Criticism of Knowledge, Medicine and Ethics (Estadão)
Posted by Paulo Rosenbaum in Articles
In all acceptable versions of what essentially characterizes medical activity, we find at least one main historical objective that is reasonably consensual: taking care of people’s health.
We have observed a pattern of behavior with controversial scientific subjects in the media — intensified in this pandemic period — that have been characterized both by the fulanization of the problem and by disqualification — which, for unexplained conveniences — selects or simply deletes other people’s arguments.
All consistent criticism needs to be praised, at least this should be the role of opposition in politics, and rival theories in science.
The tradition of polemics, unfortunately impoverished in the country and in the world – replaced by a sterile polarization – would have the merit of rescuing a healthy debate. Where all parties would come out more enlightened, even with the risk of us leaving with fierce divergences. This is the essence of criticism. Deepen knowledge of sensitive matters to make them more available to the general public. This would be one of the press papers.
It is necessary to combat the misinformation that — often under the cloak of an alarmist and sectarian discourse — we find every day in the communication vehicles. Therefore, it is equally important to denounce the strategy of, in the name of informing, disinforming.
It is unreasonable that systematic disinformation is ethically acceptable. And, in some cases, recalcitrantly. It is this approach that needs to be called out as sensationalist and deceitful. In the case of medicine, the spread of misleading information affects people undergoing treatment, creates disorientation for public health guidelines and, at times, generates unnecessary confusion, psychic damage and mental suffering.
In a recent article published prominently in a Rio de Janeiro journal, a microbiologist without any clinical experience, spread news of dubious techno-scientific accuracy about a complex epistemology that is based on the principle of similars. The critique of knowledge and scientific dissemination are essential, but require academic preparation and responsible journalistic treatment.
In addition to making unfounded and generalizing judgments about the practice of homeopathic medicine – insinuating that all physicians who work in the specialty are under a scientifically inconsistent scope, the writer took the clouds for Juno when she entered a field, which, notably, she ignores. As is known, arrogance is one of the hallmarks of a fool, who thinks he has mastered subjects he has no idea about or worse, has distorted essential notions about a discipline. First of all, the column, in addition to being clumsy, is a crass error in terms of proper research and compromises the serious scientific media.
What is experience from a scientific point of view?
These are not just reproducible laboratory data in controlled environments, as common sense might think. According to the epistemologist Gaston Bachelard, experimenting consists of asking the right questions . He highlights that the history of science cannot be merely empirical, but, above all, the progress of the rational connections of knowledge. Thanks to this way of thinking, procedures that were prematurely discarded by science can be rescued and given a new meaning. Demonstrating that history can be very far from a final word.
It was, for example, the typical case of acupuncture. From its early discard to its redemption, we have an interesting story related by the Austrian epistemologist Paul Feyrabend. This author tells that when Mao Tzé Tung came to power, he wanted to know what alternatives there would be to what he classified as ‘bourgeois Western medicine’. It was reported that in the mountains, far beyond Beijing, there were practitioners of a millenary form of traditional Chinese medicine that involved the combination of procedures such as moxibustion, acupuncture and herbal medicines.
The Chinese dictator called these supposedly anachronistic representatives who were proving their worth when installed in an environment that stimulated research at Peking University. For anachronistic ideological reasons, the agent ended up producing an important rescue. Decades later, they had reconstituted the tradition, sometimes even at the risk of mischaracterizing it, and continued to be funded to apply and research it in an academic environment.
The process of scientific validation of the so-called non-hegemonic medicines has progressed. It found more and more fans around the world, especially after the boom in North America in the 1970s. Until, very recently, acupuncture (just one of the branches of traditional Chinese medicine) became institutionally established, even in the most traditional medical circles. Environments in which, for a long time, they were openly hostile to this practice. Today, along with traditional medicines, they are even medicinal systems recommended by the World Health Organization.
Thus, it is necessary to criticize the false notion, still fertile within the hard sciences, that there would be a ‘crucial experiment’ that would determine the complete acceptance or repudiation of a discipline. Even because, according to Imre Lakatos, crucial experiences are only seen as crucial a long time ahead.
When the analysis focuses on the history of medicine, rare are the historians who take a retrospective look at this science.
There is no reason to be surprised that science is not neutral and nurtures political and economic motivations in its determinations, and also in its argumentative leniency. That is, it is necessary to recognize the non-universal nature of normative standards of any science.
For Bachelard, identifying and understanding a science is to map its methodological and theoretical-practical impasses that originated it as a rational procedure. This handling of the problem was conceptually quite innovative. It was part of an important reaction against the excessive confidence that industrial society placed in experimental sciences and their methodologies, characteristics of classical positivism, and which gave rise to a strange version of secular fundamentalism, this time, a kind of scientistic apostolate.
Confidence that gained an axiomatic status: it was about univocal and irrefutable truths. Some devotees of the experimental sciences intended to construct “superparadigms”.
Positivism, like all currents of thought, had its moment and value, however its determinism and its hegemonic pretension no longer sustain themselves as exclusive parameters for the construction of genuine scientific dialogues.
Under the persistence of this profile a desirable intellectual openness in the scientific mainframe cannot yet be operationalized.
The epistemology proposed by Bachelard, therefore, criticizes the anachronism of logical positivism in its aspiration to be the hegemonic method in the construction of scientific postulates:
‘Seeing is believing, this is the ideal of this strange pedagogy. It doesn’t matter if the thought is, consequently, from the poorly seen phenomenon to the poorly made experience… instead of going to the rational research program for the isolation and experimental definition of the scientific fact, always artificial, delicate and hidden’
Scope and limits of science
This philosophical version of scientific facts is of enormous value when we analyze the practical life of contemporary society. Historical epistemology being, par excellence, a critical analysis of science that also reaches its historical-social and logical dimensions, examined less the ‘how’ of scientific activity and much more its ‘why?’ Bachelard uses applied rationalism in the search for these answers, asking very uncomfortable questions, especially for those who practice selective skepticism. For this very reason, they became vital questions: what ideologically directs science in its trajectories? What are its possible scope and limits? How does it fit into the relationship and connections with other fields of knowledge? Will it meet the needs or even the desires of the subjects of society?
