A new study shows that control trials are flawed. What helps is their faith in the treatment. This puts the onus of patient care on the physician
“It is only those who are in constant revolt that discover what is true, not the man who conforms, who follows some tradition. It is only when you are constantly inquiring, constantly observing, constantly learning, that you find truth, God, or love.”— Jiddu Krishnamurthi
George Bernard Shaw was right when he wrote the title that we have used for this article. I have become unpopular in my profession, and all I did was tell simple truths in my articles and speeches. I get blamed for every article that I write. My professional brethren follow their medical school teaching and the plethora of ‘scientific’ literature, to the letter. Unfortunately, most are doctored to suit the vested interests in the name of science. They want to sell the idea that the solution to every ill is a pill or an operation. The propaganda along these lines has been so effective that it is almost impossible to convince a patient and/or his doctor that the patient’s illness does not require any outside intervention, in a majority of the cases.
I feel so relieved that a new study, published in one of the leading medical research journals, The Journal of Translational Medicine showed that almost all randomised controlled trials (RCTs) have been seriously flawed and that their conclusions cannot be relied upon! This boils down to the simple truth that reductionist scientific base of modern medicine, the so-called evidence-based medicine (EBM), is only a myth. The study elegantly showed that what helps patients at the end of the day is their faith in the treatment that the doctor gives: the placebo effect. This puts the onus of patient care on the treating physician. We have come a full circle from the time Robert Hutchinson wrote that medical consultation is the vital meeting between two human beings: the patient and his/her physician. It is the faith that the former has in the latter that works.
What we need are good human beings as doctors. A doctor, following any one of the many systems of medical care prevalent in India, is as good as any other, if only he/she is a good human being who has the ultimate good of patient at heart. The wise people at the helm of affairs at the Medical Council of India should read the writing on the wall that quantity, not quality, is the issue. They have been losing sleep in getting the magic number of 10,000 extra doctors per year in India at one go!
There are two kinds of doctors. The placebo prescribing doctors are ones that generate positive mental attitude towards treatment in patients while the nocebo administering doctors create the opposite effect. They scare the patient away with their bleak deterministic future predictions like ‘you have six months to live’, etc. No one can predict the future, as the future is yet to be born. To be able to predict, in any dynamic system, one must have the complete knowledge of the organism. Albert Einstein rightly said that, “All complicated problems in this universe have very simple solutions.” Mind and body being but one single entity, good doctoring boils down to caring for the patient. We need to de-school society and doctors to develop the placebo trait in them.
As Winston Churchill said: “The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is.” We need doctors to guide every patient to the right path. Authenticity should be their goal and compassion their path. Vaidyo Naarayano Harihi (Doctor is the God incarnate). Some of our great brains in the past had predicted this. “If the whole materia medica could be sunk to the bottom of the seas, it will be that much worse for fishes and that much better for mankind,” wrote Oliver Wendell Holmes. “More people make a living off hypertension than dying of it,” wrote Sir George Pickering. “Patient care is CARING for the patient,” wrote Sir Francis Peabody. The most powerful drugs ever invented by man a re the kind words from a caring doctor. Long live doctoring.
“Truth is the property of no individual but is the treasure of all men.” — Ralph Waldo Emerson
Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.
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NTPC has withheld payment of Rs25.3 billion on account of the impasse on the quality of coal received (as admitted by NTPC) versus coal supplied (as billed by Coal India), points out Nomura Equity Research in its Quick Note
State-owned power utility major NTPC has proposed a final dividend of Rs2 per share (total FY13 dividend is at Rs5.75 per share), implying a 43.8% payout (including dividend tax). Regulated equity for operational projects stood at Rs326 billion as of FY13. Receivables remain in check; excluding unbilled revenues, debtor days stood at 30 days. FY13 consolidated net profit stood at Rs125.9 billion.
According to Nomura Equity Research analysts in its Quick Note on NTPC, the long-term investment thesis remains intact—defensive earnings growth outlook with relatively high earnings visibility, lowest funding risk among peers and relatively adequate fuel security. The stock trades at 1.4x P/B and 11.5x P/E based on its FY15F earnings forecast. Nomura reiterates its ‘Buy’ rating on the NTPC share.
On a note of concern, Nomura Equity Research points out that NTPC has withheld payment of Rs25.3 billion on account of the impasse on the quality of coal received (as admitted by NTPC) versus coal supplied (as billed by Coal India - CIL). The amount is disclosed as a contingent liability (if materialized, the amount is likely to be recoverable from beneficiaries). NTPC did not elaborate on the manner in which this dispute with CIL would be settled, but stated that joint sampling of coal has commenced both at the mine-end and plant-end on a pilot basis for coal supply from Eastern Coalfields (100% CIL’s subsidiary).
Nomura analysts have summarised the fourth quarter performance of NTPC in the following table: