Philosophy of Science and Its Implications for Western Medicine
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The practitioners of western medicine proudly speak of it as being firmly grounded in science. It is science that gives allopathic doctors the authority to speak on physiology, diseases and treatments of disease. In this paper, “allopathic” means pertaining to treating the disease by conventional means (i.e. western medicine). This authoritative voice has toned down somewhat in recent years, partly due to consumer demand for more options in health care and for more patient rights. Still, it is not hard to find doctors speaking with a touch of superiority when talking about their own profession, ridiculing other healing modalities, such as traditional Chinese medicine, lay midwifery, homeopathy, chiropractic, etc. Is allopathic medicine really “better” than other types of healing that people choose to practice or participate in? If it is better, then in what ways? Does science allow allopathic medicine to speak on the matter of healing from the authoritative and domineering position that it holds in our society? The answer to these questions will probably depend on one’s view of science itself. Do you believe that science is generally a better way of learning about the world? In this paper, I aim to answer the question of whether western medicine deserves the prestige it has bestowed upon itself, through the lens of philosophy of science. Eventually I would like to demonstrate that there is no reason to believe that conventional western medicine is better way treat human mind and body compared to other healing practices.
In the first part of this paper, I will examine the definition and aim of science and determine whether it is the best way of learning about the world while relating these considerations to western medicine and how medicine is practiced. The second part of the paper will examine the difference between western medicine and alternative medicine. The purpose here is to see how western medicine differs from alternative medicine in its incorporation of science and to determine if in fact, western medicine is rooted in science at all. The last part of the paper will determine if science gives western medicine the authority to talk about body and healing above other professions, and what direction western medicine can take from this determination.
The questions “what is science (or scientific method)?” or “what is the aim of science?” have not been resolved even through much discourse among philosophers of science, spanning decades of debate. I do not aim to give a single answer of what science, scientific method, or aim of science are in this paper, but rather discuss the major claims regarding the above questions as they relate to medicine. Schools of thoughts that address the nature and aim of science still influential today are: falsificationism, constructive empiricism, and scientific anarchism. This list is not comprehensive, but is a survey of some of the major schools of thoughts in philosophy of science.
Falsificationism states that a scientific theory must be one that can be falsified. A falsifiable theory does not necessarily have to be proven false. But it could be falsified by current empirical data or data that is likely to be found in the future. A theory can be falsified by an observation that contradicts it, such as Aristotelian physics being refuted by Galileo’s demonstrations. When a theory is falsified, it is replaced by a new theory that contains more explanatory power. Karl Popper, the founder of falsificationism, wrote,
Thus the problem which I tried to solve by proposing the criterion of falsifiability was neither a problem of meaningfulness or significance, nor a problem of truth or acceptability. It was the problem of drawing a line (as well as this can be done) between the statements, or systems of statements, of the empirical sciences, and all other statements — whether they are of a religious or of a metaphysical character, or simply pseudo-scientific….The criterion of falsifiability is a solution to this problem of demarcation, for it says that statements or systems of statements, in order to be ranked as scientific, must be capable of conflicting with possible, or conceivable, observations (Popper, 39).
An example of a theory with “greater explanatory power” replacing the one with lesser explanatory power would be the Einstein’s Theory of Relativity replacing Newtonian mechanics as an all-encompassing theory. Newtonian mechanics could not explain the behavior of light or atomic particles, although it explained a lot of other phenomena, such as planetary motion and the behavior of gas. Einstein’s theory explained what Newtonian mechanics could explain and more. Hence, Newtonian mechanic was falsified in a sense. It was not that Newtonian mechanics was wrong. It was simply that Einstein’s theory accounted for more about how the things work in the universe.
