Professor BM Hegde, renowned physician and former Vice Chancellor of Manipal University, highlights the growing incidences of nefarious and unethical practices in healthcare
“Power does not corrupt men; fools, however, if they get into a position of power, corrupt power.”
– George Bernard Shaw
Modern society, with the influence of the western education, has come to revere money and power as the most vital part of human existence on this planet. Even as far back as 1802, the romantic British poet, William Wordsworth, became so sad when the first industry came up in England, what is now called the Industrial Revolution. He wrote a beautiful poem, ‘The world is too much with us’: “The world is too much with us; late and soon, Getting and spending, we lay waste our powers;— Little we see in Nature that is ours; We have given our hearts away, a sordid boon!”
The poem tells it all about today’s scene in modern medical practice, which unfortunately has percolated to even all modalities of sickness care. Even in the name of ayurveda, homeopathy and what have you; people have started making money in a big way. Today, one can have a week’s ‘ayurvedic’ treatment for $25,000 in bigger cities like Bengaluru and Mumbai, so the contagion of greed is not restricted to Western medicine alone. That brings us to the crux of the problem. It is not modern medicine that is at fault, it is the greedy practitioners of modern medicine who are at fault. Any industry, including the sickness industry, needs to sell its wares. But, this has led to a new speciality in modern medicine; i.e. disease mongering. Along with that, we have obliging epidemiologists who can create epidemics at the drop of a hat, if you need it.
One example would suffice: Coronary artery disease was not a very common disease even when I was a student in the 50s. And the diagnosis was purely clinical, based on the patient’s story. No investigation can clinch the diagnosis of coronary artery disease. Naturally, the incidence of coronary artery disease was not very high. Today, we have transformed the scenario. We have started a new business called ‘routine checkup’ of the apparently healthy, based on the faulty premise that early diagnosis in the pre-symptomatic stage is better for prevention. This is scientifically untrue, no disease will benefit in the asymptomatic stage by outside intervention. However, the myth perpetuated by the screening industry, aided and abetted by heavy advertisement through the electronic and print media in our present “health scare” system nets in almost 75 per cent of the healthy population, who have blocks seen in the epicardial large coronary arteries. These are seen even in children. These intraluminal blocks are just a bandaid put by nature on injured vessel endothelium. The latter is not a disease, as the intraluminal blocks gradually increase, nature provides plenty of collaterals to feed the distal part of the heart muscle. The real coronary artery disease is due to hot inflammatory intramural blocks, which are not seen in the coronary angiogram. These hot blocks can attract a clot producing the various presentations of coronary artery disease, viz: angina of effort, unstable angina, intermediate coronary syndrome and heart attacks. Consequently, there has been an epidemic of coronary heart disease in the last couple decades with the availability of coronary bypass surgery and angioplasty. So today, coronary interventions are done not to help the patients who are asymptomatic anyway but to collect, “billions of dollars in cash for the doctors, hospitals and instrument manufacturers, social status and respectability for the star performers”, as Harlan Krumholz, the Chief of Cardiology in Yale University wrote in an editorial a few years ago, in the New England Journal of Medicine.
The story is the same in every other field, leading amongst which is the cancer industry. This is a trillion dollar industry. Linus Pauling, a scientist who got two Nobel prizes, emphatically wrote that cancer research has been a fraud. This idea has been reaffirmed by many studies since then. John Iaonnidis, a Stanford professor has found out that almost 85 per cent of the cancer research data cannot be replicated independently. Most cancer research is funded by the cancer industry. Billions of dollars of cancer research are poured into animal studies, which cannot be replicated in human beings. There has not been a serious effort to prevent cancer as other industries are pouring in thousands of cancer producing chemicals into human food channels. We live in the midst of carcinogens, which is a good idea because we want more cancer patients to cater to the expensive cancer industry. One example would make the point: Imitanib, a tyrosine kinase receptor inhibitor is the latest darling of the cancer industry. In India, a course of this drug might make even the reasonably rich people paupers, what the industry does not want is for the world to know that many such powerful tyrosine kinase receptor inhibitors are there in our kitchen turmeric powder, which can be bought for almost nothing.
Mark Twain was right, when he wrote, “A lie can travel half way around the world while the truth is putting on its shoes.” How true. So corruption is an integral part of the healing arts in the 21st century. Around this nucleus of corruption grows an industry of corruption.
Family doctors in the olden days were friends, philosophers and guides of their patients. Today, they are slowly transforming themselves into a supply chain for the greedy corporate hospitals. With each referral, the man gets 10 per cent kickback from the final bill, that too in cash, making them quite rich overnight. The pharma industry, the motivator of all this, thrives on falsehood, half truths and blatant lies. In the name of having poured in billions for fundamental research to discover a chemical molecule, they claim they have a right to claim a patent over the drug and sell it at an enormous cost. One will be shocked to know the various methods they adopt to influence the prescribing doctors. With all the strict laws in place, they still bribe doctors and find their way through. They create multiple indications for each drug, while the true
science says that any reductionist chemical molecule will not be accepted by the human body’s wisdom.
Other overt and covert methods of corruption in this arena are: drug companies doling out millions of dollars to the so called, ‘thought leaders’ to sit on guideline committees and invent new diseases to sell drugs. Couple of examples come to mind: one is the famous JNC committee on blood pressure management, the so called normal blood pressure started coming down from 160/100 when I was a student to almost 110/70 in the JNC 7 report. The only conceivable reason why the so called normals came down could be that the drug pushers invented newer chemical molecules to lower blood pressure. Such ridiculously low blood pressures may push the blood pressure further down in sleep, helping elderly patients to meet their maker in heaven prematurely. Sanity has seemed to prevail on the committee now, and thank God, JNC 8 has now gone back from the original level of 160/100 to a nicely camouflaged 159/99. I am sure millions must have changed hands, although I have no proof of that.
Every reductionist chemical molecule introduced into the human system is first rejected by the human body’s wisdom and sent to the liver for destruction [first pass effect], creating a new epidemic of non-alcoholic cirrhosis. Studies have also shown that whatever good comes out of medical treatment is exclusively because of the placebo effect. The unfortunate fallout of all this has been an epidemic rise of adverse drug reactions [ADRs]. The latter has now been found to be one of the leading causes of death in all those countries where medical audits exist. A recent study of the medical world since the advent of the journal, The Lancet, in 1823, to scientifically rectify the corrupt and incompetent practices of London doctors in 1823. James Wakeley, the founder of The Lancet, a doctor himself, thought that the doctors in London in 1823 were a bunch of corrupt, nepotistic, incompetent lot who had become an abscess on the human body, eating into the flesh. He called his journal The Lancet, and thought it could open the abscess and drain out the pus. Unfortunately, nearly 175 years after the advent of The Lancet, an audit showed that what was in 1823 an abscess on the human body has transformed itself over the years into a corporate monstrosity. All because of the greed for money by the people concerned. The only way we can see an end to this nefarious practice is by a change of heart of doctors. I hope it is possible. Society is changing, thanks to the information overload, patients are becoming wiser and I hope, sooner than later, doctors will have to practise the essential part of medicine, enunciated by the Father of Modern Medicine, Hippocrates: “Cure rarely, comfort mostly, but console always.”
I hope this day will not be far off. A good doctor must basically be a good human being and a good human being should be an authentic human being. Corruption as a disease will die a natural death when mankind becomes altruistic.
“The surest way to corrupt a youth is to instruct him to hold in higher esteem those who think alike than those who think differently.”
– Friedrich Nietzsche
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