Year : 2019 | Volume
: 7 | Issue : 2 | Page : 139--150
Scientistic reductionism and the “dark side” of modern medicine: A personal reflection
Bhaskara P Shelley
Department of Neurology, Yenepoya Medical College, Yenepoya (Deemed to be) University, Mangalore, Karnataka, India
Prof. Dr. Bhaskara P Shelley
Department of Neurology, Yenepoya Medical College, Yenepoya (Deemed to be) University, Mangalore - 575 018, Karnataka
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Shelley BP. Scientistic reductionism and the “dark side” of modern medicine: A personal reflection.Arch Med Health Sci 2019;7:139-150
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Shelley BP. Scientistic reductionism and the “dark side” of modern medicine: A personal reflection. Arch Med Health Sci [serial online] 2019 [cited 2020 Apr 7 ];7:139-150
Available from: http://www.amhsjournal.org/text.asp?2019/7/2/139/273065
It is reasonable to expect the doctor to recognize that science may not have all the answers to problems of health and healing.
– Norman Cousins
Opinions cannot survive if one has no chance to fight for them.
– Thomas Mann
A Prologue: Ancient Wisdom of Science and Health in Indian Medicine
“Open-minded people don't care to be right, they care to understand. There's never a right or a wrong answer. Everything is about understanding” is an aphorism that I believe in, a crucible for opinions, changes, and deep truths.
Being an Indian physician, firstly my salutation to the Hindu God in the ancient Indian Medicine, Lord Dhanwantari. He is conceived as “Physician of Gods” and “God of Ayurvedic Medicine” during the Vedic period around c. 1200–1000 BCE. Lord Dhanwantari, a celestial physician, is indeed comparable to Aesculapius of Greek medicine. I invoke his blessings, and reiterate that the 'Art and Science' of Medicine should be “The Defender of Mankind's Dis-ease' and “The Fountain of Health-ease and Salutogenesis” thus taking absolute care not to stray away from the 'human caring theory'. These healing practices must be conceived as “a work of the heart and soul”, and not as an 'immoral sciences' vexed by the impossibility of immorality. We should not forget our proud ancestry in medicine which held the highest ideals and sacredness in Medicine.
As a physician trained from the Eastern hemisphere of the globe, and in particular, having been “doctored” in a milieu of the Indian subcontinent, I would reiterate that all Indian physicians should remember the “footprints” of our Ancient Indian Medicine and Healing Systems, namely the Vedic system of Medicine, Maharishi Patanjali's “Yoga Sutras,” and the Ancient Literature of Ayurveda. The seat of this ancient wisdom of science and health, “the wellness concept,” and the healing systems were indoctrinated by the Ancient Universities of Nalanda and Takshashila. We must remember our great Indian physicians: Sushruta (Father of Indian Surgery), Charaka (Father of Indian Medicine), and Ayurveda (“The Mother of All Healing Sciences”) that emerged in the Indus Valley Civilization, all of which are chiseled in the Annals of Medicine several hundred years before Hippocrates. Charaka (in the 3rd century BC, who studied at the University of Ancient Takshashila) was one of the principal contributors to Ayurveda (author of the medical treatise, the Charaka Samhita), a system of medicine and lifestyle developed in the ancient India.
From our ancient Indian medicine (and Vedic system of Medicine), I underscore that we have undoubtedly learnt from antiquity various health-promoting practices such as diet (Sattvic, Rajasic, and Tamasic foods) and health (intelligent nutrition of Hatha yoga and energetics); brain–gut–mind axis through religious fasting rituals (Upavasa and the “theory of fasting physiology”); the Indian culture of “Ekadashi” (interrelationship between Ekadashi fasting, internal circadian clock mechanisms and autophagy); and caloric restriction and creative ageing (via mitochondrial networks, autophagy, and telomere dynamics). Furthermore, the brain-enriching properties of coconut oil and the enzymatic fermentology of yogurt underscore the concept of nutritional psychiatry (“Mano Vijnana Avum Manasa Roga” which is indeed an emerging branch of Ayurvedic psychiatry). AYUSH (Ayurveda, Unani, Siddha, Homoeopathy); mahapanchabhuthas; body movement-based therapies (kinesiotherapeutic interventions of dance, music, and art therapies); breathing (Pranayama) and relaxation techniques; mindfulness-based stress reduction meditation; Austerity (Tapas), Chakra Healing, and Chakra Meditation; Ayurveda-Medhya Rasayanas; yogic practices; spiritual practices of mantras; and religious chantings. All these were all well-rooted ancient practices in India. Undoubtedly, it is our folly that we have drifted away from these “lifestyle and traditional practices” which were, in fact, preventive epigenomics, nutritional epigenomics, and wellsprings of salutogeneis, and wellness promotion which was then a “prescription for health-ease.” All these ancient practices in the fervor or religious rituals did, after all, promote health and a harmonious lifestyle enshrined in a truly encompassive physical, emotional, mental, and spiritual spectrum well-being. What is the relevance of this today? Unfortunately, the medical scientism of modern medicine has a rather monotheistic mindset that strays away from confronting the “modern science gap” of the ancient wisdom of our healing practices in the Indian civilization. I call this ancient wisdom as “Ancestral Medicine and Ancestral Healing Systems.” Are we not blindly regressing from our “ancient holistic models”? Are we right to ignore the wisest of the philosophy of our ancestors in Medicine? I am sure of the universal existence of indigenous healing remedies practiced in various other civilizations of the ancient world. Why does our modern scientism in search of an “absolute truth” or “Holy grail” for “fixing human ailments” ignore this restorative holistic “ancient science gap”? Is the 'Sanctity and Sacredness' of Medicine threatened? Is modern medicine 'fixing' disorders that perhaps has gone too far beyond the 'sanctity of life doctrine.' The modern myth of scientific progress and “rationality” posits that science inevitably evolves toward greater precision, certainty, and understanding. We take it for granted that contemporary science provides a more accurate representation of reality than does the science of bygone eras. The genuine rationalist is the one who has understood the limitations of reason. Therefore, I use the Indian ancient context of “Soul Mind Body Science System” illustration as an ideal trajectory for fostering a pluralistic mindset for integrative research intersection into the ancient wisdom of well-being and positive health. This would reaffirm the aphorisms by Lyndon Johnson “Doing what's right isn't the problem. It's knowing what's right” and that of Henry David Thoreau “It is never too late to give up your prejudices.”