It is interesting to note that Popper talks about the explanatory power of a scientific theory, but does not mention the truthfulness of scientific theory. Falsificationism provides a way of assessing a theory by putting it up to a test against observations and other theories, but it does not state whether the aim of science is to provide a true account of the world. In fact, even though Newtonian mechanics has less explanatory power than Einstein’s theory, Newtonian mechanics is still taught in every introductory physics class, as it is useful for explaining and predicting many phenomena of the world that we can observe. The same thing happens with Bohr’s atomic theory. His model shows an atom with positively charged nucleus with electrons going around the nucleus in circular path. Even though it is considered obsolete, it is still commonly taught due to its simplicity and accuracy within a certain system.
So does science give a true account of the world or is it simply a model that is useful for explaining and predicting physical phenomena of the world? No one can say for sure if current scientific theories will hold up indefinitely or will be overthrown by new information and technology that we acquire. Looking back at history, it would not be wise to say that the scientific theories of today will hold up forever and represent the truth of how the world works. They are useful models of how the world is and they provide a framework for finding out more about the world. We then can look to constructive empiricism for the limits of science.
Constructive empiricism states that the goal of science is to find out more about our observable world and the theoretical entities that “save the phenomena.” This also means that you can make up whatever theory you would like, so long as it explains how the observables work. This statement is relevant when looking at different healing practices. There are many different systems and philosophies among healing practices, where one type of practice may look a lot different from another practice. One may talk about the difference among meridian system chakras [i] or nervous system, but all types of medicine aim to heal the body when it is out of balance. The difference is that each practices uses different language to explain the workings of human body. Western medicine uses the language of science that divides the body into different systems (depending their categorization) using anatomical cues – muscle organ system, cardiovascular, lymphatic, etc. In other types of medicine, the mind/body paradigm is used where a person is seen as more than the sum of different organ systems. Mind and body go together for practitioners and participants of mind/body paradigm medicine. For them, it would not be at all illogical to conclude that psychological problems have caused a gallstone, a myocardial infarction, or cancer. Different practices work better for certain individuals or conditions. Therefore, no one type of medicine, including western medicine, can work for everybody and every condition. Taking the cue from constructive empiricism, one might say that while these different healing practices may differ in their explanation of how the body works (the theoretical entities) most healing modalities helps to restore the balance (the observational result). In other words, if western medicine is as scientific as it is often claimed, then it should aim to learn more about getting to the results of healing, rather than being concerned with which theory should be used to explain the results of healing. Scientific theories are there to explain the results and give a framework to expand knowledge upon. Its purpose is not to place value judgment on different types of medicine based on the presence of science or lack thereof. In any case, one wonders if science is really a better way of learning about the world, when encountering Paul Feryerabend’s scientific anarchism.
Scientific anarchism states people should pursue science with whatever methods they would like. Feyerabend’s definition of science is broader than most –hence his motto: anything goes. He says science is any attempt to learn about the world. Feyerabend argues that the more methods used to accumulate more knowledge, the better it is, because it gives each theory more opportunities to test itself, which leads to more progress.
Everywhere science is enriched by unscientific methods and unscientific results, ... the separation of science and non-science is not only artificial but also detrimental to the advancement of knowledge. If we want to understand nature, if we want to master our physical surroundings, then we must use all ideas, all methods, and not just a small selection of them (Feyerabend, 305-6).
He was critical of the condescending attitude of the scientific community toward alternative ways of learning about the world, such as astrology. He asserts that although, science had started out as a movement to liberate people’s mind (particularly from religion), it has become a repressing ideology itself, with followers that do not think about what the advantages of science are and what its limitations are. This statement is particularly true when people look up to medicine for being so scientific. Most people in western culture are brought up where western medicine is the only option for their health care and many give all their decision making over to their doctor without taking any responsibility for themselves. Many doctors report that patients educate themselves through much more accessible medical information (mostly through the internet) compared to even a decade ago, and even demand certain type of medication or treatment (Jacob, 2002). But when the available information on the web is mostly provided by the mainstream medical community, anything alternative to the mainstream medical opinion will seem like a fringe movement with little substance. Feyerabend argues that since there is not one universal scientific method that guarantees to produce true knowledge, there is no reason to believe that science deserves the prestige that it enjoys in our society. To the argument that science is more useful or applicable than other discipline –and hence more important- he counters by saying that one cannot objectively decide which problems are more important to solve when one is coming from a scientific perspective. He argues for equal treatment of all disciplines and that science be separated from the state, just as the religion is, so that no one ideology trumps all other disciplines.
