B M Hegde

All great truths begin as blasphemies

It is only those who are in constant revolt that discover what is true, not the man who conforms, who
follows some tradition. It is only when you are constantly inquiring, constantly observing, constantly
learning, that you find truth, God, or love.
Jiddu Krishnamurthi, Think on These Things

Bernard Shaw was right when he wrote the above caption. I have become so unpopular in my
own profession. I thought I was telling the simple truths that occurred to me in my day to day
bedside experiences in all my articles and speeches. People blame me for every article that I
write. Truth is like the town whore. Everybody knows her, but nonetheless, it's embarrassing to
meet her on the street, wrote Wolfgang Borchert years ago. Medical fraternity and business try
their best to suppress the truth to the extent possible. Many of my professional brethren are not
to blame. They follow their medical school teaching and the plethora of scientific literature to
the letter. Unfortunately, most of those data are doctored to suit the vested interests in the name
of science. They want to sell the idea that every ill has a pill or an operation; which is not true.
The claptrap and the schooling of society on those lines has been very effective in that it is
almost impossible to convince a patient and/ or his doctor today that the patient's illness does
not require any outside intervention in the majority of cases except his/her own inner handyman,
the immune system, to be aroused.
I feel so relieved today that a new study, published in one of the leading medical research
journals, The Journal of Translational Medicine, showed that almost all Randomised Controlled
Trials (RCTs) have been seriously flawed and that their conclusions can not be relied upon! (Sci.
Tranl. Med 2011; 3: 70. DOI. 10.1126/translmed.3001244) This boils down to the simple truth
that reductionist scientific base of modern medicine, so called evidence based medicine (EBM), is
only a myth. The study elegantly showed that what helps patients at the end of the day is their
faith in the treatment that the doctor gives-the placebo effect. This puts the onus of patient care
on the treating physician. We have come one full circle from the time Robert Hutchinson wrote
that medical consultation is that vital meeting between two human beings-the patient and his/her
physician. It is the faith that the former has in the latter that works. The present study, which
you are going to read in detail below, has made use of some of the most sophisticated scientific
methodologies to show that it is the faith that does the trick.
What we want are good human beings as doctors and not their numbers. A doctor, following any
one of the many systems of medical care prevalent in India, is as good as any other, if only
he/she is a good human being who has the ultimate good of his/her patient at heart. The wise
women and men at the helm of affairs at the MCI today will take note of the writing on the wall
that quantity is not the issue but the quality. These wise men and women have been losing sleep
in getting the magic number of 10,000 extra doctors per year in India at one go!
In fact, if one cares to count, we have more doctors per capita patients in India compared to any
other country in the world. We have many systems of medical care working together in society. If
the systems are practised by good human beings they are all equally effective (as per the correct
science of patient response to treatment) as long as the patient has faith in his/her doctor. Even
as far as forty years ago WHO had done an exercise to see the effect of five systems of medicine
prevalent at that time in Thailand. The prospective study did show that all systems were equally
effective. That was an observational study. The present science amply supports that data. In
addition, a fourteen country study recently showed that where there were more doctors per
capita, the health status of society was the worse compared to the countries with lesser numbers
of doctors per capita. The study also showed that if the number of doctors with sub specialization
was higher vis--vis humane family doctors, health status was worse. Japan with the lowest
specialists among the fourteen countries had the best health status, least illness incidence and
highest longevity of the populace!
Drs. Bingel and colleagues, working from Oxford, Cambridge, Munich, and Hamburg did
demonstrate the effect of the expectation effect on drug therapy, which in their own words goes
thus: Evidence from behavioral and self-reported data suggests that the patients' beliefs and
expectations can shape both therapeutic and adverse effects of any given drug. We investigated
how divergent expectancies alter the analgesic efficacy of a potent opioid in healthy volunteers by
using brain imaging. The effect of a fixed concentration of the -opioid agonist remifentanil on

