Medicine and Muslims: The Road Ahead

(Talk delivered at the 28th Annual convention of the Islamic Medical Association of South Africa. Durban, 6 July 2008)

I am thankful to the IMA for this opportunity to share with this distinguished gathering some thoughts about medicine and where we should be going with it in the future. Although I am in that stage of life where a person’s medical knowledge increases rapidly as he hears new concerns, new tests and new names of diseases from his doctor or his reference age group, the perspective I want to share is not based solely on personal experience. It is also built on study and reflection on the history of medicine and the interplay of various forces that determined the path of this history.

I graduated from engineering college about thirty-five years ago. When I went for my MBA studies in Canada some years later, my perspective on some of the things I had learnt earlier changed. It was there, for example, that I learnt that “An apple a day, keeps the doctor away” was a marketing slogan coined by farmers in the US as the demand for apples went down during Prohibition years. It was also there that I learnt something new about Frederick Taylor. In the engineering college I had learnt that Taylor was a genius who revolutionized manufacturing through his scientific management. He was called as the father of scientific management. A great man. A benefactor of humanity who helped usher in the new era of abundant and cheap manufactured goods. Naturally, when I found his original monograph on scientific management in the library, I read it with great enthusiasm.

It was a shocking experience. In the monograph he described his experiment with a laborer whose productivity he increased, and expressed his thoughts on the subject. He asked the laborer whether he was a good man and defined a good man to be one who stood up when he was asked to stand up, sat down when he was told to sit down, lifted a load when he was asked to lift, took a step with it when he was told to do so. In other words his good man was not a man but a perfect robot. He also described his scientific management philosophy: “Now one of the very first requirements for a man who is fit to handle pig iron as a regular occupation is that he shall be so stupid and so phlegmatic that he more nearly resembles in his mental make-up the ox than any other type. The man who is mentally alert and intelligent is for this very reason entirely unsuited to what would, for him, be the grinding monotony of work of this character. Therefore the workman who is best suited to handling pig iron is unable to understand the real science of doing this class of work.”1

I mention Taylor here for two reasons. One is that the engineering college had given me a distorted picture of the man and the discipline he founded. That applied to many other things as well. It is not that the things I learnt about thermodynamics, heat transfer, metallurgy, strength of materials, theory of machines, electrical technology, production techniques, and dozens of other subjects were wrong. It was that there were other things about the rise of the factory, its social, cultural, and economic impact on the society, the struggles between segments of the society, and the role of the factory in helping some of these warring sections and exploiting others --- all of these were never discussed. We saw some of the trees but not the forest. As engineers we were only interested in mastering the technical details. And technology, we had firm belief, was perfectly neutral. No one could argue with science or technology. These other issues could be of interest to the lesser people who could not get admission in the engineering college and had to pursue a study in humanities.

Taylor did improve manufacturing efficiency. But he did it at tremendous cost to the society. He had successfully developed a method for the social control of the society and facilitated a brutal exploitation. But bright engineering graduates who would be implementing his techniques would not have any idea of what they were doing. They, themselves were the “good men” as he defined, obeying his commands without question.

This technical mindset is not limited to engineering. In medicine also subjects like biology, anatomy, physiology, pharmacology, etc. are very important and wonderful subjects. But there are other non-technical subjects like the interplay of economic, social and political forces that have a tremendous impact on the development and availability of therapies, which may be ignored by our focus on the technical.

The second reason I mention him is that there are parallels between the “scientific management” that he championed and the “scientific medicine” that arose at the same time. Our life was changed for good or for bad by the industrial revolution. This also applies to modern medicine. I am not sure this history of modern medicine is covered in medical schools. But it is important both for the physician and the patient to know it to understand why things are happening the way they are happening today and find an alternative. It is that perspective that I wish to share with you today.

The phenomenal rise of medical science is of recent vintage. Much of it took place in Taylor’s homeland and under the patronage of the same class of people whom he served. In the nineteenth century the US was far behind Europe in medicine. To earn respect and greater fees, an aspiring US doctor had to travel to Edinburgh to get good medical education. At the same time, different sects like homeopaths, ecclesiastics, and herbal healers had an equal claim to medical expertise. It changed in the twentieth century with the US getting an uncontested lead and allopathic medicine emerging as the preeminent authority for medical questions.

