“Surely in the creation of the heavens and the earth, and the alternation of night and day, are signs for people of understanding— those who remember God while standing, sitting, and on their sides, contemplating the creation of the heavens and the earth: “Our Lord! You did not create this in vain! Glory to You! Keep us, then, from the torment of the fire! “Our Lord, whomever You cause to enter the fire You have disgraced; and there are no saviors for the unjust. “Our Lord, we have indeed heard someone calling, inviting us to faith— ‘Believe in your Lord’—and we believed. So forgive us our sins, our Lord, and efface our evils; and take our souls with the just. “And grant us what You promised us, our Lord, according to Your messengers; and do not disgrace us on the day of resurrection. For You surely do not break a promise.” And their Lord answered them, “I am never unmindful of the work of a worker among you, male or female. You are from each other. So for those who emigrated or were driven from their homes or suffered harm for My sake, or fought or were killed, I will efface their evils and admit them to gardens below which rivers flow, as a reward from the presence of God. And the finest reward is in the presence of God.”
- Holy Qur’an (2:190-200)
“The most beautiful and most profound experience is the sensation of the mystical. It is the sower of all true science. He to whom this emotion is a stranger, who can no longer wonder and stand rapt in awe, is as good as dead. To know that what is impenetrable to us really exists, manifesting itself as the highest wisdom and the most radiant beauty which our dull faculties can comprehend only in their primitive forms - this knowledge, this feeling is at the center of true religiousness”.
- Albert Einstein
“Je le pansai, et Dieu le guarist” (I treat the wounds, but God heals them)
- Ambroise Pare, 16th century surgeon
Although it is extremely unlikely that one would find a statement like that made by Ambroise Pare, the great French military surgeon, in present day medical journals or textbooks, or uttered by currently practicing physicians or surgeons, it is possible that this may change in the near future. For many years, medicine, particularly in the Western world, has been taught and practiced without any regard to God, or any sense of the divine. God has been displaced, and His glorious name seems to be confined, if that, to ethical discussions and ‘moral’ affairs. God, to who belongs the dominion of the Heavens and the Earth, to whom we are indebted for everything, is discarded, ridiculed, insulted and forgotten, and the consequences of that are only too painful for me to remind the kind reader thereof. The realisation of this is especially painful to one who believes in Him and wishes to remember and please Him in all actions.
NEGLECT OF GOD - THE REASON FOR THE DECLINE OF HUMANITY
Part of the boredom, not to say dislike, which many have sustained out of the study of medicine is the fact that it seems so dissociated from everyday life, and has become so intertwined with political motives and party agendas. In the United Kingdom, where I currently reside, hardly a day passes by without a statement of sorts being made by some politician regarding the NHS. This has been on an exponential rise over the past year (2008), while England celebrates the 60th anniversary of its declining health care system.
If it is not mentioned in a political context, it is mentioned in the context of an ethical debate – abortion, euthanasia, genetic engineering, stem cell research, competence, confidentiality and the rest of the big topics we all encounter regularly, particularly those of us involved in hospital medical practice.
Is that all that there is to medicine then, an entirely secular, unfulfilling specialty, which brings, to many of its practitioners, a great deal of distress and agony?
Of course, there are many who are fulfilled by medicine – the joy they derive from seeing the recovery of the health of others is the greatest source of happiness of their lives. Such an attitude was epitomized, in our time by the late Michael De Bakey, a man whose story we recount in a later section. The sight of the grateful patient, whose doctor is the lucky recipient of a material gift, or a grateful smile, is one of the most beautiful things any one can encounter.
Such joy is probably experienced to the greatest extent and most frequently by the surgeon, who, using the minimum of tools (they are arguably the most clinical of doctors – we are yet to devise an instrument that can adequately describe a lump or any other mass for that matter) [though by no means always] proceed to heal the surgical defect, with a much quicker recovery rate than most other specialists. Compare this to the physicians, the medical consultants, whose daily practice seems to be confined to the encounter, on their ‘post-take’ ward rounds, of acute exacerbations of ‘chronic diseases’ (such as myocardial infarction (or acute coronary syndrome - an acute exacerbation of a chronic inflammatory (atherosclerotic) process), the acute exacerbation of COPD or asthma, of Crohn’s disease or ulcerative colitis, diabetic ketoacidosis or HONK), and in their clinics with the chronic picture of these diseases. There is no healing here – just control, sometimes coming at the price of iatrogenic damage. And the control often comes after months and months of experimentation, trial and error. Compare this to the immediacy with which good surgeons achieve their desired outcomes (of course, the story is very different with the technically-incompetent surgeon, but those are mostly filtered out by the extremely efficient and progressive surgical tutoring systems in place throughout the world).
Alas, there are several reasons why I cannot develop such a joy, apart from the fact that I have unfortunately not been blessed with the manual dexterity of a surgeon.
Perhaps owing to a great degree of sadness that I have sustained in recent years, I have come to attain a very dismal view of humanity. A doctor should never make such judgmental statements about it, and indeed, in my actual practice, I have always been conscientious of our oath, always doing my job to the best of my ability, to the joy of my seniors.
But doctors are humans, and it is difficult for them to completely avoid making judgmental thoughts about the circumstances that have led many of their patients to present themselves. Doctors are as entitled as any other profession to thinking and reflecting on these things.
Could there be anything more mindless than smoking, a habit that, according to WHO, killed 100 million people worldwide in the 20th century, kills over 120,000 people in the UK a year - more than 13 people an hour, and kills “10 million people a year (worldwide), making it the single biggest cause of death worldwide, with the largest increase to be among women. WHO forecasts' the 21st century's death rate from smoking to be ten times the 20th century's rate.” A habit that costs the NHS a great deal of money, up to £1.7 billion every year.
What of those who are alcohol dependent, or drug dependent. What about all those who are not prepared to face their sadnesses – which are usually ‘petty’ in the grand scheme of things – and are prepared to commit suicide because ‘they had an argument with their boyfriend or girlfriend’. What about the 17 year old girl, who is coming with an ectopic pregnancy, predisposed to by her smoking and previous STDs….I can go on and on. Yet at the end of the day, because of this irrationality, because of the tendency of most people to put matter over mind, of the satisfaction of desire rather than the exertion of self control, the medical professional is expected to take the burden and ‘look after’ these patients, sometimes at the expense of patients who are ill due to diseases that they have not brought upon themselves.
Needless to say, it is the job of the medical professional to help those patients acutely. But his or her role does not just stop there. He or she ought to try to prevent future problems from occurring; this is simply because, our elders said, prevention is better than cure. Not that cure is available for all problems; infact we are yet to devise a cure for anything in medicine, except perhaps some infectious diseases.
Alas, prevention advice is rarely successful. Smoking remains widespread, despite all attempts at reducing the incidence of this horrible habit. Only the diagnosis of a terminal or serious illness, like cancer or a heart attack, forces the patient to believe that smoking kills, and to stop smoking afterward. Alcohol abuse and sexually transmitted diseases are on the rise, the latter reaching epidemic proportions, and leading the BBC not unrecently to state that, “There is widespread concern throughout the medical profession that increasing levels of promiscuity coupled with failure to take precautions is leading to an explosion in the numbers of STIs in the UK”.
In addition, there are some disorders for which there is no ‘prevention’ advice. These include depression, anxiety, and a whole host of other psychiatric problems, as well as suicide. These extremely important disorders have become a huge burden. A recent ‘Guardian’ article announced two years ago:
“Depression, anxiety and other forms of mental illness have taken over from unemployment as the greatest social problem in the UK, a health economist warns today…. Around 15% of the population suffers from depression or anxiety, says Lord Layard, emeritus professor at the Centre for Economic Performance of the London School of Economics. The economic cost in terms of lost productivity is huge - around £17bn, or 1.5% of UK gross domestic product. "There are now more than 1 million mentally ill people receiving incapacity benefits - more than the total number of unemployed people receiving unemployment benefits," he writes in the British Medical Journal.”
In order to understand why these problems occur, we need to understand why patients behave as they do. Why do they smoke, why do they drink excessively, why do they act promiscuously and become slaves to their sexual desires as soon as they have been introduced to the subject of sex? Why do they get so depressed, and are prepared to commit suicide, and forsake their entire lives for a relationship difficulty, or other ‘petty’ matter? Why is it that humanity has come to act so mindlessly, with the doctor eventually carrying most of its burden? Why is it that minds and hearts cannot rest, with a great number of people on anxiolytic medication, and sadness so prevalent, with so many on antidepressants?
Sigmund Freud tried to explain all the actions of humanity as being due to the conflict of psychological impulses and sexual desires. Karl Marx tried to reduce them to the struggle of dialectical materialism, saying in the preface of one of his books, “It is not the consciousness of men that determines their existence, but their social existence that determines their consciousness”, that the prime triggers for human behaviour are the struggle for wealth and economic power. Bertrand Russell tried to reduce all of human behaviour as the struggle for power of all types.
None of these, I feel, explains human behaviour in our contemporary world well. When a girl is taking a paracetamol overdose, is she thinking of ‘power’, of ‘money’, of ‘sex’? Of course not. Her behaviour cannot be explained in those terms. And neither can the young chap who is taking a heroine overdose, or getting drunk, or smoking away despite his asthma, all different forms of suicide. Albert Camus was not that wrong when he stated “there is but one truly serious philosophical problem and that is suicide”. In many ways, we can rephrase that and say, “there is but one truly medical problem, and that is suicide”. But that would be a great exaggeration, not without an element of truth however.
Their behaviour can only be explained in three words – loss, forgetfulness and neglect. They are at loss regarding their purpose in life – no one with a sense of purpose in life will consider suicide. They are forgetful of their duties to others. They are neglectful of logic, reason and common sense, and when man turns away from those, his only refuge is his animal instincts and desires. There is no third route.
In their neglect, and in becoming the slaves of their passions, the everyday man and woman living here in England (and I am sure it is not very different in other nations) has become no different to the beasts. He or she works, eats, drinks, copulates, defaecates, sleeps but rarely thinks. Bertrand Russell put it brilliantly, saying, “Most people would rather die than think; in fact, they do so”.
But why are people lost, forgetful and neglectful. Why is thinking so uncommon. Why has it become an almost cumbersome activity for some.
The answer is quite simple. It is the neglect of God, or a pathetic idea of Him, that has lead to these problems. A society devoted to Him, to His remembrance, and the realization of His wishes, will never fail or stutter. A society that realizes that the purpose of life (which, all three Abrahamic religions teach) is the worship of God will never fall prey to its passions (The same idea, of our purpose in life being to glorify God is expressed in the wonderful deistic traditions of the American Fathers and French Enlightenment, whose chief American exponent, the great Thomas Paine, writing in his classic ‘The Age of Reason’ (1794), said,
“The true Deist has but one Deity, and his religion consists in contemplating the power, wisdom, and benignity of the Deity in his works, and in endeavoring to imitate him in everything moral, scientific, and mechanical…(his religion) honors reason as the choicest gift of God to man, and the faculty by which he is enabled to contemplate the power, wisdom and goodness of the Creator displayed in the creation; and reposing itself on His protection, both here and hereafter …While man keeps to the belief of one God, his reason unites with his creed. He is not shocked with contradictions and horrid stories. His bible is the heavens and the earth. He beholds his Creator in all His works, and everything he beholds inspires him with reverence and gratitude. From the goodness of God to all, he learns his duty to his fellow-man, and stands self-reproved when he transgresses it. Such a man is no persecutor”).
As a result of this neglect of God, we live in the worst of times. This is precisely the Qur’anic viewpoint. God says, “Do not be like those who forgot God so He made them forget themselves. Such people are the deviators” (59: 19). It is natural law that God has declared – those who forget Him, will never remember anything of any benefit to themselves or humanity. They will become followers of desire. The Book of God talks about this repetitively:
“Now there hath succeeded them a later generation whom have ruined worship and have followed lusts. But they will meet deception. Save him who shall repent and believe and do right. Such will enter the Garden, and they will not be wronged in aught (19:59)
And Allah would turn to you in mercy; but those who follow vain desires would have you go tremendously astray (4:27)
Restrain yourself patiently with those who call on their Lord morning and evening, desiring His face. Do not turn your eyes from them, desiring the attractions of this world. And do not obey someone whose heart We have made neglectful of Our remembrance and who follows his own whims and desires and whose life has transgressed all bounds. (18:28)
Do not let those who have no faith in it and follow their whims and desires debar you from it or you will be destroyed. (20:16)
Have you seen him who has taken his whims and desires to be his god? Will you then be his guardian? (25:43)
If they do not respond to you then know that they are merely following their whims and desires. And who could be further astray than someone who follows his whims and desires without any guidance from Allah? Allah does not guide the people of the wrongdoers. (28:50)
However, those who do wrong pursue their whims and desires without any knowledge. Who can guide those whom Allah has led astray? They will have no helpers. (30:29)
Have you seen him who takes his whims and desires to be his god–whom Allah has misguided knowingly, sealing up his hearing and his heart and placing a blindfold over his eyes? Who then will guide him after Allah? So will you not pay heed? (45:23)”
The Quranic law is – forget God, you will forget yourself, and you will end up following your desires. It’s a simple law. Without God, life becomes an undisciplined affair.
The majority of human beings do not carry the correct idea of God. Statistics may tell us that the majority of human beings believe in a god, but the truth of the matter is that they have a distorted view of Him (e.g. the ethnocentric God of Judaism, the trinity of St. Paul’s Christianity, and the absurd concept of God ‘The Father’, and the polytheism of Hinduism, not to say the polytheism of the former two) or a distorted view of His teachings (manifest most evidently by traditional Islam as it is taught in this day and age by the various religious institutions in Saudi Arabia and Egypt, the two nations with the most prominent Islamic institutions). Once again, the words of God rule supreme, “And though thou try much, most men will not believe” (12:103).
It is only by a return to God that the mess that is this world will be tidied up, and therefore the medical world. As Harun Yahya concludes one of his works, “All the problems of the world today can end provided that the values of the Quran and the Sunnah, in their original form purified from all bigotry and innovation are introduced to mankind”. Note the purification clauses – it is herein that the Muslims, the carriers of God’s blessed message, have failed. They have contaminated interpretations of both with many corrupt ideas. Only by their eradication will we have success.
THE WORLD NEGLECTS GOD
The most prominent characteristic of this time is that, as Martin Gilbert put it, it is an extension of the century of war. There is no peace in this world. This is natural, when the ‘Peace’ is going to be neglected. As a result, it is an absolute mess. It is a state of chaos, of lack of security, which can only be redeemed by the remembrance of God, and not a tablet of diazepam or citalopram. As He informs us, “Those who believe, and whose hearts find satisfaction in the remembrance of God: for without doubt only in the remembrance of God do hearts find satisfaction” (13:28). Nearly 150 years on from the day when Charles Dickens wrote the famous introductory lines of his great novel, ‘A Tale of Two Cities’ , the words are more applicable then ever before:
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way--in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.”
It is the best of times in terms of technological and scientific advance, but the worst of times in terms of the degeneration of modern man and all his moral and artistic pursuits. Albert Einstein put it well in his 'Out of My Later Years':
"By painful experience we have learnt that rational thinking does not suffice to solve the problems of our social life. Penetrating research and keen scientific work have often had tragic implications for mankind, producing, on the one hand, inventions which liberated man from exhausting physical labor, making his life easier and richer; but on the other hand, introducing a grave restlessness into his life, making him a slave to his technological environment, and—most catastrophic of all—creating the means for his own mass destruction. This, indeed, is a tragedy of overwhelming poignancy."
The Egyptian Islamic thinker Sayyid Qutb summarized our current state very well too in the introduction to his book, ‘Milestones’. He said:
“Mankind today is on the brink of a precipice, not because of the danger of complete annihilation which is hanging over its head-this being just a symptom and not the real disease -but because humanity is devoid of those vital values which are necessary not only for its healthy development but also for its real progress. Even the Western world realises that Western civilization is unable to present any healthy values for the guidance of mankind. It knows that it does not possess anything which will satisfy its own conscience and justify its existence.
