Episteme issue.

Paulo Rosenbaum, PhD.

Master in Preventive Medicine, Doctor of Science from USP

“Life is the set of factors that resist death”

Bichat, 1829

“The usual substantialist intuition is, in a
certain way, contradicted by the existence of homeopathy. In fact, in its formative, that is to say in its pure form, substantialist intuition claims that a substance acts proportionally to its mass, at least up to a certain limit. It is admitted that there are light doses, the excess of which produces disturbances. But it is not easy to admit the effectiveness of extreme dilutions administered by homeopaths. As long as the medical substance is considered as a quantitative reality, it is not easy to understand a substantial action that occurs, in some way, in inverse ratio of quantity.”

Gaston Bachelard – Dialectics of Duration

Homeopathy, and therefore all integrative medicines, has been ostensibly questioned. Would they be unscientific practices? Do they have a research program or not? Do they show empirical results from a clinical point of view? Are they plausible from a biological point of view?

For all this has been discussed in the media with a single catch: the monopoly of a shrill voice. For some years now, the microbiologist who heads the entity “Questão de Ciência” has been raising these and other questions. Some with some relevance. However, in his recent column in the newspaper “O Globo” he proved to be erratic and made a serious mistake. The bias of scientific prejudgment: it peremptorily answers all the questions it raises. Now, this is simply incompatible with reflection, especially for critical thinking, as one of the central characteristics of epistemology is well known.

Immersed in the anachronism of a typical dispute that goes back to the 19th century in the 21st century, it resurrects a polemic that we believed had overcome. Would it lack the fundamental intellectual opening: the possibility that its hypothesis is wrong? After all, as everyone should know, good scientific practice presents doubt and curiosity as essential. Science often has more questions than answers.

Dynamic processes of illness and healing

Life is inherent in vital processes. What defines the processes are some characteristics: every process is dynamic. Processes are made up of non-linear sequences of events. The process tends to produce normativity, but there is often a good deal of unpredictability until it comes to an end. If health is, as Aristotle wanted, an unstable equilibrium, it requires that the scientist or those who study biological processes dedicate themselves to the study of rhythms, also called the analysis of organic rhythm, and pay attention to vital phenomena.

This is what integrative medicines propose. Not only homeopathy with its supposedly enigmatic infinitesimal doses, but also the clinical interferences that are not limited exclusively by the field of biochemistry, but must be complemented by studies of biophysics, bioelectromagnetic fields, the information that subsists in ultra-molecular solutions ( Buck -balls or fullerenes ), and finally on the rapport effect resulting from the doctor-patient relationship. Here’s another excerpt from Gaston Bachelard:

“Moreover, there is nothing to prevent a homeopathic substance, having
taken the form of pure vibration, from being reconstituted in the form of substance. substances would perhaps quite simply trigger natural biological vibrations. It would also be explained that the ultra-diluted dose is preserved
fully than a massive dose because it can be restored.
it loses less easily than gross
and inert matter.”

Anyone who reduces homeopathy to minimal doses is wrong, it adopts another system of understanding and evaluating symptoms. Extends the healing criteria. It considers that each one has a personal way of convalescing and regaining lost health. So also concludes the Nobel Prize in medicine and discoverer of the AIDS virus, Luc Montaigner, who was surprised by the findings when he investigated the action of ultra-molecular drugs.

Ultra-molecular doses

If science still does not have the means to test such substances and elucidate them, this does not mean that they “are nothing” (sic) as the microbiologist and her team have categorically stated to resigned journalists, but only that the detection of these substances still requires a study that explains the phenomena induced in vivo (in living beings) and in vitro (in laboratory studies).

This means that there is evidence of the phenomenon even without a consensual and formal explanation that justifies it. Scientific skepticism is desirable and healthy, as long as the spirit of inquiry is not clouded by convictions that mimic dogmas. Axioms and prejudices that perniciously replace intellectual objectivity.

And it seems that the smartest response to suffering may not be just progressive doses of psychotropic drugs. It should be added that it is still not understood exactly how practices such as Yoga, psychotherapeutic techniques, meditation, massage therapy work, but they produce undeniably favorable results for many people who resort to them.

Drug experimenters in this pathogenic process (one of the elements of the hard core of the episteme), reveal their symptoms by anticipating – in modified physiological states – their nosological predispositions. So what happens? We anticipate our pathological potential. We organize our preconceived nosological potential more quickly and efficiently. We can observe these phenomena using one of the most consistent tools in the episteme that guides the methodology: the so-called pathogenesis (experimentation of ultra-diluted medicinal substances). Many are probably unaware of these elements when they are willing to judge what to make of homeopathic practice. It is surprising how many insist on not taking into account these phenomena that may have reproducibility. Here is an experiment, easy to demonstrate with double or triple blind crossover. And it remains accessible to anyone, from hardened skeptics to fanatical enthusiasts.

