Articles

Philosophy Meets Medicine

Note: This was written as a book review for Skeptical Inquirer magazine and will be published in its Jan/Feb 2014 issue.

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Medicine is chock-full of philosophy and doesn’t know it.  Mario Bunge, a philosopher, physicist, and CSI (Center for Skeptical Inquiry) fellow, wants to bring philosophy and medicine together for mutual benefit. He has written a book full of insight and wisdom, Medical Philosophy: Conceptual Issues in Medicine.

Whether doctors recognize it or not, medicine is firmly based on the philosophical principles of materialism, systemism, realism, scientism, and humanism. Bunge explains that:

Without materialism, both diseases and therapies would be taken to be purely spiritual.

Without systemism, every disease would be attributed to an independent module.

Without realism, diseases would be viewed as either imaginary or as social flaws.

Without scientism, either nihilism or dogmatism would prevail, and all the achievements of biomedical research of the last 500 years would be consigned to oblivion.

Without humanism, all medical practice would be mercenary, and there would be no public health care.

He points out that all these scenarios are alive and well elsewhere. Under the guise of “alternative medicine,” ancient prescientific medical systems are still being practiced nearly everywhere “to the detriment of people, the flora, and the fauna.” CAMs (complementary and alternative medicines) are isolated bodies of belief that are not based on science and do not examine their own philosophical presuppositions. Like religion, alternative medicine relies on the gullibility of its clients, who have been educated to believe without evidence and without explanation. Bunge says that acupuncture is useless except as an analgesic placebo, that the Ayurvedic pharmacopeia is fantastic, that only a few of the 11,000 Chinese herbal medicines have ever been subjected to controlled clinical trials, that fully 1/5 of the most commonly prescribed Japanese medicinal herbs are toxic, that homeopathy ignores the whole of science, and that naturopathy is only marginally better in that it combines an ignorance of the scientific method with remedies in amounts that might have actual effects on the body. The CAMs have contributed nothing true or useful to health care. He discourages any further research on CAM hypotheses that are incompatible with the bulk of scientific knowledge.

The concept of vitalism is now obsolete. Reductionists postulated some kind of supernatural vital spark because they couldn’t imagine how the whole could have properties not present in the parts; today we understand that new properties are emergent and develop by purely natural processes. A remnant of reductionism is seen in DNAism, the simplistic idea that everything is reducible to DNA. Understanding complex facts in biology requires both a top-down and a bottom-up approach. We exist on several levels, and conditions like obesity and addiction are affected by social factors, inadaptations, and wrong decisions. Social and environmental factors can affect the action of genes through epigenetics and alterations of gene expression.

In medicine, “it is systems all the way.” Holism sees a forest but not the trees. Individualism sees a single tree. Systemism recognizes that there is no whole without its parts and that some wholes have global properties that their parts lack.

Bunge throws another wrench into intelligent design: if our body were wise, it wouldn’t get sick except through accident. The body produces antibodies for protection against infections, but it also produces endotoxins and maintains cancer cells.

He covers the history of medicine and the emergence of science, defined by Richard Feynman as “the belief in the ignorance of experts.” He laments the way so many people confuse frequencies with probabilities: there isn’t a 30% probability that you have a disease, you either have it or you don’t.

He covers the scientific method, why randomized controlled trials (RCTs) are necessary but insufficient, and why most published research findings are false. He explains that the placebo effect is not evidence of the power of an immaterial mind over the material body, but just the opposite: the effect of a material cerebral cortex on material subcortical organs.

Like those of us on the Science-Based Medicine blog, he is a critic of evidence-based medicine (EBM). He complains that evidence-based medicine is not as novel as its champions claim it to be and that it exaggerates the weight of evidence at the expense of that of hypothesis. EBM “has only strengthened the empiricist tendency to accumulate undigested data and mistrust all theory.” Science only advances when experiments are guided by hypotheses. Those who hold that passing a randomized controlled trial is all we need for proof are stuck in empiricism. RCTs are the gold standard, but there is a platinum standard (RCTs plus mechanisms of action) that is better. And even studies that fit the platinum standard should not be idolized.

Preventive medicine is arguably the most important medicine of all, and it is a social issue. Secular humanism is the only ethical system that defines “justice” as the balance of rights with duties. Everyone has the moral right to medical assistance. This implies a moral obligation to providing sanitation, vaccination, and access to health care for those who can’t afford it. Today, modern pharmacology only reaches 2 out of every 7 human beings.  Libertarians would let individuals make their own decisions about vaccination, but in health matters, individualism just doesn’t fly. Sanitary systems, compulsory vaccination, and epidemic management require action by society as a whole.

