What Determines a Good Medicine - Essay Example

147565 The modern public health policy of Britain is open both to admiration and criticism; admiration for what has been achieved and criticism for the flaws and difficulties in it. area of dental health is gaining prominence in recent years, and sometimes it is shown as a measure of public willingness and positive approach. There are arguments that in spite of a well-laid out public health and dental policy, people do not reciprocate as they should and problems go undetected for a long time. This argument is countered by the disheartening wait for treatment. Setting all these aside, it is important to find out how thinkers, sociologists and philosophers have reacted to the modern health policy, or indeed, to the modern medicine itself. There are arguments that modern medicine has an entity of its own, totally severed off from tradition and today’s medicine gets ridiculed tomorrow and making it groundless and rootless. It is of paramount importance to know how modern medicine appeals to learned minds of thinkers, sociologists, and intellectuals. MIRAGE OF HEALTH: Rene Dubos (Davey, 1995) argues on Laws of Nature and Taoist philosophy that had influenced Chinese life and had led to a sustained reverence of nature. China was Buddhist in those days and this philosophy blended very closely with their religion based on non-violence and worship of all forms of nature and life. Chuang Tzu wrote of times when people and nature lived in harmony and did not die young and yin and yang worked harmoniously. Concept of unadulterated nature provided health, cure and sustenance. Western philosophers argued that nature is too abstract to be revered or considered, beyond a certain limit, as it is not a definite entity. It simply represents platonic beauty and lacks the flesh and blood of life. This argument did not allow the Chinese philosophy to enter into Western sphere. Whatever is the argument, it is a proven fact that people lived a longer and healthier life in the absence of present immunisations and medical help. Writer argues that specific etiology came into being only in 19th century, when Pasteur, Koch and other scientists discovered specific and researched answers to problems of various diseases followed by discoveries about biochemical and physiological aspects, microbial agents, metabolic process, deficiencies, hormones and physiological stresses that keep contributing to the ill health. Many theories and diverse ways of treatments with specialities, effective therapies came into being even though they do not constitute evidence for doctrine of specific etiology. Hippocratic medicine and discoveries of Darwin and Claude Bernard like scientific philosophers definitely rendered a great service in this field. Dubos discusses Greek Gods of health, cult of Hygeia, Asclepius a young God and Panakeia, a healing goddess of Greek Mythology and how Greeks depended on healers and surprisingly most of the healers had scientific knowledge of their craft, showing that cleanliness was godliness. There is no denial that Hippocratic writings and wisdom are part of modern day public health movement. Traditional wisdom lays great stress on purity of food, water, air, and no health system has defied this fact till date. Conventional faith in the healing power of nature had led to the conquest on epidemics in a practical way in pre-medical days and it is foolish to negate the practicality behind it. Health and happiness was symbolised by a contented way of thinking. The writer quotes Rousseau: “Hygiene is less a science than a virtue.” Writer argues that we have to return to nature, the global utopia, because there is no other way to health and well being. They cannot be achieved by severing humankind off nature. MEDICAL CONTRIBUTION McKeown discusses various forms of sicknesses. Airborne diseases like whooping cough, tuberculosis, measles, scarlet fever, diphtheria, small pox, infections of ear, pharynx, larynx, and says from time immemorial and even today, these diseases could be prevented only by cleansing the air and keep it as unpolluted as possible. Water and food borne diseases like cholera, malaria and dysentery, non respiratory tuberculosis, typhoid typhus etc. again need cleanliness of food, water and surroundings. There are many diseases like convulsions, syphilis, appendicitis, peritonitis, puerperal fever etc. that come through micro organisms and once again, they could be wiped out or controlled through unpolluted and clean elements. He does not deny that vaccinations have made a difference and have increased human opportunities and possibilities of life. Small pox death rate with vaccination came down by 1.6 percent. But it is wrong to say that immunisation or therapy has made a significant effect on mortality before 20th century and people managed to live a healthy and long life. Immunisation created side effects and vaccinations resulted in many diseases due to toxic material. Till recently it was accepted that human population multiplied because of decline in mortality rate due to infectious diseases and mankind has achieved a lot by eradicating them. Now continuous research has proved otherwise. Contribution of immunisation and therapy has to be examined thoroughly and there is every indication that even though marginal contribution does exist, it has never been as significant as is believed. EPIDEMICS OF MODERN MEDICINE According to Ivan Ilich, modern research has definitely found out the causes and reasons of infectious epidemics, malnutrition syndromes, duodenal ulcers, hypertension, cancer etc. enhancing the field of health. Still, intensive research has to continue for many more years, before complete explanation is available. He argues that environment is the primary determinant of general health as food, water, air and their purity is correlated with environment in which we live. Undoubtedly use of detergents, soap, scissors, and vaccination needles; sewage, contraceptives and antiseptic agents have made a great difference in the field of health. He insists on the absolute necessity of environmental improvements and cleaning with new techniques. It is imperative to continue research for recognising diverse and acceptable ways of treating, cleansing, sustaining and refreshing the natural elements so that the basic necessities of man remain pure and serene. This would help much more than a hoard of doctors, professionals and medical technologies. He says, they make a great show of being effective and in command. “Awe inspiring medical technology combined with