constant heat pain was assessed under three experimental conditions using a within-subject
design: with no expectation of analgesia, with expectancy of a positive analgesic effect, and with
negative expectancy of analgesia (that is, expectation of hyperalgesia or exacerbation of pain).
They used functional magnetic resonance imaging to record brain activity to corroborate the
effects of expectations on the analgesic efficacy of the pain modulatory system, and the negative
expectancy effects with activity in the hippocampus. On the basis of subjective and objective
evidence, they contended that an individual's expectation of a drug's effect critically helped
him/her. Positive treatment expectancy substantially enhanced (doubled) the analgesic benefit of
remifentanil. In contrast, negative treatment expectancy abolished remifentanil analgesia. These
subjective effects were substantiated by significant changes in the neural activity in brain regions
involved with the coding of pain intensity. The positive expectancy effects were associated with
activity in the endogenous influences its therapeutic efficacy and those regulatory brain
mechanisms differ as a function of expectancy. They proposed that it may be necessary to
integrate patients' beliefs and expectations into drug treatment regimes alongside traditional
considerations in order to optimize treatment outcomes.
Talking to the BBC, Professor Irene Tracey from Oxford University said, "It's phenomenal, it's
really cool. It's one of the best analgesics we have and the brain's influence can either vastly
increase its effect, or completely remove it." (http://www.bbc.co.uk/news/health-12...).As
pointed out by George Lewith, a professor of health research at the University of Southampton,
these findings call into question the scientific validity of many randomized clinical trials. He
said, "It completely blows cold randomized clinical trials, which don't take into account
expectation."
(www.naturalnews.com/031451_drug_trials_placebo_effect.html#ixzz1ES4z9KmM)
There are two kinds of doctors. The placebo doctors are the ones that generate a positive mental
attitude towards treatment in a patient while the nocebo doctors create the opposite effect. They
scare the patient away to begin with thanks to their wrong deterministic future predictions like
you have six months to live etc. No one can predict the future as the future is yet to be born
and to predict that in any dynamic system we must have the complete knowledge of the initial
state of the organism. Even to predict the future of this globe one has to have all the information
about its initial state- an impossibility. Albert Einstein rightly said that all complicated problems
in this universe have very simple solutions. Medical care looks simple if only we cater to the
mind of the patient. Mind and body being but one single entity, patient care boils down to caring
for the patient. We need to de-school society and doctors to develop the placebo trait in them.
It is better to end this with a quote from Winston Churchill: The truth is incontrovertible, malice
may attack it, ignorance may deride it, but in the end; there it is. We need doctors to guide
every patient in the right path. Authenticity should be their goal and compassion their path.
Vaidyo Naarayano Harihi. Some of our great brains in the past had predicted this. If the whole
materia medica could be sunk to the bottom of the seas, it will be that much worse for fishes and
that much better for mankind, wrote Oliver Wendell Holmes. More people make a living off
hypertension than dying of it, wrote Sir George Pickering. Patient care is CARING for the
patient, wrote Sir Francis Peabody. Two most powerful drugs ever invented by man are the two
kind words of a caring doctor. Long live doctoring.
Truth is the property of no individual but is the treasure of all men.
Ralph Waldo Emerson
Email: hegdebm@gmail.com
COVER: Information turns into energy through the mind route.
Informaticians have now moved from the back end of medical science to
the deep end of clinical support. Besides generating many aspects of
multi-phasic health check-ups, health informatics help in creating large
data bases for healthcare. The role of information as a bridge to the
human mind to generate energy leading to sustainable healing outcomes
is now under the scanner of medical researchers. Efforts are being made
to explain how human life is maintained by flow of information. It is true
that all living things interact with their environment. This interaction
defines the concept and conduct of life. In the case of human beings,
information turns into energy through the mind. Illness, for example,
originates first in the mind.

Illness is also gets cured with the help of mind. The science of information has developed into an
autonomous system controlling and penetrating all other subsystems of society. It is concerne
with origination, collection, organization, storage, retrieval, interpretation, transmission,
transformation and utilization of information. It covers both natural and engineered informationprocessing systems. Medical informatics deals with resources, devices and methods needed to
optimize the acquisition, storage, retrieval and use of information in healthcare and biomedicine.