Bunge calls for a systemic approach to solve problems at the intersection between medicine and politics; he proposes a whole package of social policies with a multifaceted program to address access to health care, planned parenthood, more effective preventive measures including better education about diet and hygiene, income inequality, housing, environmental protection, price control of pharmaceutical drugs, reinforcing NGOs, and more participation of the citizenry in politics. Even if you don’t agree with his solutions, you will probably agree with his identification of the problems.

This is not a “fun” read or an easy one, but it is packed with information and with food for thought about serious issues that affect every one of us. It is a challenging book that will make readers re-consider their unconscious assumptions, confront new ideas about things they haven’t thought about, and think more deeply about things they may have taken for granted. Oliver Wendell Holmes, Sr. said, “A mind that is stretched by a new experience can never go back to its old dimensions.” This is a mind-stretching book.

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Followup note: This book gave me a new perspective on the term “holistic.” I had interpreted it as being similar to the conventional medical approach of looking at all aspects of a patient, treating the whole patient rather than just one body part; but according to Bunge it means seeing the forest only as a whole, without paying any attention to individual trees. What conventional medicine does is what he calls systemism, recognizing global aspects as well as individual parts. CAM “holism” can mean seeing only the global aspects and ignoring basic details like anatomy, physiology, and biochemistry. Good medicine has always encompassed both the details and the emergent global properties, seeing the whole forest along with the details of every tree. It is holistic while simultaneously being individualistic; in a sense, it is more “holistic” than so-called holistic CAM: there can be no whole without its parts.

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56 thoughts on “Philosophy Meets Medicine

  1. Marisa says:

    According to wikiquote, the Oliver Wendell Holmes, Jr. quote is a misattributed one; credit should go to his father, Oliver Wendell Holmes, Sr. http://en.wikiquote.org/wiki/Oliver_Wendell_Holmes,_Jr.
    http://en.wikiquote.org/wiki/Oliver_Wendell_Holmes,_Sr.

    1. Harriet Hall says:

      Thanks for catching that. I’ll correct it.

  2. windriven says:

    Well thank you very much, Dr. Hall. How am I supposed to get anything done at work today?

    Bunge’s book is available in a Kindle edition for $25. Powell’s Books doesn’t seem to have an e-book version. Too bad. B&N doesn’t seem to have Nook edition either. Bezos’ cash register rings again.

    Windriven the Magnificent predicts that in the not too distant future we will all do our bricks and mortar shopping at WalMart (sales $469 billion) and our internet shopping at Amazon (sales $61 billion). There may always be a few alternatives but they will be economically insignificant. By way of comparison, the GDP of Ecuador, a country of 15 million people has a GDP of $81 billion – less than a fifth of WalMart’s annual sales.

    1. nancy brownlee says:

      @Windriven
      “Windriven the Magnificent predicts that in the not too distant future we will all do our bricks and mortar shopping at WalMart (sales $469 billion) and our internet shopping at Amazon (sales $61 billion). ”

      I think you may be right- especially if you include EBay on the retail roster.

      1. Greg says:

        IMO Walmart is evil, so I don’t shop there, nor does my wife. Target is off our list too, as they think it’s ok to charge Canadians more than Americans, because supposedly Canadians are used to it.

    2. mousethatroared says:

      Ehhh… I buy alot of stuff second hand or antique, then brick’n mortar hardware stores, grocery stores, garden stores. I don’t do Walmart. But I do Amazon. Prime is genius marketing.

  3. irenegoodnight says:

    I have tried to avoid both WalMart and Amazon, but twice this week I was referred to one or the other by a small, local business :-(

    Amazon was also the only place I could find a Darwin fish cap for the hitch on my new truck.

    Back to topic: This is interesting, and I may have to force myself to read it because I have always pretty much mocked philosophy as being about one baby step ahead of sCAM as something to be taken seriously. Perhaps it is time to stretch my mind a bit.

    1. Iolaire says:

      Philosophy can be OK. My daughter is studying it as a sixth-form school subject. Their very first lesson was devoted to critical thinking, understanding logical fallacies and debunking some of the common urban myths. It’s good educational stuff, at least here in Scotland.

      1. irenegoodnight says:

        Gosh, that’s impressive! I am obviously ignorant of philosophy or have only noticed some other expression of it. There is a column in the NYTimes that tried to use philosophy in rather New Age-y ways to basically justify woo and diminish science.

        1. Iolaire says:

          I was very impressed. They had similar stuff taught them in history lessons too: how to assess the reliability of documentary evidence by looking at accuracy, sources of bias, whether different accounts of the same event matched up, and so on.