Let those who think with horror of experiments not be terrified, because the induction of symptoms can happen with any traditional medicine and with any non-iatrogenic vicissitudes. And it is essential to remember the empiricist origin of medicine. Not forgetting to mention that there are only 10 drugs with 1A certification (that is, with proof of very high efficacy) according to the most recent scientific papers.

Health and illness: a medicine situated between art and science

Situated between art and science, is the medicine of the subject – a medicine of the specifically human – a viable proposal as an effective clinical care?

It is from this perspective that the issues of health and illness should be addressed. As the epistemologist Karl Rothschuld explained, medicine is and always will be “operative science”, that is, it will always demand some artistic skill from the one who applies it – in the “artisanal” sense – because it cannot be reduced to pure science. Each integrative medicine adopts an interpretive system that is not limited to a special pharmacology.

If Hippocrates, the inventor of scientific medicine for having invented clinical history, a legacy that continues to this day – also known as the “Hippocratic school” – still has something to offer modern humans, it is that the health-disease binomial needs be understood within a context: the ananke physeos . Some epistemologists opt for the term translated “need of nature”. Now, why would illness be necessary? If pathology is a necessity of nature, it must serve something, that is to say, have a biological purpose. It has a meaning. It is not a matter of defending a teleology of diseases, but of verifying that it exists. Thus, we live in a battle between genomic and phenotypic patterns and the interference of the environment. All in almost random combinations that pressure us throughout our existences . Preserving health and preventing illness derive from these combinations.

At this point in contemporary history the main question should be: “ Is there a future for the medicine of the subject?” Probably the greatest contribution of medicine with a vitalist tradition to medicine.

Giving a new meaning to the tradition of integrative medicine, heir to a less mechanical conception of the subject, is to put it in contact with the main currents of contemporary thought, from epidemiology to philosophy, creating the opportunity for this medicine to be understood by current thinkers. . And have equal opportunity to be taught in health science schools with the same status as standard knowledge.

It could be summarized as follows: health — as Hans G. Gadamer thought is a mystery — pathology is not. In other words, the probabilistic chances of losing self-regulating homeostasis must be infinitely greater than maintaining health. There is an enigma whose elucidation is precisely the role of the researcher, who, in order to be successful, must be open to the counterintuitive, that is, to find proof of his hypothetical test (thesis) as well as unexpected and even contradictory answers to his initial assumptions.

Intuitive methods in nature and shock organ deviation

Organisms such as small rodents usually know they need artificial fever and bury themselves in hot sand when affected by infectious processes to better fight them. The inevitable question would be: how do they know they are sick and what do they need to overcome it? How do they know what they need to recover? In humans, other curious phenomena such as “pica”: the violent desire to ingest normally inedible products: earth in those suffering from iron deficiency anemia, hardened paint shell for those who have calcium deficiency, burnt wood or animal bones for other vitamin deficiencies or minerals.

Phenomena that can only be understood through the moment and clinical experience. An anguished subject with phobic neurosis migrates from the anxiety drive to a certain well-being when he becomes feverish, or while developing a sinus disease. Aspects that become more evident when an exonerative function, — one that aims to produce and eliminate secretions — is in progress. Clinicians can better understand and evaluate such processes than researchers for two reasons: because they are directly linked to the individual history of each patient and because they have a more systemic and integrated view of nature’s cycles.

The neuropathologist Prof. Walter E. Maffei stated that, in his vast clinical experience and in the autopsies he conducted, he had never seen a single chronic mental patient in a psychiatric hospital present a case of bronchial pneumonia as a cause of death . This is apparently counterintuitive, as he himself emphasized when he was the clinical director of Juqueri for more than five decades. Malnourished people usually have lung pathology as the end point of their existence, but this seemed not to be the case when it came to the chronically mentally ill. The pathologist relied on the old but very pertinent “shock organ bypass” theory. When a disease “migrates” from an anatomical region or organ system to a more superficial one, producing relief for the patient.

For this reason, even certain concepts and clinical approaches cannot be reduced to laboratory results or searched only by Magnetic Nuclear Resonance images. This does not mean that they are not verifiable clinical phenomena, only that we still do not have the tools to fully understand them. If only 1% of the funds earmarked for research could be made available to investigate the mechanism of action of infinitesimal drugs and other experimental drugs, we might have a different picture. And then we could decide the impact that the adoption or rejection of these therapies would have as a preventive policy and resources for health.

We must admit the complexity in order to reach a consensus on which field medicine should embrace to care and cure, especially when it comes to the aforementioned primary health care. The inevitable question: how can we still be deceived by evidence that is limited to the control of pathologies without taking into account the subjective and general substrate of sick patients? To use an expression from Edgar Morin, the complexity often hailed or evoked as a solution is much more – as I emphasized before – a problem concept than a solution concept.

The ethical rescue of the subject

The evidence must also be produced in the ontological turn of modernity, which is in the ethical rescue of the subject. That is, there are other conceptual dignities in science that are not limited to quantitative clinical trials. Studies such as quality of life health questionnaires, psychometric tests, assessment of people’s well-being are as relevant as the degree of efficiency of drugs on nosological entities.