Although philosophers may never agree on what science and the aim of science are, scientists carry on and do science, largely not affected by or even considering the philosophy of science. Also, as philosophers debate the nature of science dynamically, the perception of science by the general population is another matter. For most people whose contact with science may be limited to high school biology, and chemistry, the idea that things that are taught in school science classes may be just a model or a representation, but not necessarily truth , may never even enter their minds. For that matter, professional scientists themselves may think of scientific entities and theories as true or likely true, but not as a construct of the human mind to learn about the world. For example, the idea of atom as this circular entity that is composed of charged “particle” of protons, neutrons and electrons, may seem to some students, like a reality of what all materials are made out of, when in fact it is just a model of atomic theory. It is as if when we hear the word “particle” we imagine it to have some type of shape and dimension to it, when in reality, particles may have structures incomprehensible to the human brain.
This phenomenon happens in biological science and medicine as well. People are so blinded by all the “science” that supports medicine that they are not able to see medicine for what it really is. Western medicine is good. It is really good at what it does best, namely acute surgery, trauma treatment, transplanting etc. When it comes to chronic disease, inflammation, infection, autoimmune, allergy, cancer, etc, western medicine is busy treating physical symptoms, but has not figured out all the mechanisms of how those conditions work even in their own paradigm. But is it really important that a doctor figure out all the physiological mechanism in order to treat a person in medicine? What is the aim of medicine? Is it to achieve the highest understanding of how the body works to the nth degree…or it is to help people?
No doubt obtaining knowledge for knowledge’s sake is integral to human progress. But when doctors lose sight of their job description as healers, health care will decline to a state where patients are used as lab animals to test out their newest method and experimental drugs. Feyerabend talks of philosophy of science, but what he really wanted to talk about was not philosophy or the definition and aim of science. The thing that he really wanted to talk about was the integrity of humanity in its fullest sense and the social structures that inhibit it, and the role of science plays in maintaining the status quo. Feyerabend writes,
One of my motives for writing Against Method was to free people from the tyranny of philosophical obfuscators and abstract concepts such as “truth”, “reality”, or “objectivity”, which narrow people's vision and ways of being in the world. Formulating what I thought were my own attitude and convictions, I unfortunately ended up by introducing concepts of similar rigidity, such as “democracy”, “tradition”, or “relative truth”. Now that I am aware of it, I wonder how it happened. The urge to explain one's own ideas, not simply, not in a story, but by means of a “systematic account”, is powerful indeed (Feyerabend, 1995, 179–80).
Science has become the source of knowledge or so many people in modern times, that people have hard time accepting knowledge or tools acquired through means that are considered unscientific. Western medicine has co-opted science and labeled other types of medicine as quackery that should have no place in healing, since these alternatives do not follow the “scientific method.”
Then again, one cannot help, but wonder if western medicine’s intention is to heal people or to treat symptoms. This is a not-so-subtle difference. To heal a person, a practitioner has to consider the all the aspects of a person. Healing has to do with that buzzword: “holistic.” A holistic practitioner helps a person be aware of the source of the problem, whether it is sociological, psychological, psychical, physical, etc. When you step into a typical western medical doctor’s office it is a very different game. The doctor will examine you, if he/she is a caring one, that is. Then he or she may order some lab tests or make a primary diagnosis using history, symptoms and signs. There will most likely not be any talk of the patient’s social or psychological problems that may be factoring into the person’s physical symptoms. If a patient complains of anything other than physical symptoms, patient is most likely directed to a social worker or a therapist. In this way, treatment for a person is compartmentalized and externalized in western medicine. It is a rare instance when you, as a patient, are asked to look internally for the root of the problem.