          Sadly, these skills were not taught in either biology or chemistry. It’s bizarre, but someone who chooses arts/humanities subjects could come out of school with better critical thinking skills than someone who had gone for science subjects.

          The only thing I’ve really needed to add to what my daughter is learning is to remind her to apply these skills to everything that is presented as a fact, not just to questions of history and philosophy.

    2. windriven says:

      If I had my life to relive I’d study philosophy and economics instead of physics and math. So much cool stuff to learn. So little time.

      1. Neil J says:

        Oh good, now you’ve gone and made me question my career choice. Just kidding, it was the 16-hour synchrotron shift that did that.

      2. WilliamLawrenceUtridge says:

        History. With a smile and a bucket of student loans.

  4. Ed Whitney says:

    “There isn’t a 30% probability that you have a disease; you either have it or you don’t.”

    Disease is a binary variable with values of 0 and 1. You cannot have a little bit of it.
    For which diseases is this true?

    Is it true of pulmonary embolus? This is an issue which vexes many diagnosticians when there are equivocal values of available tests and there may be a small embolus which does not require aggressive intervention.

    Is it true of lumbar degenerative spondylolisthesis? Does this condition have values of 0 and 1 only, or can you have a little bit of it?

    And of course, cancer presents true dilemmas in which there is widespread concern of overdiagnosis of disease which is present in the sense of histologically malignant cells but absent in the sense of not likely to progress anywhere.

    Some diseases lend themselves to binary thinking, but most of those two by two tables (in which exposure has values of 0 and 1 and disease has the same two values) are constructed for the convenience of epidemiology students. Like those problems in high school physics classes that tell the student to ignore friction, they are necessary for learning the basic principles of science, but need to be recognized as having been constructed by observers.

    Disease as a binary variable deserves some philosophical discussion.

    1. Harriet Hall says:

      I would argue that you either have or don’t have a condition like a pulmonary embolus. The condition itself is binary; the certainty of diagnosis and the significance are not.

      1. Ed Whitney says:

        It is fine to have binary variables at the level of the presence/absence of disease, as long as the necessary nuance arises at a different level, such as the clinical significance of the diagnosis and the need to do something about it. Aortic stenosis is a matter of gradients which need to be considered jointly in deciding what to do next: valve area, pressure gradients, ejection fraction, wall thickness, and functional status. These gradients are expressed as continuous variables, and they are at the center of planning and prognosis; it is true (but not very helpful for management purposes) to say that you either have it or you do not.

    2. mousethatroared says:

      “There isn’t a 30% probability that you have a disease; you either have it or you don’t.”

      I was diagnosed with undifferentiated connective tissue disease based on tests and symptoms. But, the doctor is clear that there are people with my test results that are completely healthy – not symptomatic. It’s possible that some or all of my symptoms are related to other health conditions and not my test results. Or possibly all or some of my symptoms ARE related to my test results.

      I suppose I either do or don’t have the disease, but if there’s no way to get at a definitive diagnoses, then it just seems better to stick with the question of whether it is more or less likely that the disease is causing a particular symptom.

      1. mousethatroared says:

        I guess what I’m saying is that some diseases fall on a spectrum between normal and abnormal. There is not necessarily an exact point where normal becomes abnormal.

        Not really trying to make a point, here. Just thinking things through.

  5. BobbyGvegas says:

    Wow. Based on my read of the available previews, I just ordered the hardcopy via Amazon Prime and will also download the Kindle edition. Looks like a good one. I will be reporting on it on my REC blog.

    “Well thank you very much, Dr. Hall. How am I supposed to get anything done at work today?”

    Copy that.

  6. Gulo says:

    “Everyone has the moral right to medical assistance.”
    Wow. When did the definition of secular humanism get altered to mean collectivism? As a nice person (in addition to being a secular humanist) I would certainly think access to medical care would be a good thing for all, but I am not going to confuse my hopes with my interpretation of ethics.

    I am sure you and your readers are familiar with all the basic philosophy around what constitutes a “right”, but when you speak of rights as though they are innate, you do secular humanism a disservice. We don’t have innate rights – we only have those rights we
    a) decide to grant ourselves, and
    b) which we have the means to provide and enforce.

    U.S. citizens have the right to bear arms. Female Saudi citizens don’t even have the right to bare arms. That’s what “rights” are, not some platonic ideal.

