Allopathic approach: Strengths and insights
Dr Arun Bhatt

‘‘Life is short, art long, occasion sudden and dangerous, experience deceitful, and judgement difficult.’’
— Hippocrates, father of medicine

Benefits of Allopathy

Recently, at a conference on ‘‘Symbiosis of Medicines for Better Global Health,’’ I had to talk on the strengths and insights of allopathic approach. The above quotation is an apt summary of my predicament. It was difficult to assess the benefits of the discipline, in which I have been involved as an internist and clinical pharmacologist for over two decades. Usually, reduction of infant and maternal mortality, and increase in life expectancy are cited as achievements of allopathy. Compared to many developing and developed countries, India is still far behind in these parameters. Obviously, other factors like poverty and literacy interfere with the strengths of allopathy.

However, for many conditions allopathy has led to improvement in survival rates and reversal or delay in disease progression. For most conditions, allopathy can relieve the symptoms and even improve quality of life. Indeed, the outlook has so altered that, with the exception of diseases such as cancer and AIDS, attention focussed on morbidity rather than mortality, and the emphasis changed from keeping people alive to keeping them fit.

Elements of Allopathic approach

Uncertainty, hypothesis, assimilation and collaboration:

The alternative medical systems claim successes in individual patients and harp on the limitations and adverse effects of the allopathy. In spite of such attacks, allopathy, has still remained a successful scientific system, because of the strength of its progressive and pragmatic approaches.

The critical care has saved many lives. Even in a patient, who is unconscious or unable to give history, an astute intensivist will move heaven and earth to diagnose and manage the problem. The success of critical care management depends on the speed of action, medical acumen, versatile selection of potential investigations and tremendous energy.

The progress of allopathy has been a successful example of experimental approach pioneered by Sir Francis Bacon, who said ‘‘If a man will begin with certainties, he shall end in doubts; but if he will be content to begin in doubts he shall end in certainties.’’ Following this method, William Harvey drew truth from experience and not from authority and discovered circulation of blood. Challenges to prevailing dogma or hypothesis, coupled with ongoing critical review of advances are fundamentals of hypothesis testing in medical research.

Evidence-Based Medicine (EBM), the new philosophy for medical practice, combines these approaches. EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. It requires integration of individual clinical expertise with the best available external clinical evidence from systematic research. There is a healthy debate ongoing on the relevance and hierarchy of EBM.

A recent review in the British Medical Journal commented that only about 10 per cent to 20 per cent of medical interventions are supported by solid scientific evidence. A study (Lancet 1995 346:407-10) showed that evidence from randomised controlled trial is available for 53 per cent and convincing non-experimental evidence in found for 29 per cent of clinical situations; and there is no evidence in 18 per cent.

Many other sciences like physics, chemistry, and optics have been consumed and assimilated by allopathy, and have become part of diagnostic and therapeutic approaches. Until 1895, when Roentgen discovered x-ray, medical diagnoses were based on feel, inference, or superficial symptoms. Little was known about what was going on inside the body to cause disease or pain.

Today, the use of diagnostic imaging from x-ray to Computed Tomography and Magnetic Resonance Imaging, has become an integral part of allopathy. The imaging sciences are always finding new ways to see and seeing new ways to cure. Another major strength is collaboration amongst scientists from different disciplines.

The recent HOPE (Heart Outcomes Prevention Evaluation) study was a multi-centre, multi-country randomised study of ramipril vs. placebo in 9,541 patients followed for 4.5 years. Ramipril group showed a 22 per cent reduction in combined endpoint of cardiovascular death, non-fatal myocardial infarction and stroke. The results of the study implied that ACE inhibitor use could prevent 400,000 deaths and 600,000 non-fatal cardiovascular events per year. Such landmark studies impact the medical practice internationally!

Allopathy does not shy of borrowing useful therapeutic approaches from alternative systems. Several large meta-analysis based on randomised trials are available for medicinal herbs such as St John’s Wort, Gingko biloba and Saw palmetto. These herbs, like digitalis, are becoming part of the allopathic armamentarium. There are collaborative trials ongoing with alternative system practitioners.

In USA, National Centre for Complementary & Alternative Medicine (NCCAM) has initiated a double blind randomised controlled trial of acupuncture using Traditional Chinese Medicine (TCM) needling points specific for depression. The collaborators include practitioners of TCM, allopathy and acupuncture. The results of such studies could support rational integration of different medical systems for treatment of individual patients.

Popularity and Reach

Commemoration, communication and education:

No medical discipline can become popular and useful unless the achievements are known globally. Commemoration of significant breakthroughs through the Noble Prize has contributed to the development of many disciplines like immunology, genetics and biotechnology, and therapeutic pharmacology. Rapid communication of research through publications, conferences, Internet and electronic media has led to fast spread of medical progress. The need for continuing medical education has kept individual doctor in the race for better management. A judicious combination of all these approaches is the real achievement of allopathy! The fundamental approaches of research and communication make the allopathy rapidly move from yesterday’s novelty to today’s curiosity to tomorrow’s necessity!

(The author is consultant, pharmaceutical medicine & clinical pharmacology. He can be contacted at arun_dbhatt@hotmail.com)