Leisure, Lifestyle & Wellness
Auditing shows modern medicine has not done much

Modern medicine’s scientific base is still shaky. Yet, it is prevalent today, thanks to pharmaceutical and medical devices lobbies who earn millions. If the profession can overcome the enormous pressure of the powerful pharmaceuticals lobby, mankind could hope to get modern medicine to do most good, to most people, most of the time

 

We understand and agree that performance audits are a good thing, but this goes beyond what is needed or prudent right at this moment. Pam Carter

 

“Learn from history; if you do not, you will relive history”, wrote Cicero, the great Roman thinker. Knowledge can only advance if we are able to audit our outcomes to see where we have faulted and whither should we be headed. The so called ‘modern’ medicine, which is hailed as the best in the world, has had its share of ups and downs, but is firmly in the driving seat today thanks to its claptrap and the trillion dollar pharmaceutical and the medical devices industries backing it to the hilt, for their own benefit, and least bothered about human welfare. Medical research is also directly and indirectly controlled by these greedy people. Disease mongering is rampant these days, with the market forces working in the medical arena, as we have taken the noble profession of doctoring to the market place in a corporate economy. Audit does clearly show us that the two abovementioned patrons are our biggest detractors today, thanks to their greed and proclivity for big profits, irrespective of consequences.

 

Auditing the then modern medicine in 1823, a young doctor and Member of the House of Commons, Thomas Wakeley, with his indignation and reforming zeal, wrote, “Doctors in London are a bunch of incompetent, nepotistic, and corrupt lot.” He said that they had become an abscess on the patient’s body, so to speak. He started a science journal in that year to educate London doctors. He called it The Lancet used to puncture the abscess that he was referring to. Nearly 187 years later, in 2010, The Lancet commissioned a leading medical historian, Hillary Butler, to audit and find out the impact of The Lancet on the medical profession. She wrote that the incompetent, nepotistic, and corrupt body that it was in 1823 has transformed itself in 2010 into a Corporate Monstrosity which would cut all Wakeleys at the knee! So it has been a sad saga for mankind of being pushed from the frying pan to the fire!

 

Bad Medicine is an educative book written in 2006 by one of Britain’s great historians, David Wootton, who teaches history at the York University. This wonderful book could help doctors to understand their calling in a better light. Wootton has had an advantage that he has been able to look from the outside which gave a different perspective of the problem. As an outsider he might not understand the finer nuances of medicine which basically deals with the enigma called the human body. Wootton divides the scene for the first 2500 years from Hippocrates era as the first half and the second half from then on till today. Let me sum up his finding for the first half as follows:

  Simply put, from the 5th century till the end of the 19th century, doctors found out that patients were prepared to pay for their treatment, which was both “ineffective and usually deleterious.” The poor who could not pay for their sickness were lucky that they escaped torture, so to speak

  During this period, surgery, most of it was abdominal surgery, was almost universally fatal. Rest of the modalities like blood letting, emetics and purging only weakened patients and many a time killed them. Only 20% to 30% of the patients survived which was attributed to the placebo effect! Bone setting did some good though.

•  Progress did not take place despite the fact that biology did improve during the period. Blood circulation and progress in anatomy were significant but they did not translate into therapy in any area.

   A Kansas City doctor, Arthur Hertzler, wrote in 1938, “I can scarcely think of a single disease that doctors cured during these early years except with an exception of malaria and the itch.” Doctors knew how to relieve suffering, set fractured bones, sew up cuts, and open boils. Joseph Mathews, the president of the American Medical Association, wrote in 1905 that the only drugs that doctors needed were emetics and laxatives.

  Homeopathy was introduced by Samuel Hahnemann, in 1810, which was quickly condemned by the American Medical Association as placebo. Interestingly there is sufficient and more proof in this period to show that the so called Hippocratic medicine was also just a placebo treatment where patients rarely recovered. Extensive studies on placebo effect were done during that period.
 

Homeopathy, chiropractic, praanic healing, radio aesthesia, and many other useful methods of treatment were successfully killed by the wealthy Rockefeller and Carnegie foundations who produced the now infamous Abraham Flexner report of 1910 in America.
 