The history of this revolution is fascinating. As Richard Brown documented it in his Rockefeller Medicine Men – Medicine and Capitalism in America, this happy result was not an accident but the result of a carefully thought out and executed strategy on the part of the people with money. Between 1910 and 1930 the big philanthropic foundations, led by the Rockefeller, gave a total of $300M to medical education and research. This staggering fund gave them much say in determining the direction of these institutions.

No doubt providing a healthy workforce was a goal of their campaign just as providing cheaper goods to the masses was a goal of their factories. But this was not the only goal or the only result. It also laid the foundations for the development of technological medicine and what came to be called as the medical industrial complex. It was medicine dominated by hospitals, drug companies, laboratories, doctors, insurance companies, even banks, joined together by pursuit of profit from people’s pains.

It was expensive medicine because of the very expensive machines and devices which became indispensable for doctors and hospitals as a result of these efforts. This was by design for they were looking for products and techniques that could assure nice returns on big investments. Bruce C. Vladeck, professor of Health Policy and Geriatrics, Mount Sinai School of Medicine, stated the obvious when he said: “Modern medicine and medical science have really accomplished some extraordinary things, but some of them are very expensive.”2

It was no longer possible for most people to pay for the medical care when it was needed. A system of health insurance was thus necessitated so every healthy person would keep on paying for the healthcare every month so he would not be bankrupted by a sudden illness or injury. The insurance industry--- that adds no medical value but adds to a significant part of the costs --- thus came into being. (According to a study published in the New England Journal of Medicine (2003) administration consumed 31.0 percent of U.S. health spending).

The result has been a huge marketing success. If healthcare is a market then the more that is spent in the market, the better it is for the marketers. And the amount has been increasing greatly with no end in sight. In 2007 healthcare spending in the United States alone reached $2.3 trillion. Those $2.3 trillion are certainly going to somebody. The winners are the insurance and pharmaceutical companies, which have been some of the most profitable businesses in the US. In 2007 prescription drug sales totaled $286 billion in the US and $712 billion world wide.

If they were selling ice-cream or cosmetics, we could congratulate the entrepreneurs on their great achievement. But a sick person, a person in pain, is the farthest from the rational decision-maker that the free-market model presupposes. We are dealing with an unsuspecting, rather trusting, and vulnerable clientele that can be manipulated into buying useless and even harmful therapies. And manipulate it did, in all ways conceivable….

In her book on the drug industry, Marcia Angell, former Editor-in-Chief, New England Journal of Medicine says: “This book will expose the real pharmaceutical industry – an industry that over the past two decades has moved very far from its original high purpose of discovering and producing useful new drugs. …Now primarily a marketing machine to sell drugs of dubious benefit this industry uses its wealth and power to co-opt every institution that might stand in its way, including the U.S. Congress, the Food and Drug Administration, academic medical centers and the medical profession itself. Most of its marketing efforts are focused on influencing doctors, since they must write the prescriptions.3

Families USA, a watchdog group, documents some of the methods used by this industry: “The drug industry files bogus patents, buries its competition-generic manufacturers-in frivolous lawsuits, and even colludes with those manufacturers to keep lower-priced generics off the market. The industry also engages in fraudulent drug pricing and deceptive marketing, and it funds groups that claim to represent consumers opposed to strategies aimed at putting a lid on prescription drug prices.”4

Even the health guidelines that the whole world may assume represent sound science, may have a hidden business agenda behind them. Moynihan, a health journalist for the New England Journal of Medicine and the Lancet, and Cassels, a Canadian science writer, explain the simple mechanism through which sales of statins were increased worldwide. Statins are in the five top selling drug categories in the world. They reported: “Eight of the nine specialists who wrote the 2004 federal guideline on high cholesterol, which substantially increased the number of people in that category, had multiple financial ties to drug manufacturers.”5

Marcia Angell mentioned expensive drugs of dubious quality. It gets worse than that, though. The robber barons of the medical frontier demonstrated that they were not above knowingly selling harmful medicines if they could get away with it.

Iconoclastic thinker and social critic Ivan Illitch, in his famous book Medical Nemesis has described some of these horror stories. I will mention just one here. During the 1960s chloramphenicol, packaged as Chloromycetin by Parke-Davis, brought in about one-third of the company's over-all profits. By then it had been known for several years that people who take this drug stand a certain chance of dying of aplastic anemia. Some of them would die within days. Others a year or more after its administration was stopped. Despite that through the late fifties and early sixties Parke-Davis spent large sums to promote it. Doctors in the United States prescribed chloramphenicol to almost four million people per year to treat them for acne, sore throat, the common cold, and even such trifles as infected hangnail. According to Illitch, in the United States hundreds of them died undiagnosed.

