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Medical
Ignorance &
The Democracy
of Intellect
By Professor Dr. Manu Kothari
Department of Anatomy,
Seth G.S. Medical College, Mumbai, India.
Member of the SA AIDS Panel
This Edit by Fintan Dunne
 In
1996, the KEM Hospital, in Mumbai --the institution where
I work, celebrated its 50th year. And the Dean asked me to suggest
to him a rather unusual, offbeat topic for a conference to be
held.
So I said, Sir, why don't you hold a first ever conference on
Medical ignorance. And he started laughing. He didn't take up
the issue for the simple reason, he said, that if this conference
is held, money flowing in from pharmaceutical firms will cease!
Somehow it never came to pass.
MEDICAL IGNORANCE
All this spurs me to discuss the failure, or otherwise, of medicine
in such leading areas as cancer, heart attack, hypertension, stroke,
diabetes, arthritis, peptic ulcers. First let's go back to a very
important book from the Rockefeller Foundation in 1977 called
'Doing better and feeling worse, Health in the United States'.
Now, who is "Doing Better"?
Until the '60s, the United States used to spend about 8 billion
dollars a year on health. Now it is spending billions of dollars
a day. Moral of the story: doctors, hospitals and manufacturers
are having a gala time!
And who is "Feeling worse"?
Obviously the patient!
The question is "Why so"?
In the first chapter written by Lewis Thomas, a Yaler, philosopher,
physician, and who was lately the Director of Sloan Kettering
Institute, he says, "..When it comes to these major issues like
cancer, heart attack, hypertension, stroke, diabetes, arthritis
and peptic ulcer.. Medicine knows next to nothing"!
And in the same book, another medical physician Dr. Wildarsky,
says that in 9 problems out of 10, medicine can do precious little.
In fact, there is a global survey that 9 prescriptions and procedures;
9 investigations or whatever out of 10, are not only unnecessary
but unwarranted!
Why have we come to this?
We have come to this because, I think, beginning 1930, technology
started taking over thinking. Betrand Russel, circa 1930, said
that Modern Education teaches how to do, but not how to think.
The common man wants Medicine - like Justice, to be not only done,
but be seen to be done. And so, he demands therapy not only be
done, but be seen to be done. Assertive action has become a priority
issue in medicine, however wrong it may be.
Epistemology is the science of knowledge. It is a science which
takes any piece of information and weighs its worthwhileness,
its possibility, its impossibility or its uselessness. Consider
that about 300 years ago, an apple fell on the bald pate of Newton
and gravitation was born. Since then we have been studying gravitation
left, right and centre! We know everything about it to the 10th
decimal point. But one thing remains certain, we can't alter gravity.
As Robert Arturu says,"The apple must fall down"!
Therefore, no matter how much we know everything about cancer
cells, that in no way will allow us to alter the cancer cell.
In fact, Lyall Watson on the European side and Lewis Thomas on
the American side, both have generalised that the biggest discovery
of the 20th century is the discovery of Human Ignorance!
Back in 1977, one of my American students, sent me the 'Encyclopedia
of Scientific Ignorance'. This was followed up by Pergaman Oxford
in 1979 with the 'Encyclopedia of Medical Ignorance.'
These two encyclopedias more than underscore what Lyall Watson
and Lewis Thomas said. Let us go back in the hoary past to Shankaracharya.
He said in 9th century, that if "Gyaan"(knowledge) is "Aananth"
(happiness), so is "Agyaan"(ignorance).
And much later Blaise Pascal said that knowledge is the inner
surface of the sphere, whose outer surface is painted with ignorance.
So sometimes when somebody tells me that I am well read, I tell
him that I know that I am very very ignorant, because the more
you know, the more exponentially you become ignorant.
And that explains to you why some of the greatest people who are
very learned, are almost painfully humble. You almost get irritated
that this man knows so much and yet he pretends to be humble.
But in the depths of his heart you see, he knows that he doesn't
know!
THE DEMOCRACY OF INTELLECT
I am a teacher, and so I've got to teach my students. And I often
ponder what is my role here? Then I realise that I am a member
of "the democracy of intellect". This is a phrase used by Jacob
Bronowski in one of his small books titled 'Democracy and Intellect'.
There is neither dissidence nor proponence. There is only a democracy
of intellect.
And what is my task? The task of any teacher is to take the student
to the outer limits of knowledge and to the beginning of his ignorance,
thereby establishing an epistemological equality which must be
at the heart of any democracy.
So thinking along these lines, in our own department where I have
been teaching for the last forty years, we have very cardinal
principles. That on the first day, the student must learn to have
a healthy disrespect for the three T's.... teacher, what is taught
and the textbook. And towards that end we encourage them to take
an oath which was supposed to be a ritual in early Europe, especially
in particular universities. You take an oath, that here I have
come not to worship what is known, but to question!
TOO LATE FOR CANCER
In 1946 Augustus Bier wrote, that all you know about cancer can
be written down on a visiting card! And still today it remains
unchanged. Around 1983, James Watson of the double helix fame,
characterised cancer research as intellectually bankrupt, financially
ex-invigorating and therapeutically useless. And he said cancer
establishments are a lot of shit. That is the term he used.