Democracy in the West has become infertile to such an extent that it is borrowing from the systems of the Eastern bloc, especially in the economic system, under the name of socialism. It is the same with the Eastern bloc. Its social theories, foremost among which is Marxism, in the beginning attracted not only a large number of people from the East but also from the West, as it was a way of life based on a creed. But now Marxism is defeated on the plane of thought, and if it is stated that not a single nation in the world is truly Marxist, it will not be an exaggeration. On the whole this theory conflicts with man's nature and its needs. This ideology prospers only in a degenerate society or in a society which has become cowed as a result of some form of prolonged dictatorship. But now, even under these circumstances, its materialistic economic system is failing, although this was the only foundation on which its structure was based. Russia, which is the leader of the communist countries, is itself suffering from shortages of food. Although during the times of the Tsars Russia used to produce surplus food, it now has to import food from abroad and has to sell its reserves of gold for this purpose. The main reason for this is the failure of the system of collective farming, or, one can say, the failure of a system which is against human nature… The leadership of mankind by Western world is now on the decline, not because Western culture has become poor materially or because its economic and military power has become weak. The period of the Western system has come to an end primarily because it is deprived of those life-giving values which enabled it to be the leader of mankind.”
Let us look at some of the details of the consequences of the neglect of God in various areas of human life.
With regards to medicine, we are living in a time in which the possibility of the death of the profession, as it has been regarded for thousands of years, has been entertained by many of its prominent thinkers. It is a time when the patient is regarded as a customer, “who is always right”, and the medical profession merely as a service provider. This has been a triggered by the GMC, the government, and of course by patients themselves. James E Parker, a retired paedatrician writing in the BMJ a few years ago, said:
“Now that the GMC has extended the precedent of consent for diagnosis by the patient to other conditions in the name of patient autonomy, we can expect the philosophy of the market place to prevail. 'The customer is always right'. Whether or not this serves the greater good of society is quite another matter.”
David Haslam, a Hertfordshire based GP also wrote about how the government has affected and will likely affect his profession in the future, in a pessimistic BMJ article aptly entitled, ‘The Beginning of the End’:
“British general practice is part of the fabric of our society. It is effective, precious, and threatened. It is not only possible but likely that within a few years the central feature of general practice- personal continuing care-will exist only in nostalgic memories.
Absurd? Let me explain. To reach this unhappy conclusion you have only to look at some of the apparently separate strands of recent government thinking to be able to see the type of cloth that it is weaving.”
He concludes, if things are not sorted out now, that general practice may well become, “the medical equivalent of an out of town hypermarket. Open 24 hours, efficient, cheap, reliable, and totally without a soul.”
It is a time when the patient’s chief interest lies, in many instances, not in treatment in hospital by a caring doctor, but the opinion of a lawyer and the verdict of a judge in court. We are living in the age of ‘litigation’ or ‘compensation’ neurosis, when patients “adapt or exaggerate their symptoms, and physical signs if they are present, in an effort to increase the possibility of compensation - or to gain in some other manner.” An age described brilliantly by Philip K Howard, an American lawyer, who said in his book, ‘The Collapse of the Common Good: How America's Lawsuit Culture Undermines Our Freedom’:
“A schizophrenic strain has crept into the society, with people edging around the baseboards, looking this way and that before doing anything in the common realm, but then, when they can, aggressively using law to gain a personal advantage. There's a "litigation neurosis," Chief Justice Warren Burger noted almost 20 years ago, developing "in otherwise normal, well adjusted people." Like savages, rather than citizens of a great civilization, we pounce when there's an opening and cower in our caves the rest of the time”
It is an age when every medical professional is expected to attend court at some stage, an age when the number of biscuits and spoons of sugar that the patient had in his tea is ‘documented’ in his notes, when the doctor’s documentation is the most important of all his or her work day duties. If more time is spent helping patients out, and less in ‘prophylactic’ documentation, everyone would benefit, except of course the lawyers who relish every case of litigation. And this will remain the case until our current medical culture changes.
It is an age when the junior doctor especially, but also all doctors at all levels of the hierarchy, are treated as slaves of different types to the hospital managers and medical directors, who often are not doctors, but highly qualified accountants who occupy the biggest and most plush offices in the hospital. We are living in an age when these hospital managers and non-medical professionals are in control of hospital fate, at least here in England.
Because of the fact that we live in an increasingly litigious world, all such doctors, from the house officer to the consultant, have become, in the majority of cases, over-investigative screeners, costing a great deal of money, effort and time, much of it unfortunately going to waste, unless of course the waste all these things is documented on a solicitor’s report in the future, in which case it is all ‘well spent’. We are living in the age of ‘cover yourself’; to use the favourite line of health professionals today, the age of defensive medicine, where the patient and his or her relatives are attacking from one side, forcing doctors to act against all their wishes, for fear of being taken to court. This is a natural outcome of conceding too much power to patients.
No one has described the problems of such defensive medicine better than Raymond Tallis. Writing in his aforementioned book, he says:
“The term ‘defensive medicine’ is a desperate euphemism for a profound corruption of the patient-doctor relationship that will make the much-derided notion of a grateful, trusting patient and doctors doing their best and ‘giving over the odds’ seem quite attractive. An obstetrician, who has a low threshold for performing Caesarian sections to avoid litigation, and personal ruin and disgrace, has lost his or her professional soul. Where he or she ignores the evidence pointing to the safety of a lower operative rate for fear of being outsmarted by a claims lawyer, the first plank of professionalism – the knowledge base – has been abandoned.
Yet this is what is happening; it is becoming almost impossible to live with uncertainty (the essence of good clinical-decision-making) because uncertainty will be trumped by the certainties of the courts and the media, who will not hesitate to deploy the superior wisdom of hindsight. The doctor who informs a patient of every possible risk, however remote, of a treatment or investigation and gets the patient to sign that he has understood all of these risks, and leads the patient to expect the worst, may be acting in the new spirit of transparency and partnership, but is more likely to be giving his own fears priority over those of the patient. The doctor who always eschews reassurance in case it might be false and chases down every symptom with a battery of tests he does not really believe in may have abandoned paternalism for something worse – inhumanity….Evidence-based medicine (EBM), the glory of the profession, will give way to LPM (lawyer-proof medicine) or GRM (grievance-resistant medicine).
As I suggested earlier, the fundamental injunction of Hippocrates – ‘First do no harm’, will, since optimal care informed by the intention to do no harm will not necessary prevent harm from being done, be displaced by one yet more fundamental: ‘First cover your ass and damn the harm’. Ironically, the principle of informed consent will be undermined, because the patient will not truly know the primary reason for the investigation of intervention”
Tallis concludes saying that all these changes “are liable to make medicine an unnattractive career option”. On the other side we have the government, with its obsession of achieving ‘governmental targets’ and what are referred to as ‘QOF points’ (Quality and Outcomes Framework) as more important than the patient’s welfare. Our current practice of medicine is akin to the way the great totalitarian that is Plato would have liked. As Karl Popper explains, “Plato interprets medicine as a form of politics, or as he puts it himself, he ‘regards Aesculapius, the god of medicine, as a politician’. Medical art, he explains, must not consider the prolongation of life as its aim, but only the interest of the state.”
We are living in an age of medical intellectual dishonesty. This I have seen many times throughout my relatively short career so far. One of the most revealing things about the mentality of the modern medical consultant mind with regards to investigations, for example, is the following embarrassing story. I was on a ward round with a young consultant physician about 6 months ago, and we encountered a patient who was seen by my colleague, who was clearly not jaundiced. Even a blind man could have said that. My colleague went through the history, and the patient’s blood results. She noted his bloods at 7 am - she was very tired and mistakenly wrote his bilirubin at 111. The consultant noted this and then announced to us, "Yeh, I thought he looked jaundiced". He was not jaundiced - and with a bilirubin of 111, he would be a lemon, not just jaundiced. I could not believe it. So, I went across to the nearest computer terminal, looked at the results. Bilirubin - 11. I was in two minds - shall I tell the consultant the true result, or shall I leave him with the satisfaction of diagnosing 'jaundice' through his 'clinical expertise'. I had to tell the truth, and I can't describe how bad I felt for him. He didn't show much of a response. I felt so bad, I couldn't even ask him if he wanted to cancel the liver screen he requested in view of the ‘clinical jaundice’ and false result. I left it at that.
Even clinical examination these days seems a deceptive enterprise. The medical mind works backwards. You have an 80 year old, and he's got bibasal coarse crepitations, even before the head of the stethoscope has touched the patient. If he was a smoker, he's got that and a bit of a wheeze, or he had it before you cured it with your harmless salbutamol nebuliser. What possible harm could possibly come, the medical mind wonders, of giving someone a nebuliser? If anything, it will have a placebo effect - after all, you're the doctor, and you told the patient it will make them feel better - and if the patient is 'better' after you have given it, it will look good on you. The wheeze that wasn’t there in the first place is not there when the consultant listens to his chest, and so he has increased trust in your management. You win both ways.
I once saw a patient with florid pulmonary oedema. A just qualified doctor who wanted to impress the final year medical students with his clinical acumen takes them to listen to his chest. He takes his mammoth stethoscope, listens over the chest and reports back, pointing to the regions involved, "Coarse crackles right base, fine crackles left base, and bronchial breathing in the right midzone". The poor medical students were convinced, and impressed. I knew the patient’s diagnosis myself, and had listened to his chest earlier. I proceeded to examine him again, in the fear that he might have developed new signs. He displayed none of them - it was just a wet chest, what was expected.
The sheer dishonesty that surrounds most, but certainly not the entire world of medicine is most revolting. This is not an NHS or doctor's mentality issue. It extends to the core of medical practice, so far as our most basic function - that of assessing patients - taking their history and examining them.
History taking is affected by linguistic and social factors, and education, as well as other factors. One of the lessons I learnt from a consultant cardiologist at Newham was never to pay great attention these days to the patient's description of chest pain. This conclusion he has come to by seeing thousands of patients who do not fit the ‘classical’ description of cardiac chest pain - patients who describe their pains as sharp, stabbing - only to have a raised troponin and abnormal angiogram, and patients who describe their pains as 'like a pressure', radiating to the left arm, with sweating and shortness of breath, a classic description of myocardial ischaemia, only to have a negative ETT. How many times have we, the juniors, seen obese Bengali ladies come with pain all over, or slim Pakistani men coming with abdominal pain, only to be diagnosed with an MI afterward and ending up in CCU?
I can't help quoting a small paragraph from that hilarious medical book by John Larkin, "Cynical Acumen":
"Cardiac history taking is simple...this is why cardiology outpatient appointments are usually over within ten minutes of the patient crossing the threshold (even allowing for one interruption on the consultant's mobile from his stockbrocker). Basically, it boils down to whether or not you have chest pain. If you do, you have an exercise tolerance test and maybe an angiogram. If not, an echocardiogram and maybe a 24-hour tape. Unless of course you see the cardiologist in a 'private' hospital, whereupon you automatically have all four tests organised - even if you're just the guy who's come in to fix the radiator"!
Another bit of wisdom comes in the next paragraph, where he describes cardiac pain.
"Cardiac pain is tight...heavy...gripping...the patient clenches his fist involuntarily when describing it (a dead giveaway) ...it radiates into the jaw..and particularly the left arm"
All essentially true, but basically useless. Why? Because everybody knows all that. Everybody. That includes the patient. A generally unrecognised feature of the medical consultation, when we take a history in order to elicit a diagnosis, is that such diagnoses are made by knowing something about their symptoms that the patient doesn't. This isn't simply an exercise in one upmanship. Once the patient has decided that they have, for example, angina, they will be delighted to give you the story that they know you want to hear. Thus you will only be making the diagnosis that the patient has already made for him - or herself - and what is the point of that? You might as well cut out a middle man and let them do their own coronary artery bypass graft (a study vetoed by a decidedly overzealous Ethics Committee in my last hospital). Symptoms lose their value once the patient knows about them. To my mind the best example of this is the 'pain going down the left arm' fallacy, and I present it thus:
IF A PATIENT VOLUNTEERS (I.E. BEFORE YOU HAVE ASKED WHETHER) THAT A CHEST PAIN GOES INTO THEIR LEFT ARM, THEN THAT PAIN IS LESS LIKELY TO BE CARDIAC
They've all read about it. They've all seen Superman’s Dad having a heart attack consisting entirely of left arm pain (beautifully underplayed by Glen Ford). It’s not that you can’t trust patients (though we will be assessing this concept later). It’s just that you can no longer trust the symptom. It has lost…the element of surprise. Far be it from me to outcrazy the retired General in Airplane who refuses to put on the landing lights to help the stricken passenger aircraft because “that’s exactly what they’ll expect us to do...” But I stand by the contention that the pain-going-right-down-the-left-arm pointer no longer points in the right direction”
The physical examination is also slowly dying, and for obvious reasons. Medical schools are placing more emphasis on sharpening "communication" skills, than examining patients. They cannot really be blamed for this; this is because all studies and audits of patient complaints show that poor communication is by far their most common cause. Even when clinical care is substandard, it is poor communication, not the clinical care, that causes patients distress; as one recent study showed:
“The majority of the complaints were directly related to clinical care, poor communication, attitudes of staff and nursing care. However, 99% of patients were satisfied with an explanation and an apology indicating that almost all have been due to a lack of good communication than due to real deficiencies in the clinical care. The hospital management has investigated the majority of cases within 20 days and has made several policy changes after the investigations”
The rise of investigations is a natural result of this decline in clinical skill, and is also a cause of the decline itself – it’s a vicious circle. If a patient is thought to have a murmur, it is very easy to obtain an echocardiogram. If a patient is thought to have failure, one doesn’t listen for S3 and gallop rhythms and all that, but would await the echocardiogram to confirm the diagnosis and give the ejection systolic fraction and other indicators. If a patient is suspected of having a DVT/PE, in the knowledge that the history and physical examination are useless tools in excluding it, a Doppler US, CT-PA or V/Q scan is performed to diagnose or exclude it.
Because the NHS is free, and anyone can come in whenever they like, we have to deal with huge volumes of patients. So the NHS has developed this system, contrary to all classical medical thought and practice, whereby nurses bleed patients with a fixed protocol before anyone has seen them, ordering all these tests in the most monkey-like fashion. This is quite unreasonable, and makes medicine much more a practical game, based on chance, than a science and art based on solid logical foundations. That is a very important digression from proper medical practice, and illustrates another fault of the NHS. Proper medical practice means being seen by a doctor, taking a brief history, examining and then finally investigating the patient. Only in the very acute scenario do we have to break this routine – if the patient is so unstable as to be in ‘resus’, that as many of these are done simultaneously. Not if they come through the A&E door with SOB or chest pain having been stable.
Medicine has become flawed in many other ways. At a less personal level, the medical world has been ruined by the ugly politics and economic motives that are exerted by the capitalist junta dominating its affairs at the moment, and equally so by religious fundamentalism, as I explain more clearly in the first chapter.
How can anyone regard medicine, as currently practiced, as a secular field, when in Israel, a nation based entirely on religion, and funded chiefly by Christian fundamentalist parties in the USA, we see the utmost impact of religion on the morality of doctors and others (see chapter on ethics).
A nation where Palestinians are deprived of medical treatment, where the women are expected to deliver at checkpoints (and many of them end up dying there), old men are expected to be searched inside out lest they be carrying missiles (in truth, it is just a form of humiliation and oppression), and even a quadriplegic man is not spared from murder. As far as I know, no one in the medical establishment has spoken out against these crimes, which are inextricably connected with the ugly politics of the Zionist state.
