Healthcare: Lost Art of Healing
Medicine which was once a professional calling has become a technocracy focused on dysfunctional organs. As a result doctors are ignoring the psychological and social impacts of illness, says Syeda S Hameed

As Member responsible for Health in Planning Commission of India, I have spent four years trying to understand the complexities of this sector. In a country of billion plus, what can I do to reach basic health to the poor whether they live in rural or urban India?

I have read hundreds of pages written by experts on aspects of promotive, preventive and curative health. I have attended many meetings where activists have told me what is wrong with the system or health ministry officials have told me what they are doing to make the existing system work or introduce a paradigm change. I have tried to understand various models for health care presented to me by many international institutions. But what I read last night touched my mind and heart; six pages of the Introductory chapter to the Indian edition of The Lost Art of Healing written by an American cardiologist and Nobel Laureate, Dr Bernard Lown.

Dr Lown’s basic thesis is that medicine which was once a professional calling has become a technocracy focused on dysfunctional organs. The individual, tensely sitting on a chair in his consultation room is no longer the physician’s primary concern. Psychological and social impacts of illness are either downgraded or ignored by most takers of the oath of Hippocrates. Dr Lown then writes about the health scenario in United States. In terms of health outcomes, it ranks (according to WHO) an embarrassing 37th among 191 countries. Of the eight industrialised countries, Americans are most dissatisfied with their health care. They have a very low level of trust of the medical profession which accounts for more Americans shopping for doctors, resorting to malpractice litigation and seeking alternative healing practices.
Reading the chapter, I became deeply aware of my personal vulnerability. I call it dread of disease. Most of us self diagnose our health problems every day. Structural abnormalities, hypertension, diabetes, heart; I think of myself afflicted by any or all of these. In former times, says Lown, patients had to experience symptoms before seeking medical help. Now those who are without symptoms and regard themselves as healthy may be diagnosed as having some ‘predisease’. The ‘set points’ defining risk have been progressively lowered. A cholesterol level of 250 mg/dl was long regarded as upper limit of normal. It has since been reduced to 180 mg/dl. Same holds for hypertension. Earlier it was 140/90; now anything above 115/75 is labeled pre-hypertension. When the doctor pronounces the words ‘this must be watched’, it causes anxieties. Imaginary symptoms create sickness where nothing existed before, compelling the individual to undergo rounds of tests and medicines.

Another fact that struck me was Lown’s analysis of ‘revolutionary imaging technologies’ like CT scans, Magnetic Resonance Imaging and PET scans. Having accelerated the process of medicalisation, these tests expose any structural abnormalities hidden in the recesses of our bodies. Each person is biologically unique and differs from some abstract ‘normal’. Finding ‘abnormalities’ is therefore inevitable. He writes that there is no way to tell whether these ‘abnormalities’ are normal variants or early cancers. So the anxieties get triggered. To ‘defuse the time bomb’, people have to subject themselves to further tests. More anxiety ensues. By the time the results come out negative, the person has become a nervous wreck. When the doctor gives the ‘clean chit’, we fall at her feet as if our healthy body is a gift from her rather than a consequence of our own lifestyle and good genes bestowed on us by our parents.

On the larger issue of developing countries and lifestyle diseases, Lown sees that our rural and urban areas are experiencing mounting epidemic of cardiovascular diseases. In the West, he rues the shift in agricultural production from small to large farmers, food distribution from shopkeepers to supermarkets, consumption from fresh to processed food. Unfortunately, India is catching up with all of these. Junk food has replaced fruit and vegetables, fats and salts have increased. Per rupee, junk gives more calories than fruit or vegetables. Caloric intake increases, physical activity diminishes. This mismatch of energy intake and energy output results in pandemic of obesity and diabetes. Factors like unemployment, wanton violence, and environmental degradation cause social and psychological stresses. ‘Added to this witches’ brew is the rising consumption of tobacco. The outcome is as tragic as it is preordained.

I recall Ganiyari Village in Bilaspur District of Chhattisgarh. Here I met a team of five young doctors. They had left lucrative careers in metros cities and gone into uncharted wilderness that probably had never been sighted on the health radar of the state. Here, bit by bit, in six years they set up a hospital for poor Baiga and Gond tribals. Here I was amazed to see the high prevalence of lifestyle diseases such as diabetes, hypertension and HIV Aids. I saw pre-teen kids suffering from diabetes! In urban parlance, the poor suffer only from snake bites, worms and TB. But the Ganiyari doctors told me about the altered burden of disease among poor tribals. They have discovered it because they bothered to look for it. Most rural health facilities don’t have the wherewithal to look deep. It is this changing scenario that Lowns refers to when he asks how will India counter the challenge of cardiovascular disease, diabetes, and a glut of other chronic diseases increasingly afflicting its own population. He warns that whatever we devise, we should not model it after the American system. He then goes on to describe the system and doing so lifts veil after veil from our eyes.

In the last lines of Lown's chapter, one reads the answer to India's problem of providing health to its millions. Characteristically, he writes a profound truth in a simple sentence. “As India moves forward, industrialises, and lifts millions of people out of poverty, it will face numerous challenges, paramount will be how to forge a national health care system... This book demonstrates that providing effective health care requires adherence to ancient principles of a healing profession sanctified over several millennia. What health care demands is medicine with a human face.”