What Price Rationality?
Item
- Title
- What Price Rationality?
- Creator
- Sunil Kaul
- Date
- 1998
- extracted text
-
^6
WHAT PRICE RATIONALITY?
Yada yada hi dharmasaya, glanirbhavati bharatah,
abhyuthanam dharmasya tadatmanam srijamayaham.
According to Hindu mythology, Lord Vishnu said the above lines promising his followers that
he shall reincarnate on earth if there is any threat to religion and morality. It seems Vishnu
has decided to reincarnate again : this time as a sub - microscopic vishaanu (Hindi :
vishaanu = virus). Instead of his traditional gigantic forms, he appears to have chosen this
form to combat population explosion and also the lack of sexual mores, two problems which
many would argue to be behind many of our problems.
With its deadly surety of causing death, as has been evident in Sub Saharan Africa and
elsewhere, the Human Immuno-deficiency Virus has demonstrated that it can control
population more dramatically than any other discovery I invention that we could dream of in
the last two centuries. Besides, as the condom is being marketed as the most effective tool
to protect against the deadly virus, it shall also help to keep the population under check.
The return to one partner sex being the mantra chanted by every one to avoid HIV / AIDS
would warm the cockles of many who believe in the Brahmanical / Catholic morality.
Without trying to sound facetious, doesn't it appear that Nature is mocking at us ? Ever
since HIV and many of the newer viruses (viri ?) have appeared, shouldn’t we be going red
in the face for falsely believing that by finding cures to deadly diseases we had conquered
nature? Isn’t it time that we sat up and realised that for every disease that we can cure,
there are two more that Nature pulls out of its hat ? We have managed to eradicate only
one disease i.e., small pox in the Age of Science; bbt we have been hit by Hepatitis B & C,
HIV, Ebola, Dengue and Hanta viruses meanwhile; these have acted as spoilsports for our
self-patting arrogance.
Should we grieve death?
Prevention of death being the single point agenda of modern civilised society of the modern
era -and its health professionals - has caused the gravest yet curiously acceptable
intervention which has upset the ecological balance. Some early successes in the field of
antibiotics and vaccines and the tendency to accept the results of fifty years as more
important than those of centuries of history- a distorted history which we are taught in
schools that insists upon the superiority of modern man's intellect over his ancestors made us believe that humans could defy Nature. Instead of humbly accepting its immense
powers and cooperating with it, we decided to challenge it further. And continue to do so.
Year after year, we choose some disease and try to eliminate it. Little do we realise that
Nature's strides are far longer than ours. It teases us for some time, tantalises us to take us
to the wrong path, and then strikes deeper and mightier. The scourge of HIV and AIDS is
just one such display of its might. Unless we take stock of and accept our fallibility, i am
afraid we shall be doomed.
As people who have responded to several epidemics in recent times, many like me have
found a disconcerting apathy to the high mortality figures amongst the communities affected
the most. The large scale deaths may be the motivating reason to act for many of us who
have learnt the urban 'civilised' way of life; for the people in rural India who are the worst
affected, death is no more than an acceptable display of the suzerainty of Nature. They
can’t even think of trying to question its decision. All they would like is to get on with life and
live
In my personal opinion, the high and often unnecessary premium to death is one of the
main reasons for making choices which have ruined this earth. To restrict our concern for
life to its brief phase before death is to deny the devil its due: it goes against the tenets of
most of the religions, which we so avidly, passionately and blindly believe. Almost all the
major religions talk of the life beyond death, yet our hysterically increasing concerns to
preserve our lives are getting the better of our faiths. The greed to see ourselves, our kith
and kin. and our species survive even at the cost of others has driven us to falsely believe
that it is indeed possible. The few decades of decreased rates of mortality recorded in
recent history books would have us believe that the eons of Nature's superiority etched in
the strata of the earth are things of the past. Despite seeing the common cockroach which has outsmarted the changes of climates and environments on this earth for ages scamper around every day in our kitchens, our self aggrandising attitude makes us prevents
us from accepting that there has ever been any species smarter than us. It is this attitude
more than any thing else which forecasts our doom. The new viruses like HIV are just one
of the reminders posted by Nature to set records straight.