egalitarian rhetoric to create the impression that contemporary medicine is highly effective “(p. 238) An unimaginable amount of money poured into medical expenditure and research does not justify the results, because medicines invented for most infections, have been unable to show any comparable results. This is proved by the reappearance of malaria, Tuberculosis (though controlled to a very large extent and this is one disease that shows gratifying results of modern medicine) and many other health problems. No doubt, some disease mortality has definitely been reduced, but not all. Medical intervention in non-infectious diseases still remains highly questionable. Drugs for blood pressure, diabetes like problems has been outweighing the benefit for a long time now. He argues that modern medicine has also brought doctor-infected injuries, pain, dysfunction, disability, anguish resulting from intervention. Today people die due to traffic and industrial accidents, war related activities, sickening agents, side effects from sprays, chemicals, strong weed killers, house disinfectants and pest destroyers. Potential poisonous medicines, medically prescribed chemicals, drugs being mutilating, mutagenic, addictive, food colouring, insecticides, pesticides, all are today’s health destroyers. Apart from this, people have to face doctor inflicted pain, infirmity, professional callousness, negligence despite good intentions, while health industry keeps shifting the blame on victims. “In second level, medical practice sponsors sickness by reinforcing a morbid society, that encourages people to become consumers of curative, preventive, industrial and environmental medicine,” (p. 241). He extends further arguments saying that present day health professions have cultural health denying effect. Social introgenesis and cultural lactrogenesis have set in and are medically irreversible while doctor effectiveness remains a fond illusion. EFFECTIVENESS AND EFFICIENCY: A.L. Cochrane introduces experimental approach into clinical medicine, by arguing that Randomised control trial (RTC), could be the solution to many prevailing problems. It is a pragmatic approach of bringing out comparability of two groups, good technique of wide applicability. He is aware that RTC cannot have a universal application, as it is a pure statistical method, and inapplicable for ethical reasons and also has limitations like geographical distribution. Still, it could be beneficial in many ways as patients get divided into two groups independent of human choice like allocating a set of random numbers. He has negative opinion about present health practices, its effect on patients’ mental health, length of stay, observational inefficiency that is appallingly transparent at times etc. He is unimpressed by place of treatment and the mass-application of medicines regardless of individuality of complaints. He feels that applying the same yardstick to all patients will have negative effect. WESTERN SCIENTIFIC MEDICINE This is an introduction to social model of health and an overview of medical model. Doyal offers a philosophical and scientific definition for health related field in his above work. He says today’s health practice has blurred frame work due to almost merging into a political atmosphere. It is an integral part of political struggle and defending it is work of leaders as part of their political invincibility. Present health service has isolated itself from ancient wisdom and ecological practices and has resulted in an insignificant scientific revolution that has resulted in unfortunate mechanisation of nature. Greek and medieval explanatory approach should never have been abandoned. Mankind was wrong in thinking about nature in a dismissive way, because after achieving studies of motion, light, electricity, magnetism etc., European intellectuals believe that all benefits and mysteries of nature are already conquered by human civilization and this message was spread around. He argues on behalf of Dualism and against mechanisation of medicine. He feels that old methods like blood letting etc. should never be ridiculed because those professionals were combining the knowledge of body and symptoms of sickness. He feels that herbal and chemical purgatives were not entirely without purpose, but they established the correlation between symptoms and body. According to him, public health should never focus on present day medicine alone, but a genuine biomedical model of an individual patient should have a combination approach of physiological, psychological, sociological, and emotional variables. He says most of modern drugs are unhealthy medicines and medical priorities and knowledge still remains fragmented now into unwanted specialisations. He believes in holistic medicine and holistic alternatives in the biomedical model. According to him, medical knowledge should be a combination of all approaches, especially of old and new and the research should state specific alternatives. There is a growing recognition of these alternatives and controlled trials should be conducted to achieve scientific explanations, which should be specific case related and not universal. There is a need of change in the political ecology of health, and a need of redefining medicine and health. The present inherent conflicts between the two should be avoided and connection between ecology of health with political issues has to be discontinued. WHAT IS DONE ABOUT HEALTH AND ILLNESS Mitchell in the above work argues superbly that illness always comes for a reason and never without certain help from the individual. Many studies have shown indicators of illness and death and their connection with the social pyramid. He argues that there is surprising difference in health problems between men and women. For example cancer kills more for women and less men, even though today one in four gets cancer. Research has established that different cancers attack different classes of people for certain apparent reasons. Continuing his argument about the susceptibility of women, he says they are more prone to mental disorders too. This could be connected with their surroundings, sometimes, their unimportance in a family, job frustration, stresses of raising a family attending to children’s needs and family problems and mental strain etc. Women take more drugs, because they visit physicians and hospitals more than men. It is noted that higher mortality rate prevails amongst widows, singles, and women living alone. There is a strange interaction between marital status and health of women that warrants further