Scientific information has been disseminated as if we were in a therapeutic tournament, whose prize would be definitive conclusions. To the dismay of many they simply do not exist in the true spirit of scientific activity. Researchers committed to scientific criteria should be the main protagonists of the insurgency. The first to rise up against static convictions based on intuition. On the contrary, the greatest value is in detecting unexpected results and valuing unexpected and counter-intuitive findings.
This reflection leads to other concerns: if a society can produce and publish millions of papers a year in peer review journals, will readers be available for each one of them?
What about the value of practical knowledge? Society knows this well, so it looks for doctors with experience. Because the lens of clinical experience is still an irreplaceable tool for self-training. As well as the existential density provided by dealing with peers translated into clinical medicine through the doctor-patient relationship.
Bachelard dreamed of a philosophy sufficient for science to be able to construct its own critique. The proposal would be to resist the idea that sensitive knowledge could be the immanent source of discoveries.
One should be suspicious, thought the philosopher, of an intrinsic conceptual clarity that claims that everything dominates. Who ignores the ignored and disregards the unexplainable. For this reason, it is worth investing in the formative instinct that seeks a new pedagogy of science – against the old conservative spirit – committed to obtaining clear evidence through induction, evidence and abduction.
For it is this self-criticism that is lacking in a universal application of the evocation of a finished science to the medical arts. Undoubtedly, the more standardized, tested, that is to say, the more evident the therapeutic benefit is, considering the unavoidable epidemiological risk-protection equation, the better and more desirable the procedure chosen for a patient will be.
And medical science seeks to pursue this ‘gold’ standard of scientific excellence in its research. What neither she nor her protagonists can avoid is subsuming that because it is based on epidemiological findings of statistical relevance it can abstract other medical rationales from its horizons. Logics that could not have the same constancy or statistical regularity in traditional clinical research designs.
Independence and budget
There can be no moral equivalence in comparing the development conditions of integrative medical rationales without considering the proportional effective availability of resources for research and publications.
It is evident that it would be necessary for the States to adopt public policies that would grant some emancipation of the research centers in relation to the pharmaceutical industry. Here is an area where a more present State could be beneficial for the population: instead of breaking patents (a political measure, as a rule, used in a populist way), would it not be much better to generate patents for medicinal substances open?
As the historian of medicine Henry Sigerist stated in the mid-twentieth century, only independence and a budget for scientific investigations provided by the State can make drug research and investigation of clinical procedures more impartial, safe and, above all, reliable. This is in the public interest.
It is also impossible to disregard that other therapeutic procedures act on different aspects of the subject. A lot of them. beyond the illness itself. Or do psychoanalysis, massage, meditation, exercises, dietary patterns, procedures that do not involve drugs, not to mention leisure itself, play relevant roles in human life?
They certainly interfere with other success criteria, and therefore produce other evidence. If medical science has been finding important answers in genetic research and molecular biology, it is even more important to turn to the subject and understand his idiosyncrasies and susceptibilities, aspects that characterize him both in illness and in health. This is how it becomes even more relevant to answer the disturbing question of why the same causal agent does not determine the same pathology in all those exposed, or why we react differently to the same drugs.
Therefore, it is not enough to give humanities classes to physicians, even though this would already be, in itself, a very auspicious beginning. It is necessary to rethink the training criteria in a more acute way and only to use a word modestly avoided, radical. It is necessary to place greater weight on generalist and primary health care, as this is what can make care more accessible.
It is these currents that together can effectively prevent illness and promote health. It is necessary to teach the new generations of doctors everything that is most modern available, but giving due counterweight to technological sophistication. What would be truly harmful to society would be if only one type of medical thinking prevailed. There is room for all types of medicine and for all good medical practice.
Find new forms of coexistence between the different healing techniques. Methodological hegemony is not only anachronistic, but an insult to science that intends to be investigative and that adopts the Popperian criterion of refutability.
So how about less peremptory diagnoses and more open-mindedness? Less misinformation for those who seek ethical methods to assuage their suffering, and more reflection and respect? How about valuing more clinicians who strive to bring care, relief, solidarity, palliation, and when possible cure to sick people?
______________________________________________
With regard to the discussion on ethics and medicine, I recommend that readers who want precise information access the CREMESP (Regional Council of Medicine of the State of São Paulo) website to read and reflect without prejudice on a recent publication. It is a text that, certainly, will not be unanimous, but will contribute to clarify society about the Ethics and Reasons of Medicine from the point of view of the specialty.
The book “Ethics in Homeopathy” is an anticipation with public clarifications that prevents biased misinformation about the specialty and, mainly, stimulates the discussion about what type of care should also be available in public and private services in the country. It resumes the discussion on the subject’s ethics, the importance of a research program, the preventive aspect of therapies, the ethos of care, the rescue of the doctor-patient relationship, without anachronistic opposition to technoscience.
*Below Text extracted from the CREMESP website
“With a special focus on the reality of the country, Ethics in Homeopathy brings themes that reflect, for example, the insertion of homeopathy in the public health system, the teaching of medical ethics, the rights and duties of doctors in general and, in particular, doctors practicing homeopathy. The work is available in the digital version, and can be accessed on the Council’s website, in Ebooks and Publications and in the Cremesp Application.”*
Here are the links:
Access via youtube too:
Paulo Rosenbaum 