Skepticism on Reductionist Medical Scientism
As a critical insider, a free thinker, an optimistic pessimist, a controversialist, an autodidact, and a realist, and definitely not being a “humdrum routinist,” I am faced with several vexations to my “doctored” spirit. I have now developed a skeptical scrutiny with boldness and anguish regarding the fallacies of modern medicine and its philosophical epistemology and scientism. I now question the empiricism, rationalism, reductionism, and authoritarianism of the fundamental doctrines of modern medicine. These crucial self-reflective questions on the cold hard reality are (i) Is medicine decidedly not a science, but only a human endeavor and philosophy epistemology for a “science-using medical practice”? (ii) Is the final destination of the progress in modern medicine truly scientific? (iii) Isn't human fallibility and medical fallibility inherent in medical scientism? (iv) Do we need to heal medicine and its medical systems washing away its dark side and disadvantages imposed by the development of the science base of medicine? (v) Do we need to embrace “systems-oriented biological perspective” as an alternative solution to the limits of reductionism in medicine? (vi) Is it not a scientistic reductionism to stray away from humanistic health care and whole person medicine? (vii) Will the analytical “piecemeal breakdown” to singular components be able to address more complex questions where multifactorial variables such as sleep, internal circadian clocks, stress, nutrition, whole lifestyle behaviorism, other comorbidities, and/or epigenetic factors have an collectivistic risk attribute to a specific human disorder, and lastly (vii) What are the other disturbing, frightening, and ugly underbelly of modern medicine? To my mind, these include - The times of scandal of Health for Wealth and Healthcare for Profit; Crisis in Caring; the Lost Art of Empathy; Lack of Humanistic Relationship-Centered Care; Perils of Professionalism; Forgotten Art of Doctoring; Forgotten Art and Science of Bedside Medicine, Big Pharma, Fallibility of EBM, Artificial Intelligence and the Future of Global Healthcare Systems.
In this editorial, I deal, in particular with two fundamental issues i.e.. (i) the epistemological foundations of our medical scientism, and (ii) the cultural deception and exceptional lies that exposes the secretive 'dark underbelly' of Medicine. Before, I dwell on my criticisms let me state some 'truths'. I'm not arguing against the benefits the scientific method and its consequent technologies have brought to humanity. I do see what is beautiful, what is wonderful and certainly feel so deeply appreciative of the leaps of modern medicine. I do visualize the whole imposing edifice of 21st century modern medicine as a revolutionary and breath-taking success. But I reiterate that the 'hubristic' trajectory and technological determinism of modern medicine, devoid of a social embeddedness, will continue to pose as challenges to human health conditions.
My surmise is that reductionist science is blind to its own inherent lacunae of looking at bits and pieces and not the whole. This article throws light on the other “maladies, scandals, and follies” such as our excessive reliance on the conventional scientific orthodoxy of the “disease pathogenesis model,” thus recognizing the need to move away from reductionism to holism as the hope for the restoration of holistic health care for humankind. Some reflections on “The Dark Side of Medicine” which posit the culture of deception in the moral soulful enterprise of medical practice such as consumer capitalism venture with the practice of medicine; the transformation of health care to a “profit-maximization model” and a “healthcare industry;” the uncomfortable symbiosis between doctors, drug, and the pharmaceutical industry; the dark side of drug trials; the exploitation in clinical trials; and the scandals, evils, and illegal facts of Big Pharma including their dark secrets of false/poor-quality research. Next, the “health scare” headlines of modern medicine such as disease mongering; the epidemic of unnecessary medical treatment; the dark side and fallibility of evidence-based medicine (EBM); the dehumanization and commoditization of the medical enterprise as a “hi-tech, no touch medicine” the corruption in global health and a health security threat; the forgotten art of doctoring and bedside medicine; and the hazards of hospitalization, specialization, and/or overspecialization – “One patient, too many doctors,” and the terrible expense of overmedicalization. The other frightening truths are the silent killer of medical mistakes; a crisis in empathetic care with professionalism; the overreliance of emerging medical commercialized technologies including artificial intelligence (AI) in revolutionizing health-care systems, and ultimately the doomsday of physician burnout and physician suicide, which are the other sordid tales of the underbelly of modern medicine. The looming threat lurking on the darker side of modern medicine, namely “Primum non nocere,” harmful medical mistakes, hubris syndrome, and human fallibility, were addressed in a previous editorial. This dark reflection is aptly quoted by Ivan Illich as “Modern Medicine is a negation of health. It isn't organized to serve human health, but only itself, as an institution. It makes more people sick than it heals.”
Beyond Reductionist Scientism and Skepticism: an Integrative Holism
The quest for absolute certainty is an immature, if not infantile, trait of thinking.
– Herbert Feigl, Inquiries and Provocation: Selected Writings, 1929–1974
It is my conviction that are blindly drifting away from our heritage of the ancient Indian medicine, and so to speak, are we not “barking up at the wrong tree” of “elephanomics” akin to the “The Blind Men and the Elephant.” We have become ardent followers in a monolithic paradigm cum “scientism” and, succumbed to the “irrationalism and fallibility” of the orthodoxy of Western medicine. This drift of our scientistic reductionism has completely and erroneously ignored the fusion of alternative horizons, pluralisms, and holisms in healing sciences! In my reflection, modern science and medical scientism have become increasingly imperialistic. However, completely ignoring the hard reality of material existence, and in the medicalization of human afflictions into disorders for which, it boldly fights for “quick fixes,” many a times, unaware of its fallibility and medical powerlessness. All else is unscientific, insignificant, and of little relevance to human health. Human illness has become a strictly physical event, a “pathogenesis-model.” In my opinion, an optimal approach to health restoration in our society should involve the right balance of a properly functioning pathogenic model (understanding and responding to the true root causes of dis-ease) and a “salutogenic model” (understanding the origin and creation of holistic health-ease and well-being).
The epistemology of our medical scientism is, in effect, one manifestation of philosophical modernism, which expounds on the belief that reason, coupled with scientific analysis and evaluation alone, can bring us to complete understanding of all mysteries. This notion has several flaws. First, the knowledge, and the observed information, relied upon must not be fallible, i.e., the philosophical principles underlying the scientistic claims should be enduring. This is untrue, as the practice of health care is pivoted on determinism-based “pathogenesis-disease” model, ignoring any other factors. Medical scientists in modern medicine create this “model” based on their experimental studies, combined with randomized controlled studies and meta-analyses (statistical science) to explain the experimental results that have accumulated. I firmly believe that this conceived model is certainly flawed, and no matter how “smart” it is, it is still a “model” we created from our “medical scientism.” Second, the translations of reductionist analysis and statistics must be amenable to scientific scrutiny and analysis (individuality, and other intangible factors in health-ease model). Lastly, the summation of our scientism must be applicable to not only an individual, but should represent a convergence science to population health.
Thus, I would unhesitatingly retort that our medical scientism is not a synonym for “rationality.” Do we understand the difference between sciences (the scientism of medicine) and absolutism? Science is not “absolute” as, in my view, its epistemology attempts to seek truth only by a series of approximations. Why do I raise such intriguing questions in my mind? Since Renaissance and Descartes, science and medical epistemology have adopted a paradigm “reductionism” approach of an analytical evaluation of the natural world where the “wholesome complex” is fragmented into “solvable, smaller, simpler, tangible basic units. I address this “medical scientism” as the “reductionism versus holism” debate. Dr. Daniel Dannett, an American cognitive scientist, philosopher, and writer, did coin the word “greedy reductionism” to differentiate a “good” reductionism from a kind of “erroneous” reductionism, i.e., a tendency to feel that every explanation in every field of science should be reduced all the way down to cellular biology and particle physics. The reductionist philosophy deconstructs a complex process into its component parts to enable better comprehension. I believe in an antireductionist philosophy, merely because of the fact that reductionism will not work as a singular paradigm in the science of clinical medicine, simply because the human machinery and disease concepts are increasingly viewed through the nonlinear dynamics of chaos theory-fractal geometry (mathematics) rather than the simplistic pathophysiological approach. The Chaos Theory highlights the interdependency among variables and the overall holistic patterns that emerge from these dependencies in basic medical science. The fundamental premise of reductionism is the absolute “focus on a singular factor,” illness be simplistically conceived as “failed homeostasis,” the risk factor “prevention paradox,” and a “piecemeal treatment” with a fragmented approach, thereby neglecting the complex interplay between disease and treatment.