This mad rush was stopped only after the facts were brought up in a congressional hearing. Within two months after that hearing, the use of chloramphenicol in the United States dwindled. Parke-Davis was forced to insert strict warnings of hazards and cautionary statements about the use of this drug into every package. But these warnings did not extend to exports.

Oral chloramphenicol has not been manufactured in the USA since 1991. Its use even on animals that produce human food is banned. As the US National Institutes of Health (NIH) warns, “The potential for aplastic anemia must be considered whenever chloramphenicol is used, regardless of the route of administration.”6 But it is probably still being used in many parts of the world for conditions other than the typhoid which does not respond to safer antibiotics.

The cumulative result of these and other practices that resulted from the association of healing arts with and ---their subservience to ---capitalism is now a full blown disaster.

Today, despite the phenomenal success that resulted in the “medicalization” of not only the Western world but also big parts of the non-Western world, Western medicine is facing unexpected problems in its own home. The word used by serious analysts to describe the situation in the US is crisis. From the media to the physicians to the churches, people are talking about the healthcare crisis in the USA.
Says Marcia Angell: “We certainly are in a health care crisis. If we had set out to design the worst system that we could imagine, we couldn't have imagined on as bad as we have… Our health care system is based on the premise that health care is a commodity like VCRs or computers and that it should be distributed according to the ability to pay in the same way that consumer goods are. … And that market ideology is what has made the health care system so dreadful, so bad at what it does.”7

According to the National Coalition on Health Care, in a Wall Street Journal-NBC Survey almost 50 percent of the American public said the cost of health care was their number one economic concern.8 In a survey by Deloitte’s health research center, only 7 percent of Americans said they felt financially prepared for their future health care needs.9 According to David Himmelstein, associate professor of medicine at Harvard Medical School, about half of the 1.5 million families that declared bankruptcy in the US in 2001 did it because of medical causes.10

The economics of medical education assures that, left to itself, this cycle will continue. A medical student in the US is on the average $140,000 in debt upon graduation. Some have as much as $300,000 or even more. The number one goal they have is to pay back this huge debt. A doctor under those pressures cannot be expected to spend an hour with a patient talking about lifestyle improvements for which he will get no extra money rather than propose a stent insertion for which he will get a few thousand dollars.

This reminds me of the surgeon who said he did not believe in unnecessary surgery; he only operated when he really needed the money. But that surgeon lived in earlier times in the USA. Today he constantly needs money, which explains the well-known over-prescription of surgery here.

There are other factors leading to the run-away escalation of medical costs. One of them is the current drug discovery procedures, which are normally considered to be the best that science could offer. I will leave that for you to decide but I can see the economics of it. The idea that randomized, double blind, placebo controlled trials are the only way to determine the safety and efficacy of a new drug serves the capitalist enterprise just fine. It erects the barrier to entry so necessary for maintaining monopolies and oligopolies. It takes $100 million to $1 billion to discover and test a new drug. Who will be investing that kind of money to discover therapeutic benefits of a non-patentable herb that one could buy from any herbalist for a small amount of money?

This “scientific” idea resulted in throwing all the medicines that were discovered over thousands of years into the dust bin. Ibn Sina’s Cannon was used for five hundred years in Europe and for a longer period in the Muslim world. On the other hand the billion dollar R&D funds produce drugs whose side effects and problems start to show in a few years, although the drug companies have made their profits in those years and they can move on to the next drug. And the cycle continues.

Medicine, which seemed to promise a magic pill for every ailment the day it developed penicillin, today seems to have lost its magic tricks. For countless ailments from arthritis to common cold to cancer, to hypertension to urticaria it has no cure. Unfortunately the previously available alternate cures were thrown out with the success of penicillin. Penicillin was scientific medicine while others were the relics of the dark age of medicine.

The situation in the poor countries, including all the Muslim countries is much worse.