research. Class conditions too affect and there is no indication that class difference is fast vanishing. It is not true always that there is direct connection between illness and social condition. But constant reminders of a disease like cancer could be depressing and worrying women, unless positive measures are taken to help them. ORAL HEALTH Locker in his above book discusses the changing concepts of health and universal outlook. He is sceptical of health and death figures that represent only a fraction of population. He argues that oral health depends on status, and socio dental indicators could reflect level of health and the individual’s involvement in life and outlook. It could show theoretical and conceptual frameworks, physical and psychological wellbeing, social contacts, cognitive functioning, and also disadvantages like inequality of opportunity, deprivation, and dissatisfaction. He says people tend to accept impairment, functional limitation, discomfort, and handicap and hardly make an effort to emerge out of limitations. He applies the conceptual model to properties of socio-dental measures, taking measures and indicators of discomfort, disability, disadvantage, acceptability, resignation, helplessness, simplicity, and sensitivity and feels that social change is necessary to come out of mind sets. HEALTH PROMOTION Naidoo and Willis comment that public health is the result of governmental and political concern for people and desire to improve social factors to achieve welfare state. Public Health, in the smallest unit consists of community nurse, environmental health officer, child accident prevention group, and this unit is responsible for rising health profile in society with right health awareness. Modern public health is very different from old public health. Many legislations of 19th century have led public health matters to the present outcome. He cites an example of John Snow’s action in stopping cholera by removing handle of Broad Street water pump in 1854, and argues that this shows the importance of public participation, and place of hygiene. New public health has created awareness of health ecology. Recent years have seen the rise of environmental movement and Green Politics, d with sustainable development. This has necessitated corrective action on basic essentials of health, food, water, sanitation and housing, and the need of controlling communicable diseases, protecting vulnerable groups like children, controlling pollution, excessive energy consumption and waste. Today’s citizen is urged to think globally and not locally. Health organisations have succeeded in promoting exercise and healthy activities spearheading the announcement of ‘health for all’. It has brought in empowerment, participation, wider understanding of health, better coordination, increased capacity and capability, effective joint working between professions and organisations. Health workers, public health principles, nurses make an earnest effort towards this goal with promotion of equity as a political task. Public health works in collaboration and today, it is a high prolific issue. SALUTOGENESIS Contemporary research shows that this approach could have a more central position in public health and health promotion. This word was introduced by Medical sociologist, Antonovsky 25 years ago. It deals with peoples’ capacity to create health as main focus. It argues that by creating health in day today lives, people can increase general resistance, adapting health as a movement. This improves life orientation and coherence, and leads to practical application of the concept with practical implications. Worth mentioning is Sanders and Carver, Struggle for Health, where they argue that modern medicines have failed in promoting or maintaining health in developing and developed countries. They are of the opinion that in spite of the propaganda and visibility of modern medicines, there had never been a genuine improvement in any society due to the practice. Most of the writers show the absolute necessity of a more fundamental approach towards nature. It should never isolate itself from nature, as research has shown that without nature medicine or any other knowledge cannot exist on its own. It is necessary to imbibe knowledge available from old medicine, herbal approach, green ecology and any other course that could be made use of. Absolute scientific and technological approach might not work in the long run because research shows that pure modern medicine has failed in many ways. Disembodied approach of modern medicine should be discontinued. Implication of modernity in dental field goes beyond medical reasons, and touches psychological approach. Both public health and dental care should have utopian approach grounded in nature and unlimited modernisation with technological help would not help human bodies. Instead, old approach of treating individuals taking into consideration unique constitution and symptoms into account will help. Medicine and treatment should have holistic approach and dental care should not be segregated, as it is part of it. Treatment should never focus only on physical symptoms, but on emotional, cultural, psychological and sociological issues too. The main argument of most of them is not to disregard ancient wisdom and imbibe it into public health and health awareness in ordinary life, because over dependence on modern medicine by public health could be dangerous. BIBLIOGRAPHY: 1. Cochrane (Year), Effectiveness and efficiency. Publication 2. Davey, Gray & Seale (1995). Health and Disease. A reader. Open University Press 3. Dubos, Rene (Please put year), Mirage of health, Please put publication. 4. Doyal L & L. (1984), Western Scientific Medicine.A philosophical and political diagnosis, Pluto, London. 5. Ilich (year), The epidemics of modern medicine, Publication. 6. Locker, D.Measuring (1988), Oral Health; A Conceptual Framework. Community Dental Health 7. Locker, D, (2005), Behavioural science and Dentistry. Publication. 8. Lindstrom, B & Eriksson (2005), Salutogenesis. Journal of Epidemiology and community health 59, 440-442. 9. McKeown (Year), The medical contribution. (Please put publication) 10. Mitchell, J. (1984), What is to be done about health and illness? Crisis in the Eighties. Penguin London. 11. Naidoo, J. & Wills, J. (2000) Health Promotion: Foundations for practice. Publication 12. Sanders, D and Carver R. (1985), The Struggle for health. Medicine and the politics of Underdevelopment. Macmillan London. 13. Sheiham, A. (2005), 2005 Strategies for Oral Health Care. Euro Observer. Read More