Because of politics, the health of nations has been put at risk. The Japanese are still suffering the after effects of the atomic bombs that the American government decided to throw at them in 1945, and nowadays the rest of the world (including many Iraqis, Palestinians and other victims of American government greed) have died of easily treatable or preventable diseases as a direct consequence of their military action. Everyone knows that Israel’s military is almost fully American in origin. The medical journal, ‘The Lancet’, “estimated conservatively that the most probable number of "excess deaths" due to the war (on Iraq) is about one hundred thousand. Their cluster sample excluded Falluja, where the number of violent deaths was much higher and would have greatly inflated the total; and it included the Kurdish regions, where there was almost no fighting and which therefore lowered the national average”, a war where the ugly ‘ethics’ of war led “Iraqi Red Crescent vehicles attempting to deliver medical supplies to besieged and wounded Iraqis (to be) turned back”. Even hospitals were not spared of the American governments atrocities, as explained by Chomsky again:
“One of the first acts in the conquest of Falluja was to take over the general hospital, which was a major war crime. And they gave a reason. The reason is the hospital was a "center of propaganda against allied forces" because it was producing "inflated civilian casualty figures." First of all, how do we know they were inflated? Because our dear leader said so. Secondly, the idea that you take over a hospital because it's publishing casualty figures is obscene. The Geneva Conventions could not be more clear. The wording says explicitly and clearly that "Medical and religious personnel shall be respected and protected and shall be granted all available help for the performance of their duties.... Medical units and transports shall be respected and protected at all times and shall not be the object of attack.” In the attack on Falluja General Hospital, patients were kicked out of their beds and doctors and patients were forced to lie on the floor, handcuffed. This is a grave breach of the Geneva Conventions. In fact the entire political leadership should face the death penalty under U.S. law for these actions. They're all eligible for the death penalty, according to the War Crimes Act passed by the 1996 Republican Congress.”
The Vietnamese, too are still suffering medically from the effects of the American invasion in the 1960s, whose government, as Noam Chomsky elaborates, “"cannot afford to repair many of the roads, hospitals and sewage drains destroyed 20 years ago by U.S. bombers, John Stackhouse reports from the shattered city. In 1991, the children's hospital was forced to close 50 of 250 beds and to ask patients to provide medicines. Doctors perform surgical operations on a table donated by Poland, largely without equipment. At the Vinh Medical Center, where the hospital's pharmacy remains "a pile of rubble," a doctor states the obvious: "the problems here are a consequence of the American war, and the embargo has made it worse."”
Does anyone recall the way former president Bill Clinton decided to bomb a Sudanese pharmaceutical company in August 1998 to divert the world’s attention from his various personal scandals, with Monica Lewinsky and others? This was “one little footnote in the record of state terror, quickly forgotten”, as brilliantly put by Chomsky in his little book, ‘9-11’. I would like to recount the memory of this, and find no better analysis of the event than that of Chomsky himself in that book, as it illustrates brilliantly the way politics can interact and ruin medicine:
“Though it is merely a footnote, the Sudan case is nonetheless highly instructive. One interesting aspect is the reaction when someone dares to mention it. I have in the past, and did so again in response to queries from journalists shortly after 9-11 atrocities. I mentioned that the toll of the "horrendous crime" of 9-11, committed with "wickedness and awesome cruelty" (quoting Robert Fisk), may be comparable to the consequences of Clinton's bombing of the Al-Shifa plant in August 1998. That plausible conclusion elicited an extraordinary reaction, filling many web sites and journals with feverish and fanciful condemnations, which I'll ignore. The only important aspect is that that single sentence- which, on a closer look, appears to be an understatement- was regarded by some commentators as utterly scandalous. It is difficult to avoid the conclusion that at some deep level, however they may deny it to themselves; they regard our crimes against the weak to be as normal as the air we breathe. Our crimes, for which we are responsible: as taxpayers, for failing to provide massive reparations, for granting refuge and immunity to the perpetrators, and for allowing the terrible facts to be sunk deep in the memory hole. All of this is of great significance, as it has been in the past.
About the consequences of the destruction of the Al-Shifa plant, we have only estimates. Sudan sought a UN inquiry into the justifications for the bombing, but even that was blocked by Washington, and few seem to have tried to investigate beyond. But we surely should. Perhaps we should begin by recalling some virtual truisms, at least among those with a minimal concern for human rights. When we estimate the human toll of a crime, we count not only those who were literally murdered on the spot but those who died as a result…In this case, we count the number who died as a consequence of the crime, not just those killed in Khartoum by cruise missiles; and we do not consider the crime to be mitigated by the fact that it reflects the normal functioning of policymaking and ideological institutions-as it did, even if there is some validity to the (to my mind, dubious) speculations about Clinton's personal problems, which are irrelevant to this question anyway, for the reasons that everyone takes for granted when considering the crimes of official enemies.
With these truisms in mind, let's have a look at some of the material that was readily available in the mainstream press. I disregard the extensive analysis of the validity of Washington's pretexts, of little moral significance in comparison to the question of consequences. A year after the attack, "without the lifesaving medicine [the destroyed facilities] produced, Sudan's death toll from the bombing has continued, quietly, to rise... Thus, tens of thousands of people-many of them children- have suffered and died from malaria, tuberculosis, and other treatable diseases... [Al-Shifa] provided affordable medicine for humans and all the locally available veterinary medicine in Sudan. It produced 90 percent of Sudan's major pharmaceutical products... Sanctions against the Sudan make it impossible to import adequate amounts of medicines required to cover the serious gap left by the plant's destruction... [T]he action taken by Washington on August 20, 1998, continues to deprive the people of Sudan of needed medicine. Millions must wonder how the International Court of Justice in The Hague will celebrate this anniversary" (Jonathan Belke, Boston Globe, August 22, 1999).
Germany Ambassador to Sudan writes that "It is difficult to assess how many people in this poor African country died as a consequence of the destruction of the Al-Shifa factory, but several tens of thousands seems a reasonable guess" (Werner Daum, "Universalism and the West," Harvard International Review, Summer 2001). "[T]he loss of this factory is a tragedy for the rural communities who need these medicines" (Tom Carnaffin, technical manager with "intimate knowledge" of the destroyed plant, quoted in Ed Vulliamy, Henry McDonald, Shyam Bhatia, and Martin Bright, London Observer, August 23, 1998, lead story, page 1). Al-Shifa "provided 50 percent of Sudan's medicines, and its destruction has left the country with no supplies of chloroquine, the standard treatment for malaria," but months later, the British Labour government refused requests "to resupply chloroquine in emergency relief until such time as the Sudanese can rebuild their pharmaceutical production" (Patrick Wintour, Observer, December 20, 1998).
The Al-Shifa facility was "the only one producing TB drugs- for more than 100,000 patients, at about 1 British pound a month. Costlier imported versions are not an option for most of them- or for their husbands, wives and children, who will have been infected since. Al-Shifa was also the only factory making veterinary drugs in this vast, mostly pastoralist, country. Its specialty was drugs to kill the parasites which pass from herds to herders, one of the Sudan's principal causes of infant mortality" (James Astill, Guardian, October 2, 100).
The silent death toll continues to mount. These accounts are by respected journalists writing in leading journals. The one exception is the most knowledgeable of the sources just cited, Jonathan Belke, regional program manager for the Near East Foundation, who writes on the basis of field experience in Sudan. The Foundation is a respected development institution dating back to World War I. It provides technical assistance to poor countries in the Middle East and Africa, emphasizing grassroots locally-run development projects, and operates with close connections to major universities, charitable organizations, and the State Department, including well known Middle East diplomats and prominent figures in Middle East educational and developmental affairs. According to credible analyses readily available to us, then, proportional to population, the destruction of Al-Shifa is as if the bin Laden network, in a single attack on the U.S. caused "hundreds of thousands of people-many of them children-to suffer and die from easily treatable diseases," though the analogy, as noted, is unfair. Sudan is "one of the least developed areas in the world. Its harsh climate, scattered populations, health hazards and crumbling infrastructure combine to make life for many Sudanese a struggle for survival"; a country with endemic malaria, tuberculosis, and many other diseases, where "periodic outbreaks of meningitis or cholera are not uncommon," so affordable medicines are a dire necessity (Jonathan Belke and Kamal El-Faki, technical reports from the field for the Near East Foundation). It is, furthermore, a country with limited arable land, a chronic shortage of potable water, a huge death rate, little industry, an unserviceable debt, wracked with AIDS, devastated by a vicious and destructive internal war, and under severe sanctions. What is happening within is largely speculation, including Belke's (quite plausible) estimate that within a year tens of thousands had already "suffered and died" as the result of the destruction of the major facilities for producing affordable drugs and veterinary medicines. This only scratches the surface.”
Interestingly, because of politics, many nations of the world have been deprived of medical care in previous times too; it is not a feature of just the more recent American politicians. For example following the Cyclone Flora that devastated Cuba and the Caribbean during a time of political embargo in October 1963, and although, “Theoretically, medicines and some food were exempt from the embargo … food and medical aid were denied …Standard procedure, incidentally”. Also:
“Consider Carter's refusal to allow aid to any West Indian country struck by the August 1980 hurricane unless Grenada was excluded (West Indians refused, and received no aid). Or the US reaction when Nicaragua was fortuitously devastated by a hurricane in October 1988. Washington could scarcely conceal its glee over the welcome prospects of widespread starvation and vast ecological damage, and naturally refused aid, even to the demolished Atlantic Coast area with longstanding links to the US and deep resentment against the Sandinistas; its people too must starve in the ruins of their shacks, to satisfy our blood-lust. US allies timidly followed orders, justifying their cowardice with the usual hypocrisy”.
However, I don’t think I am mistaken in saying that the poor American people themselves have actually been the first victims, medically speaking, of their current socio-political establishment. As Chomsky explains:
“You'd think that in a rich country like this, these wouldn't be big issues, but they are for a lot of the population. Lancet, the British medical journal -- the most prestigious medical journal in the world -- recently pointed out that 40% of children in New York City live below the poverty line. They suffer from malnutrition and other poor conditions that cause very high mortality rates -- and, if they survive, they have very severe health problems all through their lives. The New England Journal of Medicine pointed out a couple of years ago that black males in Harlem have about the same mortality rate as people in Bangladesh. That's essentially because of the extreme deterioration of the most elementary public health conditions, and social conditions.”
He elaborates elsewhere, that in the USA, “medical care is rationed by wealth. If you're rich, the system is working just right. The insurance companies, the health maintenance organizations, the pharmaceutical corporations are doing just great. Wealthy people are doing fine. If most of the population can't get decent medical care, that's not our problem. If health care costs are astronomical, too bad.” Our NHS is paradise compared to America’s health care system. In fact, there is no comparison. Gore Vidal explains:
“We are not actually people in the eyes of the national ownership: we are simply unreliable consumers comprising an overworked, underpaid labor force not in the best of health: The World Health Organization rates our healthcare system (sic—or sick?) as 37th-best in the world, far behind even Saudi Arabia, role model for the Texans. Our infant mortality rate is satisfyingly high, precluding a First World educational system.”
American politicians have also ruined the health of nations indirectly, through their cultural imperialism, leading to all the illnesses that are associated with it. But I shall not delve into this any further now.
American imperialism is one of the most important, if not the most important direct and indirect cause and fuel for terrorism. The American government, as we mentioned above, is the initiator of ‘radiation terrorism’, and the only government to have hit another nation with nuclear warfare (the Japanese army may have been at fault, but the victims of Hiroshima and Nagasaki were certainly innocent), and its crimes in many places have led to an unprecedented rise in extremism, and the threat of terrorism (including bioterrorism). This has led to a new problem in medicine, never seen before by our elders.
So much for politicians affecting medicine. But it is those same politicians who insist on making us believe that this is the best of times for medicine. I refuse to believe this. What we have achieved is – increasing the duration of one’s life, at the cost of increasing the duration of their misery, and this can hardly be regarded as a success. As explained by Alexis Carrel, the great French vascular surgeon and Nobel Prize winner:
“Nevertheless, in spite of the triumphs of medical science, the problem of disease is very far from solved. Modern man is delicate…Medicine is far from having decreased human sufferings as much as it endeavors to make us believe. Indeed, the number of deaths from infectious diseases has greatly diminished. But we still must die, and we die in a much larger proportion from degenerative diseases. The years of life which we have gained by the suppression of diphtheria, smallpox, typhoid fever, etc., are paid for by the long sufferings and the lingering deaths caused by chronic affections, and especially by cancer, diabetes, and heart disease. In addition, man is liable, as he was in former times, to chronic nephritis, brain tumors, arterial sclerosis, syphilis, cerebral hemorrhages, hypertension, and also to the intellectual, moral, and physiological decay determined by these maladies. He is equally subject to the organic and functional disorders brought in their train by excess of food, insufficient physical exercise, and overwork. The lack of equilibrium and the neuroses of the visceral nervous system bring about many affections of the stomach and the intestines. Heart diseases become more frequent. And also diabetes. The maladies of the central nervous system are innumerable. In the course of his life, every individual suffers from some attack of neurasthenia, of nervous depression, engendered by constant agitation, noise, and worries. Although modem hygiene has made human existence far safer, longer, and more pleasant, diseases have not been mastered. They have simply changed in nature.”
We are also living in an age where men like Carrel are running out. We are not in the age of heroes. Where are the outspoken physicians, like Carrel, who have the guts and integrity to stand up in the face of modern politicians and society, and see through all the masks and corruption that they display. I am yet to see anyone write anything like Carrel’s ‘Man The Unknown’, which says in its introduction:
“Newspapers, magazines, cinema, and radio ceaselessly spread news illustrating the growing contrast between material progress and social disorder. The triumphs of science in some fields mask its impotence in others. For the marvels of technology, such as featured, for example, in the New York World's Fair, create comfort, simplify our existence, increase the rapidity of communications, put at our disposal quantities of new materials, synthesize chemical products that cure dangerous diseases as if by magic. But they fail to bring us economic security, happiness, moral sense, and peace. These royal gifts of science have burst like a thunderstorm upon us while we are still too ignorant to use them wisely. And they may become highly destructive. Will they not make war an unprecedented catastrophe? For they will be responsible for the death of millions of men who are the flower of civilization, for the destruction of priceless treasures accumulated by centuries of culture on the soil of Europe, and for the ultimate weakening of the white race. Modern life has brought another danger, more subtle but still more formidable than war: the extinction of the best elements of the race.”
He wrote that in 1939, the year the Second World War began. He also wrote that, “The premature wearing out of modern men is probably due to worries, lack of economic security, overwork, absence of moral discipline, and excesses of all sorts” and, “The brutal materialism of our civilization not only opposes the soaring of intelligence, but also crushes the affective, the gentle, the weak, the lonely, those who love beauty, who look for other things than money, whose sensibility does not stand the struggle of modern life”.
In my opinion, medicine is one of the two things in our world that have endured the greatest injustices of our time (the other is the idea of God). Medicine has become a victim of all that is ugly and wrong with our world – excessive materialism, consumerism, and in short, inhumanity.
In his quite brilliant book ‘Hippocratic Oaths – Medicine and Its Discontents’, one of the few philosopher-physicians of our time, Professor Raymond Tallis raised the possibility that in the future, medicine may become “a business, its practitioners tradesmen, and health care just another industry”. He predicts a world where:
“The patient as client or customer in the shopping mall of medical care will see the doctor as a vendor rather than as a professional. There will be an increasing emphasis on the accoutrements that make the first experience, or the first encounter, customer friendly. The key to doctor-as-salesman will be the emphasis on those aspects of customer care that give the patient the feeling of ‘enpowerment’ – only weakly correlated with the actual empowerment that comes from effective evidence-based medicine. The almost robotic standardisation of the way doctors are taught to interact with patients – even down to when doctors should move from open to closed questions, when and how often they should use techniques to indicate they are listening, and the bodily postures that should be adopted – will make the professional, with a depp compassion and the ability to makes and stick by difficult unpopular advice, an ever-rarer bird. The doctors of the future will be easy-going and friendly conformists, relentlessly because, as George Bernard Shaw said, “The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man””
This, I believe, is already the case. The human side of medicine is disappearing. Far from developing the vision that the great William Osler had for it, who described it as “an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish”, it has become the exact opposite. Most junior doctors these days show, as Tallis explains, “an expressed unwillingness to work long hours and in particular, to do the unpaid work that earlier generations accepted as the norm”. Unlike previous generations, where “many, perhaps most of those who worked in the NHS….assumed that their job would be a way of life: it was going to be hard, rarely fun and sometimes a sheer grind. It was, however, serious and deeply worthwhile. This was what a calling was about. The notion of ‘creative fun’ had not yet taken hold in the collective consciousness. Doctors in the 1950s found working all hours an improvement on war-time service – working all hours and being shot at. The notion of a life-work balance had not entered their vocabulary”, medicine, to most people nowadays is merely a means to a living, and as John Saunders explains, “As the practice of medicine becomes more like just another industry, it is easy to narrow the concept of service to that of personal convenience”.