    It is all too easy to toss around words that purport a benefit to everyone, without tying them to costs that are tossed around like a hot potato. I certainly feel it would be unethical of me to not help others in need, but isn’t it also a little unethical of me to force others to do the same, in order to lessen my burden? Is it a balance that has to be struck somewhere? Where? According to what social theory? Show me the hypothesis and how you would test it. Even assuming you had a good case, saying everyone “has a right” to something implies we are willing to enforce that right.

    Canadians and Europeans are willing to use the coercive power of the state to grant themselves universal health care. The majority can do so because the dissenters are too weak to matter, politically speaking. That majority is also willing to sacrifice certain other potential rights that would conflict with the collectivist rights they have granted themselves, such as universal health care. Is the U.S. ready for that kind of dictatorship of the majority? Maybe, but only barely. But let’s not confuse the goals of secular humanism with the goals of one particular part of the political spectrum.

    As far as theories of ethics go that are compatible with secular humanism, there are many. Empirically, a large portion of people in the world do not now enjoy the right to access medical care (as we think of it, anyway). We have an enclave covering perhaps 20% of the worlds population that does enjoy that right to a reasonable extent, but, empirically, that 20% is not too concerned that others do not. We 20% live our lives quite comfortably knowing that the money we spent on a concert ticket could have saved a kid’s life, but nothing in our ethics compels us to forgo the concert. We wait until the taxman compels us to give up our money, and then we want the (now public) money to be spent in our home towns. You need to form a theory of ethics that explains the facts as they are, not as we’d like them to be. Maybe, just maybe, that theory will then suggest an ethical way to get to where we’d like to be.

    1. Sawyer says:

      You are reading WAAAAY too much into a single sentence in a book review. No one is jacking up your taxes 50% or forcing you to build wells in Afghanistan because of what Dr. Hall wrote here. No one is insisting secular humanists now have to affirm their allegiance to Mao Zedong. It’s ONE SENTENCE. And what does Mario Bunge say about this issue? Maybe it’s worth reading the actual book before complaining. Or recognizing that despite the promotion of the book, the name of this website is not “Medicine That is Rigorously Derived From the Principles of Ethical Humanism.org”

      And morals aside, the two specifically examples given were sanitation and vaccines. I doubt that was an accident. Most of the experts that work in these fields will tell you the same thing: it doesn’t even matter if you consider them a right. The cost-benefit ratio on these two technologies is so insanely high that it’s downright idiotic when they are poorly distributed. Everyone is happier and healthier when these wonderful discoveries are made available to a greater percentage of the population.

    2. WilliamLawrenceUtridge says:

      Canadians and Europeans are willing to use the coercive power of the state to grant themselves universal health care.

      As a recipient of this health care, as a taxpayer who has used said health care for his entire life, I simply can’t understand the American rejection of a universal health care system on the basis of “health freedom”. I am only coerced to pay taxes, which I do happily as I get stuff out of it – like health care. I am not coerced to go to the doctor, receive treatment, or receive a specific kind of treatment. The dissenters you cite are idiots. Universal health care is fantastic, and it is to the Americans’ detriment that they lack it. Why you think it’s better for millions of your citizens to go bankrupt or be unable to access preventive health care so the wealthier among you can avoid paying a trivially larger amount of taxes is a mystery to me. Modern health care should be fundamental underpinning of all states that claim to serve their citizens.

      All states are to a certain extent collective. They all use the economic, social and coercive power of its citizens, and institutions, to enforce certain norms and punish others. You simply can’t avoid it, if you are going to have any sort of society beyond one person living in the woods (at which point you wouldn’t have the electrical grid powering your computer, the communications grid linking it to other computers, and in particular the transportation grid that let the lineman hook up your dwelling to that communications grid). A minimalist collective coercion is a desirable goal; there should be collective support for the things that matter – food, health, education, transportation, safety, police and courts. Collective goods and efforts to overcome asymmetric information, the kind of basic contributions that make a state worth having and provide the kinds of services that free markets and individual citizens can’t easily provide themselves. Like designing, building, staffing, training, maintaining, interpreting and ultimately disposing of an MRI.

      Seriously. The bizarre netherworld lunatic fringe of the US needs to stop pretending that universal health care is anything but a boon to all citizens. It’s great. You should try it.

      1. windriven says:

        @WLU

        The biggest irony to me is that you Canucks commit a far smaller portion of GDP to health care than we do and yet somehow manage to provide coverage for essentially all Canadians. And the idiot wing of our body politic will challenge you to a fist fight if you suggest that American health care isn’t the best in the world.

        1. WilliamLawrenceUtridge says:

          It’s not just Canada though, on a lot of measures we are handily beat by other countries’ health care systems, particularly in Europe. Sure, you have to wait a year or more for non-life-threatening joint replacement, but if you have cancer, you get treatment within the month.

