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Aim for minimum medicine, maximum health

THE TRIBUNE Dec 25, 2018    

Unfortunately, we follow the model of western countries, which focusses on treating the disease, rather than attending to a person or community. This is an enormously profitable system for manufacturers of pharmaceuticals or owners of diagnostic and radiologic centres as well as for advertisers and insurance companies. We need to look at a model practised successfully by Cuba.

The medical sector has become a major threat to health not only through negligence or drug reactions but also due to overuse, unnecessary use or abuse of medicines and interventions, coupled with arrogance of the profession. Anybody who consults a doctor gets the label of a patient, which is hard to remove, subsequently. 

This has happened because the people have become disease-minded, instead of being health-minded. In urban set-ups, this power given to the doctors expands to a bureaucratic, rude, inhuman approach. Thus, blaming doctors alone for unethical use of medical resources would be unfair: patients are equally responsible. 

The use of medicines with impunity, either on self-prescription or chemist’s advice or suggestion from a relative, friend, neighbour or colleague, is rampant. Even surgical operations are demanded and commanded by patients, which otherwise may be avoidable. Spending fabulous money on avoidable interventions or visiting a five-star hospital has become a status symbol or something to brag about. 

The fact remains that this misuse of national resources and personal assets is harmful to health. The unethical practices that have crept into the sacrosanct area of a doctor-patient relationship have heightened the nemesis, ie inescapable medicalisation of health. There is the case of the medicalisation of death, pregnancy, beauty, fatigue, weakness, starvation, obesity, sleeplessness, anxiety and so on. Junk foods, foods with high contents of salt or sugar or trans-fats are sold across the counter. These white poisons cause several health problems such as obesity, but nobody restricts their use. Ailments caused due to indiscretion in food are attempted to be corrected by medicines, tests, surgery etc. 

Let alone minor complaints of being unwell that bring patients to the doctor, Evan Illich in her book ‘Medical Nemesis’ has stated in relation to serious patients: “Pipes in different orifices of the body, radical surgery, chemotherapy, dialysis, organ transplants add untold agony to the patient’s life and use up most of her resources at a rate all out of proportion to the benefit they provide.” 

Preventive services more vital

Incidentally, 70 to 80 per cent of the entire health budget goes to medical/surgical treatment as opposed to the more important public health education and preventive services. All countries want hospitals, and many want them to have the most exotic modern equipment. India has also announced the setting up of several AIIMS-like hospitals without the provision of budget and adequate faculty. 

The poorer the country, the higher the real cost of each item on their inventories. Modern hospital beds, incubators, laboratories, respirators and operating rooms cost even more in India than their counterparts in Germany or France where they are manufactured; they also break down more easily here and are more difficult to service, and are often out of order. 

The overconsumption of medical drugs is rampant in our societies. Old age has been medicalised disproportionately; 28 per cent of the medical budget is spent on the 10 per cent of the population who are over 65. 

Will this approach of ‘maximum medicine, minimum health’ usher in a healthy India? Technological medicine, with its batteries of machines, has to be restricted. There is simply not enough money to make it feasible for all who might benefit from it. 

Realising the finite level of resources, an active programme of health education becomes a dominant prioriy that our society must accept, concentrating on adjusting an individual’s habits and lifestyle so as to avoid factors known to predispose toward serious disease.

Why is there a rise in the abuse of prescription drugs?

In recent years, there has been a dramatic rise in prescription drug misuse or abuse. There is a growing social acceptance of sedatives, antibiotics, painkillers and anti-anxiety medications, and the perception that pharmaceutical drugs are the panacea for dealing with any kind of ‘feeling unwell’, even of non-medical origin and that they are safe at all ages. Doctor-shopping is another trend: getting several different doctors to prescribe medication has long been thought to be a major source of abused prescription drugs. This trend has led to more hospital visits because of accidental overdoses and more admissions to treatment programmes for drug addiction.

Unfortunately, we follow the model of western countries, which focusses on treating the disease, rather than attending to a person or community. This is an enormously profitable system for manufacturers of pharmaceuticals or owners of diagnostic and radiologic centres as well as for advertisers and insurance companies.

Cuba’s model

India cannot afford the luxury of an expensive and wasteful curative model of the West. Why not look at a model practised successfully by a poor country like Cuba? Praising Cuba, the World Health Organisation has observed: “It is possible for third-world countries like Cuba with limited resources to implement an efficient health care system and provide all segments of the population with social protection worthy of the name.” Cubans call their system ‘comprehensive general medicine’. Its programmes focus on preventing people from getting diseases and treating them as rapidly as possible. It has brought the Cuban infant mortality rate to 4, which is below that of the US. Cuba has an unmatched record in dealing with chronic and infectious diseases with amazingly limited resources. 

To retard the process of fast medicalisation it may be imperative to ‘make all medicines, tests, devices and prosthesis available at cost price or absolutely free to all. Further, to produce ethical doctors, it will be prudent for the government to make medical education free, based only on merit, and include subjects like ethics, communication, compassion and empathy in the curriculum. There should be a sensitisation of the fresh graduates to convert a patient into non-patient, rather than making a perpetual patient out of him!

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