Part of the blame has to be put on the politics of it all, as I explained above. But also a lot must be put on the shoulders of materialism of the modern world, which may have spread itself to doctors. This is what Tallis himself believes, “We reflect the values of the society in which we have grown up. Doctors reared in a consumerist society will be consumers too”.
The selfishness and greed that predominates our world is also reflected in modern medicine. Tallis explains:
“Social attitudes have changed dramatically. One could grossly oversimplify the sequence of events by dividing the changes into two phases:the 1960s and the 1970s said that it was perfectly OK to be selfish: Thatcher’s children in the 1980s learned that it was almost a responsibility to be selfish. A more recent generation, perhaps, has build on this with the notion that it is more important to be cool and successful than to be truly useful and to help people in grave need. The tabloidisation of the national consciousnes has inculcated an ethos which accepts as role models empty characters in whom surface is more important than substance…it seems the emergent social ethos is hardly compatible with a life of caring for and worrying over others, especically in public service where it may be rewarded by low status, continuing criticism, and the possibility of public execration”. He further predicts, “Consumerism in patients who see the doctor as addressing their customer rights, and in cynical self-protecting doctors who want a life but who do no want to antagonise their customers, will push the profession from a calling to a business”.
Most people who enter medical, or any type of college for that matter, these days do not enter it because of any deep seated desire to help others. As explained on an encyclopedia article on consumerism:
“Beginning in the 1990’s the most frequent reason given for attending college had changed to making a lot of money, outranking reasons such as becoming an authority in a field or helping others in difficulty. This statement directly correlates with the rise of materialism, specifically the technological aspect. At this time compact disc players, digital media, personal computers, and cellular phones, all began to integrate into the affluent American’s everyday lifestyle. A large change in American culture has subsequently occurred – “a shift away from values of community, spirituality, and integrity, and toward competition, materialism and disconnection.”
Companies and corporations have realized that rich consumers are the most attractive targets for marketing their products. The upper class' tastes, lifestyles, and preferences, trickle down to become the standard which all consumers seek to emulate. The not so well off consumers can “purchase something new that will speak of their place in the tradition of affluence”. A consumer can have the instant gratification of purchasing a high-ticket item that will help improve their social status.
Emulation is also a core component of 21st century consumerism. As a general trend, regular consumers seek to emulate those who are above them on the social hierarchy. The poor strive to imitate the rich and the rich imitate celebrities and other icons. One needs to look no further than the celebrity endorsement of products to dissuade the notion that the American population makes its own decisions and models itself as a group of individualists.”
Society expects those same doctors, inculcated with those beliefs, to be the most perfect and virtuous humans. Society needs to realise that, as Sir Maurice Shock put it, “society is changing – gone are the ‘social contract’ and the ‘rights of man’; instead we have ‘the sales contract’ and the ‘rights of the consumer’”, and an environment like this is hardly conducive to the production of those angels. As Tallis says, “Dying, terrified, depressed patients will not get the doctors they need because a society whose overriding values are consumerist will not produce them.”
Instead of those angels, society has succeeded in producing doctors like Harold Shipman, who has killed more people than any other doctor – possibly over 200 patients, a man who was a drug addict as a junior doctor, who was “in 1976, fined £600 on drugs and - significantly for the future - forgery charges, but although he had a warning letter from the General Medical Council, he was not struck off. He accepted psychiatric treatment, and appeared to have rounded a difficult personal corner.”
Enter any medical school nowadays, and witness the corruption therein. I have, in my time as a student, encountered many colleagues who resorted to all sorts of drugs, and have continued this habit to their working days. As explained by one recent ‘Anaesthetics’ journal editorial, “Physician substance abuse is a significant societal problem that affects all aspects of medical care. Previous studies of addiction, which have included alcohol abuse, have projected that 10%–14% of physicians may become chemically dependent at some point in their careers”. Professor Roger Cicala, an American anesthesiologist states, “The impact of the problem is severe. Chemical impairment has been shown to be a major risk factor for medical malpractice and negligence lawsuits, the development of physical and psychological illness, and adverse effects on the substance abuser's family. Left untreated, the mortality rate of substance abuse among physicians has been reported as high as 17%”. A recent study, ‘Drink and drugs: from medical students to doctors’ in the journal ‘Drug and Alcohol Dependence’, showed that in recent years, “Mean alcohol consumption had increased significantly (P<0.015) title="" style="mso-footnote-id: ftn12" href="http://www.blogger.com/post-create.g?blogID=2074784451807076634#_ftn12" name="_ftnref12">, a recent NEJM article rightly said, “Medical students are reflective of society at large. Lack of professionalism among medical students is hardly surprising when high schools and colleges seem rife with unethical behavior that seems to be tolerated by society”. And until society is sorted, this will be an escalating problem, and the words of William Osler, that “In the records of no other profession is there to be found so large a number of men who have combined intellectual pre-eminence with nobility of character”, will become a distant memory or even a myth.
There are two other quite major problems that have afflicted medicine, that have become a huge burden on it. The first is the collapse of proper high quality research, and second is the fact that we live in the culture of the worried well, thanks primarily, to the efforts of the pharmaceutical industry that we mentioned above.
About the first point, Professor Colin Dollery, who worked in one of the best research institutes in the past made the following remark in his monograph:
“Problems seem larger, and solutions to them more elusive…the morality and cost-effectiveness of scientific medicine has been challenged…many people, including some of the most senior of the medical research hierarchy, are pessimistic about the claims of future advance. The age of optimism has ended.”
This point is emphasized immensely by James Le Fanu, one of the brilliant medical writers of our time, in his best-selling book, ‘The Rise and Fall of Modern Medicine’. He mentions how the number of medical researchers has declined immensely over the years, how “genuinely new drugs, had dropped off sharply from over seventy a year in the 1960s to less than twenty in the 1970s”, and how an analysis of the most recent newly released drugs found “only a third that seemed to offer even moderate therapeutic gain.”
Le Fanu elaborates on this further in another chapter:
“It would be wrong to suggest the scientific road to discovery from the mid-1970s onwards has not produced some genuinely useful drugs. Its successes include, most recently, a vaccine against the chronic liver infection hepatitis B and ‘triple therapy’ for the treatment of AIDS. But the current list of the top ten big ‘blockbuster’ drugs – the ones that generate the billions of dollars of revenue that sustain the industry’s profitability – features, for the most part, new or more expensive variants of the antibiotics, anti-inflammatories and antidepressants that were originally introduced twenty or more years ago. They might well be more effective, have fewer side effects or be easier to take, but with the occasional exception none can be described as making a significant inroad into previously uncharted therapeutic areas in the way the discovery of chlorpromazine, for example transformed the treatment of schizophrenia.
The most striking feature of many of the most recently introduced drugs is that there is considerable doubt about whether they do any good at all. Thus, there was much hope that the drug finasteride, ‘scientifically designed’ to block the metabolism of testosterone and thus shrink the size of the prostate, would reduce the need for an operation in those in whom the gland is enlarged. This would indeed have been a significant breakthrough but, as an editorial in the New England Journal of Medicine observed, “The magnitude of the change in symptoms (of patients) is not impressive”. Similarly, a new generation of drugs for the treatment of epilepsy based on interfering with the neurotransmitter GABA were dismissed by an editorial in the British Medical Journal As having been ‘poorly-assessed’ with no evidence that were any better than the anti-epileptic drugs currently in use. New treatments for multiple sclerosis and Alzheimer’s disease appear to offer such marginal benefits that their “clinical cost-effectiveness falls at the first hurdle”
Le Fanu makes the brave connection between those two points in the next paragraph.
“Frustrated at the failure to find cures for serious diseases like cancer and dementia, the pharmaceutical industry has been forced to look elsewhere for profitable markets for its products. This explains the rise of the so-called ‘lifestyle’ drugs whose prime purpose is to restore those social faculties or attributes that tend to diminish with age: Regaine for the treatment of baldness, Viagra for male impotence, Xenical for obesity and Prozac for depression.”
In order to survive, in the absence of serious therapeutic revolutions, the pharmaceutical industry may invent illness, and this is perhaps easiest in the field of psychiatry, whose disorders are diagnosed not in the same scientific, objective, quantitative fashion as other specialties, but is based totally on the patient’s ‘history’ and the observation of his or her behaviour and other things. Its diagnoses lack the objectivity of other specialties. Hence it is not uncommon to see five different diagnoses given for the same patient by five different psychiatrists. As explained by Richard Hunter in the ‘Proceedings of the Royal Society of Medicine’ in 1972:
“Psychiatrists do not diagnose their patients like other doctors do. They discard four of their senses and literally play by ear. It is the no-touch technique adapted to new purpose….Presenting symptoms are elevated to the status of disease like varieties of fever were in the eighteenth century. The pharmaceutical industry provides corresponding antidotes and reinforces the illusion.”
History has never heard of an anti-cardiology movement, or anti-gastroenterology movement, but it has heard of an anti-psychiatry movement, which is opposed to the medicalization of human behaviour (e.g. calling shyness ‘social phobia) to the benefit of the pharmaceutical industry (and those in power, as Michel Foucault and others illustrated).
Because of the medicalisation of many aspects of life, the wealthy West has become obsessed with its ‘medical’ health; this is evidenced by the flourishment of ‘healthy eating’, gymnasiums and other things. As Roy Porter explains:
“The irony is that the healthier Western society becomes, the more medicine it craves…Immense pressures are created – by the medical profession, by the media, by the high pressure advertising of pharmaceutical companies – to expand the diagnosis of treatable illnesses. Scares are created, people are bamboozled into lab tests, often of dubious reliability. Thanks to diagnostic creep or leap, ever more disorders are revealed, extensive and expensive treatments are then urged…This is endemic to a system in which an expanding medical establishment, faced with a healthier population, is driven to medicalising normal events, converting risks into diseases and treating trivial complaints with fancy procedures…The law of diminishing returns necessarily applies. Extending life becomes feasible, but it may be a life exposed to degrading neglect as resources grow overstretched. What an ignominious destiny if the future of medicine turns into bestowing meager increments of unenjoyed life!”
James Le Fanu devotes a big chunk of his book on the analysis of this phenomenon of the ‘worried well’:
“This is not the only sign that medicine is in trouble. Surveys reveal that the proportion of the population claiming to be "concerned about their health" has increased from one in ten in 1968, to one in two last year. And the most curious aspect of this new phenomenon of the "worried well" is that it is medically inspired. The well are worried because repeatedly and systematically they have been told by experts that their health is threatened by hidden hazards. The commonsense advice of the past-"don't smoke and eat sensibly"-has metamorphosed into an all-embracing condemnation of every sensuous pleasure: food, alcohol, sunbathing and sex. And every week brings yet another danger. Who would have thought until a few weeks ago that night lights which have reassured generations of children should be damaging to their eyesight?
The paradox of modern medicine that requires explanation is why its spectacular success over the past 50 years has had such perverse consequences-leaving doctors less fulfilled and the public more neurotic about their health. These are, of course, complex matters with any number of explanations. But consider a list of significant medical advances in the past 60 years-starting in 1937 with blood transfusion, and moving through penicillin, kidney dialysis, radiotherapy, cortisone, polio vaccination, the oral contraceptive pill, hip replacement operations, kidney transplants, coronary bypass, the cure of childhood cancer, CAT scanners, test-tube babies and concluding with Viagra. Several themes are easy to identify: the assault on infectious disease (penicillin and childhood immunisation); major developments in the treatment of mental illness, cancer and heart disease; the widening scope of surgery (hip replacements and transplantation); and improvements in diagnostic techniques (the CAT scanner). But what is most noticeable about the list is the concentration of the important breakthroughs in a 30-year period from the mid-1940s to the mid-1970s. Since then, there has been a marked decline in the rate of therapeutic innovation. This "rise and fall" runs counter to the common view of an upward and onward march of medical progress-but it provides the key to understanding current medical discontents.”
The result of this overmedicalisation and disease manufacture is what we have now – the culture of the worried well. The consequences of this are phenomenal. The following is an extreme example, given by none other than Anton Chekhov, the Russian novelist and physician:
“Z. goes to a doctor, who examines him and finds that he is suffering from heart disease. Z. abruptly changes his way of life, takes medicine, can only talk about his disease; the whole town knows that he has heart disease and all the doctors, whom he regularly consults, say that he has got heart disease. He does not marry, gives up amateur theatricals, does not drink, and when he walks does so slowly and hardly breathes. Eleven years later he has to go to Moscow and there he consults a specialist. The latter finds that his heart is perfectly sound. Z. is overjoyed, but he can no longer return to a normal life, for he has got accustomed to going to bed early and to walking slowly, and he is bored if he cannot speak of his disease. The only result is that he gets to hate doctors--that is all”.
Because of human greed, pharmaceutical companies, which may be regarded as the right arm of medicine, have turned into political and economic forces. For anyone interested in this exploitative aspect of medicine, there are many books and articles clarifying their many crimes. Far from being the idealistic research institutes that appear to be solely interested in the health and welfare of individuals, medicine as currently practised is dominated by the presence of these companies, which spend over twice as much of their income on marketing than on research, often on drugs of dubious effectiveness or value, or what are referred to as ‘me too drugs’. It is a world where marketing is mostly dressed up as science, where consultants and GPs, as well as more junior doctors fall often to the many temptations of the often artificially-friendly drug company representatives (‘drug reps’), which is often dressed up in an ‘educational meeting’ cloak. As explained by Marcia Angells, a prominent American physician and one of the foremost critics of the pharmaceutical industry, as well as a senior lecturer in Social Medicine at Harvard Medical School and former Editor in Chief of ‘The New England Journal of Medicine’, writing in the ‘New York Review of Books’ under the heading, “The Truth About the Drug Companies: How They Deceive Us and What to Do About It”:
“While the rhetoric is stirring, it has very little to do with reality. First, research and development (R&D) is a relatively small part of the budgets of the big drug companies—dwarfed by their vast expenditures on marketing and administration, and smaller even than profits. In fact, year after year, for over two decades, this industry has been far and away the most profitable in the United States. (In 2003, for the first time, the industry lost its first-place position, coming in third, behind "mining, crude oil production," and "commercial banks.") The prices drug companies charge have little relationship to the costs of making the drugs and could be cut dramatically without coming anywhere close to threatening R&D.
Second, the pharmaceutical industry is not especially innovative. As hard as it is to believe, only a handful of truly important drugs have been brought to market in recent years, and they were mostly based on taxpayer-funded research at academic institutions, small biotechnology companies, or the National Institutes of Health (NIH). The great majority of "new" drugs are not new at all but merely variations of older drugs already on the market. These are called "me-too" drugs. The idea is to grab a share of an established, lucrative market by producing something very similar to a top-selling drug. For instance, we now have six statins (Mevacor, Lipitor, Zocor, Pravachol, Lescol, and the newest, Crestor) on the market to lower cholesterol, all variants of the first. As Dr. Sharon Levine, associate executive director of the Kaiser Permanente Medical Group, put it,
If I'm a manufacturer and I can change one molecule and get another twenty years of patent rights, and convince physicians to prescribe and consumers to demand the next form of Prilosec, or weekly Prozac instead of daily Prozac, just as my patent expires, then why would I be spending money on a lot less certain endeavor, which is looking for brand-new drugs?
Third, the industry is hardly a model of American free enterprise. To be sure, it is free to decide which drugs to develop (me-too drugs instead of innovative ones, for instance), and it is free to price them as high as the traffic will bear, but it is utterly dependent on government-granted monopolies—in the form of patents and Food and Drug Administration (FDA)–approved exclusive marketing rights. If it is not particularly innovative in discovering new drugs, it is highly innovative—and aggressive—in dreaming up ways to extend its monopoly rights.”
