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Hi Jack (and everyone else too, of course),
Medical science is one of the areas that can benefit most from the
change in perspective that my father was advocating. Consider this excerpt from
one of the papers in "Essays on Life, Itself" after which I want to make a few
comments:
"Medicine has been called an art, and it has been called a
science. Indeed, it must possess elements of both. But primarily, it is a craft
in its practice, and a technology in its aspirations. It is applied science;
primarily applied biology. In some of its aspects, it is even rather more
applied technology than applied science.
Science has always had philosophy associated with it; indeed, for a long
time, science was called Natural Philosophy. The ancient Greeks were keenly
interested in the way the world was put together, and how it worked, and had
laid out the major alternatives in this connection (e.g., atomicity or infinite
divisibility; evolution or special creation?) two millennia ago. But, perhaps
because the Greeks affected to despise craft, and considered technology to be
the province of slaves, there has never been much of a philosophy of either
craft or technology in general.
Indeed, one would be surprised to find a work entitled ?The Philosophy of
the Airplane? or ? The Philosophy of the Automobile?, and even more so to find
one entitled ?The Philosophy of Automobile Repair and Maintenance?. The former
involve technologies; the latter is a craft. Although a medical doctor would
likely resent being analogized to a repairman, there are powerful grounds for
doing just this. Indeed, contemporary biological science is currently locked in
the grip of a Cartesian tradition, which asserts that organism is
machine; nowadays perhaps qualified to read ?molecular machine?, but machine
nevertheless.
If one accepts this ?Machine Metaphor?, which is one of the primary
underpinnings of contemporary Reductionism in biology, then an organism becomes
a piece of engineering (albeit without an engineer), and a physician is one
responsible for the maintenance and proper functioning of this piece of
engineering. Indeed, in this light, Medicine itself becomes a species of
engineering, of a kind nowadays called Control
Engineering.
If a machine malfunctions (i.e. exhibits pathology), or otherwise
deviates from nominal behavior, one must seek the causes for the aberration
(troubleshooting, or diagnostics), and then make the necessary repairs or
adjustments (therapeutics and/or prosthesis). Even in the absence of such
pathology, one must generally maintain the machine, in such a way that nominal
behavior will be preserved (preventive maintenance, or
hygiene).
The only difference between Medicine and other forms of control
engineering is that, since we neither built the machine we call an organism
(i.e. are not responsible for its ontology), nor know much about how it actually
works (i.e. its epistemology) the physician is much more in the dark than is his
technological counterpart. Instead of nominal performance criteria, he must make
do with a notion of ?health?, which has proved difficult or impossible to
quantify completely. Instead of explicit troubleshooting protocols, based on
design, he must rely on a restricted set of diagnostic procedures, which rest
ultimately on experience. The same is true for therapeutic procedures, most of
which create further problems (side-effects), requiring further therapies
(Iatrogenics). About the only
advantage the physician has is that his ?machine? can often heal itself, and can
report to him where it hurts.
Because of these intrinsic uncertainties, Philosophy re-enters the
picture, even if one accepts the Machine Metaphor (itself, of course, a
philosophy of organism). We must ask questions like ?What is health??, or
equivalently, ?What is pathology??,
?What is disease??, ?What are symptoms or syndromes??, ?What is a
therapy??, ?How can we minimize or eliminate therapeutic
side-effects??
One can, of course, frame such questions whether or not one accepts the
Machine Metaphor. But the kind of answers we come up with, or even can hope to
find, differ radically if the Machine Metaphor itself is wrong. I have come to
believe the latter, for many reasons. "
What he was saying here is not that modelling is of no value. He was
saying that the way we model these systems needs to reflect the truth about what
these systems are really like. If they do, we will have even more success
creating cures and therapies, and less of the side effects that are currently
being produced because our models are all based on a presumption of the human
body's similarity to a machine. Thus, he said that reductionist approaches are
not something we need to throw out when designing therapies, but DO need to
be thrown out when addressing what those therapies are supposed to
achieve.
Judith
PS: Jack, I want to express my empathy over what you're dealing with.
Kick its ass! (apologies to the list for the naughty
language)
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