What does rationality in medical intervention mean?
“The illogical man is what advertising is after. This is why advertising is so anti-rational; this is why it aims at uprooting not only the rationality of man but his common sense.” — Henryk Skolimowski
The mad rush for irrational medical interventions— both medicine and surgery—seems to be at its peak now. Demands are growing all over the world for rationality in medical interventions, not the least in the UK and USA. Going through the history of the word rational, I found that, way back in 1803, the meaning was: “to explain, to make reasonable;” in the psychological sense of “to give an explanation that conceals true motives.” Makes sense. This article draws heavily from one of my earlier articles in the British Medical Journal (BMJ).
There is a good movie, Big Bucks, Big Pharma, on this topic which is worth watching. I shall give the readers a glimpse of the theme of the movie here. Big Bucks, Big Pharma, pulls back the curtain on the multi-billion dollar pharmaceutical industry to expose the insidious ways that illness is used, manipulated and, in some instances, created, for capital gain. Focusing on the industry’s marketing practices, media scholars and health professionals help viewers understand the ways in which direct-to-consumer (DTC) pharmaceutical advertising glamourises and normalises the use of prescription medication and works in tandem with promotion to doctors. Combined, these industry practices shape how patients and doctors understand and relate to disease and treatment. Ultimately, Big Bucks, Big Pharma challenges us to ask important questions about the consequences of relying on a for-profit industry for our health and well-being.
There is an apt comment on this movie by an American movie critic: “In my opinion this is the best made film regarding the pervasiveness of drug companies in our everyday lives. The film starts with narration by the famed journalist Amy Goodman but lets the interviews themselves narrate the film later on. Though this film doesn’t address the subject directly, if you want to know why the United States doesn’t provide universal healthcare, I think that you should watch this movie. Why should we have free or inexpensive healthcare if the current system is so profitable?”
I think, our present therapeutics and its attendant pseudo-science would be correctly described by this meaning of the word—rational. The industry that tries the marketing strategy of rationalising drug-pushing and disease-mongering by concealing their true motive—to make the highest profit for themselves—can never be altruistic and listen to your sane advice. The story of insulin pens was one such effort. Now, many other drugs have come with pens! I am reminded of what Bernard Mandeville, the guru of laissez faire, when he wrote: “In the corporate economy profit is the sole motive irrespective of consequences.” How very true! Our drug cartels have taken his advice to their heart.
Taking the advice for rationality in the New Year, I hope some one will come up with audits like the one which showed aspirin in its true colour for all the newly introduced drugs. Remember we have had digoxin for nearly 350 years since William Withering’s time.
Even now, the DIG (digoxin investigation group) recently failed to find out why digoxin is prescribed for heart failure patients in sinus rhythm. Why is the rate of death from adverse drug reaction (ADR) going up exponentially with so-called scientific advances in modern medicine? Was not Ruth Richardson right in saying that modern medicine, which has become a corporate monstrosity, would have cut many James Wakelys in the knees?
James Wakely, a young doctor in London and a member of the House of Commons, thought in early 19th century that medical profession, at that time. had become a bad abscess on the body of society. He wanted to cure it by taking out the pus using a surgical lancet. He started the now famous medical journal, The Lancet, for that purpose in 1823AD. He had assessed the profession at that time to be a bunch of “incompetent, corrupt and nepotistic of crooks.” Poor man, even after nearly 200 years, the abscess, that modern medicine was then, is only growing bigger by the day, despite The Lancet!
Even the president of NICE (National Institute of Health and Care Excellence), Sir Michael Rawlins, in his Harveian Oration at the Royal College, had this to say in 2008: “Randomised controlled trials (RCTs), long regarded as the ‘gold standard’ of evidence, have been put on an undeserved pedestal.” Sir Michael outlines their limitations in several key areas, arguing that a diversity of approaches should be used to analyse the whole of the evidence base. Let me remind the readers that the ‘first pass effect’ that we, medical students all over, memorised for the pharmacology examination, must have given us the warning that all (I mean all) reductionist chemical molecules, ranging from aspirin to rosiglitazone, are alien to the human system. The body tries to get rid of them. This has now been demonstrated by Douglas C Wallace, using his software MITCHIP, to be true!
We will have the same story every year to welcome the New Year, if we do not learn from our mistakes. We need another Bernard Shaw to write a drama on patients’ dilemma today.
When you watch the movie cited above, you will come to know how people like you are brainwashed to ask your doctor for those wonder drugs advertised daily as panacea for this or that disease. Often, it is likely that you might even imagine a disease (disease-mongering by the industry) to have the treatment ‘very early’.
How does the common man, even the literate one, survive in this polluted atmosphere where the industry and the profession seem to be in cahoots with each other for personal gain? To add to this, a new industry has grown around this rationality, corporate hospital industry, especially in developing countries like India, where even today more than 400 million people get less than one clean nutritious meal a day. Some 47 million children suffer from nutritional immune deficiency syndrome (NIDS) and die by the thousands daily! Let us have a heart.
“Appeals to rationality are mostly bluff. There is no good theory of what it is or of how to recognize it.” — Mellor DH
(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.)