About the Brand New Medicine
It is not unusual to hear people talking about crises in medicine. However, no matter how much I look for them, I cannot detect them. At least, not as a subtle drama, crises of conscience or exhaustion of the scientific model where it is based. On the contrary, its hegemony is increasing solidly and comprehensively. Then, where would it, this crisis, be located? I state that it is not in the success of technological reasoning, since the success of new technologies is not only spectacular, but also seems to have the consistency of what is both final and irreversible.
The validation regime of medicine procedures is so extraordinary and it cannot afford to care too much for the so called “minor” issues, such as, for instance, the conflicts of interest that take place in scientific publications, even when not recognized. It is not that the conflicts are not being evaluated and much less that they do not generate true concern, but that there is no reasonable solution for them. This may generate perplexity, but in a very practical way: a subsidized researcher is, first of all, a paid employee. His/her function is to submit to a system that, either explicitly or implicitly, requires the presentation of accounts. They have to produce to justify their costs in the technology production/generation line, and this leads to the fact that papers, that grow geometrically against readers that are not able to update themselves, end up by being a de-luxe surplus. In other words, the problems of scientific production are like roots that cannot be properly separated. To control them, we would need research centers subsidized by the State, that would also have to be relatively exempt and independent in its scientific production and evaluation policies. Obviously, this does not happen, since the States have become less and less impartial in their research policies. In the case of medicine, unfortunately, the development of an expensive drug addressed to a disease that has higher visibility in the public opinion – although it may not be a priority – takes precedence over social-educational actions or substitutive/supplementary techniques that have a lower immediate impact on the media. Considering that elections are all short or extremely short-term events, it is not difficult to infer to what side economic decisions in health will lean. This is the game currently played by scientific research in the political world of subsidies and it does not help – quoting Ronald Laing – to pretend that we do not see the game that they pretend they are not playing.
As most of the experiments with new drug substances and vaccines, as well as the development of biotechnology are in the hands of private initiative, there is no space, or perhaps, even interest, in going beyond the bureaucratic dimension of the discussion. It becomes automatically hostage to vices that the anti-vice regulations tried, uselessly, to correct. This is not about understanding the script of the way Franz Kafka saw the world, but to point out problems, that, by being so astonishing, operate as blind points of scientific discussions’ development.
In practice, this means that he new is, a priori, doomed, or, at least, with high chances of never being born, or of being prematurely suffocated in the institutional environment. In this direction, the sanctuaries of innovation, the Universities, end up by working against themselves, or, at least, against the idea of their permanence. Therefore, we have a new paradox, since the purpose of research – that is not necessarily the endorsement of institutionalized procedures – but of acting against the nature that created it: the creation of the new.
As an example, this may be better seen in public policies for the cultural area: independent movies or any artistic activity that is not commercial, are able to survive only with the government support and backing. This induces at least two types of questionable statements: the denouncements of overuse of simplistic and abstract generalizations, such as to blame the “system” for the status quo and another one, not less compromised, of defending the automatic alignment with the status quo. This means, in practice, a certain inertia before tampered game boards.
Perhaps nothing better has been invented and the regulations and methologies that are around, although extremely problematic, are still the less absurd. But, would scientific revolutions surface under them, leading to scientific and technological development proper? We cannot answer, but this problem continues unsolved, since the structuralism on which the worldwide scientific production is based continues systematically to deny its basic vocation.
Next question would be to know if, in this same involuntary cycle, that blocks any and all perspective of disruption, one could expect a significant change in medical praxis, for instance. In other words, how to expect renewed perspectives within this scenario? How to believe in the induction of a brand new medicine? If we depended on the canonic scientific production and on the instrumental apparatus of publications, as they are designed, we would never achieve boldness. The opportunities, the good opportunities, are in places located outside the hegemonic mainstream. Such areas create pressures required for renovation, although they still not mainstream. These escape areas are still uncharted territories. They are unknown continents that create the pressures necessary for renovation. However, there is one key to better understanding the power of these excluded regions: people.
These are people that wish for medicine to have a sense and a direction quite different from the features it has taken to this date. It is from this space, with no defined latitude or longitude, that dissatisfaction, discomfort, a kind of humane ill-feeling, that instigates and fosters changes, has originated. It was because of this majority, silent until some time ago, that talks about “narrative-based medicine” were started, as well as “patient-centered medicine” and “medicine of the subject”.
There are patients and their demands; their needs to be heard; of expressing interpretations of their biographies together with their clinical complaints; there are narratives with details showing the specificity of each subject’s context. The non-verbalized claim for solidarity; the search for people that care; the strong desire that the dialogue with physicians is not restricted to mere scientific discourse constructs; the honest sharing of questions, protection and risks behind each intervention; attention focused on what is vital in health more than on pathology itself; quality of existence as the most important success criterion. All of these aspirations continue to grow even in a society saturated with information screened by scientific journalism, dictated in accordance with the climate in newsrooms or political articulations woven in corridors.
It is from this point that homeopathy, integrative medicines and a renewal of the researchers’ behavior may kindle the rebirth of the natural inclination for challenges that is a characteristic of science. This challenge acts against two contemporary forces that deceive with a pre-dialectic battle: scientificism versus doctrine strictness. A challenge that may break the dependence that we have today on the techno-science mainstream. A challenge that refuses the discarding what is considered outdated. It may be a brand new event that will group ideas that have already been tracked, the resurfacing of research already out of use; the reuse of an old formula of Hypocratic medicine based on observation and empirical rituals. It may be the rethinking of categories proposed by Samuel Hahnemann, who, even if well-positioned among the men of his time, insisted in stating his resistance, always a more difficult path than to enjoy the ease of a mainstream. The practical result of not letting himself be taken by the common sense flow installed in the mind of the old continent about the concepts of disease and treatments was to distance himself from the average and announce the novel. It was not about learning totalities only, but of observing, analyzing and medicate specific subjects: beings with extremely personal diffuse suffering. Hahnemann wanted a medicine with characteristics completely different from the ones he knew. He noticed that any brand new idea required a permanent intellectual opening to reinterpret canonic bibliographies, including those produced by him.
The same exact thing happened there, in the 19th century, and is happening here and now. Contemporary physicians, as well as the physicians of previous centuries, can easily discard the power of this undertaking. There are those who evoke evidences to block away any rethinking of clinical philosophy. But, even before the increasing scarcity of champions in medical arts, counter-thinking still survives with a certain vigor. But, this time, there is the detail of reversion: those who murmur now are outside medical ranks.
Let us think together as follows: the new medicine does not refuse anything a priori since it understands, before the vastness of contemporary ill-being, that it cannot afford to do it. It accepts what seems to be the most rational, the less invasive and more in accordance with a human economy based on the knowledge of vitality.
The brand new medicine embraces the need to include human sciences into natural sciences, reopening a lost-in-time interlocution. Involved by the third Hypocratic principle, this medicine can only be the medicine that best fits each one.
 Paulo Rosenbaum. M.D. MsC. PhD. Associate Researcher Universidade de São Paulo. firstname.lastname@example.org