Diseases for sale?

Prof B M Hegde

“There are two kinds of statistics, the kind you look up and the kind you make up.”

- Rex Stout

This is a very strange world. Man is built to last by Nature as long as he lives. Diseases are only accidents. The medical establishment began thousands of years ago with altruistic motives of ‘curing rarely, comforting mostly, but consoling always.’ Rather, it all began basically to allay anxiety, relieve pain and suffering of mankind. Lately, medical establishment seems to have transformed itself into big business. Advertisements go all out to sell drugs as well as technology. The drug and technology people seem to have invaded the medical profession in such a way that recent studies published almost simultaneously in the leading British journal Lancet and the American New England Journal of Medicine show that medical education is completely under the influence of drug and technology companies.

As if that is not enough, lately reports are pouring in from different sources showing how drug companies get medical scientists to invent new diseases to sell their wares. This was going on in the past in a more dignified but quiet style. Lately it has all come out in the open. The latest one is the example of a new disease, “Female Impotence”- a brainchild of the company selling “sildenafil” - countering erectile dysfunction in the male. Having made a small net profit of $11.2 billion last year, the company has lavished material benefits on six American urologists to create a new myth of women suffering from impotence, albeit silently and, in many cases, unbeknownst to them. The doctors were made to claim that female impotence is much more widespread than the well understood male impotence! One could always confuse people with complicated statistics, anyway. To achieve this end they attempt to medicalise human life at every stage and create newer problems to sell their drugs. Researchers with close ties to drug companies try to define and classify medical disorders at company sponsored meetings. Practising doctors do not realize the attempts by these drug giants to establish “normative data” for a range of physiological measurements, like normal blood pressure, sugar, cholesterol and sexual response etc. These levels keep changing almost by the day depending upon the need for drug sales.

Serum cholesterol levels which were at 150-250 mg % during my student days have come down below 200 mg lately. I have not been able to find a good scientific reason for this fall except that the cholesterol lowering drug market would have gone up by a few billion dollars. Similar is the story with blood pressure levels and sugar levels. To give the reader the enormity of this problem a few such meetings are cited here. A large gathering of “clinicians,” “researchers,” and drug company representatives met for two days at the Cape Cod Hotel to “discuss the future directions for research and clinical trials in the area of female sexual dysfunctions against the backdrop of widespread lack of agreement about its definition.”

Much later, in October 1998, the first international consensus development conference on female sexual dysfunction took place in Boston under closed session deliberations. The participants were picked up by the American Foundation for Urologic Diseases as “thought leaders in America”! They produced a new definition and classification —- featuring disorders of desire, arousal, orgasm, and pain during coitus, to be used in medical and mental health settings. This meeting is thereafter called International Consensus Development Conference on Human Female Sexuality! Eventually this would reach the medical textbooks like many other definitions in the past. Since then many epidemiological studies have been “generated” to show that anywhere between 49-80 per cent of all women suffer from one of the above mentioned sexual dysfunctions and the company claims that they could all be helped by regular use of sildenafil. This is the similar story with the definition of hypertension, hypercholesteraemia, hyperglycaemia and many others. The reason for thus defining female impotence is not far to seek. Men, past the middle age, who complain of impotence, usually have other concomitant potentially dangerous diseases that make the drug administration in them quite dangerous. Many have lost their lives already. That apart, there are more women than men in this world. The company is also selling the idea that female impotence being mostly occult; it is better to prevent it by using viagra in every girl after menarche, at least thrice a week, lest she should fail to enjoy the full potential happiness of sexual act all her life! It is not for nothing that they are going all out to sell this idea. The estimated profits could be one hundred times that of selling viagra to middle aged men only!

Earlier a similar campaign was mounted to sell expensive hormones (HRT) to post menopausal women. It was made out that regular HRT use after menopause would not only make life enjoyable, it would, at the same time, prevent dangerous diseases of elderly women like bone loss and fractures, heart attacks, cancers and what have you. The brainwashing of doctors was such that the poor souls did not and could not think beyond the artificial boundaries of the bio-medical model of man in this dynamic universe, where Nature has a reason for everything but human reason cannot comprehend all of it. If hormones were good for women after menopause, why did Nature stop the secretion of such good a thing after menopause? In addition, modern medical science has lately realized, to its dismay, that this world is a wonder. The infradian rhythm (beyond 24 hours rhythm) that controls the menstrual cycle in a woman is directly under the control of the gravitational effect of the moon!

This truth, of course, was known to Indian ancient wisdom of Ayurveda thousands of years ago. So Nature must know better to stop the flow of some sex hormones after menopause. One could not do better than Nature to sleight her. Now comes the revelation that long term use of HRT after menopause is dangerous. It increases the incidence of all those dangerous diseases, which were supposed to be suppressed by HRT. But HRT has a role to play in a young girl who, because of a defect in her gonads, does not secrete the much-needed sex hormones during her reproductive period! Again go with Nature and you are safe. If one goes against Nature, she would kick one in the teeth! Bio-medical models of diseases have their limitations. They have served the limited

purpose of teaching medicine to the uninitiated. Beyond that, when a doctor obtains his/ her degrees, (present examinations are based on that model only) he/ she would do well to unlearn all that to relearn the real life situations wherein the bio-medical models play very little role in human physiology. Everything here is wholistic. Reductionism does not hold good in human affairs.

A glaring lacuna in the medical wisdom that affects the lives of millions of hapless humans is in the arena of doctors trying to predict the unpredictable future of apparently healthy people with the limited knowledge of the phenotypical (body) features that the present bio-medical model permits them to assess. Prediction of the future (time evolution) in any dynamic system, like the human body, depends only on the initial total (complete) knowledge of man, including his mind (consciousness) and his genes. That being impossible one can never predict the future of anyone by routine (check up) screening being practiced by the medical technological fraternity. Routine check up would dangerously damage human health if doctors intervene with drugs or surgery to alter the initial state of the partial knowledge obtained from screening, avers a recent editorial in the leading British Medical Journal.

This regular screening, claiming to help toavoid diseases and premature death is, thus, the greatest myth, invented by drug and technology lobbies. Almost all interventions in people who are healthy and active, without any symptoms, for abnormalities doctors detect on screening, like borderline high blood pressures, marginally raised blood sugar, cholesterol etc. have caused more harm than good on long term audits. Doctors and their interventions are a boon to people in distress. However, healthy people, who are active, would be much better off trying to alter their life style to healthier ways avoiding alcohol and tobacco with the additional benefit of regular physical activity to remain well. These would postpone chronic illnesses and might even avoid premature death and disability. Death would come anyway on the appointed time and diseases also might strike like any accident in life. Under those circumstances doctors are required to “cure rarely, comfort mostly, but to console always.”

Recent research confirms the timeless Indian wisdom that a healthy life style, combined with altruism and hatred towards none, would keep healthy people well as long as they live. Enjoy good health at no extra cost. Keep the mind happy by loving everyone as also all other creatures in this universe. Medical fraternity, including drug barons, should love mankind to make money for a living, but should never love money and use mankind for making a luxurious living. It would be a sad day when doctors love money and use mankind for that sake.

“I don’t give them hell, I just tell the truth and they think it is hell.” - Harry S Truman

(The author is vice chancellor, MAHE University, Manipal)