Flexner was a retired high school headmaster at the Carnegie Foundation who wrote the report, on the state of medical education in the USA! The American government was made to ban all other medical systems based on this report! Homeopathy survived in Europe, especially in Britain, where the Royalty patronizes it even today! Dr JN McCormack, the then American Medical Association’ most powerful member in 1903, during one of his unguarded moments, admitted that they killed homeopathy. He said: "We must admit that we have never fought the homeopath on matters of principle. We fought them because they came to our territory and got our business.” Is not the cat out of the bag? The 1953 Abraham Fitzgerald report on cancer treatment fraud in modern medicine, which came to light lately, should expose shady dealings.    

 

Even to this day institutions teach medicine and award degrees in London, Bologna, Montpellier, US or Paris. Wotton clearly indicates that during the period under review mentioned above (i.e. 5th to 19th centuries), Hippocratic medicine was bad medicine which did more harm than good. Even Thomas Sydenham, known as the ‘English Hippocrates’, otherwise a wise man, was in agreement with the Hippocratic tradition.

 

The 20th and 21st centuries saw a lot of progress in biology and other sciences. Some of these developments have had profound influence on medical practice. Understanding of the human body has gone too far. Pharmaco-therapeutics has moved forward by leaps and bounds, with drugs coming out of the thousands of greedy pharma houses like a magician pulling out rabbits from his hat. Advances in anesthesia and surgery have reached their peak with doctors being able to operate on any organ. Microsurgery, robotic surgery, laser surgery and many more practices seem to have perfected the surgical technique. Preoperative and postoperative mortalities have fallen drastically.

 

Wootton thinks, which I’m in total disagreement with, that the most important advance in the modern era was the ‘Germ Theory’ along with the discovery of antibiotics. He goes overboard praising the last two in his book, not realising what it has brought in their wake to mankind—the curse of nosocomial infections with super bugs that can not be killed by any antibiotic. Super bugs cause real jitters to the medical world and our expensive intensive care units (ICUs) are slowly converting themselves into conduits to go to meet our maker in heaven. However, ICUs are a great rage today as 90% of the corporate hospitals’ profits are derived from dying patients in ICUs.

 

Wootton also thinks that the unraveling of the human genome has been another milestone development. He is wrong there as well. The new human meta-genome comprising of just about 25,000 human genes and trillions of germ genes upsets the calculations of our pundits who have been working overtime on genetic mapping and development of exogenous stem cells. This also brings the curtain down on Wootton’s euphoria on the germ theory as germs are now shown to be our friends in need and part of us. The latest treatment for fatal gastrointestinal infections is to introduce faeces, called faecal transplant, from a healthy donor through a Ryle’s tube into the gut which brings about recovery in hours to a usually fatal outcome.

 

The audit could be summed up based on three studies.

Writing about the disease era, Mary Tinnetti from Yale (Am. J. Med 2004; 116: 179) has this to say: “The time has come to abandon disease as the focus of medical care. The changed spectrum of health, the complex interplay of biological and nonbiological factors, the aging population, and the interindividual variability in health priorities render medical care that is centered on the diagnosis and treatment of individual diseases at best out of date and at worst harmful. A primary focus on disease may inadvertently lead to undertreatment, overtreatment, or mistreatment.” 

 

Barbara Starfield from Johns Hopkins, in her comment in the Journal of the American Medical Association (2000; 284: 483), feels that present day doctors, drugs and surgeries together lead the list of causes of human death and disability!
 

Gary Null and his colleagues from The Institute of Nutrition, using the US government statistics, arrived at the conclusion, in 2008, that the medical fraternity of modern medicine leads cancer and heart attack deaths with the first rank in that order of preference, as the causes of mortality and morbidity.
 

All is not well with us.

