Anita Jain: Lessons from history for modern medicine

“Medical knowledge usually relegates history to an incidental and anecdotal role but always outside the boundary of development of pure scientific knowledge.”

Quoted from a chapter in the book Towards a Critical Medical Practice, here the authors examine the historical evolution of kala azar (visceral leishmainiasis) in India using medical, political, and socio-cultural constructs. A deadly vector borne disease, kala azar has long afflicted populations in the Indian subcontinent, and unfairly more so marginalized communities. Indeed, India is home to half of the world’s burden with 100,000 new cases each year.

The protagonist of the story, a ‘forgotten figure’ claims the book, is Upendra Nath Brahmachari, a scientist at the Calcutta Medical College and School of Tropical Medicine. In a quest to “save the lives of millions of fellowmen,” he toiled for months on end conducting experiments in meagre settings. And so emerged urea stibamine as an indigenous, cheap, efficacious, and non-toxic treatment for kala azar. Publications from his work followed, to spread the word among the medical community, and recommend its usage and further validation.

Brahmachari went on to manufacture the drug in a unit in his house, making it freely available across hospitals, and charging, if at all, only at cost. The present times seem to ridicule the altruistic foundations of medicine. As shared in the book, the branded form of sodium stibogluconate (current injectable treatment for kala azar) costs US$273 per patient, with the generic version priced $23 per patient. Brahmachari, with the ambition of making the treatment as widely available, never patented the drug.

Taking on the baton, as a resurgence of Kala Azar was witnessed in the 1980s and 90s, Shyam Sundar and C P Thakur, both doctors from Bihar, undertook clinical trials to compare efficacy of different drug options. In doing so, they collaborated with pharmaceutical companies, the government, and international agencies. Yet the mission remained finding a cure to alleviate suffering of local populations, and making this available through the public health system. An ethical imperative is that medical research be relevant to the needs of the community. Increasingly, funding from international agencies and multi-national corporations tends to dictate the research agenda of a country, using its resources and people to test interventions misplaced from the country’s real needs.
Often in the course of scientific writing workshops, I have asked participants why they would like to do research and publish. An overwhelming majority respond it is to build their publication profile and rise in their professional careers. Honest, but a tad disheartening to see the gradual shift from a legacy of socially relevant and medically necessary research.

The World Medical Association in the Declaration of Helsinki recognizes medical research as central to medical progress and recommends ‘even the best proven interventions be evaluated continually through research.’ It calls on us as medical professionals to do research because it is the right thing to do, and to do it the right way. As Brahmachari did, to be followed by Sundar and Thakur. Research need not be a complex enormous undertaking initiated with the goal of a high-profile publication. Rather an endeavour that is perceptive to our patients and communities, and fulfilling to our essence as medical professionals.

The story left me questioning why medical education remains deprived of history when it can so remarkably shape an understanding of disease and the development of interventions, whilst also inspiring budding medical practitioners.

Anita Jain is  India editor, BMJ.