousands dying of our efforts directly or indirectly. 

A study by researchers in a  respectable US university of the placebo based RCTs did show that the contents of the placebo capsule, which need not legally be made known to the regulating agencies like the FDA, were very potent substances that would show the company drug as very effective in comparison. To cite an example, anti-diabetic drugs are usually compared with sugar-filled placebo capsules! Many such glaring criminal activities have come to light now in the field of “Evidence based medicine” of today!) 

This morning I had a message from one of my old students who is a leading dermatologist in India doing innovative research in his area. “I always wondered when I used to listen to you during my student days and respected your views all along. In dermatology, evidence is found only in 28% of published studies. All molecular biology companies come with an offer to give authorship if we buy their equipment for our laboratory! Doesn’t that mean that most molecular biology studies are prototype and try to find out how what is known fits into their study?”  

Foundations of our evidence in modern medicine like the statistical risk calculations, (especially the relative risk reductions in place of absolute risk reductions that are sold to gullible doctors in most of the “scientific” articles without mentioning the NNT figures) and, the RCTs, which have no true science base, are very shaky, indeed. We need to have a new science of man, which is sadly missing in this whole bargain. Physics changed in 1925 and there is no more solid state physics, but we still use the same old physics laws for our statistics. Matter is not made up of matter. Matter and energy are interchangeable. 

(journalofcosmology.com/QuantumConsciousness106.html) Human molecules communicate with one another which can now be documented through the photon lights emitted from each DNA. 

What is the science base of our reductionism, organ-based specialization and our reliance on Mendelian inheritance? Instead of trying to rehash the existing evidence base it is better to think of a new evidence base for health and illness. Health is a state where each human body cell is in sync with other cells. Illness is when this communication breaks down. (en.wikipedia.org/wiki/Biophoton) We need a new non-linear, holistic, dynamic, scientific base for future medical research. Nature has provided a robust repair mechanism inside the human system which has been weakened by our modern life style. Even though both Claude Bernard and Louis Pasteur did note that the “terrain is more important than the seed” we have gone whole hog on the seed, risk factors, and what have you. Modern medicine has forgotten the essence of illness care which is basically to strengthen the terrain.

Indian Ayurveda and many other complementary systems stress just that fact to strengthen one’s immune system. Ayurveda has many immune boosting modalities in its armamentarium. Many simple methods which have stood the test of time are being forgotten now, thanks to the brainwashing of the masses through mass media advertisements about the wrong approaches to keep one healthy. The leading one among them is goading people to have regular a “health” check up. Nothing could be more dangerous than that to apparently healthy people. When one is healthy one should NEVER ever go for a check up! Common man will have the doubt as to how s/he could know about health. One is healthy when one has a) enthusiasm to work and b) enthusiasm to be compassionate. One of the ancient exercises could be the most potent modern medicine— a daily walk if one is not a physical labourer. Universal love is another life giving elixir. Recent studies have shown daily walk can reduce the risk of premature death and disability by 80%!

After twenty-five years follow up of one of the largest ever studies of risk factors (which are being sold to the gullible public day in and day out as silent killers), the MRFIT study (Multiple Risk Factor Interventional Trial) came to the strange conclusion that: “in conclusion, we have shown that it is possible to apply an intensive long-term intervention program against three coronary risk factors, high blood pressure, cholesterol and smoking with considerable success in terms of risk factor changes. The overall results do not show a beneficial effect on CHD or total mortality from this multiple risk factors intervention trial. (Zukel, Paul and Schnaper, 1981). In other words, they found that changing the “risk factors” does not apparently change the risks. This necessarily means that the “risk factors” are not as important as was thought. Indeed, it should be concluded that the “risk factors” were no such thing, at least as far as this trial is concerned. At the University of Maryland, School of Medicine, Roger Sherwin was Principal Investigator of the Baltimore Center of the Multiple Risk Factor Intervention Trial (MRFIT). He served on several national MRFIT committees and was the first chairman of the intervention committee, which was responsible for the implementation of the complex intervention program. He was disappointed that the MRFIT turned out to be only a boondoggle. 

An audit by Uffe Ravnskov of the 17 leading hypertension intervention trials in the world literature showed hardly any significant difference in the outcomes at the end of the day in mortality between the groups where the blood pressures were tightly controlled with drugs compared to the groups that changed their mode of living to a healthier one. Recent CADD study did show that very tight control of blood sugar with powerful drugs in diabetics only increased the micro-vascular complications. Most of our studies, based on which we model our treatment plans, show only a decrease in the surrogate end points like blood sugar report improvement in diabetics; they have never shown in the long run any fall in mortality. Surrogate end point research could, at times, be dangerous especially in medicine where the NNT (a statistical term denoting the number needed to treat) is prohibitively high. One example will suffice. The large MRC study on mild to moderate hypertension treatment showed that to save possibly one stroke death in the next five years in society we will have to unnecessarily treat 850 healthy human beings with powerful anti-hypertensive drugs whose side effects could seriously damage the health of at least 75 healthy people with some of them meeting their maker prematurely! The NNT in heart ailment drugs and cancer treatment could be much more than in hypertension. 

I am sure the reader by now would have realized the significance of what William Osler’s prophetic statement of 1905 meant when Osler did not have any of these powerful drugs that we have today. Cure rarely, comfort mostly but, console always should be our motto when one is ill. Patient care simply is caring for the patient. Let me make a fervent plea for parsimony in using drugs in the healthy segment of the population, by labeling these so called risk factors as silent killers, in the fond hope of averting major problems in the future. We simply do not have any scientific evidence for their benefit as of now.

“I have but one lamp by which my feet are guided; and that is the lamp of experience. I know of no way of judging the future but by the past”—Patrick Henry (1736-1799) US patriot

(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS. He is also the editor-in-chief of the Journal of the Science of Healing Outcomes, chairman of the State Health Society’s Expert Committee, Govt of Bihar, Patna. He is former vice-chancellor of Manipal University at Mangalore and former professor for cardiology of the Middlesex Hospital Medical School, University of London. Prof Dr Hegde can be contacted at hegdebm@gmail.com)