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Certainty is, at best, an illusion.
- BM Hegde (4 August 2008)
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Nature is our only hope!
- Nikhil Kaushik (4 August 2008)
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population control--everybody's role
- konerugangadhara rao (26 May 2009)
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BM Hegde, Retd. Vice Chancellor Mangalore-575 004, India
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Exciting editorial, indeed! What would be the population next year? In our linear thinking it is this year’s population multiplied by the fertility rate! This never comes true! Uncertainty wins the race. If we apply non linear mathematics, the uncertainty gets reduced considerably. The same holds good for clinical therapeutic outcomes. Is there any certainty at all in medicine? Why are we running away from the naked truth that our present thinking based on the faulty statistical science of modern medicine does not/can not have certainty as an outcome. My article in the JAPI and the landmark paper by Professor WJ Firth in the BMJ in 1991 categorically explain the roots of uncertainty. (1) (2) (3) Professor Firth is a professor of physics! I do not see any citations of those papers; mine can be ignored: ignoring Professor Firth’s warnings would become costly in the long run. Therapeutic certainty is a malignant myth in modern medicine despite all the statistical Olympics. MRC study of mild-moderate hypertension showed that to save one probable stroke death in society in the next five years we have to drug 850 apparently healthy people unnecessarily for five years just because we do not know who amongst the 850 will get that stroke-one for all and all for one! (3) The ADRs in those 850 people will only be statistics. If we find out the absolute risk reduction and the number needed to treat (NNT) in each of our RCTs and share them with our patients they will make their own decisions in partnership with us. (4) (5) (6) (7) (8) (9) (10) (11) Population and environmental concerns in this issue make interesting reading. I wonder if the Amazon forest is gradually getting denuded because of the population growth? I was lecturing in a prestigious US university last week and found, to my horror, the destruction of a beautiful wooded hillock behind the University Inn where I used to go for evening walks. I was told that the city authorities have filed a case against the builders for violating the environmental laws. Do we have a population problem in the US? Man, with his proclivity for comfort and his greed, will eventually destroy all the natural resources sooner than later. After poisoning the last river, cutting the last tree and genetically modifying all the natural foods, and polluting the ground water table with chemical germicidals man would realize that money can not be eaten as food! Let us take India as an example of population explosion. India can not be classified as a poor country any more. We have more number of billionaires than the US has. We also have the other India where the infant mortality exceeds Sub Saharan Africa. We have a total load of 47 million malnourished children dying at the rate of 6000 per day due to NIDS (nutritional immune deficiency Syndrome). The total AIDS load of about 40 million in this world pales into insignificance if one knows that there are 530 million hungry people out there in the world on a given day. We vaccinate these malnourished/undernourished children with multiple vaccines. God only should know as to where does the globulin come from to produce anti-bodies in response to vaccination. As if that is not enough a recent paper in the BMJ was advocating vaccinating poor children in the third world with all the newer vaccines to eradicate those diseases globally. (12)Some people even doubt if small pox, the only disease so far eradicated, had much to do with vaccination alone as only a small fraction of the world was vaccinated at that time. Do these diseases have their own dynamic cycles? Story is the same with tuberculosis, diptheria, plague, bacterial pneumonia etc. McKevon's book "Role of Medicine", out of print now, goes into these in great detail. I was shocked to read a Nobel Laureate, quoted in the BMJ paper, opining that in the “broader effect as an "autocatalytic process" connecting health and development, whereby improving health through direct means such as vaccines unlocks the capabilities of populations to thrive economically.” While I do not understand economics, I do understand immunology where this statement does not make much sense to me. Reminds me of that famous paper of George Orwell-“Politics and the English language”- where Orwell quotes Professor Harold Laski using complicated language to confuse politicians. More than Harold Laski we, in medicine, use Greek and Latin sprinkled English to confuse the world. We seem to have lost the woods of poverty while counting the trees of the germ theory to the total exclusion of the warning by Louis Pasteur himself that the “germ is nothing; it is the soil that is everything?” (10) There are wonderful immune boosters in Ayurveda, the Indian system of medical wisdom. Who cares? (13) The greatest discovery of the 21st century is the certainty of man’s ignorance about most of the wonders of this world. Science should aim at trying to understand the working of the world rather than trying to change the world order to suit our conveniences. If only we had incorporated human consciousness in medical science to understand health as well as ill health, like physics is doing to understand the quantum world where uncertainty rules the roost, (14) we would have made much more progress compared to our reductionistic scientific outlook in medicine. Yours ever, Bmhegde References: 1) Hegde BM. Chaos- a new concept in science. J Asso. Physi. India 1996; 44: 167-168 2) Firth WJ. Chaos-doctors predicting the unpredictable. BMJ 1991; 303: 1565-68. 3) Hegde BM. Uncertainty is the only certainty in patient care. http://bmj.com/cgi/eletters/331/7528/0-f#122966, 3 Dec 2005 4) MRC study group. MRC mild-moderate study-principal results. BMJ 1985; 291: 97-104. 5) Oliver MF. Risks of correcting risk factors of coronary artery disease and strokes with drugs. NEJM 1982; 306: 297-298. 6) Andersson OK, Almgren T, Persson B et. Al. Survival in treated hypertension: follow up after two decades. BMJ 1998; 317: 167-171. 7) Editorial. Who benefits from medical interventions? BMJ 1994 Jan 8th. http://bmj.bmjjournals.com/egi/content/full/308/6921/72. 8) Dusen LV. The business called medicine. CMAJ 1997; 157: 1724. 9) Le Fanu J. The case of the missing data. BMJ; 2002; 325: 1490-93. 10) Shannon B. Why too much medicine is making us sicker and poorer? 2007. Bloomsbury USA. Page 343. 11) Alderman MH. BP management: individualized treatment based on absolute risk and then potential for benefit. Ann Intern Med 1993; 119: 329-35. 12) Chokshi DA & Kesselheim AS. Rethinking global access to vaccination. BMJ 2008; 336: 750-753. 13) Hegde BM The best complementary system for early authentication http://bmj.com/cgi/eletters/330/7484/166#93635, 21 Jan 2005. 14) Gribbin J. In search of Schrödinger’s cat. 1991. Transworld Publications, London. Competing interests: None declared |
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Nikhil Kaushik, Consultant Ophthalmic Surgeon North Wales NHS Trust, Croesnewydd Road, Wrexham LL13 7TD
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It indeed is important to limit the population of the world, true! But it can only be achieved if we lived our natural life span, and not prolong it with chemical (medical) aids. But if we do that then what is the point of being human, and why all this progress? I visit India often, and the slums where I grew up. I have not met anyone there who is complaining about population explosion. A standard response to any talk of population control is, "We live short and simple lives, enjoy our vegetarian meal, and are happy, and so what is your problem with us having six or seven children?" They ask and I can not answer that. Competing interests: None declared |
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konerugangadhara rao, professor,nri medical college,vijayawada-10,ap,india 520010
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over so many decades we have seen mainly doctors' role in controlling population in several countries. In india public organisations like lions, rotary clubs, teachers, ngos, other medical and paramedical workers have achieved targets of tubectomies to the expected level. But the reduction in growth rate is not very effective. There are certain areas where doctors should concentrate. They are emergency contraception, counselling regarding various temporory contraceptive methods after delivery, caesarean section and mtp procedures. In this aspect obstetricians should take a major role. It also avoids certain health problems in woman. The ministry of education should see that some lessons regarding population control are added in school and college level curricula. It is better that the leading population countries like china, india, us may follow it. Competing interests: population control |
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