MEDICAL
ARTICLES / LECTURES
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GUEST ARTICLE |
Prof.P.Upadhyaya |
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Former Prof. & Head Dept. Of Pediatric Surgery, All India Institute of Medical Sciences, NEW DELHI. Invented Upadhyaya Shunt For Hydrocephalus Present
Address: 7/C Mohini Road,
Dehradun - 248 001,
INDIA
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| THE DARK SIDE OF MEDICAL TECHNOLOGY | ||
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The overwhelming advantages of medical technology can not be denied. I do not have to recount the benefits of ultrasonography, CT, MRI and radioisotope scanning. I will also not dwell on the blessings of minimally invasive surgical modalities using endoscopy, laser beams and gamma
knife. Just as an evangelical preacher does not start his sermon on evils of drinking by
eulogizing the pleasures of drinking, I will omit all that and come straightaway to the ill-understood side of medical technology. I strongly believe that the brilliant success of technology has dazzled our vision so much that we can not see the evil shadow cast on the conduct of the practitioners of modern medicine. Not too long ago, a physician used to spend quite some time in eliciting a detailed clinical history, followed by a head to toe physical examination of the patient. Not any more. Because of the omniscient superiority of the modern diagnostic machines, the physician does not have to spend much time at the bedside. He goes through the results of investigations and promptly prescribes treatment. The doctor-patient relationship thus often gets lost in the sheets of tests. In this respect the faith healers and quacks win over us. They talk to the patient, establish a one- to-one rapport and gain the patient's confidence, which as we know, makes all the difference in recovery. It is not surprising that more and more patients, not only in India, but also in developed countries go to such faith healers because they give something that we have altogether forgotten to give - time and a sympathetic ear. I am not one of those who believe that newer diagnostic techniques have undermined doctors' clinical acumen. But I do believe that they have, albeit unwittingly, reduced diagnosis to a mechanistic exercise rather than a personalized thoughtful process. Today's patients regard investigations as supreme; they rely more on the results of the test than on the doctor's capability to diagnose. To the extent that some patients get the ultrasound scan, at times even the CT, done on their own, before seeking a medical opinion, incurring unnecessary expenditure and causing avoidable anxiety. Unfortunately, we do not seem to discourage this practice. In fact, we have failed to impress on our patients the dangers of this improper use of technology. We ought to be telling them that investigations are only a part of the total diagnostic strategy. They do not by themselves, make the complete final diagnosis. Perhaps the most evil influence of medical technology is the vulgar commercialization of medical care. As an illustrative example take the case of silicone breast implants developed by the firm Dow Corning. This new "cure" had to find a disease. The American plastic surgeons found it and called it "micromastica", a high sounding name for small breasts. Though anatomically and functionally normal, such breasts are not considered adequate for displaying at the beach. For this reason the American Society of Plastic and Reconstructive Surgeons spent thousand of dollars in a campaign to allure women onto getting their breasts made bigger. Over a period of ten years more than two million women received breast implants, not for any medical reason, but simply because American males find larger breasts more attractive. However, with the passage of time there were reports of adverse reactions viz. Interference with lactation and difficulty in detecting cancer on mammography. Some women developed serious complications like lupus and scleroderma. What was proclaimed to be a harmless procedure has become a serious health hazard. At last the law has swung into action. The court has recently awarded millions of dollars as compensation to victims of this misadventure and the firm Dow Corning has gone into bankruptcy. Highly sophisticated and extremely expensive tools require an investment of several crores. The investor, often a businessman, demands prompt and profitable returns as well as a provision for buying the next generation of more complex and inevitably more expensive technology. Diagnostic tools thus become money-spinning machines. No wonder that ultrasound "shops" have mushroomed even in small towns. In spite of the law against it, foetal sex discrimination goes on, often leading to termination of the female foetus, as abhorable as infanticide. Unethical practices of ordering needless investigations and performing unrequired operations, and the newfound system of giving cuts by some are the growing signs of degrading commercialization of medicine. It seems the medical profession has developed a vested interest in human suffering. Money and machines are reducing the practice of medicine to a sordid pecuniary pursuit. From the high pedestal of a noble profession medicine is being degraded to the level of a trade. Are we not forgetting the professional code laid down by Charak some 2,500 years ago? Not for self, not for the fulfillment of any earthly desire of gain, but solely for the good of suffering humanity will I practice my art and so excel all. Those who sell the treatment of diseases as merchandise gather the dust and neglect the gold. With the advent of high technology medical practice is progressively becoming depersonalized, if not dehumanized. Technical manipulations such as laparoscopic removal of the gall bladder, crushing of kidney stones by lithotripsy and clearing of coronary artery blockage by angioplasty are acclaimed more for their glamour and surgical heroism than their true therapeutic content, so much so that conventional medical and surgical methods still relevant to the needs of the poor are being forgotten altogether. Possessed by the glitter of technology, we do not pause to think about how to prevent the formation of urinary stones or coronary clots in the first place. Often, we fail to find out how anxiety, family tensions, financial worries are interacting with the disease of an organ. While applauding, for example, the diagnosis of bone tuberculosis by CT, we tend to forget our responsibility to trace the source of infection and to screen the rest of the family for tuberculosis. Alas, technology has reduced human suffering to the disease of an organ. We have forgotten that illness affects the whole human being. We are becoming dealers in disease rather that promoters of health. A holistic approach to health is, unfortunately, time consuming and financially unrewarding. It has, therefore, been relegated to yoga teachers, faith healers and practitioners of traditional systems of medicine. There is yet another dark facet of medical technology; a total neglect of the deprived sections of the society. Sophisticated high-cost diagnostic and therapeutic facilities cater to the needs of those who have the money to afford them. What about the poor people who constitute the majority of India's population? They fall quite outside the ambit of technologically oriented medical care. Is it not the responsibility of the society and the medical profession as well to provide at least the time-honoured, conventional modes of diagnosis and treatment for them? Is it not our responsibility to create some kind of social funding for them? Modern medical technology has given us great power to heal as well as power to harm. We must be careful not to abuse this power. While utilizing its tremendous benefits, we should not allow technology to corrupt us, to deflect us from our avowed vocation of service to the sick. In our day-to-day clinical practice we ought to be aware of the dark side of medical technology. The courage and conviction to rise above it must come from within, and soon, before the damage becomes irreparable. * Published as an invited article in the Journal of Internal Medicine, APR-JUN 1998 |
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