Testing the diagnosis

All medical systems strive for one purpose - help the ill get well. Would it not be ideal if traditional and scientific medical systems were integrated into one system of curative medicine? If the physician knew all systems, the patient could be treated with the best, instead of the patient choosing a particular system. This romantic view, desiring the integration of all medical systems, is naive and unrealistic. Traditional and scientific medical systems cannot be integrated.

To understand this cruel reality, we must know what is common and what the differences are among them. All cultures wanted explanations why some fell ill while others did not, and, what remedies cure different illnesses. All had come up with concepts, dogmas and beliefs, as well as many treatment modalities. Three examples that have survived the test of time are the ancient Indian and Chinese traditional systems and the more recent homeopathy. All of them are together called ‘traditional medicine’.

In homeopathy, the basic doctrine is that molecules of chemicals that simulate symptoms similar to those in illnesses, given in minute and non-toxic quantities, are the remedies. The principle similia similibus curentur (likes cure likes) is implied in the name homeopathy, in contrast to allopathy (synonym of scientific medicine), in which antidotes counter the causes of diseases.

The major doctrine in the Chinese system is that Qi, life’s vital energy, flows via ‘meridians’ that connect all organs and tissues. If any gets blocked, illnesses result. Acupuncture, acupressure, massages, specific exercises and special diets and herbal medicines are applied as remedies. Ayurveda has the Thridosha doctrine. Imbalances between three hypothetical doshas cause illnesses; remedies are herbal concoctions, oils, oil massages, special diets, purgation, deworming, etc. We do not know how these concepts and therapeutics came to be two-three millennia ago, but we do admire their systematization in textbooks and many treatment successes.

Europeans had lagged behind - until two-three centuries ago. Scientific medicine developed and grew in Germany, Austria, France, Britain and the U.S. during the 18th and 19th centuries through an iterative and cumulative process. Natural sciences (physical and biologic, including microbiology, biochemistry, and genetics) with their methods of inquiry and emphasis on objective evidence heavily influenced its growth, which continued in the 20th century and is still continuing. Scientific medicine can and must question and revise dogmas, concepts, explanations and therapeutics through research inquiries - that is what science is all about.

In traditional systems, doctrines and therapeutics are given and fixed. Students accept them en route to becoming physicians of such systems. Traditional and scientific systems follow contrasting definitions of ‘truth’. In the former, the truth is what one is taught and is believed subjectively. It need not and cannot be verified by research. In the latter, the truth is what has been verified through experimentation. By definition and practice, objective evidence can be reconfirmed by anyone who repeats the experiment.

Verifiability in modern medicine comes with a price - as well as a prize. The price is that the physician’s diagnosis and treatment can be scrutinized and assessed against the system’s norms. Liability to negligence arises if norms were not followed; if guilty the physician can be penalized. The prize is correct diagnosis and treatment, irrespective of who the physician is - an immense benefit to the patient.

Since the scientific system is open to verification, physicians have accountability to make an evidence-based diagnosis and formally recommended remedies. Any two independent physicians are required to make the same diagnosis and the same guidelines of therapy. All diseases have been named, numbered and classified into a compendium - the International Classification of Diseases, the 10th edition being in current use and 11th edition in the making. If one physician makes a diagnosis and treats as such, the patient has the right to ask if both are based on evidence available in books and periodicals. In case the physician had not followed such norms, he/she is liable to be tried for medical negligence and the patient compensated, if so proven.

In other words, scientific medicine demands ‘accountability’ on the part of the physician - for ‘correct’ diagnosis and treatment. Since such verifications and detailed classifications are not present in traditional medical systems, a physician diagnoses and treats as best as he/she could, but without verifiability or accountability. Fortunately, therapies in traditional medicines are generally harmless - hence patients do not face much risk.

But the scientific system is far too complex to be mastered by one person; hence the need for specialties and specializations and diagnostic laboratory services.

Does a physician of a medical system have to believe in its doctrines or could the physician apply the remedies while disbelieving the doctrines? Since the doctrines and their ‘truths’ are disparate and often contradictory, all of them cannot be believed honestly as true by one person. Traditional and scientific medical systems cannot be integrated. But one physician can learn any or all systems; but then should a physician practice a system in which he/she has no faith in its doctrines? Can a priest of one religion learn the rituals of another and function as its priest also?