 

Modern medicine’s scientific base is still shaky. Physics changed science nearly 90 years ago but medicine is yet to catch up. Quantum physics has shown that the human body is immaterial-mental and spiritual. Diseases are just an altered energy pattern and the remedy, naturally, should be rearranging the altered energy pattern. If the profession can overcome the enormous pressure of the powerful pharmaceuticals lobby, mankind could hope to get modern medicine to do most good, to most people, most of the time. Interestingly, modern medicine has been kind to the poor as they were not touched by it. The poor were spared of the sorrows of iatrogenesis and nosocomial deaths. Of course, the poor pay for their poverty with their lives. Even placebo effect seems to be the sole cause of human relief as per the latest study, done using the latest technologies, in Oxford, Cambridge, Hamburg and Munich universities. (Sc. Transl. Med. March 2011 and Genetics 2008; 179: 727)
 

Interestingly, life expectancy and good health have very little to do with drugs, surgeries and what have you. Life expectancy was based on Hippocratic medicine to the tune of 2% to 18% only. Rest of it, between 82% and 98%, came from economic prosperity, better nutrition, employment, sanitation, better work environment, better living, education, and tranquility of mind. Modern medicine was probably about 3.4% useful to mankind. The developing countries could learn a vital lesson from the audit to concentrate on the factors that bring down mortality and improve health.

 

In conclusion, I would like to agree with the title of David Wootton’s book in full, which reads: Bad Medicine—Doctors Doing Harm since Hippocrates. If only we could do what Maimonides advised us that we will do much better: “The physician should not treat the disease but the patient who is suffering from it.”
 

 “A bitter reality of truth can be wisely told in a sweet tale of lullaby.” Toba Beta
 

To read more articles from Dr Hegde, please click here.
 

(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 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.)

 

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COMMENTS

Vaibhav Dhoka

4 years ago

In India slight deviation from normal is SEEN as DISEASE.And this phenomenon has been used to EN= CASH First by pharma companies who roped in doctors in chain.

nagesh kini

4 years ago

As a member of long standing of the "professional audit profession - a CA" I entirely agree with all that the great Dr.Hegde has so brilliantly written. I understand by 'audit' he means the medical audit by medical men.
As a former statutory auditor of major MNCs, myself, having carried out the Pharmaceutical Price Control certification and now closely associated with the healthcare sector, I know of dedicated senior members of the CA profession who have had clear cut insight into the entire gamut of the pharma companies and hospitals to draw up a professional audit programme encompassing all angles.

Controversy over Attorney General not coming under RTI Act

A full bench of the Central Information Commission ruled that the Attorney General of India is neither a public authority nor a public servant, sparking off a debate

The Attorney General of India (AGI) is the chief legal advisor of India and is appointed by the President of India under Article 76 (1) of the Constitution. He functions under the ministry of Law and Justice. Recently, three citizens invoked the Right to Information (RTI) Act, 2005 at the AGI’s office but were replied that it is not a Public Authority and hence the desired information cannot be supplied to them. When their appeals went to the Central Information Commission (CIC), the full bench ruled that AGI is neither public authority nor public servant. This has raised eyebrows amongst activists and academic scholars.

 

First, let’s have a look at the information sought from AGI’s office. RTI activist SC Agrawal invoked RTI to procure the following information:
 

1. Is it true that Union Ministry for Minority Affairs sought opinion of Honourable Attorney General of India on aspect of providing copies of entire communications between Prime Minister Dr Manmohan Singh and the Ministry ever since the UPA government came into power in the year 2009?

2. If yes, please provide copies of complete communication/s etc. received from Union Ministry of Minority Affairs and/or others etc on seeking such opinion of Honourable Attorney General of India as referred in query (1) above.

3. Copy of the opinion given by Honourable Attorney General Shri GE Vahanvati on the matter as referred in query (1) above.

4. Is  it  true  that  rules  prohibit  law  officers  of  Union  government providing  opinions  to  any  ministry/department  of  Government  of India or any other statutory organization or any other public-sector undertaking  unless  the  proposal  or  a  reference  in  this  regard received through the Ministry of Law & Justice, Department of Legal Affairs.

5. Was the opinion of Honourable Attorney General Shri GE Vahanvati on the matter as referred in query (1) above sought directly from him by Union Ministry of Minority Affairs?

6. If  not,  name  of  the  channel  through  which  Union  Ministry  of Minority Affairs seek such opinion of Attorney General Shri GE Vahanvati as referred in query (1) above enclosing also complete correspondence on the aspect with channels like Ministry of Law & Justice, Department of Legal Affairs etc.