However, when I reflect on the dark side of medicine, I wonder if some of the “success stories,” maybe depicted to a more ominous tale of hubris. I have grave concerns about the absolutist tendency of the scientific worldview. However, the notion of “an absolute truth” in medical scientism is not pragmatic because the human machinery and its innate intelligence follows the principles of complexity, where intricate dynamics of self-organization at one level lead to the emergence of a new set of interactions at another level, which could never be predicted by the reductionist view. We keep hearing about the astonishing predictive powers of science, but what about the stuff it can't predict? In the words of South African novelist, Laurens van der Post, “It is not reason that needs to be abolished, but the tyranny of reason.” In no uncertain terms, we need medical scientism to move away from the absolutist values of the monotheistic mindset.
The patient has a great variability resulting from the uniqueness of a human being, and it is crucial that a patient is more than numbers, statistics, and knowledge. We need to understand and confront this danger of becoming greedy reductionists, step back, ponder on our epistemological scientism of modern medicine, and to re-learn the importance of holistic approaches to patient healing outcomes in the 21st-century medicine. The self-defeating character of skepticism underlying this scientistic reductionism is lamented by the wisdom of Dr. Geroge Bernard Shaw (“Science never solves a problem without creating ten more.”), Dr. Abraham Flexner (“Science, in the very act of solving problems, creates more of them.”), and Sir William Osler (“The person who takes medicine must recover twice, once from the disease and once from the medicine.”). I would elegantly summarize the “reductionism versus holism” debate that though there are useful insights from reductionism, the future trajectory of modern medicine does seem to trespass “greedy reductionism” in many facets and domains of medicine, research, and health care. These words of biologist Carl Woese (2004) warns us of this “greedy, nonholistic reductionism” – “A society that permits biology to become an engineering discipline, that allows that science to slip into the role of changing the living world without trying to understand it, is a danger to itself.”
I certainly do negate the philosophy of reductionism and firmly am convicted to an opposite scientism of “holism” where a “disease is more than the sum of disordered enzymatic and cellular interactions,” where reductionism perspective is rooted in the assumption that the forest can be explained by studying the trees individually. In this respect, the dominant force for objectivity and universality in medical research is EBM. Let me quote T. S. Eliot (The Rock, 1934) – “Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information.” Here too, EBM comes at a cost because clinical disorders must be defined in heavily simplified terms to enable randomized controlled trials and meta-analyses. This reductionism would, therefore, require complex entities/variables to be necessarily simplified as quantitative units which can then be subjected to statistical rigor and methodology. Many a times than not, this approach becomes “evidence burdened” because unequivocal plethoric data is replete in literature due to logical inconsistencies and inconsistent methodological flaws, analytical challenges, and statistical reductionism that eventually mischaracterize EBM to be resting on a “one-legged stool,” rather than the intended “three-legged stool” conceptualized by David Sackett, an American-Canadian physician and a pioneer in EBM in 1996.
Science deals with the rationalism and empiricism of our five senses, we believe in what we “see and measure,” and what “we cannot see, observe, or quantify,” scientism claims to be “not true,” “unscientific,” or “illogical.” Our “scientism” cannot see the forest for the trees and suffer from simultagnosia, a scientific world that is unglued to holism, wellness, and healing outcomes, instead riveted to as empiricists and rationalists with an ideology of the reductionist concept of disease and hi-tech technology as its surrogate remedy, ignoring the “individuality” factors. Do we need an alternative eyepiece of a “systems-oriented perspective” of systems biology to decipher and study the holistic and composite characteristics of a problem? Recognizing the limits of reductionism, the systems' perspective is rooted in the assumption that the forest cannot be explained by studying the trees individually.
Perhaps, a futuristic step further, beyond reductionism, is a systematic and comprehensive expression of a broader “medicalization of health and life itself, the concept of 'P4 systems medicine' (P4SM).” This represents a “holistic medicalization” and technoscientific holism, and the “P4SM” acronym standing for “predictive, preventive, personalized, and participatory;” a medical application of systems biology, the biological study of wholes, disease, and “wellness” (integrative, humanistic medicine) and burgeoning toward “precision medicine.”
As an epilogue to this fundamental vexation of “Absolutism versus Reductionism” in our medical scientism, I would reiterate that “pragmatism is anti-monolithic and anti-dogmatic”; because it favors openness and plurality and reinforces the ideological context of perestroika in resurrecting hope and humanity of affordable, healing, high-quality and safe health care of the future for humankind's afflictions. Tomorrow's doctors should be the pathfinder for another alternative low-tech, low-cost, long-term, sustainable “whole-istic, holism,” “whole-person” model, or doctrine of medicine that does undoubtedly promote health and foster wellness, that will remove the current scientific orthodoxy and shackles of the “pathogenesis-dis-ease” model. Wellness is not a “medical quick-fix” endeavor but a way of living, a lifestyle health behavior attitude from the cradle to the grave, with its epistemology enshrined in a biopsychosocial spiritual model. A non-monotheistic mindset of scientism, well-being, and healing would make life worthwhile, easing our positive health journey from the cradle to the grave.
The Unholy Trinity of the “underbelly” of Modern Medicine
“The chief of poverty in science is imaginary wealth. The chief aim of science is not to open a door to infinite wisdom but to set a limit to infinite error.”
– Bertolt Brecht, Galileo
“The establishment defends itself by complicating everything to the point of incomprehensibility.”
– Fred Hoyle
As a physician in modern medicine, I do not take any pleasure in explicating this truth, however such truths must be unraveled. This polemic section is written so that the aspiring medical students and developing physicians should not be “agnostics” to the “follies, fallacies, and moral malfeasance” in the practice of modern medicine and health care today. The truth behind this unholy trinity in modern medicine and the current trajectory of health care has only been tarnished as “Not a Friend of Mankind.” We should be indoctrinated that medical scientism is indeed flawed with errors. These are errors of doctrine, systematic errors which are part of dogma and accepted truth, distortions which set obstacles in the path of rational thought and inquiry. I feel, the young inquisitive minds, in particular those uncorrupted by the dogma of medical scientism and its consequences, should be cognizant of the limits to medicine as well as its nemesis. I would vehemently proclaim that the true progress of science and the growth of knowledge for the goodwill of the human society and health-care systems for humankind as its friend will depend only if we challenge the accepted dogma and belief.
My insights to the dark side of medicine emanate from specific personal reflections, but mainly, being an autodidact, the sordid and frightening truths and the “bottle of lies” of the “underbelly” of modern medicine stem from devouring “controversial” books written by radical thinkers with a “questioning mindset.” This section will mainly reflect the critical thoughts of Ivan Illich's book “Limits to Medicine-Medical Nemesis” (1976); Petr Skrabanek and James McCormick's book on “Follies and Fallacies in Medicine” (1989), and Gary Null's book on “Death by Medicine.” (2010) I have fervent plea that all medical students and developing physicians should read, ponder, and assimilate “truths” from such radical thinkers of our time. Can we justify this “unholy trinity” of modern health care for humankind by any common thread of morality or ethicism? For one day, one of us when “falling as a sick human being,” getting strangled by “hospitalization and medicalization,” would long to be adequately cared. This hope and restoration of health care should be “mentored” by doctors enshrined with humanism and professionalism, those who are not agnostic to the fallibility of medical scientism, and by those who willfully refrain from cognitive hubris while they provide care and succor, never forgetting the “Reverence for Life's meaning” and “To be treated with Dignity.” This is my prayer for the “Catechism of a Holistic Healing Medicine,” and “Human Dignity in the Healthcare!”