How many diseases will we make vaccines for? Till when shall we continue to chase newer
and newer organisms and try to invent vaccines to prevent our next generations from
suffering their effects ? Till we run out of money, or the will to chase them or the luck to find .
them? Why should we try to find more and more specific drugs to fight more and more
specific diseases? Wouldn’t it be prudent to accept the precedence of Nature over
ourselves? By our chauvinistic, anthropocentric approaches, we have disturbed the
equilibrium so much that Nature has to make drastic corrections occasionally to bring a
semblance of order which hurt our modern sensibilities.
When our ancestors said that they had no control over death, what they really(probably)
meant was that they did not want to control death and interfere too much in the processes
of nature. Probably, they were humbly allowing the weaker set of genomes to die so as to
permit the principle of "survival of the fittest”. Is it possible that by controlling infant mortality
and U5MR, we are helping in developing generations of our species which has a large pool
of unhealthy individuals and hence an increased morbidity? Is it possible that our
successive generations are losing the capability to survive the onslaughts of diseases
because of progressive genetic deselection which has been caused by an ever increasing
percentage of population not having faced enough illnesses to get immune against?
Because, the newer generations have been treated too early or too much which has
prevented the development of its capacity to develop immunity, cross immunity and a herd
immunity against any one disease or its related diseases.
Have you noticed the children of the aboriginals who are taught to coexist with Nature? For
centuries, they were not clothed for periods ranging from two to four years after birth all'
over the world. Was poverty the only reason for this practice? Or is it that the practice
helped them grow up closer to the elements? I, for one have a feeling that this was their
way of immunising their children against the vicissitudes of Nature. Admittedly, they may
have had a higher mortality rate in their childhood. But, in a way it promoted the principle of
' survival of the fittest'; and all those who survived these initial years would have healthier
lives compared to the adults of today. Ask any one from the previous generation and s/he
will testify to this fact. Our older generations could grow up without suffering too many
diseases, their cures, or their specialists (who are as pestilent (or more) as today's diseases
themselves!). But our concern for the 'running noses of the native waifs' changed things
disastrously the world over, introducing violent medicinal systems which attacked more and
more instead of helping the body defend better.
Public Health by Shamans?
Not so long ago in a village in Bikaner, i was witness to an ojha managing to miraculously
stick a brass thaali to the back of a medium while attempting to remove the venom of an
Ecchis from its victim. I was convinced that this was no more than sorcery and that the
patient’s hope at this stage of obvious envenomation lay only in a modern facility. The ojha
didn't succeed, and the next day the patient had been referred by us to the medical college
an hour's distance away. In the next two days, we had footed a bill of eight thousand rupees
for the patient’s treatment, which i must admit worked quite well. This case, my staff and the
people of the area told me was the first case which they had seen surviving at the hospital.
I have seen almost ninety percent of my medical brethren injecting antivenin immediately on
admission of a patient of snake bite irrespective of the signs of envenomation, ” just to be
on the safe side”. Keeping in mind the fact that only five percent of snakes are poisonous;
that no more than one percent of snake bite victims develop signs of envenomation, and
that many of such patients- reverse out of their own accord, this "safe side" business by
doctors has disastrous effects on health finances, besides endangering the lives of
thousands of individuals who get subjected to the risks of antivenin. Although the motive of
developing antivenins would be laudable, what is the cost which the entire society has to
pay? Even if we accept that the shamans of yore were all frauds as far as snake bites were
concerned, see the savings as a public health measure. With the chances of death due to
snake bites being not more than one in thousand, the savings made by the ojha in the 999
cases was phenomenal. Besides, he not only provided the most important component of
treatment, that of reassurance, but also managed to make it accessible close to the house,
did it rather transparently, involved the community, and did it at a cost the community could
afford.
Similar is the involvement of these shamans in diseases like hysteria, which seems endemic
to Western Rajasthan. Modern doctors tend to mess around with this ailment by either
giving too many drugs and attention which worsens it or by dismissing it lightly as feigning.
