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What Makes Something ‘A Medicine’?


I have been planing to write this post for a long time.

I belong to several Whatsapp groups of friends and families. Many messages get forwarded on Whatsapp. There is a specific type of messages that get a lot of momentum. Messages that claim something is a herbal, Ayurvedic medicine.

So far I have received messages claiming medicinal properties in several fruits, vegetables, herbs, tree leaves, roots, barks, seeds, some common, some exotic. I have been told that anything from lemon to clove oil can cure cancer.

But I can tell you that when my father had cancer, nothing helped him other than established medicine. We tried many things, we really did. And some things did more harm than good. But the only thing that made any difference was Chemotherapy.

And that’s what prompted me to write this article.

There is a widely accepted theory that there is a big giant cartel of Pharma companies and doctors that is out to rip patients. And there may be some truth in that, but on a large scale, there are more good people than bad. There are plenty of companies and scientists working hard to find medicines for diseases. There is a very structured drug development process.

Before I begin to tell you the process let me tell you one thing. Have you heard of a sentence “You can fool others but you cannot fool yourself?” That’s a lie. You can fool yourself. People do that all the time. Your mind can play tricks on you. Psychologists have done plenty of research on that. These tricks are called cognitive biases. Here are a couple important ones.

Confirmation bias – where people like to look for information that proves what they already believe and ignore the information that disproves their belief. This is why Republicans read only news supporting Republican views and so do Democrats. Or to put in Indian context, BJP supporters read only news that makes BJP look good and Congress supporters do the same for Congress. This can lead them away from a balanced view. Sometimes there is a necessary correction that happens when you read other person’s viewpoint, but when you read biased news, that correction does not happen.

Availability bias – people tend to overestimate the probability of events that have recently occurred. This is why a large number of people buy earthquake insurance just after earthquake. Ironically a second major earthquake is much less likely after one has already happened, but people believe it is more likely because they have just experienced it.

If you want to read about cognitive biases, which I recommend you should do because it is fascinating, the Wikipedia article is here. It will make you aware of your own biases and will improve your decision making ability.

Coming back to the medicine world. There are some mental traps that are super common to the medicine development.

One very common mental trap observed in the field of medicine is placebo effect. People just feel better with the thought that they have taken medicine. Often times the relief in symptoms such as headache, nausea, dizziness is very significant and pronounced. This effect can even be seen when false medicine given to the person. Because what is helping them is the thought, not the medicine.

Second mental trap is confounders. E.g. one time doctors observed that a group of people drinking a particular type of wine were living longer. But upon more analysis they found that it was just a costly wine and those who could afford it were rich and could afford better healthcare. So it was not the wine that was helping health, but it was the money, which happened to be the reason why people could afford that wine.

Over the years scientists have developed a very mature and thorough process of deciding whether something is medicine that has checks and guards for most of the mental traps, or cognitive biases.

In the first stage of medicine development, mostly a mechanism is identified. How a particular drug has some effect on particular molecules. If an experiment can be repeated, an hypothesis is built.

In second stage, trials are done in petri dish. Or on animals. If satisfactory results are obtained, then human trials are planned.

In third stage, a small dose escalation trial is conducted. Few people take the medicine and the dose is taken up to see how much dose can be tolerated. If people tolerate the dose well, then the next step.

In fourth step, a larger group of people is selected. IT is made sure that the selection is as diverse as possible for gender, race, age, etc. Typically the experiments at this and next stages are “double blind placebo controlled randomized “. Placebo controlled means a some people get something that looks like medicine, but is really a harmless substance. Some people get the real medicine. If the number of people showing benefit from placebo group is almost same as number of people from medicine group, then you know it’s not the medicine effect but placebo effect at play. Also neither the people themselves, nor the scientists observing the people know who is getting what. This is to avoid their own mental bias. Because if they know who is getting medicine, they might suffer from confirmation bias. I.e. they will tend to focus more on improvements in people who took medicine and report that more prominently. The word randomized means it is decided randomly who gets medicine and who gets placebo. Otherwise if only men get medicine and women get placebo, and men were to respond to medicine better, that would give us a skewed result of how effective the medicine really is.

In fifth step, even a large group, perhaps hundreds or sometimes thousands is selected and same, double blind placebo controlled randomized study is performed. Details records are kept. Approvals are filed.

If everything looks good, at this stage the drug becomes a medicine. But it does not end here. The doctors keep a keen eye on patients taking new drugs and report their findings. That includes side effects, improvements, everything. Sometimes if there are too many serious side effects, drugs are recalled and banned.

At each and every step, the reports of experiments are published in leading scientific journals and other scientists rip it apart to find faults in the theory, the experiment method etc. If the faults are serious, they are improved and experiments are repeated.

After such a long and arduous journey, something becomes a drug.

And when a drug goes through such a long process, we can trust it. That’s why Aspirin or Paracetamol works like clockwork for us. That’s why we know whether a drug is good for babies, or for pregnant women, or for old people. We know what are the most common side effects. We know what is the right dosage.

Now compare this to whatsapp message you received. Do you really think it has gone that much scrutiny? Just because it’s part of our folklore and tradition, should we let it escape all this scrutiny?

Believe me, I am not against herbal medicines. I personally have experience of one medicine that helps me when I have cough – Harad, or (Terminalia Chebula). However I think we should study them scientifically. I am not arguing against the type of medicine. I am arguing against the process by which we declare something a medicine. We have to perfect the process and rely on it. Not rely on personal opinions. Because? Persons have cognitive biases.

We should not just accept them because it’s mentioned in our old books. If it’s the truth, it will stand the scrutiny. If it’s not, we accept someone made a mistake in writing those books.

Often times I think people have cultural lines drawn in their mind. They think accepting superiority of Western medicine is accepting superiority of Western culture. Our culture has been wronged by Western culture, by colonialism specifically. And I get that. But nothing wrong or shameful in taking what’s right in the culture we have problems with. After all, we speak their language and wear their style of clothes.

Actually this type of rigorous examining, critical thinking was far too common in ancient India. They have entire field devoted to that called “Nyayashastra”.  It’s we who departed from our rich tradition of critical thought process  and logic.  We have given way to emotional reasoning. If it makes us feel bad, then it must be wrong. And this habit of reasoning is hurting us more than healing.

These messages and medicinal tips are always shared with good intentions. “May be it will help someone” is what we think. But as they say, the road to hell is paved with good intentions. Too many disasters caused in this world by good intentions that lack wisdom. Having too many medicinal suggestions but not knowing which one to put your confidence in, not knowing which one you can trust when your health is in delicate state, is not really helpful.

What’s most important is the truth. It’s the truth we need to make higher priority.And if we are not sure what is truth, then we must hold our good intentions in check till we find out what is the truth.

Next time if someone forward you a bunch of message describing something has medicinal properties, please forward them this article. Let’s educate ourselves and spread the truth.

One Response

  1. Superb Kedar

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