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THE idea that the doctor is a practitioner of pure science is one of the holy cows of the modern age: this book demolishes this idea along with many other similar shibboleths of the 20th century. It points out that apart from the component of pure science, medicine has one other dimension, namely that the doctor derives material benefit from interaction with the patient and it is this notion which distinguishes it from all other branches of science. The fact that the doctor interacts with the individual through his profession creates a distinction between medical science and the application of science or "art", as the author calls it. While medical science depends on the advancement of natural sciences, the application of science is by no means value neutral and is strongly influenced by social mores, by the desire for lucre and by government policy.
In the patient-doctor interaction, the patient influences what transpires almost as much as does the doctor. Given that the patient is a consumer seeking satisfaction, he can seek redressal until such time as he is satisfied. Phenomena like the use of aminocentesis and ultrasound as an aid to female foeticide are testimony to this fact. Often the patient seeks a cure even if there may be none. Diseases such as diabetes and hypertension can only be controlled and not cured. Insofar as modern medicine is based on ascertainable aspects of human physiology and disease and acute clinical observation or pure science, it does not claim to know everything. Alternative medicine, on the other hand, often does claim to know everything. That is one of the main reasons for its survival. The problem is compounded by the poor availability of healthcare in many countries, which too drives people into the arms of alternative medicine. Simply put, they have nowhere else to go to. Dr Varma provides fascinating insights into the development and theories of Egyptian medicine, Ayurveda, Chinese medicine, Greek and Islamic medicine. He calls the perception of Hippocratic medicine as the forerunner of modern medicine, a myth propounded by the economically powerful West. He points out that there is much similarity between the theory of disease propounded by Ayurveda which talks of an imbalance in the three doshas, Chinese medicine which talks of an imbalance between yin and yang and the Hippocratic idea of an imbalance between the four humours. While Hippocratic medicine was somewhat more rooted in materialism and science than the others, it was no more accurate and it was not until the Industrial Revolution and the Renaissance arrived that we found the true beginnings of modern medicine. Modern medicine has developed along with the advances in natural sciences and Dr Varma points out that the state of medicine is an index of social development itself. If witchcraft was the expression of the healer in a hunting and gathering age, where people still believed in spirits, modern medicine is the expression of the healer in an age of capitalism. Medicine is dependent on advances made in physics, chemistry and biology which in turn depend upon capitalist development and on the need to innovate in production. It is no accident that witch-hunts happened systematically at the time of the Renaissance; not just the ideas but the healer herself needed to be rooted out of society. Yet, the contributions of old healers are with us till today. In a fascinating chapter on therapeutics, Dr Varma points out that three medicines still in use, namely morphine from the poppy seed, quinine from Peruvian bark and salicin or aspirin from willow bark, were all discovered before 700 BC. Such nuggets of information and a multitude of fascinating insights make the book very well worth a read.
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It is in the
socio-political context that Dr Daya Ram Varma traces the history of
medicine. He argues that while the advances of science have contributed
to some of the greatest medical achievements of the 20th century, the
social roots of medicine have not always been advantageous to society.
In capitalist society in particular, the patient being a link to the
market means that very often medication is prescribed where there may be
no real need for it and the consequences can be very dangerous.
Correctives are built into the process of medical research itself but
these can take a great deal of time. Thus, the prescription of DES
(diethylstilbestrol) for women as a prophylaxis against miscarriage was
eventually discontinued when there were no concrete results about its
efficacy, but many of those who took the drug did develop vaginal
cancer. Thalidomide poisoning is another such case in point.