But, look at the shamans handling it. By rituals which may hurt our sensibilities, they blame
the illness on someone unseen yet ‘blame-able’ and publicly announce a cure thus allowing
the hapless patient to come out of yet another episode of this recurring illness. Here too, the
cure is close the house, accessible, transparent, involves the community, and is accessible
at a cost the community can afford. What may be the best fallout in such cases treated by
shamans is that the patients do not have to visit psychiatric wards/OPDs and get labeled as
"mental"
Prevention Vs Cure
Good, effective antibiotics against infectious diseases, which are the bane of most third
world societies preceded good hygiene and sanitation, proper drainage and construction.
Consequently, cures have taken away our attention from the real cause for these infectious
diseases. I have actually been talked down by senior doctors in administrative jobs that it is
not cost effective to spend thousands in getting the sewage repaired because all i could
show was a few cases of dysentery requiring little or no intervention and which couldn’t be
pinned down to the clogged sewage conclusively!
Even Gandhiji was skeptical about the ingress of modern systems of medicine because
"these drugs provide fast cures and hence prevent the patient from focusing on the cause of
the disease itself, which may be due to eating too much, or exercising too less." The filth
and squalor in India's richest cities compared to the clean environs of our remote villages
tells us once again about the deep insight into human behaviour this old man in a loin cloth
had.
For every doctor, journalist, politician, or businessman backing prevention today, there are
fifty of them backing cure. Because everything in the post liberalisation era is weighed by
economics, we can actually feel happy with the increasing cost of treatments of illnesses,
because that alone may nudge our societies back into a cost effective prevention.
When we talk about the irrationality of injections for common ailments, is it possible that we
are denying the common person of rationality when he prefers to go to anyone on the street
who can give him a jab of steroid so that he doesn’t forgo his daily wage. Is our
rationalising against steroids not incongruous to the irrational world that we have accepted
in which money is the only mantra to follow ? Have we really rationalised our stance of
insisting on a course of antibiotics to prevent bacteria developing resistance to newer and
costlier antibiotics'? Aren’t the bacteria getting sensitive to the older and cheaper antibiotics?
What i intend to state is that when most people prefer not to practice rationality as we
scientifically oriented people define it, is it necessary that the norm be redefined. That the
need to live. the need for convenience, be woven into our rationality? That the right to
irrationality itself be recognised for the lay person?
Alternative medicine
One wonders what alternative would appear next for a modern society becoming
increasingly semi literate about illnesses and hence hypochondriac. We have been
observing the rediscovery of Reiki and Pranic Healing and Iridology and God-alone-knowswhat-will-come-next; why is it that each one has its own set of believers? How come all the
systems seem to work despite the “unscientific’1 explanations for all of them. Is it possible
that our science is not scientific enough yet for all these systems. Is it possible that our
rationality of modern medicine itself is not rational enough?
in our obsession with a rationality which narrowed down to believing only double blind trials
as the proof of effectivity of drugs, we have simply ignored human emotions which we know
very well are the key to successful treatment. After testing the drug in a shape and form
which is comparable to its previous avatar, it is allowed to be marketed and used in every
which form possible. Doesn't the change of form change things considerably? “Proof of
effect of a drug for malaria can only be the disappearance of the malarial parasite from the
blood after administration of the drug." insist our malariologists. Pray what is the harm in
accepting a drug as an antimalarial if the symptoms of malaria vanish even though the
parasites do not?
I am increasingly getting convinced that all the cures to our diseases probably lie within the
body. That all these cures only require an excuse acceptable to the person which can
trigger the cure. It is hence that every system of medicine seems to be work. It is also
hence that an increasing tribe of persons like yours truly is finding that using no external
system at all also seems to work as effectively. How does one rationalise that ? Could the
answers to this also unravel the reason why some people get affected by an organism while
others in the vicinity do not? Explanations to this may also help us understand how
miraculous cures are effected. Cancers melting away by some small religious ceremony,
pains disappearing at the mere touch of a hand and the reading of a few lines of mumbo
jumbo making paralysed people walking again: once these get a rational basis, they may
be accessed by a few more people in the future.