It is hard for people to conceptualize human beings as this all-encompassing but ever so extended being. In other words, different aspects of a person added together do not make up that person. A whole person is greater than its parts merely put together. In most alternative healing systems, body and mind are not seen as separate entities as it is in western medicine. Everything is intertwined. You do not go see a psychiatrist for your psychological issues, then go to your medical doctor for your heart problems, then finally confess your sins with a priest. In an alternative healing system, a practitioner sees people as who they really are instead of categorizing their problem and reducing them to their parts until they are not really themselves anymore. For example, if you were to go to a practitioner who practices from a mind/body paradigm, she may work on your body by bringing your awareness to parts of the body that you may not be aware of. The practitioner may also ask you about your relationship with your family and loved ones. The practitioner may even delve into your past life, depending on scope of practice and one’s philosophy.
It may feel really inappropriate for medical doctors to conduct their conversation with patients in the above way. In fact, it may even be against their state licensure guidelines. If a medical doctor observes that a person’s physical symptoms disappear, following an alternative therapy, the doctor may attribute the improvement to the placebo effect. In fact, much of alternative healing system is snubbed over, on the grounds of the placebo effect. But we must really ask ourselves if the presence of the placebo effect, or lack thereof, determines the value of certain therapy. We must also ask ourselves, what is a placebo effect really? Getting better without all the side effects of medication? Why didn’t anyone think of that before? Wait a minute, what do you mean that I should not use homeopathy because it is just a placebo effect? We are, again, talking about the mind/body connection. The human mind is a powerful entity. It can change the subjective AND objective reality of a person. “Placebo effect” is not an ineffectual fluke that happens in experiments or therapies. It is a perfect example of the power of human mind that any healer should take full advantage of. The value of therapy comes from whether or not the therapy provides a patient with a desirable effect, not whether or not a practitioner can explain the mechanism.
At this point, I must distinguish what I think should be the aim for the science of medicine, and what I think should be the aim for the practice of medicine. The aim of the science of medicine should be to know more about the mechanism of the body and healing. The aim of the practice of medicine is roughly the same, except that the focus should be on the observable part of discovery, not theoretical part that explains the mechanism. A medical doctor should focus on the observable and the tangible, because that is what really helps people. And the ultimate goal of medicine is to help people. Science and the practice of medicine are of course intertwined with each other. Science, as we know it, is one of the ways to learn about the world, including the field of medicine. It is rather a reductionist and compartmentalized way of learning, most of the time, but a way of learning nonetheless. It is very effective in some ways and not so much in other ways. This, a way, science, is just that: one way to learn about the world. Therefore, science should not be the measuring stick, with which people determine the value of different types of medicine.
So what is an allopathic doctor to do? Even the doctors, who realize the true aim of medicine, are helpless in front of systemic political oppression that is led by greed. The amount of influences that pharmaceutical and insurance companies have over the policymaking and consumer behavior is disgusting to me. What is an individual doctor to do in these conditions? Well, it could start with a thought and awareness. Awareness leads to direction and direction leads to action, which leads to consequences, which hopefully will lead to reinforcement of awareness and conviction for your ideology. In more concrete terms, the least a medical doctor could do is to keep an open mind and look at medicine for what it really is and what the aim of medicine is. I meet many aspiring medical students at my school, and I think how ironic is it that even the application process for medical school is set up in such a way that reinforces this notion of medicine grounded in theoretical part of science (the MCAT for example). I want to say to students who are applying to medical school to look at everything you learn in medical school with bit of reservation. Not everything you see in science and medicine is as it seems.
As a closing thought, I want to say that I do not want to put down what western medicine has achieved. No doubt, I will need an allopathic doctor that I will need if I get into a car accident or receive a bullet through my chest. My aim in writing this paper is to get people look at everything they take for granted with a fresh perspective.
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[i] The meridian chart is used in traditional Chinese Medicine and it is a map of body’s energy, or qi. Chakras are 7 energy centers running down the midline of one’s body in Hindu tradition. Each center is associated with different aspects of person’s life and health.