Friday, August 27, 2010

Research in modern medicine

Modern Medical Science Research.

“Science is making models, mostly mathematical constructs, which with verbal explanations are supposed to work!” That was the opinion of one of the great brains in science, John von Neumann. Western science is lost in this mess and is searching for a better model for future research. A leading western scientist, Douglas C Wallace, writing in the famous Genetics Journal, has shown that the non-linear model of Asian medical systems like Ayurveda is more useful to human physiology and recommends those methods for future research! The mathematical base of modern medical research is linear while the human body is non-linear. All the research we have been doing has come to grief. “First, human diseases affecting a wide range of organs could result from systemic defects in energy metabolism and, second, hereditary human diseases could result from mutations in the non-Mendelian mtDNA. Consequently, mitochondrial biology and genetics become excellent candidates for expanding the anatomical and Mendelian paradigms to address the complexities of the age-related diseases, ageing, and cancer,” wrote Wallace. (Genetics 2008; 179: 727)

It was in the year 127 AD that a “great” teacher of medicine, Galen, wrote that the liver pumps blood around the system. For the next 1500 years all teachers and students everywhere wrote their research papers based on this premise. It was only in the year 1628 AD a thinking family physician in London, William Harvey, observing a fire hydrant working, thought that the heart pumps blood. Knowledge advanced after 1500 years. I ask the same question today. Is the heart a simple muscular pump? The answer is probably-NO. But who cares? If one reads my article in an indexed journal entitled is the human heart a simple muscular pump one would be shocked to know how far away from the target are we hitting. ( Many such wrong ideas are being taught and followed.

All that I wish to convey through this response is that many good THINKERS among students could do good research. No law will make any one a thinker!! If doctors confined themselves to curing the sick rarely, comforting them mostly, but to consoling them always, they would be doing a great service to the public. Good teachers and researchers are as important to a medical school as are good bedside clinicians. These two breeds, combined with a few thinkers who could do genuine research to take knowledge forwards, would be an ideal combination in medical schools to motivate students with different skills and interests. It will be foolhardy to expect all these three in one individual except very, very rarely.

Modern medicine is becoming unpopular in the west. In the year 1997 alone 629 million people took treatment from alternative systems of medicine in the west paying from their own pockets. This is more than the number of people that saw their family doctors in the same year, according to a survey done by Eisenberg and colleagues in 1998. (JAMA 1998; 280: 1569) India should take note of this as we have one of the best systems of health care in Ayurveda, especially for chronic illness syndromes. If this could be judiciously clubbed with the emergency care methods of modern hi-tech medicine, complementing each other, we could bring down the costs of medical care to almost one tenth of its present level with less ADRs as a bonus.

The future lies in emphasizing promotive health. We should change the present teaching in medical schools from the disease-centred education to that of patient-centred community based education. We should use statistics sparingly in medical research. One of the drawbacks of applying disease statistics to the healthy population is that the latter throws up a very high percentage of false positives, resulting in epidemiologists predicting the unpredictable, resulting in epidemics. The fear of an illness could help the illness to take a strong footing in a healthy person. Modern medicine has realized that the human mind plays a vital role in disease causation as well as its control. Hence there is a need for doctors to train themselves in human psychology and behavioral sciences. Health is one’s birth right. Diseases are only accidents. If one follows the correct rules of healthy life style, accidents (diseases) will be rare indeed!

If we are interested in getting better medical scientists in the future we should see that every medical school has a department of medical research with a decent budget, headed by some one who has done real good refutative research work published. S/he must be adequately compensated lest the person should look elsewhere for succor. The departmental work must be subjected to strict periodic auditing. Such teachers alone could motivate brilliant young students to do good research. Drug studies are NOT research in the true sense. Even if such studies are needed they should NEVER be funded by drug companies as is the case at the moment.

While good research is refutative, all kinds of repetitive research must be shunned. Karl Popper once wrote that “knowledge advances not by repeating known facts but only by refuting false dogmas,” of which there are plenty in modern medicine today. The medical school should be proud of such a research department and should include that as a selling point in the brochure for prospective students. If this is genuinely pursued, a time will come when we will get a few good researchers in the world. They would make us proud. Outstanding research is only serendipitous. One can not plan such work in advance. That said I must warn that serendipity helps only those with prepared minds receptive to creative thinking. Let us work to get more prepared minds in the country and not legislate to have the usual IMRAD (introduction, material methods, results, and discussion type) research papers most of which are not even worth the weight of the paper on which they are written.
Sadly even in 2010 we do not have a correct science of man. Greta minds in western science, from the time of Galileo, were happy working on models for inanimate objects like in Physics and chemistry. Even biology does not have a model of its own. Human physiology is far, far away from reality with its linear model of the inanimate sciences applied to a dynamic human system with its all pervading consciousness. Man is but his mind, says Indian Ayurveda which has human beings classified into many gentico-constitutional types which take into consideration human consciousness as well. These classes could then be used for better RCTs; the latter at the moment compares only a small fraction of the phenotype of cohorts! One size fits all is foolishness in our present research. Individualised medicine has gone out of the window. Peer review is the enemy of progress as the peers can only deal with the known and if a refutative researcher wants to publish an out of the box thinking paper that would promptly go to the waste paper basket.

Let us think out of the box rather than use more complicated Latin words for new research with the same flawed science of man. “Intellectual integrity made it quite impossible for me to accept the myths and dogmas of even very great scientists, more particularly of the belligerent and so-called advanced nations. Indeed, those intellectuals who accepted them were abdicating their functions for the joy of feeling themselves at one with the herd.”
Bertrand Russell (1872-1969)

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