Modern Medicine and Modern Society
I may not be wrong to describe violence, greed, lack of trust and immorality as some of the
characteristics of modern society. There is more than a passing contribution of modern
science and medicine to it. There used to be a time when most people used to believe that
one’s behaviour was linked to one or the other of the serious illnesses like TB, Leprosy,
Leucoderma, Small Pox etc. Epidemics were linked to the collective morality of a
community. Come science and the organisms for these were identified, called names and
the ’myth was shattered.’ What also got shattered were the perimeters of decency, of
ethical and moral behaviour There was no longer a need to do the right things by listening
to the elders, because the consequences the elders used to cite were no longer valid in the
modern, rational and scientific world of today. Crimes of passion, violence both against
women and men, theft, loot, corruption and violence in our daily lives have increased .
phenomenally. The fact that many of these diseases could be now kept at bay by those
having the wherewithal to practise preventive measures has also ensured that the educated
and affluent violate the perimeters of ethics, decency, and morality mush more than the
illiterate, God fearing class.
Also, since modern medicine has built up a value and glamour much out of proportion to its
results, it has got a price attached to its head. It has thus become accessible primarily only
to the urban and the rich. The class divide has become sharper than ever before. Big
money has been followed by a commercialisation and commodification of the healing
ministry.
The way out
I shall confess that i haven't found a way out yet. I am nowhere near a way out which could
be called universal. It is thus that i address a set of individuals whom i respect for-their
integrity and rationality in such matters.
Yet. i feel that some turning back will be required. To start with, we may have to start
tolerating other living beings -- from humans to microscopic pathogens. Instead of trying to
fight off disease, let our medicinal systems be designed to increase our immunity to the
pathogens. Not capital - intensive, specific immunisation against specific diseases, but
general immunity available within the confines of every human body. To permit a peaceful
co- existence with all those organisms which find shelter in our bodies -- crores of them stay
in our intestinal tracts despite our best efforts; or to allow the stronger one survive. Let
Nature decide the right of way. We have a very effective immune system which has been
eroded by generations of strong antibiotics and the wanton misuse of resistance lowering
drugs. If nurtured like in the olden days, it could cut down our morbid apprehensions every
time we entered a malaria infested locality, drank a glass of unchlorinated water, or sat next
to a TB patient. It could not just cut down the costs of medicines, their side effects, and the
R & D that goes into them, but may also make patients living with AIDS, Leprosy and TB a
lot more acceptable to others.
Let us actually act smart. Let us allow ourselves to see the writing on the wall. That it is
going to be a never ending battle to hunt for the microbes for every new disease that shall
appear. That it is foolhardy to find specific nets to catch specific fish. We must honour the
over riding concern of Nature to preserve the biodiversity without showing human beings
any special favours. And accept it humbly.
■
Once we do that, we can actually do much better than we are doing presently. We can
remind our doctors what they learnt in their first few semesters. Of every body physiology
maintaining the servo controlled systems of the body till very late, irreversible changes take
place Of every portion of body anatomy having a wonderful self defense and regeneration
system which needs to act normally. Of pathways of biochemistry which if not disturbed by
the bushels of allopathic chemicals - or herbal ones for that matter -- could guide faltering
systems from one back-up system to another. If we had not been schooled too much not to
question, we could have asked doctors why they administer anti inflammatory drugs like
Ibuprofen or Aspirin or Turmeric for relieving pain caused by an injury, when inflammation
by their own textbook's definition is a body response to any damage caused by injury. Or
antipyretics like Paracetamol for bringing down fever when fever also happens to be a
cardinal sign, like pain, of the body's inflammatory processes trying to overwhelm an
external aggression or injury.
Our physiology has to be allowed to overcome our pathology once again. Our body's natural
defence being part of Nature itself has a tremendous capability of handling disease and
injuries. These defences have to be strengthened, not weakened. Supplemented, not
substituted. And since these defences can be boosted by not just drugs, but also by music,
faith, love and compassion, we have to look for succour in places other than the medical
text books and drug laboratories.
Let us not miss the woods by coming too close to the trees. We need to address the larger
question the AIDS epidemic has thrown at us. Have we seen even a single commercial
talking about the lack of trusted love as the cause of the disease? Is the link so intangible
that it needs to be glossed over. Cannot love and care be classified as a drug worth self
medicating with? We have to answer these questions to get ahead. We must not spend all
our energies into fighting this small vishaanu which causes AIDS, because we are surely
going to have more and more incarnations and manifestations of Nature which will emerge
if we do not answer the underlying issues. Let us do away with the necessity for Vishnu to
reincarnate!
(3619 words)
Sunil Kaul
Position: 2042 (4 views)