Ivan Illich's rhetoric propounded that the major threat to health in the world is modern medicine per se (through the premise of pseudo-disease promotion, disease mongering, and a fear of disease epidemics), its expropriation of health, that hospitals in particular caused more sickness than health, and his centerpiece ideology of iatrogenesis to describe what he saw as a relentless increase in disease induced by doctors (called iatrogeneis) at a three-tier level, i.e., clinical, social, and cultural iatrogenesis as coined by Ivan Illich. Is medicalized health care, disease-mongering concepts of a determinism-based “pathogenesis model,” and the fearonomics (nosophobia) becoming the “politics of fear and epidemics of fear,” standing as an obstacle to a healthy life? I call this the “war/combat politics” versus the “peace politics” of health-care ethics. Clinical iatrogenesis is the injury done to patients by ineffective, toxic, and unsafe treatments, rather a heteronomous management paradigm, in effect a hazard of hospitalization. Second, social iatrogenesis which results from the (over) medicalization of life, and the health-care threats (dangerous drugs and drug company bribery) imposed by pharmaceutical companies. The more the life is medicalized, the more the people are forced to operate under the influence of organized health care, “when all suffering is “hospitalized.” The third tier is “cultural iatrogenesis:” cultural iatrogenesis that promulgates “quick-fix” solutions (called medical treatment) on a reductionist “pathogenesis-model,” completely losing sight of “medical fallibility,” and ignoring the biological actuality of “being mortal,” dying seen as an ultimate form of consumer resistance, and deprived of a dignified care pathway of consoling, caring, comforting patients, and hospice. This pervasive and deep-rooted cultural “mis-adventure” of medicine does not sanctify the “society's image of a dignified dying process.” In another words, I would reiterate, cultural iatrogenesis completely causes a moral and ethical erosion of traditional ways of dealing with and making sense of “aliveness,” pain, sickness, and death. Ivan Illich does indeed portray a harsh, counterproductive, and even harmful criticism of health care. Health care can work against the healing people seek from it, and that health care can be as pathogenic as disease (iatrogenesis). The modern medical enterprise through its medicalization health-care paradigm, to me, does constitute a prolific bureaucratic program based on the denial of the human and the society's need to deal with health-ease, dis-ease, pain, dignified dying process, and the eventual actuality of death. This, in fact, does translate to the expropriation of health and is unjustifiable nemesis to patient subjects with “dis-ease.” Therefore, shouldn't life quality of health-ease, the “within normal limits' realism of health behavior, and the quantum of “dis-ease,” be left less medicalized, so as to leave more room for people to decide themselves if their challenges are a matter of health or not, and how/which “catechism of health-care systems” they would prefer to choose?
Turning to another medical classic, the book on “Follies and Fallacies in Medicine” certainly poses criticisms that disturb our equanimity and unravel absurdities and the failures in our “scientistic reasoning” all of which are too many to enumerate here. It argues for the “placebo effect” as a powerful therapeutic weapon. It has been estimated that 35%–45% of modern-day prescriptions are unlikely to have any beneficial effects consequent to specific pharmacological properties (or do not possess an active compound) for intervention on the diseases. This has been explicated as the neurosciences of placebo effect to involve expectancy, conditioning, anticipation, and reward mechanisms in specific regions of the brain. This does indeed embody a new physiology on placebo effects and the doctor–patient relationship. In a similar vein is the “care effect” which lends credence to the relevance of “empathetic healing” and “therapeutic empathy” that underpins the holism of mind–body self-healing processes and “whole patient-centered care.” The next section of the book unravels a humbling account of the many fallacies that plague medical practice stemming from erroneous reasoning, misinformation, a deceptive thinking culture, and a fistful of fallacies of illogical thinking in medical scientism, unidirectional ideology in the cause and effect in epidemiology, fallacies in randomized controlled trials, and thus the fallibility of EBM. The maladies of misinterpretation of medical statistics, as well as its misuse, abuse, and inappropriate extension of statistics (fallacies of inappropriate statistical extrapolation of relative and absolute risk rates [known as mismatched framing], and numbers needed to treat) in epidemiological and biomedical research, were explicated and succinctly ended with the quote “There are three kinds of lies: lies, damned lies, and statistics.” All are potential dangers that can mislead physicians, research community, and patients. The other illumination on medical fallacies criticized medical thinking styles, the malady of establishing a diagnosis, the need for a diagnostic label to medicalize dis-ease, diagnosis, and the risk of false positives.
It is surreal that medical scientism is not reaching the destination of the holy grail of medicine, namely prevention, in the absence of an alternative holistic biopsychosocial–spiritual model of health promotion and well-being. At a deeper level, there is something terribly wrong with having to define everyone as being ill (disease mongering, selling sickness, and drug marketing lobbyists) in order to make them healthier. The Greeks had a better understanding. Their god of healing, Aesklepios, had two daughters, Panacea and Hygeiea. The former, as her name implies, was responsible for healing disease, but Hygeiea, (his favorite) had the task of promoting health. And until we, as a medical profession and a society, can come beyond disease prevention to a true concept of health promotion, we shall remain mired in an ever-increasing spiral of more drugs, more medicalization of life, ever-rising health-care costs, and an elusive promise of better health.
Another Pandora's Box centers on the “Moral climate of healthcare,” the question on the morality and medicine, the nonmaleficence, beneficence, justice, and its fiduciary relationship. Unfortunately, the evil-mongering of the health-care systems resides in the unholy nexus, rot, or labyrinth of interlocking hospital, corporate, drug trials, and the drug companies. Gary Null's book on the “Dark side of Medicine” gives an unbelievable exposure of the various drugs developed and used on patients, that I would obviously state as the “bottle of lies” of the Big Pharma leading to the actuality of the truth – “death by medicine.” This puts the nail in the coffin with compelling evidence that today's medical health-care system in symbiosis with drug pharmaceutical companies is indeed causing more harm than good. The book gives gruesome statistics on the multiple causes of “iatrogenesis.” Foremost, is the stunning statistics of medicalization of health care where the number of people having in-hospital, adverse reactions to prescribed drugs is estimated to be 2.2 million per year. It is nerve wrecking to grapple with the truth that underlies the underreporting of iatrogenic events and medical errors – only as few as 5% and no more than 20% of iatrogenic acts are ever reported. The number of unnecessary antibiotics prescribed annually for viral infections is 20 million per year. The number of unnecessary medical and surgical procedures performed annually is 7.5 million per year. The number of people exposed to unnecessary hospitalization annually is 8.9 million per year. The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year. It is now evident that the American medical system is the leading cause of death and injury in the USA plagued by multiple causes of iatrogenesis and hazards of hospitalization. These include unnecessary hospitalization, rather “over-hospitalization-corporate medical insurance syndrome,” the staggering medical errors, pharmaceutical company lobbyists, nihilistic values of healthy lifestyles, iatrogenic deaths, unnecessary drugs prescribed, unnecessary medical and surgical procedures, and the escalating costs of medical interventions. The powerful pharmaceutical and medical technology companies, along with other powerful groups, have vested enormous interests that jeopardize scientific behavior. Two studies (Brennan et al., 1991; Campbell et al., 2003) have found that nearly half of the medical school faculties who serve on institutional review boards to advice on clinical trial research also serve as consultants to the pharmaceutical industry. Undoubtedly, for mutual symbiosis, there exists a powerful medical–pharmaceutical complex across the globe whose goal it is to redefine life as a continual disease, foster disease mongering, and thrive by creating a fear of epidemics threatening the human society.
