Last month, late at night, searching for a painkiller for my wife I came upon an old stock of tablets I had been prescribed for a muscle injury. It was a combination peculiar to India, and among other drugs it included Paracetamol and Diclofenac. Since she was still breastfeeding I took care to check the tablet only to find the combination I had taken for over a week was banned in several countries due to the possibility of a life-threatening reaction.
I had been prescribed the medicine at one of many new private medical hospitals that have recently sprung up in India. The old government hospitals gave off an intense smell of phenyl (a once ubiquitous disinfectant), patients would usually spill out of the wards on to long dingy hospital corridors, wastebaskets would be overflowing with discarded injections and bloodied dressings and even a dog or two roaming the wards wouldn’t be taken amiss. They were among the few places where the existence of the Indian elite couldn’t be completely cut-off from the reality of this country.
This is no longer the case. The private hospitals are run according to the same insurance driven model that funds medical practice in the US. They cater exclusively to the post-liberalization elite and medical tourists from other countries. In look and feel they resemble the four and five star hotels that have mushroomed in the country at much the same time and pace. Over the past three years I have had reason to observe them up close as my father has gone from a healthy middle age to radiotherapy for a malignant prostate, a gallbladder removal, three major surgeries for a persistent subdural hematoma, a mild stroke, all the while requiring monitoring for his diabetes and his weakened heart. All things considered he has come out of this rather well, but now on my mobile phone instead of a single number for a general practitioner I carry the contact details of a host of specialists who individually deal with the brain, heart, prostate and other assorted body parts.
Through his hospital stays much of what I saw about the impersonal nature of the entire system has been noted and written about elsewhere in far greater detail. None of this was really a surprise to me, what was a surprise was the incomprehensibility of this modern medical system – a combination of diagnostic procedures (which include imaging technology such as CAT scans and sampling methods such as blood tests), prescription of drugs which have been screened and tested on humans and repair techniques that range from minor stitches to major operations. I have trained as an engineer and then spent several years in graduate school, four in the department of mathematics and one at the centre for neural science but I can now safely say there is very little in modern science that leaves me as baffled as the practice of medicine.
One of the diagnostic tests that I grappled with after my father was detected with prostate cancer, is one widely used across the world – the PSA. It is a blood test reading for the concentration of a specific antigen manufactured by the prostate. The problem lies in interpreting this number, the more I read the literature the more perplexed I became. Clearly there was a relationship between prostate cancer and PSA readings but it was difficult to fathom what it was. The only thing I could conclude with any certainty was that the test was useful in monitoring the state of those already detected with the cancer but was only mildly indicative in those who had tested positive in a routine screening. I soon gathered none of the experts knew any better, instead they worked with various rules of thumb, a different rule for each expert.
The perceived exactitude of diagnostic procedure is but one problem, another is the one I ran into in that late night search for a painkiller. Drugs in combination do not have an impact that is the sum of their individual effects. Often, as was true in my case, doctors themselves remain unaware of the potential dangers. In case of patients such as my father each bout of hospitalization is a foray into the unknown, resulting in combinations of drugs coursing through his body which have probably never been tested together before. Occasionally I suspect there may even be fatalities born out of this practice, statistically speaking these are deaths we have no choice but to live with, a fact of little consolation to those affected.
The third is the efficacy of surgical procedures themselves. In my father’s case it was never clear why the hematoma continued to reoccur. The doctor in this case was a man who understood the uncertainties of the procedure and gave us the probabilities. I was able to make some sense of them but they were of little help to my father as he wrestled with the question of why he had to go through major surgical procedures for what was only a minor blow to the head, a mere stumble stepping out of the bathroom. And no sense of probabilities could give any of us consolation against the moment when the blood beneath the skull pressing against his brain would slowly force him to lose the faculty of speech or the anxious hours of wait as the anesthesia would wear off in the ICU and his speech would return, thankfully much earlier than the months the doctors had said it could take.
Yet given such uncertainties the modern system is highly effective, and my father is living proof. The problem though is that the system that implements this synthesis is designed to hide the uncertainties that lie at its heart. The modern hospital is not a place designed to reflect humility about the current state of medical knowledge, nor is it designed to convey the inexactitude of its practice. On the contrary it is meant to overawe with its efficacy. Doctors would argue that they hand out the necessary numbers, they explain the procedures in detail, but very few people are equipped to process the probabilities or grasp the details. Add to this the frustration of dealing with the immense insurance and hospital bureaucracy and it is clear why even reasonably well-educated people such as my parents flinch from the experience. They are far happier dealing with these hospitals through my mediation, counting on my technical expertise to make sense of the intimidation of procedure and authority that is directed at every patient.
Unsurprisingly this largely efficient system has already bred a counter-narrative in India that is no different from what prevails elsewhere. These private hospitals are seen as money-making machines, where anyone who goes in emerges only after being coerced to undergo an expensive and often unnecessary procedure. My mother firmly convinced of this after her own experiences in the company of my father has refused to go in for a knee replacement surgery. Instead of strengthening her faith in modern medicine its success in my father’s case has left her more skeptical. For her, the very eagerness of the doctor to operate, the keenness to stress the extent of damage to her knee convinced her that she was in no need for the operation, that the doctor and by the extension the hospital were willing to commit to an unnecessary procedure to line their pockets. Instead she has returned to her homeopath.
In this she is no different from a large number of Indians. Like many who have grown up in small town India, I too have vivid memories of the local homeopath. I can recall an elderly cultured Bengali sitting behind a desk in a room lined with rows of brown glass bottles full of sugar pills of varying sizes, labeled neatly with exotic Latin names and imbued with the faint whiff of alcohol. The visit conjured up none of the fear that was natural at a young age while visiting the local allopathic doctor (in much of India the terms are just seen as two different forms of medicine, equally legitimate) with his bitter pills and intimidating injections.
The elderly homeopath would then spend a good deal of time asking me peculiar questions which left me fascinated, the food I had been eating for the past week, any peculiar feeling in the body over that time, the state of my `motions' (a peculiar Indian euphemism for shitting), their color and texture. And he would insist on speaking to me directly, not through my mother as the allopath in his cursory way would. At the end of the visit, prescribed a set of useless sugar pills for my periodic bouts of cough, I couldn’t wait to start taking my medicine.
This memory and nostalgia lingers in the mind of most Indians who continue to visit homeopaths as adults. My derision and laughter do nothing to prevent my mother from consulting her homeopath for a host of ailments. Unlike the hospitals with their intimidating façade where she often would need my company I think she actually enjoys these visits to the homeopath. Here she feels a certain sense of control over her ailments and her body that the new hospitals deprive her of, none of this will prevent her from turning to the hospitals when it is really needed but her sympathy lies with her homeopath.
Nothing in the theory of homeopathy is worth consideration, but in its practice, in its sympathetic attention to what a patient has to say, in its ability to let an individual feel part of a process uniquely designed for his needs may lie much of its marketing success. In the face of the hospitals I have had reason to encounter all the arguments I will ever make in print against homeopathy will not convince my mother and hundreds of thousands like her in India. My unfortunate guess is that as the modern hospital system continues to grows in India so will the practice of homeopathy.