""Of the terrible doubt of appearances,
Of the uncertainty after all - that we may be deluded!”
— Walt Whitman
This morphologically young woman in her early 50s, let us call her Gita, called me the other day in great hurry and she was palpably agitated, to say the least. She was not even coherent. “I am truly down and feeling so low that I feel I have a serious problem. I feel very low after my evening walk.” I asked her “what happened?” She shot back, “My doctor told me my pressure is way high at 160/100. She immediately asked me to take a tablet, which I took.”“You must be feeling fine now,” I interrupted her. “No, No, No. I am feeling worse now. My doctor told me a couple of days later that my pressure is still way above normal at 130/80. She gave me a new tablet and asked me to swallow it right there as she wanted the pressure down to 110/70 as fast as possible.” In addition, my doctor asked me to urgently see a cardiologist to have a complete work up.”“What happened then? I asked. “My doctor's last advice put me off and I thought I better talk to you.” I could see her almost in tears. To cut the long story short, I had to talk to her at length to counsel and convince her that the blood pressure reading that she was worried about was all in her mind! The reader might think it is very easy. It is easier said than done. I can assure you that it would have been easier to give birth to a baby had I been pregnant than to successfully counsel an agitated 50-year-old postmenopausal, morphologically young lady to cool her down on the phone.Let us look at Gita in toto to know her better. “Know your patient better than his disease,” wrote Hippocrates. He was dead right. Gita was educated in the U.S. Her husband, a brilliant and capable scientist was the one who put together one of the most successful business groups in India. She had two beautiful and intelligent kids. She also had a cushy job on hand. Theirs was a happy & perfect family. But fate willed otherwise. Her handsome, intelligent husband died one sad morning due to what doctors called heart attack. Gita was devastated and shattered. One could understand. She came out of that reactive depression slowly but steadily and still does her job very successfully. She brought up the children like a true Indian mother and now both are successfully placed in society. Her families on either side were a great help and so were her colleagues and her husband's former colleagues.Turning 50, Gita felt lousy. An informed woman, she was worried about her menopause. That needed counselling again. Right then both her children went abroad in search of greener pastures and higher education. Gita was outwardly ecstatic but subconsciously she was feeling lonely and forlorn. That mind of Gita was somatising as “her feeling very low” which took her to her a “good” doctor in the first place, more due to family pressure. The rest is history.This sad story is all but lost on our modern medical business that tries to attack the palpable abnormal body parameter, which is mistaken for a disease to be drugged ruthlessly. Twenty-four hours after her traumatic experience, Gita was back to her usual confident self, with an on-top-of-the-world feeling, back on her job. The drugs are in the waste basket as she had to survive. “Thank you, Dr. Hegde, I feel fine. All in the mind — yes, yes, I now believe you.”Let us examine the science behind this misadventure. A thinking American professor, a rarity in that country these days, Mary Tinnetti, had this to say about our obsession with a firm diagnosis and our disease concept. “The time has come to abandon disease as the focus of medical care. The changed spectrum of health, the complex interplay of biological and non-biological factors, the aging population, and the inter-individual variability in health priorities render medical care that is centred 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.”The drugs are being pushed irrationally and the gullible doctors who depend on drug companies for their continued education believe their advice a hundred per cent. The pharma lobby even gets research data manipulated. (JAMA 2010; 303(20): 2058-64.) “Speaking of Big Pharma's big, bad influence, here's more proof they're not interested in playing on a level field. It turns out a controversial and dangerous hormone therapy that was all the rage a few years back was pushed in medical journals by writers who were paid by Big Pharma,” according to court papers found in August 2009 by The New York Times.The paper also found that “in one case that seemed typical, the drug company paid around $25,000 to a third-party medical writing firm to generate one of these reports. That might sound like a lot of money to you or me, but it's money well-spent for Big Pharma. In fact, these shady reports helped hormone treatments generate $2 billion in sales in 2001, just before that money train was derailed.”The whole thing looks like a stage-managed effort to keep the best treatment method, change of mode of living, for chronic diseases like raised sugar, blood pressure and cholesterol from practising doctors as the pharma company profits from life-long drug treatments could be mind-boggling.This reminds me of the infamous Tuskegee experiment where 400 African-Americans suffering from syphilis were observed from 1932 through 1972 withholding penicillin treatment just to record the natural history, symptoms and complications of the disease without their consent. Sir George Pickering, a doyen in hypertension research, had this to say: “More people make a living off hypertension than dying of it.” This was written in the 1950s when there were hardly a couple of crude drugs for hypertension. What would he have said about our situation today? God only knows!Right-thinking people in the medical profession have a tough job on hand to try and get at the truth, which in itself is a daunting task, and then cross a greater hurdle to deschool society of its firm belief that modern medicine is a true science and there is a pill or surgery for every illness! The truth is that while there is certainly no pill for every illness, every pill is followed by a definite illness. Pills might thrill but could even kill. Change of mode of living — diet, exercise, mental tranquillity in the midst of this maddening world running after the mirage called money, universal compassion and simple nature-given immune boosters in vegetables and fruits should set right most transitory parameters. It is too late in the day to start deschooling society to reverse the trend and help hapless patients like Gita.
(The writer is a former professor of cardiology, Middlesex Hospital Medical School, University of London, and retired Vice-Chancellor, Manipal University. Email: hegdebm@gmail.com)
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