This only goes on to merely reiterate that medicine is under threat of the perils of deprofessionalization, with conflicts in interest in scientific medicine, and that health care is reduced to a business enterprise. At this crossroads that blur academic medicine and health-care systems, I would ask these two questions “Can the sum of all these fallacies and “untruths” of modern medicine been seen as sensible?” and “Is there maleficence, malfeasance, or rather a betrayal to the covenant of trust in the soulful and moral enterprise of health care?”
Doctor's Strike – Do Patients Die or Good for Health?
Such a question posed here did emanate from a publication in British Medical Journal (BMJ) in 2000 titled “Doctors' strike in Israel may be good for health.” Whenever medical doctors go on strike, a most interesting phenomenon occurs – death rates go down! In 1976 in Bogota, Columbia, medical doctors went on strike for 52 days, with only emergency care available. The death rate dropped by 35%. In 1976, in Los Angeles County, a similar doctors' strike resulted in an 18% drop in mortality. As soon as the strike was over, the death rate went back to normal. A finding against the popular wisdom was the revelation of a 50% decrease in mortality did occur in Israel in 1973 when there was a 1-month doctors' strike! A comprehensive review of the medical impact of doctors' strikes which was published in the prestigious academic journal Social Science and Medicine in 2008 supports this paradoxical pattern: when health workers go on strike, mortality stays level or decreases. This study entitled, “Doctors' strikes and mortality: A review,” suggests that it is the fact that elective, or nonemergency surgery, tends to stop during a doctors' strike, which seems to be the key factor. It looks like a surprising amount of mortality occurs following this kind of procedure which disappears when elective surgery ceases due to doctors withdrawing their labor. Mortality declined steadily from week 1 (21 deaths/100,000 population) to weeks 6 and 7, when mortality rates were lower than the averages of the previous 5 years. However, as soon as elective surgery resumed, there was a rise in deaths. There were ninety more deaths associated with surgery for the 2 weeks following the strike in 1976 (i.e., when doctors went back to work) than there had been during the same period in 1975. Therefore, when doctors strike, the scientific research shows that patients stop dying!
The 2015 BMJ observational report definitely connects the dots between Israeli doctors' strike due to sanctions imposed on them by the Israel Medical Association in the year 2000 (as well as earlier in 1983 where 73% of doctors in Jerusalem refused to treat patients) and fewer deaths (funerals) as per the burial society in Jerusalem and Tel Aviv. Perhaps, the underlying truth to this BMJ article relates to the fact that “Mortality per se is not a specific indicator of harm to health,” and it was noted that during the months of the strike, the family doctors and emergency services, unaffected by the sanctions, may have aided as supplementary medical care that had contributed to the fewer death reported.
How disruptive are doctor strikes and what are their consequences? The eye-opener evidence to this surreal question is addressed in another publication from Harvard Medical School, Boston, USA, which was published in BMJ 2015 (Metcalfe et al.). A systematic review (of nine studies) in 2008 exploring doctor strikes (industrial action by doctors) concluded that patient mortality remains the same or fall during industrial action and did not impair the quality of care. However, although doctors' strikes do not seem to increase patient mortality, they do disrupt the delivery of health care by the widespread cancellation of elective operations (services) and nonurgent hospital consultations, especially in poor health-care settings with deficient infrastructure. In the 2008 New Zealand doctors' strike, both emergency department waiting times and hospital length of stay fell significantly, which was attributed to the replacement of junior doctors and deployment of senior physicians. The strikes in New Zealand showed that senior physicians can provide emergency care in the absence of junior doctors. The popular perception that doctor strikes risk patient safety has been proven wrong, perhaps circumvented by pressurizing the available emergency facilities and reallocations of workforce resources. A similar conclusion was also derived from a population-based cohort study from Kenya (Kilifi) during the period of 2010–2016 published in the 2019 issue of Lancet Global Health, although certain factors could have attributed to the underestimation of mortality. This section perhaps, to my mind, underscores the importance of fewer medicalization, and at the same time, the hazards of overhospitalization (elective services/operations). Could it be that the way medicine and health care are organized, rather than simply having lots of doctors around, is another fundamental issue?
Corruption in Global Health Care and Medicine
I would state with much disenchantment that humanity has been plagued by market fundamentalism, conspiracy, corruption, and monopolistic practices for as long as it has been fighting diseases on the part of orthodox medicine. Global health is now a multibillion-dollar sector driven by $37.6 billion in development assistance for health in 2016, according to the Institute for Health Metrics and Evaluation. The menace of health-related corruption, admittedly an undeniable reality in the health sector, is a complex phenomenon and a difficult problem, and arguably the most serious ethical crisis facing medicine today. In this unsound health-care system, corruption has trapped millions of people in poverty, deprived the society of health security, and has perpetuated the existing inequalities in income and health. This has inevitably drained the available resources, undermined people's accessibility to affordable health care, increased the costs of patient care, and contributed to a vicious self-perpetuating cycle of immeasurable devastating effect on human health.
Although the exact magnitude and dimensions of health corruption are difficult to measure, estimates put it in the billions of dollars. In 2014, a publication in the European Journal of Internal Medicine unraveled that China is at the top of medical corruption with extremely chaotic drug markets, with intense unhealthy competing pharmaceutical companies plagued by bribery and “kickback” scandals (e.g., GlaxoSmithKline bribery scandal). In China, some pharmaceutical companies are riddles with unethical practices where kickbacks are paid to doctors and hospital administrators to boost drug prescriptions. Some pharmaceutical companies engage in bribery to raise drug prices, expand sales, and reap inappropriate profits. The various forms of malpractices between drug companies and doctors include cash kickbacks, lavish gifts or entertainment, prescription abuse, gray incomes, all-expenses paid trips, ghostwriting services, and sponsored supplements in journals. Let us reminisce some of the hard, cold reality of “shame of drug scandals” (The Great Medicine Scandals) deeply embedded in the medical culture of health care. The first one that comes to my mind was the “Rofecoxib (Vioxx) scandal” where it took at least three studies (The Harvard-Study by Solomon et al., Food and Drug Administration-sponsored Kaiser-Permanente Study in 2004, and APPROVe Trial in 2008) to convince Merck of 2–3 times heightened serious cardiovascular complications, stroke, and higher risk for hypertension for Merck to finally remove rofecoxib from the market. Dr. David Graham estimated that Vioxx had been associated with more than 27,000 heart attacks or deaths linked to cardiac problems. These were all related to “lying with statistics,” underreporting of cardiovascular events, and ethical violations by Merck. The final truth about rofecoxib was published in NEJM (VIGOR study, 2006). These unethical tendencies have also been reported with “cancer chemotherapy” scandals, and perhaps the “Statins war.” Statinization portrays that statin drug is being sold faster than Viagra (Sildenafil) and which is being overprescribed even in those with low risk of heart disease, completely negating the various adverse effects of such drugs. The statin theory is a seductive one that has now created a “statin controversy or disaster” (The Great Statin Scam) which is the biggest fraud in medical history. There is misinterpretation and misunderstanding of trial evidence on statin's adverse effects. The risk–benefit ratio of statins has been the focus of research by Beatrice A. Golomb of The UCSD Statin Study group at UCSD. She implores for an awareness and vigilance for adverse effects to be maintained to enable informed treatment decisions, treatment modification if appropriate, improved quality of patient care, and reduced patient morbidity. My final question on our concept of “drug therapies,” don't we need to challenge the prevailing dogma of “prevention at all costs,” and instead foster a broader vision of “Lifestyle Medicine and Preventive Medical Epigenetics” to help people in the society live successfully with health-ease and wellness to the very end of their lives?
