Finally nailing the culprits
That evening as Sholmes and Whatsup sat down at a table for dinner, they were joined by one of the conference organisers. It was the same lady who had hired them to come and figure out why it was so difficult to practice rational use of medicine.
“Well, how far are you with solving the mystery?” she said with a big smile.
“Just as far as you are all with implementing rational use” said Sholmes, with a wicked glint in his eyes. “This is the toughest assignment I have taken up so far in my entire career”.
“So, you are saying we are still clueless about who are the culprits behind the demise of rational use of medicine?”, said the lady, as she ordered her dinner.
“Not at all. In fact we have too many clues and culprits. It seems to be less the work of a lone assassin and more the work of a lynch mob” said Sholmes.
Before the lady could respond it was Whatsup who exclaimed, “What exactly do you mean?”
“Policy makers, the pharma industry, prescribers, pharmacists, academics and the patients themselves,” said Sholmes. “All of us have been responsible for the death of rational use of medicine by a thousand cuts”.
“In other words, you are saying ‘We Killed Rational Use of Medicine’?”, said Whatsup.
“Exactly. That is the unfortunate conclusion I have come to. This is probably the only murder mystery I have tried to solve, where I too have blood on my hands” said Sholmes.
There was an uncomfortable silence on the table for a while, broken by the lady taking a deep breath.“Well done Sholmes. You have indeed hit the nail on the head. It is not a conventional kind of answer, but this is what we suspected too for some time but were not sure. The culprits are not always out there somewhere, but very much in our own midst – even inside us perhaps” she said. “It is easy to blame others, but ultimately it is all of us who have to take responsibility for how medicines are used or abused”.
“Medicine, health, disease, rational use are all complex subjects – as they are linked to almost all aspects of life. Many of us still think about it in very simplistic ways, as getting deeper into the subject demands too much expenditure of mental energy. The problem is compounded by some of us who are rigid about these things and can’t believe there are any perspectives other than what we hold dear” said Sholmes.
“Everyone’s point of view contains some truth, but knowing which bits or combination of bits to use in a specific situation seems to be very tough” said the lady.
“I get it now!” said Whatsup. “Medicine is as much art as it is science, with some sociology and anthropology thrown in. That’s where experience comes in. A good physician is like a master chef, who goes beyond the usual textbook recipes. By being around, observing and listening with empathy, the good chef learns how to adjust the dosage of ingredients to individual taste, get the timing right and understand the client’s digestion system” he said, tucking into his dinner. That his stomach was now back to normal was evident from the relish with which he ate.
“The problem is that not everyone can become a master chef, most don’t have the time or opportunity to become one” said the lady.
“I agree not everyone can become a physician or needs to become one. They however do need to understand the basics of health and medicine, as these are too important to be left to the medical profession alone” said Sholmes.
“Apart from such individual, community or public awareness and initiatives – a key part of this – a major part of the challenge is also perhaps to build a suitable ecosystem of professional, ethical, transparent and accountable institutions, that together can prevent such abuse” said the lady.
“Yes! That’s the way to go! We change ourselves but also change the world out there” said Whatsup, doing a high five with both Sholmes and the lady as they all beamed big smiles at each other for having accomplished the mission they had set out on.
That night as Sholmes and Whatsup went back to their favourite restaurant on the Chao Phaya river for their last round of beer before leaving Bangkok, they realized, in just three days they had learnt so much more than they ever expected. The experience had been exhausting but also very exhilarating.
“It was one hell of a complex mystery and the solution seems to be an equally complex one, but sometimes the truth is not so simple!”, said Sholmes, going for his drink.
“So how did you finally figure it all out?” asked Whatsup.
“Elementary dear Whatsup. I just found myself looking into the mirror one evening and found the answer!” said Sholmes as he raised a toast to the ISIUM – especially the wicked ladies who had drawn them into this crazy, exciting story of how to improve the use of medicines.