Sir Meg McFarlen, the Nobel Laureate, summed up the entire Nobel
scene, and he said that after a thousand years of work, the outcome
is precisely nil. And today what has happened is: the cancer cell
no longer is taken as a structural entity. The cancer cell is
taken as one more form of normal cells. Now the question is: what
is cancer cell and what is normal cell?
Albert Szent-Gyorgii, the Nobel Laureate for the discovery of
vitamin C and actin myocine, while chairing a session in America
at the 69th Ciba Symposium on Sub-molecular biology and cancer,
on the last page, he is asked, "Can you define what is a
cancer cell?" And he says, typically of a humble person,"My
dear sir, how can I tell you what's a cancer cell when I don't
know what's a normal cell?" Yet in the cancer establishment, the
bogey of the cancer cell as a vicious, savage cell is being sustained.
Another unholy humbug which they are sustaining, is that chemotherapy
and radiotherapy are useful because they tend to kill the more
fast multiplying cells as compared to normal cells. This went
on until cytokinetics arrived. And cytokinetics arrived to destroy
two illusions. Cytokinetics showed that - if at all, cancer cells
multiply painfully slowly, with the result that when you give
radio therapy and chemotherapy, before you kill a single cancer
cell, you will destroy a million normal cells. That is the trade
off, okay?
And the other illusion which it destroyed was that of early diagnosis,
yet we still drumbeat early diagnosis. From 1802 through the 19th
and 20th century, some of the most leading thinkers have shown
that early diagnosis is not possible. This was said intuitively.
Then came cytokinetics. And cytokinetics has shown that before
a tumour assumes one milligram of weight, which no scan ever can
detect, it's a billion cells strong! And to arrive at that it
will take a few years. Which means that by the time a cancer is
diagnosed, a symptomatic silent cancer - diagnosed and detected
by the most sensitive scan, it has been in the patient's body
from 5-20 years.
CANCER IS UNRESEARCHABLE
And therefore, when I think about this bogey of early cancer,
I say, quoting, almost paraphrasing Churchill :"Never in the history
of science has so much untruth been told, by so few, to so many,
for so long". We wrote the 10th chapter of our smaller book, because
Ivan Illich realised that the larger volume 'Nature of Cancer',
at 1000 pages, meant few would read it. So he said. Manu, bring
it to one tenth, and we brought it! The 10th chapter was titled
: 'Cancer is unresearchable'.
When I sent it to England, my publisher said, Manu, you are in
the habit of joking, but this is carrying a joke too far! So I
said, what you do is circulate this chapter among top cancer specialists
in England, and if they ask me to modify it - I'll do it. If they
ask me to drop it, I'll drop it. On purely intellectual grounds
they could do neither. That chapter has stayed in the series of
additions and translations and we have shown that cancer is unresearchable.
1979, 14th March was the 100th birth anniversary of my beloved
Einstein, And therefore, (Dr.)Lopa and I decided to pay a tribute
to him. Why pay a tribute to him? Let it be known to the whole
world that in the words of J.B.S. Harding, Einstein has been the
greatest Jew after Jesus Christ!
So Lopa and I wrote an article, On Time, Uncertainty, Relativity
and Normality in Medicine. It was published in Chicago. The title
was "Trans science Aspects of Disease and Death". Maintaining
that from the common cold to cancer, basically science can do
nothing about its cause, about its course, or about its cure.
So some friend told me, I'm a Luddite. I don't know what are technological
advances. There is MRI. There is CT Scan and therefore, he says,
just see. So therefore the next chapter was, "Trans technique
Aspects of Diseases and Death." Believe me, up till today,
about cause, course and cure of common cold, cancer, coronary,
heart attack, hypertension, stroke, diabetes, HIV and AIDS, medicine
knows next to nothing. And medicine must accept that it knows
next to nothing.
ABOUT DIABETES
We seem to know that there is diabetes and we treat with anti-diabetic
drugs. But I think we are kidding! Diabetes is a multi faceted
problem. Protein metabolism is disturbed, fat metabolism is disturbed,
sugar metabolism is disturbed, arterial health is disturbed. At
the moment we have only one parameter, glucose level. So we give
a drug to bring the glucose to the doctor's desired level - not
necessarily to the patient's comfort. And you call it curing diabetes,
treating diabetes! You're kidding.
I think, some years ago, there was a Conference held only to define
Diabetes mellitus. And at the end of 3 days, they gave up, saying
that it can't be defined. Medicine has not defined hypertension,
medicine has not defined heart attack, medicine has not defined
cancer, medicine can't define arthritis, and medicine can't define
HIV and AIDS! It Can't! When you are so grossly deficient, how
can you research?
BYPASSING THE BYPASS
At the moment I am writing the ABC of cardiology. A for artery,
B for blood, C for codium or heart. And what is my revelation?
I thought that cardiologists must be knowledgeable people, but
there is profound ignorance! There is not a single genuine anti-cardiac
drug, not a single one.
And I must wax eloquent on angiography, angioplasty and bypass.