The dark side of drug trials and the exploitation in clinical trials have been unraveled in the book titled “White Coat, Black Hat: Adventures on the Dark Side of Medicine.” Dr. Carl Elliot who specializes in philosophy and ethics, a professor of bioethics at the University of Minnesota, methodically exposes every aspect of the connection between Big Pharma and medicine. He unravels the uncharted dark side of medicine and consumer capitalism. He exposes us to the often shifty characters who work the production line in Big Pharma: from the professional guinea pigs who test-pilot new drugs and the ghostwriters who pen “scientific” articles for drug manufacturers to the public relations specialists who manufacture “news” bulletins. We meet the drug reps who will do practically anything to make quota in an ever-expanding arms race of pharmaceutical gift-giving; the “thought leaders” who travel the world to enlighten the medical community about the wonders of the latest drug release; even, finally, the ethicists who oversee all that commercialized medicine have to offer from their pharma-funded perches.
It is imperative that a charter and advocate for global health anticorruption program needs to be implemented under the Sustainable Development Goals (SDG) framework (especially SDG target 16.6) utilizing the emerging anticorruption technologies. The framework for global health anticorruption could be reinforced by soliciting partnership, research, and expertise from UN-specialized agencies (e.g., World Health Organization, UN Office on Drugs and Crime, UN Development Programme, and the World Bank), civil society, the private sector, and communities disproportionately affected by health corruption. Only such international advocacy and effective surveillance systems to combat corruption would be able to ensure the integrity of health and building new health-care ecosystems for the next generation of humankind.
Twin Dilemmas: The Fallibility and Corruption of Evidence-Based Medicine
The idea of EBM is great. Nevertheless, I would reiterate that it is still important to get beyond the EBM hype to identify the limits of evidence and the importance of the “art” of medicine because evidence need not necessarily vanquish uncertainties. I strongly believe that the art of medicine that consists of clinical judgment and personal physician experiences, clinical reasoning, and the interpretation of clinical information would be still necessary in a system of EBM.
As human perception is often flawed with the undercurrents of corruption in health care, the reality of the dark side of EBM is unparalleled with an unethical crisis. Many a times, we are placed in situ ations where a well-defined answer does not exist. This dilemma, known as medical uncertainty, plagues physicians on a daily basis, including those with many years of clinical experience. EBM was designed to minimize bias, reduce uncertainty, and to provide a rationality in clinical decision-making and evidence-informed medical practice. Several philosophers have argued that the methods of EBM do not eliminate the possibility of bias and error, that randomized controlled trials and even meta-analyses are less replicable than expected and not appropriately captured by the usual linear hierarchy of evidence. Medical decisions are based on an understanding of publicly reported clinical trials. If the evidence base is biased, then decisions based on this evidence may not be the optimal decisions. EBM is completely worthless if the evidence base is false or corrupted. The corruption of EBM that can be equated to the aphorism “Killing for Profit, Healthcare for Wealth” has huge implications. The two most prestigious journals of medicine in the world are The Lancet and The New England Journal of Medicine (NEJM). Richard Horton, editor in chief of The Lancet, said this in 2015: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue.
” Dr. Marcia Angell, former editor in chief of the NEJM wrote in 2009, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor.” The dark unethical side to the corruption of EBM is that most of the research is almost always sponsored by pharmaceutical industry, and therefore compelled to show a positive result. Notwithstanding this, the propriety of EBM is further threatened by selective publication bias where the negative trials (those that show no benefit for the drugs) were likely to be suppressed. This would lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio.
Another ramification to the “publication bias” in EBM was reappraised by Dr. John Ioannidis in a leading journal (PLoS Medicine 2005) with a thought provoking title “Why Most Published Research Findings Are False.” He states that it can be proven that most claimed research findings to be indeed false. Although it is a well-known fact that it is impossible to know with 100% certainty what the truth is in any research question, this dark scenario is not unavoidable. The solution lies in the scientific rigor and design of research studies (large-scale study with higher statistical power) which will be conducive for interpreting research claims and putting them in context for the totality of evidence. Such studies will have the potential for better powered evidence, large-scale evidence, with low bias meta-analyses, and without data and statistical misinterpretation (misuse), and avoidance of biases in our assumptions.
Another fallibility of EBM relates to the controversies of angioplasty in chronic ischemic heart disease (chronic stable angina). The two trials that did question the scientism of how we treat chronic ischemic heart disease were the Clinical Outcomes Utilizing Percutaneous Coronary Revascularization and Aggressive Guideline-Driven Drug Evaluation (COURAGE trial in 2007) and the ORBITA trial (percutaneous coronary intervention in stable angina). The COURAGE trial showed that coronary stent implantation in combination with medical therapy for stable coronary artery disease (CAD) was not associated with a significant reduction in mortality, nonfatal myocardial infarction, or angina, supporting a noninterventionalist approach. The ORBITA study (2017) further augmented that percutaneous coronary intervention was not proved to be helpful or may provide only a placebo effect in stable angina on cardioactive medications. These trials have far-reaching implications in an evidence-based discussion that underscores the unnecessary “nonevidence-based” cardiac interventional procedures, stenting, and angioplasty procedures in stable CAD prevalent world across both in the USA and India.
Let me take the example of Bell's palsy and its treatment. Even today, after Sir Charles Bell described it in 1821, the etiology of Bell's palsy is uncertain. Even today, there is no optimum regimen, but in adults, 50–60 mg (or 1 mg/kg/day) prednisolone daily for 10 days has been commonly used to a maximum of 80–120 mg in some studies and have been used safely in patients with diabetes mellitus. There is still uncertainty regarding the benefit of combination therapy of antivirals with corticosteroids. A Cochrane review in 2015 found that antivirals combined with corticosteroids did improve the rates of incomplete recovery compared with corticosteroids alone, but this was not significant and the evidence was of low quality. It is also stated that the prognosis is favorable, as 71% of patients with Bell's palsy do tend to recover without any specific treatment. Studies do also state that the recovery rates of facial movements in Bell's palsy with diabetes at 3 and 6 months after onset were poorer than the nondiabetic Bell's palsy, thus suggesting aggressive high-dose corticosteroid treatment with the administration of adequate insulin and close monitoring of blood sugar during steroid therapy in diabetic Bell's palsy with a cure rate of 97%. On the contrary, a 2017 study suggested that the recovery of facial functions may be satisfactory even without steroid therapy in diabetic patients with Bell's palsy as long as the regulation of blood sugar level and pressure are ensured. My question in this context will be “Do I start high-dose corticosteroid for a Bell's palsy in a 76–year-old obese patient who has diabetes mellitus with a fasting blood sugar of 130 mg/dl and a postprandial blood sugar of 280 mg/dl? Which evidence do I need to follow in an individual patient? How do I estimate the risk–benefit ratio and predict the severity, recovery course, and prognosis of Bell's palsy? How do I avoid making a “harmful medical mistake” in this clinical scenario? There's a sense that there's some shame or guilt attached to the fact that we don't get it right all the time. I wonder, is our modern science and our philosophy of medical scientism without sense and/or a soul?