The introduction of Western medicine was aimed at undermining Islamic values as well as the centuries old Islamic medicine. It was a “civilizing” mission. Thus we see that that much celebrated nurse Florence Nightingale considered creation of a public health department for India as part of a mission to bring higher civilization there.11

And the proposal for a medical college in Bombay in the 1830s was very clear about the goal: it was to wipe out the existing medicine there. Robert Grant wrote that the goal was: “To give to the people of western India a practical and well trained body of medical practitioners who by the skillful and conscientious exercise of the art would so recommend themselves to their countrymen as in time to take the place of hakims and vaids, who for want of adequate education must necessarily be incompetent to exercise healing art with safety and success.” It is also very instructive that the entrance exam for the first batch of students for this college in 1848 consisted solely of questions about Paradise Lost. The purpose clearly was to create an elite class of slaves who would love to ape the maser and serve his interest whole-heartedly.

To destroy Islamic medicine, colonial powers cut off its sources of funding, blocked the efforts to regulate it through registration so fake healers would crowd the market and bring a bad name to the discipline, and carefully nurtured Muslim doctors who would perceive it to be in their own interest to oppose Islamic medicine. They used the prestige of science to relegate other medical systems including Islamic medicine to the realm of folk medicine worthy of no more attention than the old wives’ tales.

Muslims had imported medical knowledge in the past. During their golden era they relied on Greek, Persian, Indian, and Syrian medicine. The hospitals in Baghdad, Aleppo, Damascus, Cairo, Marrakesh and elsewhere had recruited doctors from all these places. The hospital in Jundishapur in Persia was the source for the staff of the celebrated Baghdad hospital under Harun al-Rashid. But importing the medical expertise and medical theories then did not create the problems that we see now.

What is different now from then? This is a question in history, sociology, and power relations.

When Harun al-Rashid built the splendid hospital in Baghdad, Muslims were in charge. They imported everything on their own terms. They assimilated it into their value system.

The hospitals in Baghdad as those throughout the Muslim world were Islamic institutions. At these hospitals they had separate wards for men and women. The treatment and stay was free as was the medicine for the outpatients. They even gave a gift of money to the patient upon discharge so he would not have to immediately start working after leaving the hospital. The doors of these hospitals were open to all: rich and poor, Muslim or non-Muslim, local or foreigner. These free hospitals maintained a very high standard of care. They were clean and large. There were lecture halls, libraries, and masajid in every hospital. Food was plentiful and prepared under the physicians instructions for each patient. The rulers visited the hospital to learn first hand how they were running.

Did they have a hospital like that at Jundishapur? These defining features were not imported. These were dictated by the Islamic civilization. Whether the physicians were Muslim, Christian, or Jewish, the hospital was an Islamic institution.

In contrast when under colonial rule Western medicine started to take hold of Muslim lands beginning in the nineteenth century, Muslims were not in charge. What were transplanted were not just the techniques and medical knowledge but also the values and worldview. Muslim may have been working there but these were not Islamic institutions.

And we lost a lot in the process.

The act connected both the patient and the physician to Allah, for He alone can cure.

But these words were meaningless to a Western science that did not know God. As he was quietly indoctrinated into the secular humanistic worldview of this science, the Muslim physician dropped the use of these healing words, which used to set the tone for his entire treatment. Instead he wrote Rx, an apparently benign symbol, which is rooted in paganism. According to some accounts Rx refers to the eye of an Egyptian god Horus and it was worn as an amulet to ensure good health and ward off sickness. According to others it refers to the Greek god Jupiter. Haggard writes: "Rx is not, as is frequently supposed, an abbreviation of a Latin word meaning recipe or compound, but is an invocation to Jupiter, a prayer for his aid to make the treatment effective...”12

There is another symbol that reminds us of the pagan connections of Western medicine. It is the staff of a Greek god surrounded by one or two snakes. It is there on the logos of World Health Organization as well as leading medical associations of USA, Canada, New Zealand, and others.

In the logos of World Health Organization, American Medical Association, and World Medical
Association, the staff of the Greek god Caduceus and the snake around it are quite visible.
(Note: Images were taken from their own respective websites. They were also rescaled.)

It is certainly not that Muslim physicians hold these beliefs. But that they dropped the Islamic symbol and replaced it with a pagan symbol is in itself symbolic of the problem caused by Western medicine.

The cost structures there now require a system of health insurance as well but the availability of such an insurance is much more limited. In case of a serious illness, injury or medical emergency, a person may lose his life savings. In most heart wrenching stories of poverty, the beginning point is a health problem with the sole breadwinner for the family, which means he cannot even provide for the food for the family leave alone for his expensive treatment.

Like all imported problems, those related to healthcare are worse in the poor countries where even the safeguards that may have been developed in the rich countries take a longer time to reach and where the counter balancing forces are generally absent.

