The negative aspect of ‘hi-tech’ medicine

Technological advances have outpaced medicine. Let me take the example of my specialty – neurosurgery. When we speak of ‘State of the art’, for example, do we have true neurosurgery or ‘hi-tech’ advances in mind? Whether it is the present day sophisticated neuro-imaging techniques or computerised multi-dimensional surgical planning and guidance systems, the current climate seems to be favouring a shift away from patients and thcirdiseases. Nowhere is this better seen than at national and international conferences and workshops where modern investigations and treatments receive more prominence than traditional clinical or epidemiological methods. Yet it is true that ‘hi-tech’ advances, with all their dazzle just do not constitute all or even a sizeable part of medicine.

It is becoming generally evident in the West that the practice of ‘hi-tech’ medicine (mechanised medicine?) docs not substantially improve the cure rate and may, instead, be detrimental to the very progress of medicine for a number of reasons:

• Sophisticated and multiple diagnostic procedures are performed without proper clinical workup or even an X-ray of the skull or spine. We are only too familiar with the patient who unloads a bag full of MR scans on us without a word on his disease or symptoms.
• Patients, having learned from their physicians the importance of ‘tests’ in contrast to symptoms, insist on getting a ‘scan’ done for minor complaints.
• Vested or special interest groups, including physicians with whole or part ownership in a diagnostic facility propagate such tests.
• Wastage of health care resources from over treatment of a few at the expense of the many is now increasingly evident.
• Unethical medical practices are flourishing.
• Trainees in neurosurgery are increasingly identifying it with technology instead of clinical skills and the ‘art of medicine’.

Developing nations such as India should exercise great caution in acquiring high-cost, ‘hi-tech1 gadgetry under the influence of hawkers and peddlers in a misdirected effort at appearing to be at the front line of neurosurgery, especially since such technology has a high rate of obsolescence. Today, even more than in the past, we need ‘hi-touch’ rather than ‘hi-tech’ medicine.

(This letter is a modified version of that published in Neurology India 1995;43:176-177 and has been written at our request. Editor)

(ACASH — Association for Consumer Action on Safety and Health — together with Forum for Medical Ethics Society has already started work on setting up such a panel. Those willing to help are requested to contact Dr. Arun Bal at ACASH, Servants of India Society Building, Second Floor, 417 Sardar Vallabhai Patel Road,Girgaum,Bombay 400 004. Telephone: 388 6556. Editor)