Medical Uncertainty: not “taught” in Medical Schools to Be “caught” in Medical Practice
“Life is short, And the art long, The occasion instant, Experiment perilous, Decision difficult.”
Sir William Osler once mentioned, “Medicine is science of uncertainty and art of probability.” Another aphorism from the master teacher, Sir William Osler, in an address to students about to graduate from medical school: “A distressing feature in the life of which you are about to enter. is the uncertainty which pertains not alone to our science and art, but the very hopes and fears which make us men. In seeking out the absolute truth we aim for the unattainable, and must be content with finding broken portions.” To become more comfortable in situ ations that may not have a single perfect answer.
I see many medical aspiring students and young physicians entering the medical fraternity for its scientific rigor, objectivity, and evidence-based aphorisms, only to be greatly disappointed when everyone realizes that much of medicine is practiced in shades of gray rather than black and white. There is an absolute reluctance to affirming and teaching medical fallibility and uncertainty in medical schools, as far as I can see. Learning to deal with uncertainty, I would state, should be a core competency for any developing physician, and I am disappointed that the intrinsic uncertainty, and the existence of the Heisenberg uncertainty principle, is not inculcated into the very competency-based teaching and educative fabric and medical training environment of medical schools. This should not be the case as the most important stakeholder in clinical uncertainty is, undoubtedly, the patient, our patient placed in the trust of our care.
Therefore, my question is “Are we taught medical fallibility and medical uncertainty in medical schools?” Medical uncertainty has been considered an innate feature of medicine and medical practice. As practicing physicians can attest, the black-and-white world of medical school, where only one correct answer existed on a written examination, rarely mimics the grayish hues of the clinical environment. How do we learn or be taught to be comfortable managing uncertainty and probabilities with much certainty?
Medical training should acknowledge “certainty of the uncertainties” and inculcate treatment and knowledge at handling effectively and curing uncertainty. One need to be trained to recognize the type of uncertainty, whether it is informational uncertainty first. Informational uncertainty results from knowledge deficits and can be further classified into (1) conceptual uncertainty (the inability to apply abstract knowledge to specific situations); (2) technical uncertainty (the absence of scientific data or practical skill for a specific clinical situation); and (3) personal uncertainty (the lack of a relationship with patients and knowledge of their goals of care). The more opaque, intrinsic uncertainty is based on the existence of the Heisenberg uncertainty principle, which is woven into the very fabric of medicine. Intrinsic uncertainty can be explicated utilizing the Physicians' Reaction to Uncertainty scale (PRU). Teaching dual-process theory, adopted from cognitive decisional science, would certainly be an instructional paradigm for the clinical educator to somewhat improve accuracy in clinical reasoning rather than merely teaching about errors and biases using intuitive thinking (heuristics) and systematic and analytical thinking cognitive styles in the paradox of uncertain situations.
The Terrible Expense of Specialization And/or Overspecialization: “one Patient, Too Many Doctors”
The past half-century has witnessed great changes in modern medicine world across, i.e., the rise of specialist-driven care that has been unequivocally paralleled by an equally dramatic escalation in health-care costs. Besides high costs, having too many specialists and consultants seeing a patient in a fragmented piecemeal fashion merely leads to sloppiness and disorganization. I would vehemently cry out loud that inpatient care at hospitals has become a relay race for physicians and consultants, and patients are the batons. Isn't this a threat to generalism? Is specialization a threat to family medicine's generalist soul for effective patient-centric holistic care? The importance of generalism is not yet well enough understood and for practicing comprehensive care for a population of patients in the community and providing more specific care to patients in the hospital. I would say that there should be a symbiotic marriage of generalism and specialization.
The Dark Side of Physician Burnout and Physician Suicide
The dark side of physician burnout syndrome has been dealt with in a previous editorial. The statistics on physician suicide are stark. Physicians are more than twice as likely to take their own lives as nonphysicians, and more than 400 physicians commit suicide each year in the USA. Moreover, young physicians at the early part of their training are reported to be particularly vulnerable to suicidal ideation. Doctors must take care of themselves as they navigate through the often rough waters of medical life and foster strategies for revitalizing themselves while they practice medicine.
Warnings of a Dark Side to Artificial Intelligence in Health Care
The prospect of utilizing AI technologies such as deep (machine) learning in improving health care and medicine and being utilized as deep-learning AI diagnostic tools is truly exciting such as the Google's eye system. Similarly, AI, artificial neural networks, and machine learning (intelligent machines) will also revolutionize cognitive neurosciences. The downside to this technological human (super human)-like intelligence is to understand our very own “human moral behavior” in order to build such good, ethical machines and to invigorate the burgeoning field of (global) neuroethics in the complex human–machine inter-relational dynamics. A neuroscience Ethical, Legal, and Social Implications paradigm becomes quintessential for the future of humanity. Such programs will be the vanguard for enabling and enhancing neuroscience advances for the society.
Undoubtedly, there is reasonable cause for optimism that commercial neurotechnologies using deep learning can revolutionize global health-care systems. However, one such fraudulent behavior is the threat of adversarial examples among both computer scientists and medical professionals in clinical ecosystem that uses medical deep-learning systems. I reflect the warning Rollo Carpenter, the creator of Cleverbot once said, “We cannot quite know what will happen if a machine exceeds our own intelligence, so we can't know if we'll be infinitely helped by it, or ignored by it and sidelined, or conceivably destroyed by it.” Stephen Hawking claimed that AI will soon reach a level where it will be a “new form of life that will outperform humans” and said AI stands for “Human Annihilation.”
What will the futurology for the brain hold in an forthcoming neurocentric era of robotics, nanotechnology, AI, neurobionics, neuroprosthetics brain chips–brain–machine interfaces, nanobot implants with neural networks, intelligent humanoid robots, human AI hybrids (intelligence-cognitive robotic systems) all of which may take intelligence to a new level, a horizon of “God-like super intelligence.” This will also usher a new era of future evolution of intelligent life forms – a partnership and symbiosis with machines (transhumanism): Robotus primus robotics technology-Robot brains; Homo cyberneticus-through neurocybernetic prostheses; Homo hybridus; and/or Homo machines. I wonder if “super or God-like AI” would be able to fathom the absolute truth in medical scientism. I would emphasize that the value of medical scientism is to focus on “doubt” rather “in search of and worshipping a monotheistic mindset of the so-called absolute truth.” Then, is it any wonder then, that philosophers such as Václav Havel did raise concerns about how modern science “kills God and takes his place on the vacant.” Is God just a giant supercomputer! And of course, if God is the great programmer in the sky, then to understand him and his works, we need to speak his language thro AI, super intelligence, and utilizing machine learning to get the throne of the holy grail of the “absolute truth.” The intersection of AI and brain neurosciences would definitely be riddled by various unethical perils despite having many potential promises for humankind.
