SCIENCE: A GOOD SERVANT BUT A POOR MASTER

One of the dilemmas we face as practitioners in the West is the urgent and pervasive pressure to scientifically validate a system of medicine that is, by its nature, unscientific.

Science is exclusive, it seeks to eliminate variables in order to ascertain the nature of reality. In science, the more variables you eliminate, the closer you get to the "truth". This is the great strength and the great weakness of scientific medicine.

Chinese medicine, as it arises from Chinese culture, is inclusive. It seeks to assimilate variables in order to ascertain the nature of reality. In Chinese medicine, the more variables you assimilate, the closer you get to the "truth". This is the great strength and the great weakness of Chinese medicine.

The tendency of scientific medicine is to refine its focus on smaller and smaller units, to eventually find that one-damned-molecule that's screwing up the works. Chinese medicine is not as concerned with that molecule as it is with the tissue and organ system. Not just the organ system nor even the person, but also the family, the climate, the earth and the heavens.

Western medicine has a difficult time seeing the forest for the trees. Chinese medicine has a difficult time seeing the trees for the forest.

But, here is the rub: we are not "scientific" creatures. We are mammals; some say we are just smart monkeys. We have 500,000 years of non-logical, tribal behavior in our genes and less than 500 years of science in our jeans. We are tribal creatures, first and foremost.

All tribes have remarkably similar structures, and within those structures each member fulfills a certain role. These roles have evolved as survival mechanisms over hundreds of thousands of years. For us as practitioners, our role is that of the "shaman". In a significant, primal, and irrational way, a medical practitioner is a modern day shaman. On an unconscious level, that stethoscope or moxa stick is a rattle. Diagnosis is divination. This is why we expect our physicians to be emotionally invested in our lives, but we don't expect the same from our auto mechanics or plumbers. These are tribal relationships.

Because of the nature of reductionist thinking, scientific medicine fares poorly in the "shaman" arena. Science deals with the quantification and elimination of variables. A huge portion of the information a patient gives to a practitioner cannot be quantified. Without quantification science cannot eliminate variables. If one is truly practicing "scientific" medicine, then anything not quantifiable is irrelevant. This is the problem with eliminating variables in medicine: when we're done we may have factored our own patients right out of the process.

According to an August 2003 Johns Hopkins press release physicians are now using robots to interact with their patients. In many ways this is the logical next step of scientific medicine... to eliminate those messy humans from the process entirely.

Some of you are undoubtedly thinking: David, can you prove this? Can you prove that we function as shamans? Can you prove we are "smart monkeys?"
No.
Then how do you know this is so?
Because I can see it.

Many practitioners look to the research journals to see how their patients are doing. This is a mistake. Of course research is important, even vital. But we are not researchers: we are clinicians. We don't need statistics or the approval of our peers to determine how we are doing as practitioners... we can ask our patients.

As clinicians, can we prove that it was our treatment that resolved this-or-that condition?
No.
Then how do we know?
Because we can see it. We look to our patients for those answers.

While writing this article I searched for "scientific" evidence that I could cite showing that patients do not feel heard by many physicians. I found a number of studies [Marvel 1999., etc., etc., etc.] and then I laughed at myself. Of course I know that patients don't feel heard by physicians. I've been a patient and know what it feels like. The underlying assumptions of a "scientific" society are so powerful and pervasive that we rarely question them.

Believe it or not, up until the late 1980's, scientific medicine was still uncertain as to whether or not newborn infants feel pain. I am not joking about this. Ever vigilant in pursuit of truth, scientists conducted studies and double blind clinical trials to prove what any mother knows. We quote here from a few of many studies.

"Using routine, unanesthetized circumcision as a model of stress, we were able to examine the relation between cry acoustics and vagal tone in normal, healthy newborns undergoing an acutely stressful event." [Porter et al., 1988. Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Dev. 1988 Apr; 59(2):495-505]

"The results showed that although most anaesthetists in the survey believe that even neonates feel pain, they are reluctant to prescribe analgesia." [Purcell-Jones G.et al., 1988 . Paediatric anaesthetists' perceptions of neonatal and infant pain. Pain. 33(2):181-7]

"The most invasive procedures elicited significantly longer crying bouts; shorter quiet intervals; shorter, more frequent vocalizations; higher peak fundamental frequencies; fewer harmonics; and greater variability of the fundamental. Cries elicited by the most intrusive procedures were judged by adult listeners to be the most urgent...." [Porter FL et al., 1986. Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency. Child Dev. 57(3):790-802]

Any medicine that is capable of overlooking the pain of a newborn child is missing something vital about our humanness.

Let's face it; we don't need double-blind-placebo-controlled-crossover-studies to tell us that we should love our children or that we should be kind to our patients. That a forest has beauty beyond its "resources" and should not be clear-cut does not require proof.

Have you ever been in a hospital? There is a kind of madness there. That love, fresh food, and a beautiful environment will help us heal is obvious to anyone whose world is not fractured into pieces.

This depersonalized nature of scientific medicine is a direct result of putting humanity at the service of science rather than putting science at the service of our humanity.

To put science before our humanness, I feel, would be unscientific.