          I have long thought and said that Canada’s biggest downfall is (no offence) living next to the US. While we look great in comparison to our southern neighbours, compared to what I would like our meter to be (northern Europe, sans the fanatical racism) we come across rather poorly.

          On the other hand, the North American tradition of welcoming skilled immigrants irrespective background (for the most part, though there are of course problems) is far superior to Europe’s fear-based rejection of anything that doesn’t make and eat its own ham. Sigh.

          1. windriven says:

            Indeed. I’ve spent a good deal of time in Denmark and Sweden. Both have outstanding universal systems at roughly half the per capita cost as the US.

            Don’t be too hard on the Northern Europeans. Their social systems only remain viable with a homogenous culture that doesn’t game the system. Many immigrants to those countries have little interest in assimilation, have few marketable skills, and pose a tremendous load on the social welfare network. Among my friends in these countries there is animosity toward some immigrants but it really doesn’t amount to racism in that it has nothing to do with color or religion (you would be hard pressed to find more secular societies). They simply pose a threat to social and cultural systems.

            1. WilliamLawrenceUtridge says:

              I’ve heard anecdotes of true citizens, kids of immigrants who speak the language and completely buy into the Western ideals, facing racism and discrimination despite being highly educated. I can kinda see it, you want to preserve a culture unique to the geographic area you inhabit. But the long-term consequences are not pretty; accept the immigrants and two generations down the road they will think like, speak like and act like someone whose ancestors have never moved out of Paris.

              That’s why Canada’s anti-yogurtism* is in many ways an advantage. Sure, we lack soaring architecture, a long history of unique dress, dining, song and practice. OK, perhaps our museums are terrible, our churches laughable, our population negligible, our scientific accomplishments disproportionate to our size**, our health care system overburdened, our politics boring, our aboriginal populations a pernicious problem and our reliance on natural resources excessive. But we’ll take any comers, we’ll pillage your country’s best and brightest, and as long as you obey the laws and pay taxes, we’ll welcome you with open mouths.***,****

              *How is Canada unlike yogurt? Yogurt has culture.

              **This is actually a good thing, I’m bragging here.

              ***By which I mean, we’ll happily eat at your restaurants, staffed entirely by PhDs and doctors

              ****Quebec being a douchy exception :(

              1. weing says:

                “our politics boring”
                You are being modest. The mayor of Toronto has brightened our lives here south of the border.

              2. WilliamLawrenceUtridge says:

                He’s the exception that proves the rule :)

                I’ve been following Jon Stewart’s coverage of the subject with glee, though I feel sorry for everyone who lives in Toronto.

              3. windriven says:

                “I’ve heard anecdotes of true citizens, kids of immigrants who speak the language and completely buy into the Western ideals, facing racism and discrimination despite being highly educated.”

                It is difficult to counter anecdotes – and of course my experiences are just another helping of … anecdotes. But ‘in my experience’ frank racism and discrimination are more common in Germany (hates everyone), Greece (hates Albanians), France (hates Algerians and by extension all non-dead Muslims (and in Paris, most speakers of the English language as well)). The Benelux countries have gotten a lot of negative press but I don’t have enough experience there to offer even meaningful anecdotes.

                “****Quebec being a douchy exception”

                Are they still part of Canada???

              4. WilliamLawrenceUtridge says:

                Yeah, I should have qualified my statement with an acknowledgement that it’s just anecdotes and not proof.

                Yep, Quebec is still part of Canada, and I’m glad of it. I am less enamoured of their recent “values charter”, which seems specifically designed to piss off and offend Muslims. But hey, I’m happy for the rest of the provinces to accept any and all tax-paying, highly-skilled Muslims they manage to drive out, and will welcome them with open arms and a fresh loaf of bread.

                Europe does seem to be fantastically good at racism, particularly these days, but then again – humans in general are good at that. I think Canada has an advantage, because we don’t have a particularly strong “us” for outsiders to be “them” against. Japan is supposed to be horrifically bad, but since so few non-Japanese understand the language, it rather escapes our notice :)

                Japan’s awesome, it’s like an entire nation of Disneyland employees who are incredibly polite to your face and hideously rude when you leave. It was a delight to visit. And great candy!

              5. mousethatroared says:

                WLU – Damn – I was just going to bring up the Quebec charter of values (notice the restraint I showed not putting values in quotes?). But I see you have exempted Quebec.

                Are you suggesting culture and tolerance are somehow ( you know the word – means can’t exist together- ah) mutually exclusive? How about New York City? Lots of culture, although I’m not sure that tolerance is the right word, how about equal opportunity intolerance. :)

                Anyway, I think Canada’s got lots of culture, it’s just not one homeogenous culture.

