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SCIENCE AND COMMON SENSE. |
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Professor
Lewis Wolpert, CBE., FRS., of the department of Anatomy,
the University College Medical School in London, wrote an
interesting article in the recent issue (February) of the
Royal College of Physicians of London journal (
1996;30:155-161 ) entitled " Science-an unnatural
endeavour". He was arguing that common sense has no
place in science, nay in any field of human endeavour,
including economics. He was of the view that serendipity
is a misnomer in science. He was very critical of many
thinkers of the past like Karl Popper, D.H.Lawrence, and
many others. I get a feeling that he was deliberately
provoking a healthy debate on the subject of commonsense
and its role in human life. One gets a feeling that all
alternative types of health care are only quackery, after
reading Prof. Wolpert’s article. I have since
written a rejoinder to that article and have requested
the editor of the journal, Dr. David Kerr, FRCP, to
publish the same. I have a feeling that the lay man may
also be interested in its contents.
The idea that science, including medical science, is an
unnatural practice, comes as a rude shock to me, as I
always used to tell my students, during the last three
decades, that the greatest asset of a good doctor is
robust common sense. May I humbly offer a few comments
which might stimulate a healthy debate?
Dynamic human body does not obey the rules of linear
Euclidean mathematics. Stability in biology is only a
myth. It occurs only after death. We have been predicting
the unpredictable in medicine all along. What happens to
the human organism as time evolves depends on the total
knowledge of the initial state of the organism. Since we
can not know this, with the help of the reductionist
science, we are unable to predict the future. We can only
assess the human phenotype, which forms about 30% of the
organism and the rest is made up of our genotype and
consciousness. We need non-linear mathematics of "
Chaos " to predict man’s future.
Attempts at predicting the future events with the help of
the exercise ECG test (Bruce) fail to follow the
positive-negative paradigm. Diamond and Forrester have
gone back to the Pascalanian law of probabilities. Most
of our linear screening tests applied to the
"healthy" populations, are bound to end up with
many false positives, making life miserable for those
unfortunate victims. Similar is the experience with
predicting death based on the left ventricular ejection
fractions, in the immediate post myocardial infarction
phase. If one goes deep into all this one wonders how any
of our mathematical formulae could be applied to any
human organ. Let us take the heart for example. Is it a
triangle, square or an oblong? It has no integer measure
at all; and how do we apply the integer measure formulae
to calculate the various facets of cardiac function? For
want of a better measure of the non-integer human heart,
we still hang on to our old formulae.
We see daily the " Butterfly Effect" of Lorenz
in human affairs. The new science of Chaos is our only
future hope. When the conventional science has been
heading for a crisis with increased specialisation, it is
the new science of non-linear mathematics that has come
to our help.
To say that science is based on uncommon sense does not
appeal to me. Why should one feel that common sense
should tell us that the sun goes round the earth? It
could be the other way as well. It was common sense that
led William Harvey to look for blood circulation after he
saw the London fire hydrant in action on one of his
evening walks. It was again common sense that made Jenner
believe the old lady about the cow pox protection. That
was the singular discovery which has been able to
eradicate a disease from this planet, smallpox. All other
reductionist scientific methods have not been able to
eradicate any disease so far! Was it not commonsense that
got us quinine from Cinchona bark, and the all powerful
aspirin from the Willow bark?
Serendipity is the key word in science. It was
serendipity that gave Fleming the petri dishes from
Florey’s laboratory with the fungal growth inside.
Florey did not plan the experiment to grow the fungi in
the first place. It is serendipity that gave us the
benzene ring and many other examples could be given.
If one is committed to patient care one quickly realises
how deep is the mind -body connection in human affairs.
This was known even to William Harvey who wrote in
1649........." And what indeed is more deserving of
attention than the fact that in almost every affection,
appetite,hope or fear, our body suffers, the countenance
changes, the blood appears to course hither and thither.
In anger the eyes are fiery and pupils contracted; in
modesty the cheeks are suffused with blushes; in fear,
and under a sense of infamy and of shame, the face is
pale, but the ears burn as if for the evil they heard or
were to hear; in lust how quickly is the member distended
and erected!..." It will be naive to believe that
the human mind follows the linear mathematical rules.
In the field of clinical medicine " clinicians can
not avoid uncertainty or pass it off as inherent aspect
of the art of medicine. Certainty is a delusion-only
uncertainty is certain.... this must be acknowledged and
addressed explicitly, especially in clinical training, if
reason is to be used most effectively to improve quality
and cost effectiveness of clinical practice." say
Drs. Logan and Scott from Auckland in a recent article in
The Lancet.
The best definition of science was given by Federal
Judge, William R. Overton, in the Arkansas case in 1982,
Creationists Vs Evolutionists. " Scientific theory
must be tentative.... and always subject to change".
How true! Newton’s Laws of deterministic
predictability were proved wrong by the Einstein’s
theory of relativity, which, in turn, was found wanting
in space. Quantum physics finds it difficult to define an
electron correctly. If one knows its position , one does
not know its velocity and vice versa. When it is not
moving it is everywhere. Here we need the help of the
observer’s consciousness; the latter defies
mathematical measurements.
" Technology should be used to unravel the mysteries
of diseases only" said Sir Thomas Lewis. I wonder
how he could foresee the present day market forces
goading technology to run the show for doctors; the
latter only acting as gatekeepers of technology. A study
in Nottingham showed that about half the coronary
interventions were inappropriate. A study from Boston
showed still greater percentage.
I could not understand how the evolution of an elephant
could be attributed to technological marvel. Feynman, a
Nobel Laureate physicist, noted how Nature keeps its
secrets close to its bosom, only revealing bits and
pieces to us. We claim great credit for our scientific
prowess.
Surprisingly, a retrospective study published in the BMJ,
showed that Friday the 13th was, in fact, inauspicious
for at least 50% of the population. We can not laugh at
even the old superstitions! Another study in the same
journal showed that Arum Triphyllum, a homeopathic drug,
was very effective in the management of hay fever. This
study was triple blind and very well controlled. How can
we have a holier than thou attitude towards any system
about which we do not have enough data in the scientific
literature. It is estimated that about 85% of medical
interventions are based on flimsy scientific data and
only 1 of our interventions are based on hard data.
This is revealed in an editorial in the BMJ entitled
" Where is the wisdom? "
Bernard Shaw was right when he said " do not try to
live for ever, you will not succeed." I also agree
with Karl Popper’s saying that "knowledge
advances by the refutation of false dogmas and not by
repetition of the true ones." D.H. Lawrence is still
not proved wrong by our scientific and mathematical
rules, when he said " Our egress from this world
will be nobody knows where.": may I add, when and
how also?!
The Nobel Laureate economist was right when he said that
" common sense used to come in the way of his
learning economics all his life ". A couple of
examples will suffice. It is good economic sense to dump
the extra wheat grown in the New world in the Atlantic
ocean, while common sense would urge us to donate that
wheat to the starving children in Somalia. Adam
Smith’s " laws of stock market " predicted
that one man can never upset the stock market, because of
the inbuilt safety measures. The 1984 NewYork crash and
the recent Indian stock scam are good examples of how the
economic theories are not as good as common sense.
In my opinion science is "logical skepticism"
and research is " organised curiosity". Both of
them need robust common sense. " Uncertainty
Principle " of Werner Heisenberg will govern medical
science always. Like him, we will have to do a lot of
Gedanken experiments.[index]
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