Good science also needs a thriving democracy

The Art of War and the Art of Medicine both draw on ancient wisdom. Sun Tzu, the philosopher-warrior of ancient China wrote, “Winning 100 battles by fighting the enemy requires immense skill and intelligence, but winning 100 battles without fighting a single battle is the real art of war which avoids the exorbitant costs of fighting 100 battles.” But then such victories, silent and unspectacular nonevents, are not to the liking of either rulers or the ruled.

Ancient Indian wisdom echo similar views. Chanakya or Kautilya, who assisted Chandragupta Maurya in establishing the Mauryan Empire and played a role in the defeat of Alexander the Great wrote Chanakya Niti, a treatise on statecraft which mentions that in strategy, one should explore both the pros and cons. The losses should not outweigh the gains. He also wrote that if the end could be achieved by non-military methods, an armed conflict was not advisable.

Ayurveda, the 5,000 years old system of natural healing which originated in Indian Vedic culture, strives to identify the ideal state of balance of a person and offer solutions using diet, herbs, music, massage treatments and meditation to restore the body’s balance.

The wisdom and art of these two ancient civilisations cannot match the fast paced and impatient era, in which art of hockey got usurped by Astroturf and the art of cricket by T20, putting up cricketers for auction. Priorities are dictated by power dynamics accelerated by market forces.

“Visible medicine” scores over the “invisible art of medicine.” The perception of clinicians is that their professional responsibility does not go beyond the sick. Politicians who influence health even more than doctors, are rarely troubled by thoughts of the distant future. They cannot afford to swim against public perception. That would be political hara-kiri.

Ironically, India which has become one of the most favoured destinations for medical tourism because of its state of the art medical and surgical care, has one of the worst statistics for infant mortality and under-five malnutrition in the world.

Every day 2000 Indian children die from easily preventable causes. The trends from the country wide National Family Health Surveys undertaken by the Ministry of Health and Family Welfare have revealed that over the past decades Indians have become shorter while the world average height is increasing. This indicates decades of neglect in health and nutrition and requires long-term investment in health rather than quickfix solutions.

India has one of the highest cases in the world of communicable diseases such as tuberculosis, dengue, malaria, Japanese encephalitis, and many others. Excremental diseases such as diarrhoea, typhoid, jaundice etc. due to lack of safe drinking water and sanitation are also major public health problems. Doctors busy treating individual diseases miss the broader ecosystem which sustains these diseases and makes them more severe. They lose sight of the forest for the trees. Few, even in the medical profession, and none outside it, understand the nuances of epidemiology and public health. This discipline deals with the big picture, the determinants of disease and health.

This enables one to identify the risk factors and remove them before they manifest into disease, which is the true art of medicine. But the outcome, preventing a spectacular epidemic or containing a pandemic, is a nonevent. Efforts towards achieving this goes unrecognized and unrewarded. Fame and glory elude the practitioners of public health and epidemiology.

Such non-events do not help politicians and their advisers either in promoting their careers. To the masses they must seem to be coping with imaginary and hypothetical challenges. They provide no illusion of control.

Pandemics come and go and will continue to come and go in future. Science has explanation for these natural phenomena. But it is in the interest of politicians, pharma companies and physicians to sustain the illusion of controlling the decline of the disease by way of expensive interventions, often at the cost of other pressing health problems which are brushed under the carpet.

Scientists and academics have their own compulsions, perhaps even more pressing than politicians. To survive in the profession, they cannot afford to be idealists and naive. There is cutthroat competition in scientific and academic environments. Institutions vie with each other for national and international rankings. These rankings are determined by publications and research grants received by institutions and faculty. These do not come easy.

Grants are scarce from government sources. Enter the industry with their own conflicts of interest. Struggling scientists and academics fall easy prey to these predatory market forces. Science is objective but scientists have lost their autonomy due to unhealthy competition. They, like T20 cricketers, are also up for auction.

What is the way forward? Public awareness and debate. Without public awareness predators have a field day. Once public opinion demands restoration of science, politicians would change course. Like scientists they too do not have any autonomy but are driven by majority demands. For developing rational public perception, scientific debates rather than censorship of views of credible scientists need to be encouraged.

Good science can only thrive where there is good democracy and scientists regain their autonomy.

(The writer is Professor & Head, Community Medicine and Clinical Epidemiologist at Dr DY Patil medical college, Pune. Views are personal)