                Although I haven’t got to experience it as much since they/we started requiring passports to cross the border.

              6. WilliamLawrenceUtridge says:

                Culture and tolerance can exist together, and there are numerous examples of cultures of tolerance. The Persian Empire was one for instance, it’s kinda a shame they didn’t conquer the Greeks. Even the Romans were pretty tolerant as long as you paid taxes and worshiped the Caesar. Canada’s not bad, America is OK at times (as long as you aren’t brown and at an airport).

                What we really need is an alien invasion. Nothing like a common enemy to bring people together.

  7. windriven says:

    “Everyone has the moral right to medical assistance.”
    Wow. When did the definition of secular humanism get altered to mean collectivism? ”

    Bunge specifically notes that this is a moral right, not a legal or constitutional right. Moreover, if you read the comment in context you would understand that he was speaking of humanity, not just of Americans.

    Do humans have a moral right to life? Thomas Jefferson spoke of the rights to life, liberty and the pursuit of happiness as being self evident. Bunge does not assert a legal right to health care but asserts a moral right as self evident.

    “I am sure you and your readers are familiar with all the basic philosophy around what constitutes a “right”, but when you speak of rights as though they are innate, you do secular humanism a disservice. We don’t have innate rights – we only have those rights we
    a) decide to grant ourselves, and
    b) which we have the means to provide and enforce.”

    And in fact, speaking now of the US, the legal right to basic health care already exists. Hospitals have the legal requirement to treat anyone who presents, at least until they are stable. We generally do not have people dropping dead in the street here from burst appendices or septic open fractures.

    You bemoan Bunge’s assertion of a MORAL right as collectivist. But in fact we treat any number issues in LEGALLY collectivist ways. We provide for a common defense. We provide for essentially universal police and fire protection. We provide clean water and garbage pickup.

    “It is all too easy to toss around words that purport a benefit to everyone, without tying them to costs that are tossed around like a hot potato.”

    Funny how that cost thing works. The US spends almost twice per capita what the ‘coercive’ European countries like Sweden and Denmark spend for care that is every bit as good as our own.

    1. Harriet Hall says:

      Whether you choose to call it a “right” or not, evolution has imbued us humans with empathy, altruism, and a moral sense that makes us want to cooperate to improve the survival of the group. It impels us to develop group strategies like garbage collection, sewage management, clean water, etc. that benefit every individual. Don’t you think all humans have the same “right” to benefit from group projects like those?

  8. Ed Whitney says:

    Realism can sometimes be seduced by the fallacy of misplaced concreteness. Some effort is required to distinguish between a thing and a construct.

    Life expectancy serves as an example. This is a construct which is sometimes treated as if it were a thing. The construction is not difficult and can be done on an Excel spreadsheet, but the numbers have to be entered and the calculations have to be performed. The result is sensitive to the data in the spreadsheet, especially in the younger age group categories.

    Sometimes life expectancy is not only treated as if it were a thing; it is used as a metric of the performance of a national health care system. If the acts of construction are forgotten, inappropriate comparisons can be made between countries.

  9. Sastra says:

    This book gave me a new perspective on the term “holistic.” I had interpreted it as being similar to the conventional medical approach of looking at all aspects of a patient, treating the whole patient rather than just one body part; but according to Bunge it means seeing the forest only as a whole, without paying any attention to individual trees

    I can go along with this definition if by “forest only as a whole” (or “whole person”) one means “the soul.” Whenever the term “holism” starts getting thrown around by alt-med proponents the emphasis seems to be on the patient’s feelings, moral history, and spiritual status — the most IMPORTANT part, apparently. The body only reflects the state of one’s soul, so no need to narrow the focus. And, technically speaking, the widest picture of all as far as alties are concerned would be metaphysics.

    So “holism” would include metaphysical truths. Whatever the hell they’re supposed to be.

  10. daedalus2u says:

    I would add to this a requirement for Sustainability, short, near and long term. It is sustainability that provides for the teaching and training of new health care professionals, for the responsible stewardship of antibiotics, for emergency and contingency planning.

  11. “Bunge says that acupuncture is useless except as an analgesic placebo” … I have not received my copy but I will have to conclude that if this is his statement, Bunge has not delved into the ancient healing art of Acupuncture and it’s modern versions, dry needling and trigger point injections.

    Yes, I have used all these modalities in my office for 15yrs and it has convinced me and the vast majority of my patients that it’s a true therapeutic options for pain, medical conundrums and dysfunctions.