Noam Chomsky wrote extensively too on this topic in many of his works, such as his book, ‘Year 501’, saying:
“While the US seeks to ensure monopoly control for the future, the drug companies it protects are cheerfully exploiting the accumulated knowledge of indigenous cultures for products that bring in some $100 billion profits annually, offering virtually nothing in return to the native people who lead researchers to the medicines, seeds, and other products they have developed and refined over thousands of years. "The annual world market value for medicines derived from medicinal plants discovered from indigenous peoples is US $43 billion," ethnobotanist Darrell Posey estimates. "Less than 0.001 percent of the profits from drugs that originated from traditional medicine have ever gone to the indigenous people who led researchers to them." Profits of at least the same scale derive from natural insecticides, insect repellents, and plant genetic materials, he believes. The international seed industry alone accounts for some $15 billion a year, based in large measure on genetic materials from crop varieties "selected, nurtured, improved and developed by innovative Third World farmers for hundreds, even thousands of years," Maria Elena Hurtado adds. Only the knowledge of the rich and powerful merits protection.”
Politically, we are not only threatened by religious fundamentalism and terrorism done under the name of religion (and I put American foreign policy, which is based on the ideas of Christian Evangelism under this category), but also by irreligion. Hasn’t the Chinese government, since 1949 been “officially atheist, which viewed religion as emblematic of feudalism and foreign colonialism.” If atheism was a blessing, then how why do we have what Jampal Chosang, the head of the Tibetan coalition stated recently, that, “China had introduced "a new form of apartheid" in Tibet because "Tibetan culture, religion, and national identity are considered a threat" to China”. Hasn’t Russia endorsed no official religion (in communist times, it was atheism), and then turned to attach the Chechnyans, in not one, but two wars since the demolition of the USSR.
Economically, the following story says it all. Only a few days ago, on the 19th of July 2008, I came across an article in ‘USA Now’ by the economist Thomas Haffner, entitled, ‘A Defeated and Conquered Nation’, which he introduced saying, “Americans have been defeated in an economic war with consequences as meaningful and damaging as if having lost a military war”. A day later, in the British broadsheet paper, the ‘Independent’ we were informed by journalist Margareta Pagano, under the heading, ‘Recession next year: forecaster says things can only get worse’, that, “The UK economy is heading for recession next year and unemployment could top two million by 2010”. A day later, Ambrose Evans-Pritchard tells us in another British broadsheet, ‘The Daily Telegraph’, that, “The global economy is at the point of maximum danger”.
That says it all.
POVERTY, WATER AND FOOD CRISIS
As a result of political greed and economic collapse, poverty and famine is rife, due to our lack of wisdom and foresight, and other factors, such as natural disasters and disease. They have led to the current ‘Water Crisis’, through which it is estimated that, “Not only are there 1.1 billion without adequate drinking water, but the United Nations acknowledges 2.6 billion people are without adequate water for sanitation (e.g. wastewater disposal)”, with its great impact on human welfare, particularly human health. It is felt by experts that:
“Waterborne diseases and the absence of sanitary domestic water are one of the leading causes of death worldwide. For children under age five, waterborne diseases are the leading cause of death. At any given time, half of the world's hospital beds are occupied by patients suffering from waterborne diseases. According to the World Bank, 88 percent of all diseases are caused by unsafe drinking water, inadequate sanitation and poor hygiene.”
They have also led to the current food crisis; the year 2008 has been labeled by economists as ‘The Year of Global Food Crisis’. Kate Smith and Rob Edwards, writing in a recent issue of the ‘Sunday Herald’, a Scottish broadsheet, report:
“It is the new face of hunger. A perfect storm of food scarcity, global warming, rocketing oil prices and the world population explosion is plunging humanity into the biggest crisis of the 21st century by pushing up food prices and spreading hunger and poverty from rural areas into cities. Millions more of the world's most vulnerable people are facing starvation as food shortages loom and crop prices spiral ever upwards. And for the first time in history, say experts, the impact is spreading from the developing to the developed world.”
The economic crisis has led to escalating health care costs – with many people unable to pay for their medication, thus instigating a vicious circle of poverty – as illustrated in the last issue of the Global Competitiveness Report, a yearly report published by the World Economic Forum, “poor access to affordable health care makes individuals less resilient to economic hardship and more vulnerable to poverty.” The following picture is worth a thousand words; it is taken from the ‘Statistics’ section of the WHO website:
The economic crisis will also have negative effects on crime rates; hardly a month passes by these days in England without hearing about two or three victims, usually in their teens, of ‘knife crime’ – so far in 2008 there have been 22 victims, the youngest aged 14, and the oldest aged 42. Writing under the headline, ‘Crime rates expected to soar as economic difficulties deepen, fall in car theft and robberies could be short-lived, officials warn’, Alan Travis, home affairs editor of ‘The Guardian’ said (on Friday July 18th 2008), “The credit crunch threatens to bring to an end the longest recorded period of falling crime in living memory in England and Wales, Home Office criminologists said yesterday…government officials predicted the economic slowdown would lead to "upward pressure" on levels of property crime, such as burglary and car break-ins.” The American economist Steven D. Levitt described living in the United States in the early 1990s, saying:
“Anyone living in the United States in the early 1990s and paying even a whisper of attention to the nightly news or a daily paper could be forgiven for having been scared out of his skin. The culprit was crime. It had been rising relentlessly—a graph plotting the crime rate in any American city over recent decades looked like a ski slope in profile—and it seemed now to herald the end of the world as we knew it. Death by gunfire, intentional and otherwise, had become commonplace. So too had carjacking and crack dealing, robbery and rape. Violent crime was a gruesome, constant companion. And things were about to get even worse. Much worse.”
Crime rates are increasing everywhere, and security is a very difficult to attain these days, or it comes at a very huge price. And insurance companies, as many of my friends will tell you, come to do their job very slowly, very reluctantly and often at very high prices.
The following picture is worth another thousand words; it shows the percentage of populations who are living below their nations’ poverty line, and is truly shocking:
As explained by Randy Charles Epping, a financial advisor based in Zurich in his book, ‘A Beginner’s Guide to the World Economy’:
“Economic and political misjudgment can be blamed for much of the Third World's poverty, but an important factor has also been the population explosion. Many developing countries have seen their populations double in as little as twenty years. This growth was due mainly to lack of birth control and declining mortality rates, resulting from improved medical care.
Extreme poverty in the Third World has forced many parents to create ever larger families, hoping that their children can work and increase family income. But the economic opportunities are often not available, and unemployed children and their parents end up moving into already overcrowded cities, in a fruitless search for work.Many underdeveloped nations have found themselves in a vicious circle of poverty and overpopulation, with no hope in sight. The flood of poor families into major cities puts enormous strain on the economic infrastructure. Shantytowns in such cities as Bombay, Sio Paulo, and Shanghai have become glaring reminders that the world economy has left behind many of the world's poor.
Saddled with enormous debt payments, hyperinflation, surging populations, and mounting unemployment, many Third World countries struggle just to keep their economies afloat. Sometimes, with no money available for investment, even the infrastructure, such as roads and water systems, literally falls apart.
The solution for many overburdened governments is to simply increase debt in order to keep the money flowing. However, this often results in rampant inflation, which ends up eroding most of these efforts, and creates an ever-widening gap between the Third World's poorest and richest economies.”
I love the way Epping refers to the crimes of our many politicians as ‘misjudgments’! This brings me nicely to another aspect of our ugly world that fills me with pessimism – the corruption of the media. This is something that has been spoken and written about extensively of late, especially by the great Noam Chomsky. I find the following explanation of Chomsky’s ideas on the Wikipaedia online encyclopedia extremely helpful and do not hesitate to quote it in full:
“Another focus of Chomsky's political work has been an analysis of mainstream mass media (especially in the United States), which he accuses of maintaining constraints on dialogue so as to promote the interests of corporations and the government.
Edward S. Herman and Chomsky's book ‘Manufacturing Consent: The Political Economy of the Mass Media’ explores this topic in depth, presenting their "propaganda model" of the news media with several detailed case studies in support of it. According to this propaganda model, more democratic societies like the U.S. use subtle, non-violent means of control, unlike totalitarian systems, where physical force can readily be used to coerce the general population. In an often-quoted remark, Chomsky states that "propaganda is to a democracy what the bludgeon is to a totalitarian state" (Media Control).
The model attempts to explain such a systemic bias in terms of structural economic causes rather than a conspiracy of people. It argues the bias derives from five "filters" that all published news must pass through which combine to systematically distort news coverage.
The first filter, ownership, notes that most major media outlets are owned by large corporations.
The second, funding, notes that the outlets derive the majority of their funding from advertising, not readers. Thus, since they are profit-oriented businesses selling a product — readers and audiences — to other businesses (advertisers), the model would expect them to publish news which would reflect the desires and values of those businesses.
In addition, the news media are dependent on government institutions and major businesses with strong biases as sources (the third filter) for much of their information.
Flak, the fourth filter, refers to the various pressure groups which go after the media for supposed bias and so on when they go out of line.
Norms, the fifth filter, refer to the common conceptions shared by those in the profession of journalism.
The model therefore attempts to describe how the media form a decentralized and non-conspiratorial but nonetheless very powerful propaganda system that is able to mobilize an "élite" consensus, frame public debate within "élite" perspectives and at the same time give the appearance of democratic consent.”
The corruption of the media has not just affected our journalism. Leaving the Western media world aside, I don’t know when the last time I watched a decent Arabic movie was. Are not the songs of today a far cry from the enchantments of Farid and Fairuz, Om Kalthoom, Abdel Halim, Abdel Wahab and others? Even the serials – they have lost their innocence and simplicity; compared to previous times, when serials, the comedies and soap operas used to host at most twenty actors, now they have become an example of extravagance and excess – the costs of some reaching millions of dollars, with the wages of some Arab actors and actresses reaching millions. Of course, this corruption, and treatment of everything as an industry, which has taken the joy out of everything in life, has affected all that media covers, from football to horse racing. I recall reading an interview with Zionist media mogul Rupert Murdoch, who owns ‘Sky’ and other major media, published in ‘The Guardian’ a year ago, entitled, ‘Murdoch: How I changed football’. He indeed has, and has made it ugly. Is it just, or humane that footballers (and these men are not prophets or people who render any great service to humanity) get paid so much, for the very noble and civilized act of kicking a ball around. ‘The Encylopedia of British Football’ reveals to us that, in September 1893, Derby County made the controversial move of proposing “that the Football League should impose a maximum wage of £4 a week. At the time, most players were only part-time professionals and still had other jobs. These players did not receive as much as £4 a week and therefore the matter did not greatly concern them. However, a minority of players, were so good they were able to obtain as much as £10 a week.” Goodness knows what those first footballers would think if they were brought back from the dead a hundred years later, to find out what their colleagues are earning nowadays, or cast an eye on the list of the highest earning footballers in the world today (note that the earnings are annual and without considering the footballers’ commercial interests, advertising involvement etc); we are told that Ricardo Kaka of AC Milan earns about 9,000,000 € a year, his compatriot Ronaldinho over 8,520,000 € and Frank Lampard of Chelsea FC 8,160,000 €.
After reviewing all those things, I cannot help but think that this is the worst of times. Life has not got any flavour. I do not think I am being pessimistic or looking at the world ‘through black shades’. I am simply realistic. I am not prepared to live in a fool’s paradise, or delude myself into believing that this is the best of times, as many of my acquaintances believe.
For someone dismayed so much by life today, the easiest solution is suicide, for who would want to live in a world like this. But that is the cowardly option. The brave person confronts the world, with all its atrocities and evils, with the aim of helping get rid of them or change them. As I age, I have become more cynical of everything, and especially so of the medical profession, which, by virtue of the fact that I have been involved in it, as a student and professional, for nearly ten years now, I can assess more than those who have not been so involved with it. And I have come to see why someone like Bertrand Russell, a man who strived all his long life to change the world he was living, “The secret of happiness is to face the fact that the world is horrible, horrible, horrible....” Fortunately for myself, I am glad to say that I am not the only one so disenchanted with the state of the medical world. A BMJ article a few years ago began with the lines, “Doctors are unhappy. They are not all unhappy all the time, but when doctors gather, their conversation turns to misery and talk of early retirement. The unhappiness has been illustrated in a plethora of surveys and manifests itself in talk of a mass resignation by general practitioners from the NHS. The British government is rattled by the unhappiness of doctors, recognising that a health service staffed by demoralised doctors cannot flourish. It has responded by trying to hand more control of the service to frontline staff.”
Tallis, in his aforementioned work also makes the same point:
“There is mounting evidence that doctors are increasingly unhappy with their professional life. The rising levels of job dissatisfaction are striking. Of doctors graduating in 1974, the majority were reasonably content with their lot, though the prospect of the early retirement many were planning may have had something to do with this. In contrast, 25 per cent of the 1995 cohort had only a lukewarm desire to continure in medicine, and only 13 per cent still had a strong desire to be doctors. These alarming figures may be due to the greater expectation of happiness, and specifically of job satisfaction, of the more recent generation; but they will also be due to alterations in the working life.
In the USA, where morale among doctors is also low, the most important factor is loss of professional independence. What made medicine a profession in the modern sense of the term, in the authonomy they enjoyed in their everyday work, meant that they were not organisation men. Ronald Dworkin observes:
“They did not have to be backslappers or joke-tellers or handshakers; they did not have to get along with their boss or be shrewdly political…they answered to no one but their patients”
Now, “they must please some faceless bureaucrat without a medical education before ordering a test”. They are forced to become organisation men; and “since they get little more out of their work than a paycheck, the money is much more important to them, and they try increasingly to make more of it”. This is what happens “when the medical profession is shorn of its transcendent qualities – its mistique, its notion of duty, its code of honour – and made into a rational economic enterprise”.
Nevertheless, I live in hope that all of these things will change. I recently completed a book on the Palestinian problem, one of the most difficult problems of our time, which many have come to regard as insoluble. I introduced it with a message of optimism, stating that truth and justice is a promise from God, and that moroseness and pessimism have no place in Quranic moral values.
As much as circumstances could lead me to believe, I cannot think that my life and practice so far is futile. Perhaps I have become attached to it, by virtue of having studied it for six long years in medical school, and having practiced and earned my living from it over the past three years. But I don’t think that entirely explains why I have a great hope in medicine, and a deep attachment toit. It remains, regardless of what I have mentioned above, a quite beautiful world.
As everyone who knows me knows, I never wished to be part of this world in my youth, and always wished I would enter university and study the more intellectual fields of philosophy or physics and philosophy. Having entered it, owing to parental persuasion, I tried to philosophize it, and this is what has kept me going to this day. Despite its current ugliness, most of which I had not known about until I started working and beyond, I now know that medicine, stripped of its political and economic cloak is, as I say, a beautiful world, worthy of all our attentions, and that its study, besides being of immense human and societal benefit, could be of great comfort to one who believes in God, for His majesty shines everywhere within it.
Soon after he discovered his One Lord, the great prophet Ibrahim described God as ‘the Healer’, in Arabic, ‘Al-Shafi’, saying to his people, “Do you see these idols that you worship. You and your ancestors. I am against them, for I am devoted only to the Lord of the universe. The One who created me, and guided me. The One who feeds me and waters me. And when I get sick, He heals me” (26:76-82). God is inextricably connected with the healing process, something Ibrahim, in his great insight (PBUH) realized at a very early stage. It is this same quality that was described by Pare thousands of years later in his aforementioned statement, “Je le pansai, et Dieu le guarist (I treat the wounds, but God heals them)”.
But anyone with the idea of God as the most perfect of all beings will realize that there is much else that medicine can teach besides that of the idea of God as the Healer. As Pare and other religious explorers of the human body realized, the study of the human body and its diseases can reveal to us much about the ingenuity of God’s design. To quote one of Islam’s finest scholars of the past, Abu Hamid Al-Gazzali (Al-Gazel), who wrote in his ‘Alchemy of Happiness’:
“An important part of our knowledge of God arises from the study and contemplation of our own bodies, which reveal to us the power, wisdom, and love of the Creator. His power, in that from a mere drop He has built up the wonderful frame of man; His wisdom is revealed in its intricacies and the mutual adaptability of its parts; and His love is shown by His not only supplying such organs as are absolutely necessary for existence, as the liver, the heart, and the brain, but those which are not absolutely necessary, as the hand, the foot, the tongue, and the eye. To these He has added, as ornaments, the blackness of the hair, the redness of lips, and the curve of the eyebrows.
