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| Year : 2013 | Volume
: 59
| Issue : 2 | Page : 168-169 |
Authors' reply
Manu Kothari, Lopa Mehta
Formerly Professors of Anatomy, Seth GS Medical College, Parel, Mumbai, Maharashtra, India
| Date of Web Publication | 21-Jun-2013 |
Correspondence Address:
Lopa Mehta
Formerly Professors of Anatomy, Seth GS Medical College, Parel, Mumbai, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Kothari M, Mehta L. Authors' reply. J Postgrad Med 2013;59:168-9 |
Dear Editor,
The critique by Gandhi [1] is welcome as also the author's high regard for the palliative proficiency of modern medicine (MM). Palliation, however, well-intentioned should be gentle, least expensive and available to the masses. This is unfortunately not the case. Hoerr aphorized: "It is impossible to make an asymptomatic patient feel better." Ergo, MM can only make him feel worse. About the definitional-surfeit of MM, all definitions define away sans defining much as you explain away sans explaining. Every definition gets beset with ifs, buts, however, and nevertheless. Blood pressure and high blood pressure (HBP), are admittedly ill-definable, and give the physician the right to violate Hoerr's axiom.
A caveat from the American Heart Association, issued in 1951 is valid: "It should be clearly recognized that arterial pressure cannot be measured with precision by means of sphygmomanometers. Paul Merino, the noted intensivist, after quoting the foregoing concludes: "Thus, the most common medical disorder in the United States, HBP, owes its existence to a technique that was disputed by expert opinion almost 50 years ago."
Some recent reading [2] is disquieting: Over 43 million adults in the United States have hypertension. Thirty one percent are unaware of their elevated blood pressure; 17% are aware but untreated; 29% are being treated but have not controlled their blood pressure and only 23% are well-controlled." The same authors declare HBP as "usually asymptomatic". A later reading (Time, January 2, 2012) from the same country generalizes: "Any systemic medication that manipulates so fundamental a system as blood pressure - which in turn affects many related systems - can lead to a host of side effects. In the case of blood pressure medications, these include weight gain, fatigue, kidney complications and again impotence. And despite the use of multiple drugs, the blood pressure of some patients remains poorly controlled even if the medication is taken correctly, which remains a challenge for many."
The critique harps on increased lifespan without reckoning with its meaning. "The common belief that medical science has greatly lengthened lifespan is a misconception arising from a failure to distinguish between lifespan and life expectancy." (Adams and Victor). Satam Jiv Sharad - May you live 100 years - is as old blessings as the Vedas. In former times, thanks to high infant and maternal mortality, you started with a small base that truncated to 0 at 100. So for today, except that you start with a broad base hence creating the illusion that people are longer lived.
Carl Eliott in Better than well (2003) details how MM builds up and claims to fulfill "The American Dream" of perfect health. Shannon Brownlee (2007) subtitles her Overtreated with "Why Too Much Medicine is Making Us Sicker and Poorer." Moynihan and Cassals (2005) from Australia subtitled their Selling Sickness by literally a sentence (pun intended): "How The World's Biggest Pharmaceutical Companies are Turning Us all into patients." Hadler, a Professor of medicine, goes in search of the last well person (2005) to subtitle with a caution: "How to Stay Well Despite the Health Care System." Whither MM?
| :: References | |  |
| 1. | Gandhi JS. Modern and postmodern medicine. J Postgrad Med 2013;59:167-8. 
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| 2. | McPhee S, Papadaxis M, Rabow MW. Current medical diagnosis and treatment. Lange Curr Ser 2011.
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