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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.


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