Man has been truly termed a "microcosm," or little world in himself, and the structure of his body should be studied not only by those who wish to become doctors, but by those who wish to attain to a more intimate knowledge of God, just as close study of the niceties and shades of language in a great poem reveals to us more and more of the genius of its author”.
He is the Creator, the great Designer, and Great Architect of the Human Body. He is the Master, the most Beautiful, whose grandeur and artistry is immanent in all of His Creation, and very vividly in the human body, in health and disease. For without disease, would we have known health? Without the human capacity to suffer illness, would humans have entertained the idea of the study of the human body, at least as seriously as we do now? I think not, for human beings are driven chiefly by necessity. The study of disease provides a great opportunity to learn about normal human anatomy and physiology, and the great genius that is present in every single such aspect. This was highlighted by the great Charles Horace Mayo, founder of the Mayo Clinic, in a statement he made to the American College of Surgeons at the turn of the century, saying, “Disease at times creates experiments that physiology completely fails to duplicate, and the wise physiologist can obtain clues to the resolution of many problems by studying the sick” and the greatest medical writer of our time, Arthur Clifton Guyton, in the introduction to one of his fine physiology books, saying, “A small but important part of this text presents not only knowledge that has come from basic experiments in animals, but also knowledge that has come from human experiments, especially unplanned experiments caused by disease. Literally thousands of human experiments proceed each day in the fields of high blood pressure, congestive heart failure, gastrointestinal disturbances, respiratory disease, and so forth. The physiology of these abnormalities is discussed briefly, partly because study of the diseases themselves can be enlightening, but even more because they give important insights into basic physiological concepts”.
I believe that the root cause of all our problems is the neglect of God, and lack of ‘submission to Him’ – which, translated into Arabic, is called ‘Islam’. Without the most powerful and beautiful idea and realisation that He exists, mankind is on a sure road to decline. The Holy Quran states most truthfully, “They forgot God, so He made them forget themselves”. And indeed, that is what has happened. We have forgotten ourselves Our world, after Nietzsche, has come to believe, that God is dead. How those ‘thinkers’ come to these ‘scientific’ conclusions, I do not know.
Can a person with a higher purpose in life, who is truthfully and fully engaged, in heart and mind, with the remembrance and worship of God, succumb to all the above named corruption, the mindless pleasures of life which take their toll on the human body that was designed to carry the spirit of God, and destroy it?
Count the proportion of patients who enter with ‘Godless diseases’ if you like, and note the amount of money and energy that the world would be spared if we truly lived as He would like us to live.
God tells us, “And eat and drink moderately; surely, He does not love the gluttons” (7:31), and we are advised by the great prophet Muhammad (PBUH) to (in eating), “apportion a third of your stomach to food, another third to water, and leave the last third empty. The bowl most distasteful to God is a full stomach”, the same man who said, “I fear concerning my community a large paunch, oversleep, idleness and the lack of certainty”. With that kind of advice, I am sure the obesity epidemic, with all its many complications (ranging from hypertension and diabetes to osteoarthritis and cosmetic issues including ulcers) would be a lot more under control.
With the intoxication of the love of God, akin to that of the great mystics of the past, there would be no need to get drunk, and thus we are spared the thousands of admissions that we see every day with alcohol related problems. Ignoring the very wise injunction in the Quran about the prohibition of alcohol consumption given in the verse, “Oh You who believe! Wine and gambling, stone altars and divining arrows are filth from the handiwork of Satan. Avoid them completely so that hopefully you will be successful. Satan wants to stir up enmity and hatred between you by means of wine and gambling, and to debar you from remembrance of Allah and from prayer. Will you not then give them up?” (5:90-91), I am sure that neither Jesus nor Moses (PBUT), nor the great Rabbis and teachers of Judaism and Christianity would not endorse the attitude many people have towards drinking. Even if such religions allowed for excessive drinking, it would never occur to the mind of a strong believer in them, since there is no reason to drink excessively, an attitude usually triggered by a misunderstanding of life events and the purpose of life, and again, the neglect of God.
With a firm belief in God, we would be spared of much mental illness. In this Godless world, it is the firm conviction of many prominent thinkers and physicians that much of the misery and melancholy of modern man is caused by an incorrect or inappropriate conception of the meaning of life and the lack of a grand worldview. Professor Alexis Carrel, for example (the famous French vascular surgeon and Nobel Prize winner wrote many books on the spiritual crisis of modern man, where he blamed capitalism and consumerism for the present suffering of mankind (he was also a great critic of communism for that matter). In his ‘Reflections on Life’, Carrel said:
“Modern society has been preoccupied with material values. It has neglected fundamental human problems, which are both material and spiritual. Not only has it not brought us happiness but it has shown itself incapable of preventing our deterioration. The conquest of health is not enough. We must also bring about in every individual the finest development of his hereditary power and of his personality, for the quality of life is more important than life itself”
A contemporary psychiatrist, Dr. Victor Frankl also made the following testimony about his practice, “More and more of our patients are crowding out our clinics and consulting rooms complaining of an inner emptiness, a sense of total and ultimate meaninglessness of their lives.” This is increasingly due to a lack of reflection on the deeper questions of life, brought on by the exhilarating pace of our materialistic, consumerist culture. Here the words of Socrates are most apt, “The unexamined life is not worth living”. Life without deep examination of the questions that matter is utterly unworthy, because it causes too much distress and pain. Not reflecting on God would lead to a huge vacuum in one’s life. As Blaise Pascal put it, “There is a God shaped vacuum in the heart of every man which cannot be filled by any created thing, but only by God, the Creator”. A contemporary professor of philosophy, William Lane Craig put it well too, “Modern man thought that when he had gotten rid of God, he had freed himself from all that repressed and stifled him. Instead, he discovered that in killing God, he had also killed himself”.
In the past history of the West (and to this day in many other parts of the world), religious faith provided man with the grand worldview, and there is evidence that that is the reason why psychiatric disorders are a lot less common, or are far less symptomatic in religious people (18-21). The great Swiss psychiatrist Carl Gustav Jung (1875-1961) was even led by this evidence to write, “Religions are systems of healing for psychic illness”
And let’s not mention sparing the world the burden of sexually-transmitted diseases, alcohol and drug-related problems, and other diseases of excess, which as I mention above, have inflicted even doctors and those aspiring to be doctors. With the idea of God fixed firmly in one’s mind, can we imagine those problems? I certainly can’t. Can one imagine in a God-conscious society, children deposit their parents in nursing and residential care homes, and not ask about them except until the time of inheritance comes, a not too infrequent occurrence in this day and age in the United Kingdom, or a residential care home nurse force a 90 year old man, who she does not wish to look after for a night, to go to hospital, who she cunningly ‘diagnosed’ with ‘worsening confusion’ when the poor man has remained in a chronic confusional state (we call it dementia) for years? I think not. Respect for one’s parents is an axiom of all religions – it is part of the Ten Commandements, and the Quran repetitively tells us, “We have instructed man to be good to his parents. His mother bore him with difficulty and with difficulty gave birth to him; and his bearing and weaning take thirty months. Then when he achieves his full strength and reaches forty, he says, ‘My Lord, keep me thankful for the blessing You bestowed on me and on my parents, and keep me acting rightly, pleasing You. And make
my descendants righteous. I have repented to You and I am truly one of the Muslims’” (46:15), and “Remember when We made a covenant with the tribe of Israel: ‘Worship none but Allah and be good to your parents and to relatives and orphans and the very poor. And speak good words to people. And perform prayer and give the alms.’ But then you turned away–except a few of you–you turned aside” (2:83) and, “Worship Allah and do not associate anything with Him. Be good to your parents and relatives and to orphans and the very poor, and to neighbours who are related to you and neighbours who are not related to you, and to companions and travellers and your slaves. Allah does not love anyone vain or boastful” (4:36).
It is my hope, and indeed my main aim in this book, to show that God is alive and apparent in everything in medicine. I hope to use medicine as a medium, so to speak, of my deepest and most strongly felt belief – that God is. And very much so. In His reverence and praise, we have the kind of religious activity that Carrel describes in the following words:
“Religious activity assumes various aspects, as does moral activity. In its more elementary state it consists of a vague aspiration toward a power transcending the material and mental forms of our world, a kind of unformulated prayer, a quest for more absolute beauty than that of art or science. It is akin to esthetic activity. The love of beauty leads to mysticism. In addition, religious rites are associated with various forms of art. Song easily becomes transformed into prayer. The beauty pursued by the mystic is still richer and more indefinable than the ideal of the artist. It has no form. It cannot be expressed in any language. It hides within the things of the visible world. It manifests itself rarely. It requires an elevation of the mind toward a being who is the source of all things, toward a power, a center of forces, whom the mystic calls God. At each period of history in each nation there have been individuals possessing to a high degree this particular sense. Christian mysticism constitutes the highest form of religious activity. It is more integrated with the other activities of consciousness than are Hindu and Tibetan mysticisms. Over Asiatic religions it has the advantage of having received, in its very infancy, the lessons of Greece and of Rome. Greece gave it intelligence, and Rome, order and measure.
Mysticism, in its highest state, comprises a very elaborate technique, a strict discipline. First, the practice of asceticism. It is as impossible to enter the realm of mysticity without ascetic preparation as to become an athlete without submitting to physical training. Initiation to asceticism is hard. Therefore, very few men have the courage to venture upon the mystic way. He who wants to undertake this rough and difficult journey must renounce all the things of this world and, finally, himself. Then he may have to dwell for a long time in the shadows of spiritual night. While asking for the grace of God and deploring his degradation and undeservedness, he undergoes the purification of his senses. It is the first and dark stage of mystic life. He progressively weans himself from himself. His prayer becomes contemplation. He enters into illuminative life. He is not capable of describing his experiences. When he attempts to express what he feels, he sometimes borrows, as did St. John of the Cross, the language of carnal love. His mind escapes from space and time. He apprehends an ineffable being. He reaches the stage of unitive life. He is in God and acts with Him.
The life of all great mystics consists of the same steps. We must accept their experiences as described by them. Only those who themselves have led the life of prayer are capable of understanding its peculiarities. The search for God is, indeed, an entirely personal undertaking. By the exercise of the normal activities of his consciousness, man may endeavor to reach an invisible reality both immanent in and transcending the material world. Thus, he throws himself into the most audacious adventure that one can dare. He may be looked upon as a hero, or a lunatic. But nobody should ask whether mystical experience is true or false, whether it is autosuggestion, hallucination, or a journey of the soul beyond the dimensions of our world and its union with a higher reality. One must be content with having an operational concept of such an experience. Mysticism is splendidly generous. It brings to man the fulfillment of his highest desires. Inner strength, spiritual light, divine love, ineffable peace. Religious intuition is as real as esthetic inspiration. Through the contemplation of superhuman beauty, mystics and poets may reach the ultimate truth.”
I do not agree with Carrel regarding his bias towards ‘Christian mysticism’, but agree with the main thrust of his argument otherwise. I would much rather he said, ‘ deep reflection about God’ rather then ‘mysticism’, a word that has come to have several negative connotations of irrational behaviour and thoughts of late, such as whirling Dervishes and talking with spirits. I wish mysticism was looked upon like Bertrand Russell over 50 years ago, when he said, “The mystic emotion, if it is freed from unwarranted beliefs, and not so overwhelming as to remove a man wholly from the ordinary business of life, may give something of very great value - the same kind of thing, though in a heightened form, that is given by contemplation. Breadth and calm and profundity may all have their source in this emotion, in which, for the moment, all self-centred desire is dead, and the mind becomes a mirror for the vastness of the universe”, but the world, at large, has become too irrational to take such reasonable men seriously.
My main thesis in this book is to show that medicine can be a great path to God, as a mystical activity so to speak (in the sense of Russell and Mustafa Mahmood), in a similar sense that Paul Davies, one of the most popular scientific writers of our time, believes that science provides a truer path to God than religion. I do not agree with this entirely of course, but can see exactly why he, coming from a Christian background, with its rather unbelievable depictions of God, would say something like that. As far as I am concerned, only two religions provide a truthful picture of God – deism and Islam, the latter being the only uncompromising monotheistic ancient religion.
But the kind reader may oppose my thesis by looking at how primitive current ‘Islamic’ societies are. He or she may ask, if Islam is the religion of around 1.8 billion people around the world, is the world in such a dire state. Surely if Islam is so great, we would not have the chaos we are living in.
My response to this is that ‘Islam’ has come to mean, to the vast majority of people, including most Muslims, as simply a meaningless name. What it actually stands for is simple and not difficult to deduce – its in its very name for goodness sake; it simply means ‘submission to God’. The Islam we have practiced nowadays is merely a name – devoid in the majority of cases from any submission to God. It is more a submission to tradition, to what ‘the scholars of old said’, to what the Prophet Muhammad (PBUH) is reported to have said, than what he actually said, to what is ‘thought to be Islam’ than to God Himself.
The so called Islamic world today lives in a deep myth and illusion that they have referred to as Islam. The vast majority of Muslims hold very strange beliefs, which I do not wish to delve into in this introduction. These beliefs have led to some extraordinary practices that have led to the nightmare we currently live in – most importantly, the relegation of reason and rational thought, as if submission to God means we have to abandon reason. In the Islamic world, Bertrand Russell’s fantastic statement, “Most people would rather die than think: many do” is most descriptive and truthful.
It is as if God, to paraphrase the great Italian scientist Galileo, “who has endowed us with sense, reason, and intellect has intended us to forego their use”. It is as if He never mentioned the words ‘think’, ‘reflect’, ‘ponder’ in the Quran, words used many hundreds of times, as evidenced by the following verses:
“Do you not see that Allah has subjected to you everything in the heavens and earth and has showered His blessings upon you, both outwardly and inwardly? Yet there are people who argue about Allah without knowledge or guidance or any illuminating Book. (31:20)
Do you not see that Allah propels the clouds then makes them coalesce then heaps them up, and then you see the rain come pouring out of the middle of them? Do they not see how We drive water to barren land and bring forth crops by it which their livestock and they themselves both eat? So will they not see? (32:27)
Do you not see that Allah sends down water from the sky and threads it through the earth to emerge as springs and then by it brings forth crops of varying colours, which then wither and you see them turning yellow and then He makes them into broken stubble? There is a reminder in that
And do not follow (blindly) any information of which you have no (direct) knowledge. (Using your faculties of perception and conception, you must verify it for yourself. (In the Court of your Lord,) you will be held accountable for your hearing, sight, and the faculty of reasoning."[17:36]
They will ask you about alcoholic drinks and gambling. Say, ‘There is great wrong in both of them and also certain benefits for mankind. But the wrong in them is greater than the benefit.’ They will ask you what they should give away. Say, ‘Whatever is surplus to your needs.’ In this way Allah makes the Signs clear to you, so that hopefully you will reflect. (2:219)
Would any of you like to have a garden of dates and grapes, with rivers flowing underneath and containing all kinds of fruits, then to be stricken with old age and have children who are weak, and then for a fierce whirlwind containing fire to come and strike it so that it goes up in flames? In this way Allah makes His Signs clear to you, so that hopefully you will reflect. (2:266)
(People with intelligence are) those who remember Allah, standing, sitting and lying on their sides, and reflect on the creation of the heavens and the earth: ‘Our Lord, You have not created this for nothing. Glory be to You! So safeguard us from the punishment of the Fire.’ (3:191)
Say: ‘I do not say to you that I possess the treasuries of Allah, nor do I know the Unseen, nor do I say to you that I am an angel. I only follow what has been revealed to me.’ Say: ‘Are the blind the same as those who can see? So will you not reflect?’ (6:50)
If We had wanted to, We would have raised him up by them. But he gravitated towards the earth and pursued his whims and base desires. His metaphor is that of a dog: if you chase it away, it lolls out its tongue and pants, and if you leave it alone, it lolls out its tongue and pants. That is the metaphor of those who deny Our Signs. So tell the story so that hopefully they will reflect (7:176)
Have they not reflected? Their companion is not mad. He is only a clear warner. (7:184)
The metaphor of the life of this world is that of water which We send down from the sky, and which then mingles with the plants of the earth to provide food for both people and animals. Then, when the earth is at its loveliest and takes on its fairest guise and its people think they have it under their control, Our command comes upon others back for a specified term. There are certainly Signs in that for people who reflect. (39:42)
And He has made everything in the heavens and everything on the earth subservient to you. It is all from Him. There are certainly Signs in that for people who reflect. (45:13)
If We Had sent down this Qur’an onto a mountain, you would have seen it humbled, crushed to pieces out of fear of Allah. We make such examples for people so that hopefully they will reflect (59:21)”
Where is the submission to God in the presence of these verses? Why is it that “the Muslim world lags far behind in scientific achievement and research; Muslim countries contribute less than 2 percent of the world's scientific literature. Spain alone produces almost as many scientific papers. In countries with substantial Muslim populations, the average number of scientists, engineers and technicians per 1,000 people is 8.5. The world average is 40. Muslim countries get so few patents that they don't even register on a bar graph comparison with other countries. Of the more than 3-million foreign inventions patented in the United States between 1977 and 2004, only 1,500 were developed in Muslim nations. In a survey by the Times of London, just two Muslim universities -- both in cosmopolitan Malaysia -- ranked among the top 200 universities worldwide… No major invention or discovery has emerged from the Muslim world for well over seven centuries now.”
