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Photo: iStock
Photo: iStock

Why medicine is broken

Almost every stream of medicine is in disarray and should be injected with fresh thinking, but nothing seems to be around the corner

Pardon my staying on medicine as a theme in this series. But a little over a month of staying at the hospital, watching over dad after he had a massive stroke, my mind can’t help but make copious notes of all that is going around. In earlier pieces in this series, I wrote of how Indian doctors are among the most stressed and abused; and what it feels like to stand guard outside an intensive care unit (ICU).

I am now a familiar face in the environs and pretty much everybody nods in acknowledgement, asks after me, and we often exchange niceties. Life, after all, has to keep moving. That said, this is also the kind of place that creates room for contemplation and questioning. And so here I am, at a crossroads, asking a question I never thought I’d ask. Is contemporary medical science, as we understand it, broken? Does it need to be fixed? And if it can be fixed, how?

To put that into perspective, when I was much younger, my dad’s older brother gave up on a career as a practising biochemist at the Stanford University School of Medicine to come back home. We’d take long walks on the beach by our ancestral home in Kochi. Oftentimes I’d probe him on why he chose to give up a position at one of the most prestigious institutions in the world. Inevitably, a philosophical discussion would follow.

After having spent close to three decades there, he gave up on it because he thought the Western school of medicine is a mechanistic one. He was convinced there is more merit instead in Indian and other Eastern schools of medicine. So he got himself a farmhouse in the boondocks of Thrissur district in Kerala where he experimented with Ayurveda until he died happy and peaceful a few years ago.

Uncle was deeply influenced by thinkers like the physicist Fritjof Capra. Capra contended contemporary Western sciences, including medicine, are the outcome of a mechanistic and reductionist worldview as first espoused by René Descartes during the European Renaissance. Capra, in his seminal book The Tao of Physics, argued that this a flawed way to look at the world. Why?

To put it very crudely, the Descartian School argued the body is a machine. And that it ought to be looked at and treated as such. When viewed at from this perspective, to understand the body better, you ought to keep breaking it into tinier and tinier fragments. Contemporary Western medicine took its cues from there and went on to build a formidable body of knowledge and arsenal of weapons to fight diseases of all kinds. That it worked well is obvious in hindsight. That is why, when in distress, most of us turn to allopathic medicines.

My uncle was on Capra’s side, though. His point was that it is ridiculous to look at humans from a mechanistic prism much like you would at a broken automobile or any machine for that matter. That means when there is a problem, subject it to a battery of uniform tests, identify the problem on hand, and use a textbook-driven solution to fix it.

Instead, he’d often argue, a holistic approach of the kind Ayurveda prescribes is called for. Allow me dwell on it for a bit.

Ayurveda argues that not all humans are built the same. Every individual is unique. At a macro level, it begins by differentiating people on the back of three doshas (types)—vata, pitta and kapha—that include their physical and mental make-ups as defined by its practitioners. Within these doshas, there are various permutations and combinations and it is the physician’s job to first identify what dosha an individual fits into before prescribing anything.

But even more importantly, practitioners of Ayurveda argue that it needn’t come to a point where intervention is called for. Because once an individual’s dosha has been identified, the science has prescribed ways of life for individuals who belong to a given dosha to keep diseases at bay until age or some other calamity claims them.

So, Ayurveda is not so much about curing an ailment, as much as it is a way of life tailored to meet an individual’s unique requirement. When deployed effectively, advocates like my uncle argue, you don’t have to deal with a diseased body in the first instance.

While the logic is impeccable, I’d often laugh at him and argue instead that if Ayurveda is so hopelessly ingenious, then why hadn’t it thought up something as potent as vaccines that are now par for the course and have saved millions of lives? More importantly, to my mind, Ayurveda comes across as a static science. It relies on texts that were handed down over a few thousand years ago. I must confess I am no scholar on the theme. But I haven’t heard or read of any cutting-edge research by Ayurvedic practitioners either. Relying on ancient manuscripts is an awfully lazy way of going about things.

That is pretty much why I am willing to stand on any podium and scream that the reason it works in some cases is a function of trial and error that was practised over 5,000 years and not on the back of startlingly original new research or insights. I maintain my position and refuse to budge from it. If anybody thinks the ancients had it all figured out, then they are living in la-la land. Good luck and goodbye! If it pisses you off, then so be it.

And if anybody mutters the word homoeopathy, I won’t think twice about sticking out my middle finger. I have articulated why I’d do that in an earlier column in this series.

But all this said and after having spent as much time as I have at a modern hospital, I can’t help but wonder if allopathy is barking up the wrong tree as well. Because once again, when looked at from a philosophical and historical perspective and Descartian thinking, the bedrock on which allopathic treatments are constructed seems hopelessly outdated and obstinate as well.

But when I talk to researchers like my brother, a computational neurobiologist at the Indian Institute of Science Education and Research (IISER) in Pune, they disagree. Trained at the Salk Institute for Biological Sciences in the US, he argues that he isn’t willing to put his neck on the line with this strand of thought. He argues vociferously that people like him are doing their damnedest best to look at problems from a holistic perspective.

Personally though, I disagree with him. I have always maintained that contemporary medical researchers like him have until now relied on reducing everything to its tiniest part. What it means is that to understand something, they take a problem and keep digging deeper and deeper until they reach atomic and sub-atomic levels. This is where the problem begins as well. But after having understood the function of a cell at microscopic levels, they simply don’t have the tools on hand to go back to look at the problem from 30,000 feet. To that extent, theirs is a work in progress.

So as much as they would ideally like a holistic worldview, the wherewithal doesn’t exist—not with the ancients, nor with contemporary practitioners or researchers. And quite frankly, that is a terrifying thought.

Can this be fixed? Quite honestly, I don’t know. As a layperson distanced from the nuances and complexities of medicine, all I can see are researchers like my brother working at the problem while the unfortunates like my dad wait, comatose, for some respite to come their way. It isn’t a pretty place to be in. It certainly isn’t a place I want to be in. That is also why I fought hard against the consensus view to place him on the ventilator.

Perhaps, what we need now aren’t researchers in the strictest sense of the word, but researchers who are philosophers as well like Charaka, who pioneered Ayurveda, and Hippocrates for allopathy.

Charles Assisi is co-founder and director at Founding Fuel (www.foundingfuel.com), a digitally led media and learning platform for entrepreneurs. He tweets on @c_assisi

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