It was in 1993 that Renu Varmani, trained here, but now a big
person in America, majestically declared "We no longer trust coronary
angiogram in the USA. We go for intracoronary ultra sonogram".
So I said, "Madam, should I put an obituary in the Times of India
tomorrow, that coronary angiography is dead?" She said "You must
pay, you must do that." But then she said "When you do angioplasty,
the coronary arteries are invariably torn". So I said, "Shall
I announce tomorrow that coronary tear is part of coronary care?"
She said "Yes". And what is the bottom line today? That angioplasty
does not lengthen life and creates many complications.
And if you put a stent inside? Stent induced stenosis of the arteries
is today described as the most common iatrogenic, malignant disorder.
Okay! I have just received a download from American College of
Cardiology and American Heart Association, which says angiography
is unreliable!
Therefore you do intracoronary ultra sonogram which is unreliable,
therefore you do thalium optic study which is unreliable, therefore
you do coronary angioscopy! All four together are unreliable.
Now the fact that they are unreliable, I translated into the fact
that if you do angioplasty and bypass, nobody's life is lengthened.
No one!
Let's go to bypass. Let's take Harrison's Textbook of Medicine
Large volumes, Volume One and Two.. Nearly two and a half thousand
pages, which I have followed from 10th to 14th edition, 1983 to
1998! Fifteen years and Five editions! And you go to the section,
coronary bypass... and what does it say? We don't know how bypass
works! But the following are the three theories.
1) Placebo is effective 64%! This 64% I got from another
book, but no wonder N.Y.Times once described coronary bypass as
the costliest Aspirin! Okay, you spend a lot of money, and you
are convinced that the right thing has been done.
2) Sensory neurectomy. Because the pericardium is cut,
nerves are cut, the heart is botched up as ever. But because the
fellow doesn't feel the pain, he does get alarmed any longer.
3) And perhaps the worst is in cold print."Bypass probably
works by infarcting the ischaemic segment", translated into ordinary
language, it means, bypass - by killing the complaining segment.
So the segment is killed. It's nerves are killed and the fellow
is pain free immediately on the operating table. But moral of
the story... bypass is a surgery which is very very unscientific,
to say the least.
And I have a book, History of Coronary Revascularization, by Richard
Preston, one of the Brooklyn cardiologists. And he has stated
from 1890 till today (and this is a book around 1978), he asked
his cardiologist friend, why they were selling an operation which
had very poor rationale. And the reply was the consideration of
the economy. This is a marketplace, my client wants to buy, so
I want to sell!
HEART OF THE MATTER
Moral of the story, what do we do in cancerology or cardiology?
We cannot attack the primary problem, precisely because there
is no problem! It's a part of growing. Okay? Everybody gets it.
So you can't treat everybody, but what do we do? Whenever there
is a symptom, when cancer causes lump, in case the lump is bothering
the contours and the beauty of the person, remove it! If it is
blocking a tube, remove it.
Moral of the story, Tata(Mother) hospital has to ease, provided
there is dis-ease! Presence of cancer means nothing, okay?
In fact, may I read out to you from Boyd's Pathology, that cancer
is one of the classical examples where the person may be totally
at peace with himself. There is a lump, but he has no disease.
He has got cancer, but he has no dis-ease
In a similar fashion, you may take my coronary angiogram and find
it awfully diseased, but I have no symptoms. Because I have no
symptoms, I am not dis-eased. There is no need for an "easer"
called physician. And therefore, there is no need for the physician
to violate what is called Heal's Law. He says that it is impossible
to make an asymptomatic person feel better, therefore it is very
much possible to make an asymptomatic patient feel worse.
You go to Hinduja (hospital). You go well dressed, and pay a large
amount. You walk in as a person, you walk out as a patient! Because
what do they do? They investigate, and as Rousseau says, implant
into your brain a worm of suspicion which starts crawling. From
that day you start thinking that all is not hunky-dory with you.
This particular preempting a disease, is not benefiting anybody
in any field.
THE BOTTOM LINE
Therefore, my bottom line about cancer, my bottom line about
coronary, my bottom line about diabetes and hypertension is, if
they are silent, do nothing! And as and when you treat, treat
the symptom, warning the individual that this will worsen his
condition. One symptom will disappear, others will arrive!
Just to give you an example, Lawrence Clinical Pharmacology is
now in its 8th celebrated edition. You go under the section of
cardiac failure. You go to the summarizing box at the end of chapter,
and there is a very profound statement "Relief of symptoms does
not improve prognosis and vice versa".
You go to the 1956 Transactions of the N.Y. Academy of Medical
Sciences, vol 6. There is a fifty page article by Hardin Jones
of National Cancer Institute of Bethesda, Maryland. He surveyed
global cancer of all types and compared the untreated and the
treated, to conclude that the untreated outlives the treated,
both in terms of quality and in terms of quantity. Secondly he
said, "Cancer does not cure". Third he said"There is a physiological
mechanism which finishes off an individual".
Which brings me to Bertrand Russel's 1918 article on Causation.
He said, Causalism has died in all advanced sciences, but in some
sciences it survived. Because like the King of England, and the
king of Egypt, it's supposed to do no harm.
 SickofDoctors.com
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