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)