 

Another citizen, Ajitabh Sinha asked for “interpretation of orders of the Supreme Court of India in CBSE v/s Aditya Bandhopadhyay” and the Institute of Chartered Accountants of India v/s Shaunak H Satya”.

 

Third citizen, Mani Ram Sharma requested the AGI’s office to comply with Section 4 of the RTI Act for greater transparency in the system.

 

For all the three RTI applications, the Private Secretary (PS) to the AGI replied that, “…learned Attorney General for India is not an authority as per the Right to Information Act, 2005. As such, there is no Public Relation Officer in this office.”

 

All three of them, then filed second appeals with the Central Information Commission. The full bench of the CIC comprising Chief Information Commissioner Satyanand Mishra, Information Commissioner Anupama Dixit and Information Commissioner MC Sharma decided on 10th December that AGI cannot be a public servant as it has a ‘lawyer-client relationship’ ‘with the Government and not’ ‘that of servant and master’.

The CIC also decided that, “…we hold that the office of Attorney General is sui generis.  He is a standalone counsel of the Government of India. He renders legal advice to the Government of India which is not binding in nature. He is not a public authority u/s 2 (h) of the RTI Act.  Therefore, the complaints referred to hereinabove have no merit and are dismissed.’’

 

Noted RTI activist Vijay Kumbhar is shocked by the CIC decision. His contention is that, “AGI’s post is constitutional as President appoints him; government issues notification of his appointment; he stands 11th in Indian order of precedence; his service conditions are decided as per rules made under Article 309 of Constitution of India read with article 76 (1); he gets vehicle with beacon lights; he gets government accommodation in Delhi; he cannot advice any party against the Government of India or a Public Sector Undertaking, or in cases in which he is likely to be called upon to advice, or appear for, the Government of India or a Public Sector Undertaking; he cannot defend an accused person in a criminal prosecution, without the permission of the Government of India; he cannot accept appointment to any office in any company or corporation without the permission of the Government of India; he has to take government’s permission before leaving the head quarters; AGI does public duty (as per prevention of corruption act "public duty" means a duty in the discharge of which the State, the public or the community at large has an interest and; he receives remuneration as well as fees from the government ,and hence as per definition in Prevention of Corruption Act  he is a public servant ( “public servant" means- (i)  any person in the service or pay of the Government or  remunerated by the Government by fees or commission for the performance of any public duty”)

 

Argues Kumbhar, “Now can we say AGI's relation with government is just a lawyer - client relationship? AG may not be public authority but definitely he is public servant and his relation with government is that of servant and master.”

 

Venkatesh Nayak, Programme Coordinator, Commonwealth Human Rights Initiative (CHRI) who has analysed the issue states that, “A deeper reading of the very rules and authorities cited by the Additional Solicitor General (ASG) clearly indicates that the AGI’s position is neither a sui generis position nor is he merely a person. The AGI’s office is a public office established by the Constitution to which an eminent lawyer possessing the essential qualifications is appointed by the President of India. Nothing in the CIC’s decision indicates that these matters have been considered and weighed before arriving at its finding that the AGI’s position is indeed sui generis. Therefore with the utmost respect to the wisdom of the CIC it is submitted that the aforementioned findings may be treated as per incuriam.”

 

Regarding the CIC decision that AG is not a public authority, Nayak analyses in his report: “The ASG’s contention that the term ‘authority’ in law belongs to the ‘province of power’ cannot be disputed. However neither has he placed before the CIC a complete picture of the roles and functions performed by the AGI, nor have the CIC examined, in full, the responsibilities and powers wielded by the AGI under other enactments. In fact, the entire argument of the ASG is based on a limited number of constitutional provisions without reference to any other statute which vests duties and powers in the AGI. It is submitted that the CIC did not have before it all and complete facts on the basis of which to arrive at its conclusion…Such a conclusion can be arrived at only after a critical examination of all the powers and duties and responsibilities vested in the AGI not only by the Constitution but also by other enactments and through judicial interpretation.”