As the undisputed leader of the world in medical science, America represents the best and the worst that modern medicine has to offer.

Famous thinker and social critic Ivan Illitch said that Western medicine was the cause of modern diseases. He talked about iatrogenesis: not just medical iatrogenesis (7% of patients suffer injuries due to doctor or medical staff error or toxic or ineffective drugs) but also social (More and more of life’s problems are seen as amenable to medical intervention. Pharmaceutical companies develop expensive treatments for non-diseases) and cultural iatrogenesis that has made it impossible for one to be born at home or die at home. Richard Smith, editor of the British Medical Journal, commented that Illitch’s radical polemic of 1975 had by 2002 become almost mainstream.

But we do not have to accept everything he said to recognize that the healing profession is sick and it does not have the tools with which to heal itself.

The problems are philosophic, economical, and social. They arise from the worldview of Western medicine. Their solution lies in bringing the Islamic worldview to the entire practice of medicine.

We have to rid modern medicine of paganism, scientism, and capitalism. Paganism is in its symbols. Scientism is in its outlook. Capitalism is its driving mechanism. Together they have created millions for the few and misery for the millions.

Those millions ---both Muslims and non-Muslims--- are now looking for a way out of this misery.

To some extent it is happening in the West. Frustrated patients are rushing towards what is now being called Complementary and Alternate Medicine (CAM). The therapies that were considered unscientific, and therefore bogus, are being looked at again. According to a 2002 survey in the US, 74.6% of patients had used some form of complementary and alternative medicine (CAM). In response many medical schools have attempted to incorporate CAM education as elective courses. Recent studies report that 75% of U.S. medical schools offer such courses, while two hospitals (in Arizona and New York) have become centers for Integrated Medicine. The Association of American Medical Colleges now calls for physicians to be sufficiently knowledgeable about both conventional and non-conventional modes of care.

Why should we be waiting for Western universities to discover Islamic medicine before we do it? Muslim physicians need to take a lead in the movement for Integrated Medicine.

On the other hand it is heartening to see that both in its oath and its statement of objectives the Islamic Medical Association of South Africa has shown a keen awareness of these issues. But your efforts need to increase in proportion to the size of the task at hand.

Revival of any Islamic science is part of the revival of Islamic civilization and will pave the way for the revival of other sciences as well. But unlike other Islamic sciences, Islamic medicine has the distinction that despite all the efforts to wipe it out --- many at the hands of Muslims themselves---it is still a living tradition, unlike physics and chemistry. Reviving it is thus easier.

There are things our physicians can do individually.
Our physicians need to recognize the great and unique opportunity that they have for doing good not only for the body but also for the soul of their patients. Doctors are in the best position to promote Islamic lifestyle, which is the best protection against the diseases brought on by our modern lifestyles. This refers to diseases of all kinds--- physical, mental, and spiritual, although the last one is not always recognized. Today we are more concerned about the hardening of the arteries than we are about the hardening of the hearts. But Muslim physicians can furnish treatments for both.

We should set our sights at building hospital like the ones that were built in Baghdad, Damascus, Cairo, Aleppo, Marrakech etc. Then we won’t have to tell the world that we built great hospitals in the past. Even the Western doctors will be going to Karachi, Kuala Lumpur or Jeddah, or wherever to learn something about Islamic medicine because their patients will be going there anyway.

1. Frederick Taylor. Principles of Scientific Management, 1911

2. http://www.pbs.org/healthcarecrisis/Exprts_intrvw/b_vladeck.htm

3.Marcia Angell, The Truth about the Drug Companies: How they deceive us and what to do about it, Random House, 2004.

4. http://www.familiesusa.org/resources/tools-for-advocates/tips/han-newsletter-june-2002.html

5. Ray Moynihan, Alan Cassels, Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients, Nation Books, 2005

6. http://www.ncbi.nlm.nih.gov/pubmed/3055188

7. Marcia Angell, http://www.pbs.org/healthcarecrisis/Exprts_intrvw/m_angell.htm

8. http://www.nchc.org/facts/cost.shtml

9. “Even the Insured Feel Strain of Health Costs,” NY Times, 4 May 2008.

10. David U. Himmelstein, etal., Illness and Injury as Contributors to Bankruptcy, 2005

11. Roy McLeod (Editor), Disease, Medicine and Empire: Perspectives on Western Medicine and the Experience of European Expansion.

12. Howard W. Haggard, Devils, Drugs, and Doctors, (1929)