This would be the relevant discussion, whether for advocates or critics of integrative practices. Without it, in fact, everything that escapes the mainstream of standard science , looks like nonsense or Manichean objection/praise. On the other hand, it is not up to those who practice these therapies to do the same with the reversed sign: surrender to the partisan defense, enunciate the therapeutic monopoly, crystallize the accumulated knowledge as a lifetime monument.

The return of the generalist and the resumption of primary health care

So what is the best way to evaluate the effectiveness of the clinic practiced by homeopathy and other forms of integrative medicine? Firstly, to identify the referential system that guides semiology, in this case aimed at justifying a medicine that must include the subject. To show that it makes sense to seek to capture the biological, affective and mental aspects of “being a sufferer”. Not only detecting characteristic and unique traits in each sick person, but capturing the context and circumstances that mutually elucidate mind-middle-body-drugs. This set would already show that it is a phenotechnic. Which only makes sense if the subject is reinserted into another system of medical notation, without competing and never dispensing with other approaches to contemporary medicine. Incorporate all available techno-scientific procedures with rationality, but at the same time refuse the arbitrary separation imposed by the excess of specialties.

Each disease follows a different course and presents itself differently in each person and there is already very concrete evidence in this regard. Medicine should not expunge the subjective state as a legitimate objective of its intervention, or delegate it to specialists. And at the height of scientism it was imagined that the status of pathology could be confined exclusively to somatic injury. But the clamor for more comprehensive care persisted. Experts are needed, but generalists need to be a priority. It was in spite of people’s needs that the division between mind and body split the medical art. And its reunification would be the regeneration and rescue of the general practitioner and the family doctor.

Thus, the subject from the perspective of medical anthropology will approach psychotherapeutic practices if it includes the figure of the doctor, that is, they are trained in a more generous anamnesis and understand the transference, in the expression and construction of language, narratives and their Meanings.

The suspicion that the pathology contains or is contained in a dysfunctional substrate with mental distress remains a challenge for even the most scientistic of clinicians. Substrate that needs to be embraced and not expunged as “pseudoscience” or “unscientific” (sic). This deserves the utmost attention for those who dedicate themselves to a serious investigation that goes beyond the stands of common sense. It can no longer be ignored by any attentive clinician. By anyone who understands science in a broader dimension than reductionism insists on extolling.

Illness, malaise, suffering, quality of life and beyond psychopharmacology

I quote the famous definition of the French physician, founders of histology, Xavier Bichat “life is the set of factors that resist death” (Bichat, 1829). But there is also the following possible development: life is born under the sign of mortality, a tension that remains active and accompanies us until our last days.

Getting sick is not just the existence of malaise, but also not recognizing the co-authorship of the symptoms; or simply to attribute the pathology to some exclusively exogenous agent. After all, being an agent of oneself means immediately recovering the horizon of self-care and increasing the acuity of attention to life. The health-disease process is, even in the opinion of some, a struggle. Struggle between health and illness and, therefore, between life and death and even resignation and ambition.

This means more or less the following: can we say that suffering is disease? We may or may not call this destructive ancestral force a miasma, a virus, a half-plague, or any other name. If suffering is inherent to gender, what are the limits for considering it a disease? What if we understand suffering not as a penitential state, but as a more or less important inability to dedicate oneself to self-care?

Pathologies are not, in Lain Entraldo’s understanding, “localized”, they are not limited to a single place. When well investigated, one can see how they permeate the entire economy of the subject. They are ingrained along with other symptoms that may be older or more recent. In other words, despite appearances, the disease is always systemic. First the illness (illness) and then the disease itself (disease) To dismantle it, therefore, it is necessary to see the complete map of the affected organism, as well as the environmental circumstances.

Anguish can be beneficial, as well as depression, as long as it is recreating or regenerating. It can be a melancholy trait to the point of being just another item in the vast existential load. But it can determine the course of pathology.

One of the central questions of medicine has been underestimated and seems purposefully absent from many contemporary epistemological discussions. The advance of technoscience in the production of pharmaceutical ingredients has brought impressive advances in the areas of immunizations, prostheses and orthoses, rehabilitation, associated with the growing – and welcome – sophistication of diagnostics. These advances, however, simultaneously produced a harmful side effect: overdiagnosis. Just as it wrongly displaced almost all issues related to mental suffering and the individualization of symptoms from medicine. Having said that, we ask how can medical practices re-incorporate and deal with the subjectivity of each patient?

As a rule, the solution has been to refer these patients to the systematic use of psychotropic drugs. But the solution may not lie in training general practitioners to administer psychiatric drugs. The reference to the euphemism called “re-humanization of medicine” may be in taking another approach, such as, for example, rescuing an anthropological perspective for medicine regardless of the medical method adopted.

Instead of therapeutic tournaments or media histrionics these would be the issues that really interest society.

I invite readers to this reflection: it is not an opinion, it is a question of episteme.