    I will try to track him down and to give him a list of the textbooks that may help him to change his paradigm.

    1. windriven says:

      Good luck with that Stephen. I have received my copy and I can tell you with confidence that Dr. Bunge has a clear understanding of the difference between confirmation bias and valid scientific data. But you go ahead and ‘take him to school.’ Let us know how that works out for you.

    2. WilliamLawrenceUtridge says:

      Hey Stephen, I’ve a question for you. If acupuncture is so effective, why do scientific tests continuously find that it does’t matter where you put the needle, it doesn’t matter if you penetrate the skin, it doesn’t matter if you even use needles, it doesn’t affect anything but pain and nausea, but the factor that makes the biggest difference is how nice you are to the patient?

      Also, do you use filiform needles in your practice? What do you think about the traditional tools of acupuncture looking more like fleams and bodkins rather than needles? Or the fact that technology to make fine steel needles didn’t exist n the “ancient” past? What do you think about the ancients having zero knowledge of anatomy and physiology?

  12. You are so interesting! I do not suppose I’ve read something
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    Really.. many thanks for starting this up. This website is something that is needed on the internet, someone with
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    1. WilliamLawrenceUtridge says:

      Spam.

  13. RE: Caveat lector: Can Physicists truly comprehend and help — or hinder or confuse — advances already made in Modern Biomedicine or in Philosophy of Medicine and Biology today and beyond!?

    Despite his noble intents, I thought that Mario Bunge has had unknowingly (or intuitively) straitjacketed the philosophy of medicine and biology nowadays; as my observation is primarily based on the premises that 1) his pedagogical and professional training was in physics (theoretical and mathematical) and 2) his subsequent and consequent philosophy of natural sciences (including Biomedicine) is inherently predicated on his erudite materialism, physicalism, and physicalist systemism; a physicalist worldview that is dynamically opposed to bioscience and bio-dynamism in thinking: or a vitalist concept (or vitalism) that most physicists would out rightly reject or intrinsically ignore in all things and phenomena (natural, physiological, psychological, etc) including those of the living organisms and/or human beings!

    As such, Bungeism has had come to represent a perfect and straight-forwarded (or narrow-minded) 20th-century physicalist reductionist reminiscence in sciences (since 1960s) — although Bunge has had not recognized it, nor bio-phenomenologically reflected upon it, as yet!?

    As a result, all those philosophical principles of his erudite materialism, systemism, realism, scientism, and humanism that Bunge has had purported to identify, imply, and define in our Modern Biomedicine (and the Humanities, etc) are in fact the prior reminiscences 1) of a traditional physico-reductionist, since the French philosopher, mathematician, and writer René Descartes (1596-1650) who had indeed attempted to split the Hippocratic Holism of body-mind thesis into the 17th-century Dualism of the renowned Cartesian body-mind conundrum; 2) of a materialistic (shallow or superficial) positivist, since the other French mathematician and philosopher Auguste Comte (1798-1857) who had had intended to replace the age-old Religionism (or primeval metaphysics including ritualism, vitalism, emotionalism, psychology, spiritualism, supernaturalism, existentialism, etc) with his then newly and logically devised positivist Scientism; and 3) of a typically 19th-20th century-minted neo-Darwinist evolutionists who have had gravely misread and misinterpreted Charles Darwin’s biomorphism (or natural selectionism) theory as an empirical discipline of bioscience, that is genetics and cell physiology, since the 19th century past!?

    Meanwhile and specifically, please note that Bungeism or scientism (as Bunge has defined above) is intrinsically opposed to the classical holism and humanism in general; as Harriet Hall has had tried to identify and differentiate — but relented in her criticism — in her followup footnote above!? Furthermore, as I duly elaborated above, holism in our universal humanism shall also include the inquiry of our primeval religionism and existentialism that most physicists, physicalists, materialists, as well as neo-Darwinist evolutionists would incomprehensively sneer, oppose and be in self-denial in their very narrow-minded and cherished physico-reductionist professionalism and materialism in all sciences since the mid-19th century past!?

    Whereas in Biomedicine since Hippocrates (460-377 BCE) all the philoscientific principles of bioscience and medicine (including healing or soothing metaphysics, religionism, ritualism, and all things spiritual as well as intellectual and imaginable) shall be fully, systematically, bio-dynamically, and comprehensively interrogated, elaborated, and/or integrated in our modern clinical practices — especially in personalized medicine and in idiosyncratic psychiatry practice alike — as I recently analyzed and presented here: my dialogue #1 “Science, Psychiatry, and Family Practice: Positivism vs. Pluralism — RE: Pluralism vs. Positivism — or Holism vs. Reductionism in Modern Biomedicine and Psychiatry!?” (PsychiatricTimesUSA; December 2) and elsewhere in the SBM discussions before!?