 

Giving an example, Nayak states,”The AGI has the discretionary power to grant or withhold consent for the prosecution of a person under the Atomic Energy Act. If consent is granted, the accused person will be prosecuted. If consent is withheld, the case may be closed through appropriate proceedings. It is obvious that this statute clearly vests in the AGI, the power to determine the rights of a person accused of committing an offence under the statute. Nothing in the decision of the CIC indicates that the ASG placed this statutory provision before the bench as part of his submissions. Therefore with the utmost respect to the wisdom of the CIC it is submitted that its findings about whether or not the AGI has powers to affect the rights of other persons are per incuriam as they do not take into account the entire gamut of the law on the subject.’’
 

Nayak has also demanded “judicial review of this decision on grounds of errors of law”.
 

(Vinita Deshmukh is the consulting editor of Moneylife, an RTI activist and convener of the Pune Metro Jagruti Abhiyaan. She is the recipient of prestigious awards like the Statesman Award for Rural Reporting which she won twice in 1998 and 2005 and the Chameli Devi Jain award for outstanding media person for her investigation series on Dow Chemicals. She co-authored the book “To The Last Bullet - The Inspiring Story of A Braveheart - Ashok Kamte” with Vinita Kamte and is the author of “The Mighty Fall”.)

 

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COMMENTS

Manoj Dhyani

4 years ago

Well, I think no person who believes in transparency laws and philosophy of good governance can diges CIC decision. The AGI takes issues on behalf of the Govt; he is very much a constitutional functionary under parliamentary democracy. By the very sense of Govt accountability to the nation, this authority can not claim to be immune from the RTI. The CIC decision needs to be debated and challenged.

Aadhaar troubles for direct cash transfer scheme

While most districts in the first phase do not have verified digitised Aadhaar number database, some, which have this, are not linked to the bank accounts of beneficiaries which has become a major concern

 
As the government races to launch its flagship direct cash transfer programme from 1st January, the low concentration of Aadhaar database in the identified 43 districts is a cause of major concern, reports PTI.
 
The programme, under which cash subsidy will be transferred electronically in bank accounts directly, is to be linked to Aadhaar number of a beneficiary.
 
The government has identified 43 districts across 16 states for the rollout of the programme on 1st January but sources said the Aadhaar number concentration is very low, particularly in rural areas of these districts.
 
The sources say that while most districts in the first phase do not have verified digitised Aadhaar number database, some, which have this, are not linked to the bank accounts of beneficiaries.
 
With an aim to ensure smooth rollout of the programme, 43 senior officials of the government have been sent to the identified districts to assess preparedness for launch of the first phase on 1st January.
 
The Centre has already made it clear that the roll out of direct cash transfer (DCT) scheme in the identified 43 districts in the first phase from January should be done only after ensuring that intended beneficiaries have Aadhaar number linked with their bank accounts, which will be mandatory for transfer of benefits.
 
The sources add that verified database of beneficiaries as per norms is only about 25% as of now and various state governments are racing to complete their database.
 
The scheme can at present be implemented in few of the total 43 districts on 1st January, claim the sources, going by the verified database of beneficiaries. They said the programme can be implemented in the remaining districts in the next few months.
 
Under the programme, 34 central schemes would be covered in the first phase. 
 
The Planning Commission has in a recent circular to 16 states and Union territories, where the scheme is to be implemented in the first phase, made it clear that they have "to ensure that all the intended beneficiaries have or get an Aadhaar number before commencement" of the programme.
 
Prime Minister Manmohan Singh has also held a meeting recently to discuss ways to fine tune coordination between Aadhaar and banking systems with the beneficiaries.
 
It was decided that focus should be on 43 districts as eight of the remaining 51 identified districts were not ready because of Assembly polls in Himachal Pradesh and Gujarat.
 
The sources said 35 districts would be covered on 1st January and rest of 43 districts would be covered by 10th January.
 
During the meeting, ministers were told that there should be no phased roll out within any district and the entire district should switch to direct cash transfer at one-go.
 
Working on the roll out on war footing, the government is according priority to digitisation of beneficiary databases with names, addresses and Aadhaar numbers. All ministries are to ensure this immediately, the sources said.
 
Government has said that over 95% beneficiaries should have bank accounts, with all banks being Aadhaar-compliant, before implementing the programme.
 
Sources say in some districts the Aadhaar number penetration is 80% in urban areas, but a poor 5% in rural areas.
 

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