It is simplistic to say, as Pervez Amirali Hoodbhoy, a Pakistani Muslim physicist does, that, “only when reason bowed to faith, science in the Islamic world essentially collapsed”. Or as one NASA researcher recently put it, "Science has now been replaced by religious thinking…Logic unfortunately is a smaller and smaller part of society." Faith and scientific thought are complementary, and one cannot replace the other. It is only in the complete submission to God that such a harmony is achieved.
The problem lies, therefore in blind adherence to this thing called ‘Islam’, rather than submission to God, which is what it stands for. We have become a people of clichés and labels, rather than people of the essence and what our religion actually stands for. We have become more interested in the scarf and the beard, rather than beauty, justice and rational thought. And, what is even worse, is that those who stand for these things are regarded as ‘deviators’, as ‘corruptors of the religion’. It is the sad state of the world. Those who encourage this view, and advocate the spread of scientific thought and reason, are either rejected, or their life is made difficult, so they leave the ‘Islamic world’ and practice their mental faculties abroad, as one journalist explains, “Today, many of the brightest scientific minds leave their countries to study in Western universities like Virginia Tech and the Massachusetts Institute of Technology, both of which have sizeable Muslim student associations. By some estimates, more than half of the science students from Arab countries never return home to work.”
Among those Islamic thinkers who had to leave the Islamic world because they simply encouraged ‘submission to God’ (as opposed to other authorities), is Muhammad Asad. His story is extremely fascinating, and well worth knowing. One of his biographies reveals this gulf between him and the ‘Muslim world’:
“Unlike so many other Western converts to Islam, Asad chose also to live in Muslim societies, and worked to give Islam direction. But by advocating this reform, Asad remained a foreign body in contemporary Islam, a transplant rejected time and again by his hosts. Saudi Arabia declined to keep him as a journalist; Pakistan, which he served as an official and diplomat, also broke with him; and the self-appointed guardians of Muslim orthodoxy shunned him as a Qur'an translator and commentator. Paradoxically, Asad won genuine acclaim in the West. There he found minds open to his ideas, and opportunities to publish and lecture. And there he ultimately found refuge from the late twentieth-century reality of Islam.”
It is a very sad state of affairs. Personally, I feel like in a manner analogous to Martin Gardner, the American mathematician and philosopher that one can drop out of ‘traditional Islam’, the Islam of the beard and the jilbab, and the abandonment of submission to God, yet be an excellent Muslim and hava the most solid belief in the superiority of the Prophet Muhammad (PBUH) over all men. I also believe that “such a faith, unburdened by strange dogmas”, is truer to the heart of what the Prophet Muhammad (PBUH) and all the great prophets taught, than what the traditional books and most of the current ‘scholars of Islam’ state. Like Gardner believes that “if Jesus were to return to earth today he would not call himself a Christian”, I believe that if the Prophet Muhammad (PBUH) were to return to earth today he would dissociate himself from much that is regarded as ‘Islamic’ today. I would like to regard myself as a follower of the quintessence of Islam, with the aim of becoming a quintessential Muslim, with the utmost respect for reason and science, and the utmost freedom from myth, blind indoctrination and superstition; one who is happy to acquire knowledge and wisdom from everywhere and anywhere, in accordance with the prophetic statement, "Wisdom is like a precious commodity that is lost. A believer must always be in search of it. Wherever he finds it, he must act upon what it dictates"; one who has nothing to fear from any truth, science or wisdom, because all such things emanate from His Beautiful Names in all their glory.
Until ‘submission to God’ and His honest and truthful worship are instigated, ‘Islam’ will remain merely be a label, a vacuous concept not worthy of our attentions. It is my firm belief that the Taliban, which stands for everything that ‘traditional Islam’ teaches (those who believe otherwise are mistaken), are but a natural outcome of its blind philosophy. Until we submit ourselves to God, we will remain the defeated, humiliated, irrational, and blind people we are now. Muslims have abandoned God – both the seemingly ‘religious ones’ and the non-religious ones.
The religious ones, as I say, have forgotten the essence of true religion, of submission to God. For them what matters are the rituals and ‘religious laws’, what is permitted and what is forbidden. The principles that the Quran came to advocate are not interesting to them. Even when science is encouraged, it is only encouraged if put under the guise of ‘Islamic science’. One journalist notes, “Muslim scientists who do work in their native countries often find themselves embracing -- publicly at least -- so-called "Islamic science." Popularized in the '80s as an alternative to Western science and its perceived lack of moral values, the Islamic version tries to mesh religion and science with curious results. "Some scholars calculated the temperature of Hell, others the chemical composition of heavenly djinnis spirits," Hoodbhoy writes. "None produced a new machine or instrument, conducted an experiment or even formulated a single testable hypothesis." Instead, fundamentalists typically view science only of value in giving more proof of God or showing the truth of the Koran. One oft-visited Internet site reveals this "astounding scientific fact" -- the Koran anticipated black holes and genes.”
Foremost among these men is Zaghlool Al-Najjar, a wonderful man, I think, who would spend his time better if he were to use his world wide expertise on geology, on glorifying God, and singing His praises through what He has revealed to him of knowledge in the earth, its mountains, its seas, rivers and other aspects of its architecture, rather than trying to correlate all that he has learnt with the ‘Quran’ and ‘Sunnah’, as if God or God’s religion is confined to those two things. I find it immensely contradictory to say that, "The Islamic nation is currently living in a state of backwardness because Muslim intellectuals and figures have been abandoned and their services are being disregarded”, when he is equally as guilt of this backwardness with his advocacy of some rather silly beliefs, some of which I will cast an eye upon later.
In short, submission to God is not to blame for the demise of the Islamic world and its moral and intellectual decay. Rather, paradoxically, it is the lack of ‘Islam’ or ‘submission to God’. Contrary to common opinion, this demise began not long after the death of the Prophet Muhammad (PBUH); I believe it began soon after the death of the second leader of the Muslims after him, Omar Ibn Al-Khattab. With his death, the Islamic world lost a most powerful and charismatic leader, possibly the greatest political leader of all time.
His successor, our beloved Othman was a great leader too, but, as explained by his biographer, Mohammad Alias Aadil, “unlike his predecessor, Umar, who maintained discipline with a stern hand, Uthman was less rigorous upon his people; he focused more on economic prosperity. Under Uthman, the people became economically more prosperous and on the political plane they came to enjoy a larger degree of freedom. No institutions were devised to channel political activity, and, in the absence of such institutions, the pre-Islamic tribal jealousies and rivalries, which had been suppressed under earlier caliphs, erupted once again. In view of the democratic and liberal policies adopted by Uthman, the people took advantage of the liberties allowed them, and as such became a headache for the State, which culminated in the assassination of Uthman.” Othman was the first Muslim leader to be killed by a Muslim (Omar was assassinated by a Persian non-Muslim), and with his death began a series of political and social disasters that have continued to this day. The golden age of Islam was very brief; what is currently regarded as the golden age of Islam is actually the golden age of pseudo-Islam, contaminated by political feuds, persecutions and submission to authority rather than God; the Islam that came to free man from the chains of human authority and slavery to other men, was no more. Islam was to be turned into a political tool that can be used to exploit others. And what better way to exploit a people than by stripping them off their minds, of their ability to think independently, and force them to follow ‘religious authority’, disguised under the name of ‘hadith’ or ‘the works of the scholars’.
In a review of Sayyid Qutb’s book, ‘Milestones’, David Zeidan remarked that, “Qutb's view of Islamic history is that of a short golden age under the Prophet and the Rashidun Caliphs. Islam then decayed as it got buried under the rubbish of man-made traditions, interpretations, and superstitions. No true Islamic society has existed for the last several centuries…All accretions must be discarded, and Muslims must return to the model of the first Muslim generation as the paradigm for today's revival…Islam must be incarnated in a dynamic political society, totally obedient to God's sovereignty as expressed in shari`a. Any society or government that does not fully implement shari`a as the sole source of its legislation is jahili. Jahiliyya is not a pre-Islamic historical era of paganism - it is an ever present condition of denying God's rule, usurping His authority, and living by man-made laws that enslave men to their rulers and engender oppression and tyranny”. This I believe is absolutely spot on; it is only when Muslims started submitting themselves to other authorities that they started to degenerate. The view that the Golden Age of Islam, which was “inaugurated by the middle of the 8th century by the ascension of the Abbasid Caliphate and the transfer of the capital from Damascus to the Persian city of Baghdad”, and which stretched from “the 8th century to the 13th century, though some have extended it to the 15th or 16th centuries”, a period during which “engineers, scholars and traders in the Islamic world contributed to the arts, agriculture, economics, industry, law, literature, navigation, philosophy, sciences, and technology, both by preserving and building upon earlier traditions and by adding inventions and innovations of their own. Howard R. Turner writes: "Muslim artists and scientists, princes and labourers together created a unique culture that has directly and indirectly influenced societies on every continent”” is completely fallacious. The reasons for the great praise that has been heaped onto the Islamic civilizations of these times can be deduced from the above quote – it is based on the entirely material aspect of the civilization. It is a civilization akin to modern Western civilization – great in terms of material progress, science and technology, but a lack of or even absence of the human being in it. The leaders of those Islamic civilizations were extravagant, and far more interested in power and wealth than in the welfare of humanity, which is what Islam stood for in the times of the Prophet and the first ‘rightly guided Caliphs’. As put eloquently by the great H G Wells in his ‘Outline of History’, “The splendid opening of the story of Islam collapses suddenly into this squalid dispute and bickering of heirs and widows…For a moment we stand amazed at the greatness of the Abbasid dominion; then suddenly we realize that it is but as a fair husk enclosing the dust and ashes of dead civilizations”
██ Expansion under the Prophet Mohammad, 612-632
██ Expansion during the Rightly Guided Caliphate, 635-661
██ Expansion during the Umayyad Caliphate, 661-750
A brief glance at the above map, looking at the extent of Islamisation of the world during the times of the prophet (PBUH), the rightly guided caliphs, and the Umayyad era, will show that, the no further Islamisation took place afterward – it is as if the universal message of Islam, of submission to God came to a complete stand still. With their demise, as Wells says, “The first tremendous impulse of Islam was now spent. There was no further expansion and a manifest decline in religious zeal”. This is not because Islam’s message, the very simple, down-to-earth monotheism and idea of life being about ‘worship’ of God (and we are not talking here about ritualistic worship, but the dedication of one’s entire life to God) suddenly became inapplicable to the times, but rather because of something else. H G Wells put it well:
“And if the reader entertains any delusions about a fine civilization, either Persian, Roman, Hellenic, or Egyptian, being submerged by this flood, the sooner he dismisses such ideas the better. Islam prevailed because it was the best social and political order the times could offer. It prevailed because everywhere it found politically apathetic peoples, robbed, oppressed, bullied, uneducated, and unorganized, and it found selfish and unsound governments out of touch with any people at all. It was the broadest, freshest, and cleanest political idea that had yet come into actual activity in the world, and it offered better terms than any other to the mass of mankind. The capitalistic and slave holding system of the Roman Empire and the literature and culture and social tradition of Europe had altogether decayed and broken down before Islam arose, it was only when man kind lost faith in the sincerity of its -representatives that Islam, too, began to decay.”
It is because the Abbasid leaders were corrupt, and were not interested in spreading the message – they were more interested in plundering more wealth and property. H G Wells explains this very well and thoroughly in his ‘Outline of History’, in a passage I quote here in full:
“Abul Abbas was the first of the Abbasid Caliphs, and he began his reign by collecting into one prison every living male of the Omayyad line upon whom he could lay hands and causing them all to be massacred. Their bodies, it is said, were heaped together, a leathern carpet was spread over them, and, on this gruesome table Abul Abbas and his councilors feasted. Moreover, the tombs of the Omayyad Caliphs were rifled, and their bones burnt and scattered to the four winds of heaven. So the grievances of Ali were avenged at last, and the Omayyad line passed out of history.
The Abassids were adventurers and rulers of an older school than Islam. Now that the tradition of Ali had served its purpose, the next proceeding of the new Caliph was to hunt down and slaughter the surviving members of his, family, the descendants of Ali and Fatima…. Mansur, the successor of Abul Abbas, built himself a new capital at Bagdad near the ruins of Ctesiphon, the former Sassanid capital. Turks and Persians as well as Arabs became Emirs, and the army was reorganized upon Sassanid lines. Medina and Mecca were now only of importance as pilgrimage centres, to which the faithful turned to pray. But because it was a fine language, and because it was the language of the Koran, Arabic continued to spread until presently it had replaced Greek and become the language of educated men throughout the whole Moslem world.
Of the Abbasid monarchs after Abul Abbas we need tell little here. A bickering war went on year by year in Asia Minor in which neither Byzantium nor Bagdad made any permanent gains, though once or twice the Moslems raided as far as the Bosphorus. A false prophet Mokanna, who said he was God, had a brief but troublesome career. There were plots, there were insurrections; they lie flat and colourless now in the histories like dead flowers in an old book. One other Abbasid Caliph only need be named, and that quite as much for his legendary as for his real importance, Haroun-al-Raschid (786-809). He was not only the Caliph of an outwardly prosperous empire in the world of reality, but he was also the Caliph of an undying empire in the deathless world of fiction, he was the Haroun-al-Raschid of the Arabian Nights.
Sir Mark Sykes gives an account of the reality of his empire from which we will quote certain passages. He says, “The Imperial Court was polished, luxurious, and unlimitedly wealthy; the capital, Bagdad, a gigantic mercantile city surrounding a huge administrative fortress, wherein every department of state had a, properly regulated and well-ordered public office; where schools and colleges abounded; whither philosophers, students, doctors, poets, and theologians flocked from all parts of the civilized globe . . . The provincial capitals were embellished with vast public buildings, and linked together by an effective and rapid service of posts and caravans; the frontiers were secure and well garrisoned, the army loyal, efficient, and brave; the governors and ministers honest and forbearing. The empire stretched with equal strength and unimpaired control from the Cilician Gates to Aden, and -from Egypt to Central Asia. Christians, Pagans, Jews, as well as Moslems, were employed in the government service. Usurpers, rebellious generals, and false prophets seemed to have vanished from the Moslem dominions. Traffic and wealth had taken the place of revolution and famine . . . Pestilence and disease were met by Imperial hospitals and government physicians . . . In government business the rough-and-ready methods of Arabian administration had given place to a complicated system of Divans, initiated partly from the Roman, but chiefly taken from the Persian system of government. Posts, Finance, Privy Seal, Crown Lands, Justice, and Military affairs were each administered by separate bureaux in the hands of ministers and officials; an army of clerks, scribes, writers, and accountants swarmed into these, offices and gradually swept the whole power of the government into their own hands by separating the Commander of the Faithful from any direct intercourse with his subjects. The Imperial Palace and the entourage were equally based on Roman and Persian precedents. Eunuchs, closely veiled 'harems' of women, guards, spies, go betweens, jesters, poets, and dwarfs clustered around the person of the Commander of the Faithful, each, in his degree, endeavoring to gain the royal favour and indirectly distracting the royal mind from affairs of business and state.