    Best wishes, Mong 1/1/14usct5:18p; practical science-philosophy critic; author “Decoding Scientism” and “Consciousness & the Subconscious” (works in progress since July 2007), Gods, Genes, Conscience (iUniverse; 2006) and Gods, Genes, Conscience: Global Dialogues Now (blogging avidly since 2006).

    1. windriven says:

      Four questions amd a comment:

      What the F do you have a PhD in, Obfuscational Doublespeak?

      How precisely does someone “incomprehensively sneer”. How is a sneer comprehensive? Incomprehensive?

      Is there a point to be found somewhere in that blizzard of verbiage beyond ‘Bunge is a poo-poo head’ because he doesn’t write philosophy after three bowls of bitchin’ hashish?

      Is your comment, like most of the rest of your oeuvre, a work in progress or can we take this as your final word on the subject?

      And now my personal analysis, though clearly this is grounded in physico-reductionist materialism, is that your flood of barely comprehensible jabber is a desperate attempt to mask your towering full-of-shitness and a kind of pathetic attempt to appear erudite.

      1. MadisonMD says:

        Looks like Dr. Tan is the author of
        “Gods, Genes, Conscience: A Socio-Intellectual Survey of our Dynamic Mind, Life, all Creations in Between and Beyond, on Earth—or, A Critical Reader’s Theory of Everything: Past, Present, Future; in Continuum, ad Infinitum”

        He describes this book as a “treatise with a self explanatory subtitle.”

        It reminds me of the ‘postmoderning deconstructivism’ that was revealed to be impenetrable bluster and nonsense in the Sokal affair. Tan and his ilk depend on the reader to become confused and to simply concludes they cannot comprehend the wonderful insights of a genius. Few have the intellectual confidence to see through the smokescreen. But those that do quickly realize that the emperor has no clothes.

        I’m not able to find any reviews of Dr. Tan’s book–obfuscatory pseudo-intellectualism doesn’t sell. However, I expect the book would make a wonderful soporific for insomniacs.

        1. windriven says:

          After slogging through his comment I wondered whether Tan had actually read Bunge or was just whining because of Bunge’s contempt for post-modernist nonsense.

          ” I expect the book would make a wonderful soporific for insomniacs.”

          I’m in the process of rinsing my brain with good Scotch after reading that mess. I don’t know if the book or the Scotch would make the better soporific but either way I’ll sleep well tonight.

        2. Chris says:

          He seems to be a retired cancer researcher who slipped when he tried to find an intellectually stimulating hobby. At least his hobby is less dangerous than Dr. Blaylock’s post retirement hobby (which involves writing random essays on the evils of vaccination).

  14. windriven says:

    Four questions and a comment:

    What the F do you have a PhD in, Obfuscational Doublespeak?

    How precisely does someone “incomprehensively sneer”. How is a sneer comprehensive? Incomprehensive?

    Is there a point to be found somewhere in that blizzard of verbiage beyond ‘Bunge is a poo-poo head’ because he doesn’t write philosophy after three bowls of b!tchin’ hashish?

    Is your comment, like most of the rest of your oeuvre, a work in progress or can we take this as your final word on the subject?

    And now my personal analysis, though clearly this is grounded in physico-reductionist materialism, is that your flood of barely comprehensible jabber is a desperate attempt to mask your towering full-of-sh*tness and a kind of pathetic attempt to appear erudite.

    Note to Editor: I bowdlerized as required. Please delete comment in moderation.

  15. peter brennan says:

    You’re an idiot

    1. Chris says:

      What a profound statement. Do you have any substance to back that up with, or do you just think insults are a valid form of discussion.

      1. windriven says:

        Hmmm, not even sure who the object of his derision might be as his comment is positioned ‘in the wind’. I’m hoping that it is me. But it could be Bunge, Dr. hall, you, Madison, or maybe it is just a shriek to the universe.

        A well delivered insult that draws attention to a flawed argument or logical faux pas can be a thing of beauty. I’m happy to take as well as I give. But really Peter, show a bit of panache. This isn’t a barroom.

        1. Andrey Pavlov says:

          At least he used the proper form and didn’t say “Your an idiot.” That would have just been downright uncouth.

          1. MadisonMD says:

            @Andrey: I also was surprised he didn’t use “your.” Bravo, Peter!

            1. Andrey Pavlov says:

              Their is no great offence than using the wrong you’re.

Comments are closed.