A Personal Epilogue
As an analogy to reductionist scientism, being a cognitive and behavioral neurologist, I do draw similar connotations in my field, namely the reductionist concept of “neurocentricism,” which is sadly is the “Hubris of Neuroscience.” Therefore, in this context, one of my fearsome questions I posed to my very own mind, not because I am an atheist, but rather an agnostic or a pantheist, having discoursed in “Neurotheology” is “Will the progress in neurosciences coupled with the astounding, amazing technological marvels along with our concepts of materialistic reductionism and intellectual imperialism evolve into a “sciences without humanity” and leave “no room for God?”
The grand reductionism of neurocentricsm Nobel laureate, Francis Crick, who once wrote “You, your joys and your sorrows, your memories and your ambitions, your sense of personal identity and free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules.” Computational neuroscience faces an immense challenge when it comes to explaining the mind and to answering formidable question as “How does the brain foster mind?” Perhaps, the truth lies far beyond the “spiking neurons” in the various hubs and networks of neurons in the human brain (80,000,000,000 neurons). What could be the different ways of understanding the brain with some degree of such functional decomposition to be made possible if we are to understand the brain at all?
Though I comprehend computational neuroscience and functional neuroimaging (especially functional magnetic resonance imaging decoding of human behaviorism and brain–mind disorders), there are times, when I feel ambivalent that these maybe faulty biological reductionisms and a scientistic folly, where the real answer may lie between dogmatic sociotrophy and dogmatic biotrophy. As Francis Crick once put it: “You are nothing but a pack of neurons” which is the current pervasive neurocentric theory. This is in contradistinction to the aphorism “brain is more than the sum of its parts.” I do really ask myself if the scientism of neurocentric theories is one dimensional and rather narrow minded view while explicating the domains of human consciousness, philosophy of mind, and human nature.
Akin to our pedagogical strategies, I understand that the “art and science” of teaching and lecturing should ideally foster a balance between “educare” and “educere.” Medical science, as it is taught today, we are forced to adopt a monotheistic mindset, while marginalizing other scientific ideologies of exploration. We teach a single way of knowing, that allows for the assessment of “right” or “wrong” answers, where uncertainties and fallibility of our knowledge are not made fathomable. Those who unknowingly fall into the trap of scientism act as if hard science is the only way of knowing reality and as a meaningful rational inquiry. If something can't be “proved” through the scientific method, through observable and measurable evidence, they say it is irrelevant akin to the McNamara fallacy.
I feel that this medical scientism that fuels on an absolutist and reductionist teaching, prevents critical thinking in the minds of aspiring medical students and develop tomorrow's young physicians. This constant narrowing of the field of inquiry in our current medical scientism should be reappraised for a holistic epistemology, otherwise, I would state the field of modern medicine, as it stands today, will be a dying art or rather an art for dying, not a restoration for hope and humanity to health care for humankind. Our current scientism of a “disease model” is elegantly quoted by Leo Tolstoy quote “I know that most men, including those at ease with the problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives.”
My ideology of a “healing scientism” is that of an Eclecticism philosophy, one that integrates “pluralistic theories” of medical knowledge with its healing whole-person practice. This can be envisioned by the concept of meta-medicine and meta-health that harnesses “the human body's intelligence” through the positive aspects of modern medicine, positive lifestyle behaviorism from “cradle to grave,” preventive epigenomics, amalgamated with the “hidden truths” of the various ancient and traditional systems of medicine practiced worldwide. Such a transformation would be for the greater good of humankind, and ultimately for the hope and restoration of holistic health care for humankind.
In a capitalistic society with a pernicious profit motivation mindset, it is deeply regrettable to confront and comprehend the hard, cold reality of modern medicine, its cultural deception in medicine, and health-care consumerism. This trajectory has its commandments in the values of consumer capitalism and health-care entrepreneurism in this millennium, only to stray away from the “human caring theory.” This, in fact, has caused a reductionism in our “caring science,” and only to sacrifice the “art of doctoring and healing.” According to my “buddhi” (intellectualism), I do not see any reason why the finest traditions of ancient (Indian) medicine cannot supplement those of Western modern medicine. It is my fervent hope that this editorial would stir the minds of medical activists and bioethicists for one futuristic soulful mission, i.e., “To restore hope and humanity to health care.” I would reiterate that we should be able to proclaim three fundamental truths “First, Wealth is Health,” second “Health is Wealth,” and third “Health is a Human Capital.” This has to be fought more vigourously and in a more uncompromising manner.
“Putting on the spectacles of science in expectation of finding the answers to everything looked at signifies inner blindness.”
– J.Frank Dobie
“Science becomes dangerous only when it imagines that it has reached its goal.”
– George Bernard Shaw
“The health of science is in fact jeopardized by scientism, not promoted by it. At the very least, scientism provokes a defensive, immunological, aggressive response from other intellectual communities, in return for its own arrogance and intellectual bullyism. It taints science itself by association.”
– Ian Hutchinson (Physicist, Distinguishing Science from Scientism)
|1||Shelley BP. “Primum non nocere,” harmful medical mistakes, hubris syndrome, and human fallibility; Getting to the heart of the matter. Arch Med Health Sci 2018;6:195-204.|
|2||Silva SA, Wyer PC. Where is the wisdom? II – Evidence-based medicine and the epistemological crisis in clinical medicine. J Eval Clin Pract 2009;15:899-906.|
|3||Ahn AC, Tewari M, Poon CS, Phillips RS. The limits of reductionism in medicine: Could systems biology offer an alternative? PLoS Med 2006;3:e208.|
|4||Vogt H, Hofmann B, Getz L. The new holism: P4 systems medicine and the medicalization of health and life itself. Med Health Care Philos 2016;19:307-23.|
|5||Mojzesova Z, Mojzes M. The importance of holistic approaches to the patient in the 21st century medicine (Arscurandi – Art of healing). Clin Soc Work Health Interv 2018;4:84-9.|
|6||Mackey TK, Kohler JC, Savedoff WD, Vogl F, Lewis M, Sale J, et al. The disease of corruption: Views on how to fight corruption to advance 21st century global health goals. BMC Med 2016;14:149.|
|7||Bourgeois FT, Murthy S, Mandl KD. Outcome reporting among drug trials registered in ClinicalTrials.gov. Ann Intern Med 2010;153:158-66.|
|8||Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008;358:252-60.|
|9||Wray CM, Loo LK. The diagnosis, prognosis, and treatment of medical uncertainty. J Grad Med Educ 2015;7:523-7.|
|10||Shelley BP. Understanding physician burnout syndrome: Antithesis of physician well-being. Arch Med Health Sci 2019;7:1-10.|
|11||Finlayson SG, Bowers JD, Ito J, Zittrain JL, Beam AL, Kohane IS. Adversarial attacks on medical machine learning. Science 2019;363:1287-9.|
|12||Gallagher S. Embodied cognition and the critique of neurocentrism and narrow-minded philosophy of mind. Constr Found 2018;14:101-34.|