Meanwhile the mercantile trade of the East poured gold into Bagdad, and supplemented the other enormous stream of money derived from the contributions of plunder and loot dispatched to the capital by the commanders of the victorious raiding forces which harried Asia Minor, India, and Turkestan. The seemingly unending supply of Turkish slaves and Byzantine spice added to the richness of the revenues of Irak, and, combined with the vast commercial traffic of which Bagdad was the centre, produced a large and powerful moneyed class, composed of the sons of generals, officials, landed proprietors, royal favorites, merchants, and the like, who encouraged the arts, literature, philosophy, and poetry as the mood took them, building palaces for themselves, vying with each other in the luxury of their entertainments, suborning poets to sound their praises, dabbling in philosophy, supporting various schools of thought, endowing charities, and, in fact, behaving as the wealthy have always behaved in all ages.”
I have said that the Abbasid Empire in the days of Haroun-al-Raschid was weak and feeble to a degree, and perhaps the reader will consider this a foolish proposition when he takes into consideration that I have described the Empire as orderly, the administration definite and settled, the army efficient, and wealth abundant. The reason I make the suggestion is that the Abbasid Empire had lost touch with everything original and vital in Islam, and was constructed entirely by the reunion of the fragments of the empires Islam had destroyed. There was nothing in the empire which appealed to the higher instincts of the leaders of the people; the holy war had degenerated into a systematic acquisition of plunder. The Caliph had become a luxurious Emperor or King of Kings; the administration had changed from a patriarchal system to a bureaucracy. The wealthier classes were rapidly losing all faith in the religion of the state; speculative philosophy and high living were taking the place of Koranic orthodoxy and Arabian simplicity. The solitary bond which could have held the empire together, the sternness and plainness of the Moslem faith, was completely neglected by both the Caliph and his advisers . . . Haroun-al-Raschid himself was a winebibber, and his palace was decorated with graven images of birds and beasts and men . . .
Haroun-al-Raschid died in 809. At his death his great empire fell immediately into civil war and confusion, and the next great event of unusual importance in this region of the world comes two hundred years later when the Turks, under the chiefs of the great family of the Seljuks, poured southward out of Turkestan, and not only conquered the empire of Bagdad, but Asia Minor also. Coming from the northeast as they did, they were able to outflank the great barrier of the Taurus Mountains, which had hitherto held back the Moslems. They were still much the same people as those of whom Yuan Chwang gave us a glimpse four hundred years earlier, but now they were Moslems, and Moslems of the primitive type, men whom Abu Bekr would have welcomed to Islam. They caused a great revival of vigour in Islam, and they turned the minds of the Moslem world once more in the direction of a religious war against Christendom. For there had been a sort of truce between these two great religions after the cessation of the Moslem advance and the decline of the Omayyads. Such warfare as had gone on between Christianity and Islam had been rather border - bickering than sustained war. It became only a bitter fanatical struggle again in the eleventh century.”
Compare this excessiveness and spend thriftiness (which of course, we nowadays see on a regular basis in the Gulf Arabs who come to London and Las Vegas to spend their petrodollars, or who have three or four palaces each, if not more) with the simplicity of the great Prophet, who history books tell us, “He was the greatest charitable man. He did not pass a single night hoarding any dirham or dinar. Whenever any excess money came to him and if he did not then get anyone to accept it as charity, he did not return home till he gave it to the poor and the needy. He did not store up for more than a year the provision of his family members which Allah was pleased to give him. He used to take one fifth of what easily came to him out of dates and wheat. What remained in excess, he used to give in charity. He used to give away in charity to one who begged anything of him, even out of his stored up provision”. Or the great caliph Abu Bakr, who, “When he became a Muslim he had an amount of 40,000 dirhams. The entire amount was spent by him in the cause of Islam. He paid for the liberation of slaves. He financed the journey of the Holy Prophet from Makkah to Madina on the occasion of emigration. He paid for the land acquired for the construction of the Prophet's mosque at Madina. When the Holy Prophet invited contributions for financing the Tabuk expedition, Abu Bakr contributed all his assets for the purpose, and when the Holy Prophet inquired as to what he had kept for himself and his dependents he said that for himself and his dependents he had left Allah and His Prophet. He was an embodiment of selflessness. When he became the Caliph he was paid a meager allowance from the treasury. On his deathbed he sold a plot of his land and repaid the entire amount to the treasury. He lived a simple unostentatious life. One of his wives once expressed the wish to have a sweet dish. Abu Bakr deposited the amount in the public treasury and had his allowance reduced to the extent of the saving made by his wife, on the ground that such amount was surplus to his genuine needs”, or the great Omar, whose “abstinence and humility… were not inferior to the virtues of Abu Bakr: his food consisted of barley bread or dates; his drink was water; he preached in a gown that was torn or tattered in twelve places; and a Persian satrap, who paid his homage as to the conqueror, found him asleep among the beggars on the steps of the mosque of Muslims. Economy is the source of liberality, and the increases of the revenue enabled Umar to establish a just and perpetual reward for the past and present services of the faithful.” Or Othman or Ali, both of whom were known for their generosity and humanity.
I don’t agree with the famous Belgian historian George Sarton, when he writes in, ‘The Incubation of Western Culture in the Middle East':
“The decadence of Islam and of Arabic is almost as puzzling in its speed and completeness as their phenomenal rise. Scholars will forever try to explain it as they try to explain the decadence and fall of Rome. Such questions are exceedingly complex and it is impossible to answer them in a simple way."
The reason for the decadence of Islam is actually quite simple. There is one difference between the Muslims during the era of the Prophet and the Rightly Guided Caliphs, and those coming afterward. Muslims neglected God and His word. Sayyid Qutb brilliantly explained this in the introduction to his aforementioned work:
“The callers to Islam in every country and in every period should give thought to one particular aspect of the history of Islam, and they should ponder over it deeply. This is related to the method of inviting people to Islam and its ways of training.
At one time this Message created a generation - the generation of the Companions of the Prophet, may God be pleased with them - without comparison in the history of Islam, even in the entire history of man. After this, no other generation of this caliber was ever again to be found. It is true that we do find some individuals of this caliber here and there in history, but never again did a great number of such people exist in one region as was the case during the first period of Islam.
This is an obvious and open truth of history, and we ought to ponder over it deeply so that we may reach its secrets.
The Qur'an of this Message is still in our hands…The only difference is the person of the Messenger of God - peace be on him; but is this the secret?
Had the person of the Prophet - peace be on him - been absolutely essential for the establishment and fruition of this message, God would not have made Islam a universal message, ordained it as the religion for the whole of mankind, given it the status of the last Divine Message for humanity, and made it to be a guide for all the inhabitants of this planet in all their affairs until the end of time.
God has taken the responsibility for preserving the Holy Qur'an on Himself because He knows that Islam can be established and can benefit mankind even after the time of the Prophet - peace be on him. Hence He called His Prophet - peace be on him - back to His mercy after twenty three years of messengership and declared this religion to be valid until the end of time. Therefore the absence of the Messenger of God - peace be on him - is not the real cause for, nor does it explain, this phenomenon.
We look, therefore, for some other reasons, and for this purpose we look at that clear spring from which the first generation of Muslims quenched their thirst. Perhaps something has been mixed with that clear spring. We should look at the manner in which they received their training. Perhaps some changes have found their way into it.
The spring from which the Companions of the Prophet - peace be on him-drank was the Qur'an; only the Qur'an as the Hadith of the Prophet and his teachings were offspring of this fountainhead. When someone asked the Mother of the Faithful, Aisha-may God be please- with her,-about the character of the Prophet-peace be on him,-she answered, "His character was the Qur'an".
The Holy Qur'an was the only source from which they quenched their thirst, and this was the only mold in which they formed their lives. This was the only guidance for them, not because there was no civilization or culture or science or books or schools. Indeed, there was Roman culture, its civilization, its books and its laws, which even today are considered to be the foundation of European culture. There was the heritage of Greek culture- its logic, its philosophy and its arts, which are still a source of inspiration for Western thought. There was the Persian civilization, its art, its poetry and its legends, and its religion and system of government. There were many other civilizations, near or far, such as the Indian and Chinese cultures, and so on. The Roman and Persian cultures were established to the north and to the south of the Arabian peninsula, while the Jews and Christians were settled in the heart of Arabia. Thus we believe that this generation did not place sole reliance on the Book of God for the understanding of their religion because of any ignorance of civilization and culture, but it was all according to a well thought out plan and method. An example of this purpose is found in the displeasure expressed by the Messenger of God - peace be on him -when 'Umar-may God be pleased with him-brought some pages from the Torah. The Messenger of God-peace be on him-said, "By God, if even Moses had been alive among you today, he would have no recourse except to follow me" [Reported by al-Hafidh Abu Yala from Himad, from al-Shubi, from Jabir.]
It is clear from this incident that the Messenger of God - peace be on him - deliberately limited the first generation of Muslims, which was undergoing the initial stages of training, to only one source of guidance, and that was the Book of God. His intention was that this group should dedicate itself purely to the Book of God and arrange its lives solely according to its teachings. That is why the Messenger of God -peace be on him-was displeased when 'Umar-may God be pleased with him-turned to a source different from the Qur'an
In fact, the Messenger of God-peace be on him-intended to prepare a generation pure in heart, pure in mind, pure in understanding. Their training was to be based on the method prescribed by God Who gave the Qur'an, purified from the influence of all other sources.
This generation, then, drank solely from this spring and thus attained a unique distinction in history. In later times it happened that other sources mingled with it. Other sources used by later generations included Greek philosophy and logic, ancient Persian legends and their ideas, Jewish scriptures and traditions, Christian theology, and, in addition to these, fragments of other religions and civilizations. These mingled with the commentaries on the Qur'an and with scholastic theology, as they were mingled with jurisprudence and its principles. Later generations after this generation obtained their training from this mixed source, and hence the like of this generation never arose again.
Thus we can say without any reservations that the main reason for the difference between the first unique and distinguished group of Muslims and later Muslims is that the purity of the first source of Islamic guidance was mixed with various other sources, as we have indicated.”
Once again, the vastly underrated Qutb is speaking the truth. It is only when we developed an adherence to the irrational and sometimes downright bizarre teachings of the ‘hadith’, and ‘words of scholars’ that we have collapsed. It is my personal belief that blind adherence to ‘hadith’, and the belief that what certain people wrote hundred of years after the prophet Muhammad (PBUH) lived or is said to have said it can be the foundation of a nation, is one of the most corrupt influences on modern Islam, or submission to God.
The criticism of ‘hadith’ is invaluable – this is because, Islam, as we have it now, is based, to a great deal on it. That is a fact we cannot deny. It has, in many cases (for instance, in the case of apostasy, in the case of punishment of the adulterer, and other things) come to have greater importance than the Qur’an itself. And Islam as we have it now, and I have already made clear, is not submission to God. Muslim nations are the nations of darkness, of foolishness, of utter absurdity. Spirituality is ridiculed, and humanity abhorred. By criticising it, and picking out what is good from it, using the six golden principles originated by Omar Ibn Al-Khattab (RAA), we will benefit a great deal from it:
“Umar was alive to the danger that whatever was ascribed to the Holy Prophet, right or wrong would obtain currency and venerable acceptance. Umar evolved principles on the basis of which the traditions were to be accepted. The basic principles were:
§ The report should be literally faithful;
§ Every Hadith narrated should carry with it the name of the narrator and the chain of narrators;
§ The narrators must be men of proven faith and integrity;
§ In judging the veracity of a report the occasion and circumstances involved should be taken into consideration;
§ The report should not be repugnant to the Holy Quran;
§ The report should be rational.”
This is the opinion of some of our greatest current thinkers, and it is only aiming for the progress of mankind. For instance, this is how Abdul Hamid Abu Sulayman put it:
“It is imperative that the texts of the authentic Sunnah be collected, classified, and placed within easy reach of scholars, researchers, and specialists in all fields of knowledge. These texts must be indexed, ordered by subject content, and purged of all accretions. Such a classification of the Sunnah may be completed in the following manner:
§ Those hadiths which, owing to the authenticity of their narration (sanad) and the soundness of their meaning, may be accepted as authoritative evidence.
§ Those hadiths which, owing to the soundness of their meaning, may be accepted as evidence, even if their narration is open to debate.
§ Those hadiths which, regardless of what may be said about the authenticity or otherwise of their narration, are questionable in terms of meaning (i.e., their meanings seem to be in some way contradictory to the principles or purposes of the Shari'ah).
§ Those hadiths which, owing to the dubious authenticity of their narration and the contradictory nature of their meaning, may not be considered acceptable as evidence.
The importance of this methodological issue is not limited to the mishandling of the Sunnah, for in many cases the Muslim mind is overawed by what is clearly unsound, with the result that when it accepts something unsound as sound, it loses its ability to discriminate and perceive things as they truly are. Finally, the Muslim mind, thought, and methodology lose all value and utility when they become accustomed to accepting principles other than the divinely revealed principles and approaches contained in the Qur'an and the Sunnah”.
All that I find inhumane and abhorrent about Islam as currently practised, can be found in the thousands of ‘ahadith’ that the great Prophet (PBUH) is reported to have said, which I am pretty sure he didn’t, for most of them do not fulfil the above six criteria. We will see evidence of this in the next chapter. I will bring this discussion to a close by drawing the reader’s attention to some interesting historical facts:
“Out of the entire collection of Hadith running into thousands of items, only 142 items are attributed to the authority of Abu Bakr. Of all the companions of the Holy Prophet, Abu Bakr was the closest to him, and one would expect Abu Bakr to be a repository of a larger number of traditions. The comparatively smaller number of traditions owing their authority to the reporting of Abu Bakr is attributed to the extraordinary care and caution exercised by Abu Bakr in sifting the tradition.
According to Ayesha, Abu Bakr had originally a collection of over five hundred traditions, and he deposited the compilation with her for custody. Ayesha relates that one night she noticed that Abu Bakr felt very restless. He tossed about in the bed, and could not sleep. Ayesha got worried whether he was suffering or was worried. He made no reply, but remained restless throughout the night. The following morning he asked Ayesha to bring him the collections that he had deposited with her. She brought the compilation and he set fire to it. On the enquiry of Ayesha, Abu Bakr explained his conduct thus: "The collection contained many traditions that I had heard from other people. I thought that if I died and left behind traditions accepted by me as authentic, but really not so, then I would have to answer for that."
Another fascinating fact, “Lest the people should make mistakes in reporting Hadith direct from the Holy Prophet, Umar forbade the Companions to report direct from the Holy Prophet. Umar also enjoined that Hadith should not be mixed with the Quran. Lest there might be mistake in reporting. Umar enjoined, "Report sparingly from the Holy Prophet". When Umar was asked to quote traditions he would usually say "Had I not feared that I might make a mistake in reporting Hadith I would have quoted one." Umar emphasized that extra care should be taken to ensure that there was no mistake in reporting. The checks and restraints imposed by Umar on the reporting of traditions and the high standard of accuracy required by him paid dividends and all the traditions that were accepted and publicized were free from flaw.” Compare this with the way ‘Islamic scholars’ these days say on an hourly basis, “The prophet said” and “The prophet did”, without any mention of the ‘sanad’, as if they were there to witness the event.
Finally, “Omar Ibn Al-Khattab, the second guided Khalifa threatened Abu Hurayra to send him to exile if he does not stop telling hadiths about Muhammed, he did stop until Omar's assassination then started again. He kept telling hadiths to please the Khalifa of the Muslims then, all the time, including the time he lived in the royal palace of Muawaya in Syria. Abu Hurayra told his audience that he is telling them hadiths that if he ever mentioned when Omar was alive, he would be given several lashes”. Abu Huraya is the most frequent man to give ahadith about the prophet (PBUH), even though he spent only three years with the prophet. The message is clear.
I conclude this section with a wondeful book I recently picked up, ‘Crisis in the Muslim Mind’ by Abdul Hamid A. Abu Sulayman which I think is essential reading for all who care about our fate:
“The methodology of Islam in its earliest ages was a natural and automatic sort of methodology that relied on the wisdom of revelation and the soundness of human reason and ijtihad that sprang from the untainted human fitrah. Thus the prophetic and the caliphal ages were the best examples of the human spirit for all the generations that followed.”