Medicine: Science or Art?
Despite the long history of medical scholarship and research, the answer is still not straightforward. Science is based on measurable facts verified in multiple experiments. Moreover, scientific facts hold universally. For example, gravitation, conservation laws or Newton’s law of inertia work everywhere in the Universe. Therefore scientific results could be regarded as objective.
Art, on the contrary, relies on intuition and inspiration and is intimately connected to its creator. Therefore it has a local value and is subjective by nature. Between those two extremes oscillates medicine.
Contrary to positive sciences such as physics, chemistry or biology, the ambivalent status of medicine is dwelling on three major misconceptions, often preventing objective diagnostics and effective therapy.
Total is a sum of its parts.
For centuries, medicine was collecting individual physiological facts trying to describe various human organs, with limited attempts to understand their interplay.
Contrary to its oriental sisters such as Chinese or Indian medical techniques (e.g., TCM and Ayurveda) that assumed the universal interconnectedness within a person, among people, their health, and the Universe, the Western medicine believed that after “fixing” the injured subsystem with a prescribed treatment or medications the whole organism would return to its equilibrium. The entire homeostatic system of human body was dissected by the mainstream of European medicine into various diseases. This approach is now reflected by a set of diverse medical specialties such as gastroenterology, cardiology, psychiatry, etc. The knowledge in each of the specialties was mostly evolving within itself – deep, but narrow.
This approach has a fundamental deficiency well known in other natural sciences, e.g., in physics of complex systems (and human body is a complex system): the sum of parts does not constitute the whole.
Health is a holistic notion. There is no such thing as a partial health. The human organism can be regarded as a complex open system in a state of delicate equilibrium exchanging chemical substances, energy and entropy (information) with the outer world. Since the whole organism consists of a number of strongly coupled and cohesively working subsystems, the failure of any one of them tends to provoke an avalanche of other failures. Therefore, separate treatment of a single organ, disregarding impact of a disease on other subsystems or recklessly administering strong locally acting medications, may result in complications involving other organs.
This “focused” approach in medicine also leads to ignoring side effects. Take for example the wide-spread medication known as Bisoprolol, a readily prescribed beta-blocker to treat hypertension. It reduces the activity of the heart by blocking tiny areas (called beta-adrenergic receptors) where the messages are received by the heart muscle. But for patients, suffering from cardio problems, often associated with hypertension, this medication can provoke a shortage of breath and a cardiac rhythm disturbance, most frequently dangerous arrhythmia or bradycardia (especially when prescribed together with calcium channel blockers).
Many experienced physicians innately acknowledge the deficiencies of such fragmented knowledge, attempting to compensate them with intuition, rather than relying on prescribed guidance that can be based on the same erroneous assumption of compartmentalization. Quoting Dr. Jeffrey Braithwaite, Foundation Director, Australian Institute of Health Innovation: “slavish adherence to increasingly voluminous and often piecemeal guidelines is an obstacle to flexible, intuitive, effective care” .
The European medicine, unlike science, has drifted toward a technique of intuitive feature extractions and subjective judgements called “Art” when successful, and when not, then paving the way towards false diagnostics and medical errors.
- Individual equals statistical unit.
Clinical protocols and medical guidance adopted by European medicine mostly rely on averaged statistical data i.e. individual characteristics are largely neglected (being habitually labeled as “unspecific“). This method is fundamentally wrong since it is based on an implicit assumption of the Gauss distribution underlying medical statistics. Yet the statistics of emergent diseases, similarly to heavy accident statistics, seem to obey power law distributions rather than exponential ones. Note that statistical results, e.g. produced in clinical trials, in fact do not answer the crucial question: what is the best strategy for a specific individual.
Therefore the whole concept of “evidence-based medicine” which is actually based not on evidence, but on statistical simplifications does not suggest what is good for a given patient. The fact acknowledged by a number of physicians.
Medical science is applying statistical approach to models assuming their complete symmetry (i.e. that the models are basically the same), but in reality medicine is using statistics in regard to humans that are different by default. Therefore relying on statistical methods in individual medical cases is not always correct. The consequence is that many medical techniques can be more harmful than beneficial for patients.
Take for example the “sugar curve”, which is a colloquial name for a glucose tolerance curve (whose linear part is usually known as a dynamic range). Such a test nominally requiring the glucose intake not exceeding 125 g (who really controls it?) but can be indiscriminately administered, e.g., to the patients already having diabetic ketoacidosis. The beginning of adverse effects such as vertigo, blurred vision or even fainting occurs not rarely and marks the diabetic health boundary, in extreme cases leading to coma.
Another example is the ubiquitous exercise-electrocardiogram (stress ECG or cardiac stress treadmills) which is favored by the doctors but can be contingently detrimental for patients, e.g., suffering from hypertension. One patient complained that his blood pressure during ECG stress test raised up to 285 systolic and 190 diastolic. Nevertheless, his cardiologist proceeded with the test, since a patient did not complain of the chest pain, a symptom obviously more important for a cardiological test than a blood pressure (AD).
- Focus on disease vs. health
Although the notions “health” and “medicine” are commonly used interchangeably in various contexts, there is a crucial difference between them. Medicine deals with deviations from healthy conditions and treats diseases mostly by medications, surgery and, since comparatively recent times, by laser and ionizing radiation. The very term “medicine” stems from the ancient “art of healing” i.e. returning to health. It is not accidentally that the object of treatment in medicine is known as “patient” whereas health can (and should) be maintained in any person.
People feel themselves healthy as long as their organisms are capable to maintain stability under an influx of external real-life influences such as stress, psychic overload, microorganisms, fungi, allergens, etc. Contrary to the dominant – and unverifiable – presumption that diseases mainly arise from erroneous behavior or unreliable functioning of individual body organs, partly genetically determined, the idea of a holistic health leads to the concept that diseases are rooted in the very foundation of the complexity of a human organism that involves numerous interconnected components and subsystems. The possibility of a disease may not spring from the failure of a distinct body part (organ), although it can be manifested as such, but can be the property of the whole organism. Hence radical treatment of a single organ can have a overall negative effect, driving health of its stability margins.
The deficiencies of a fragmented approach to treating health is most vividly demonstrated in case of complex disabilities such as, e.g., chronic fatigue syndrome, or CFS when a person feels so tired that he/she is unable to complete normal daily activities. The CHF Health Center recognizes that “the fatigue syndrome has no known cause and is difficult to diagnose”. So the therapy decides to focus on “the major symptoms” that allegedly “can be treated”.
But how can one treat symptoms leaving aside the cause and even unable to properly diagnose the disease? Instead of bringing a patient back to healthy conditions, the therapy relies on a variety of medications such as antidepressants that are purposefully changing the balance of brain chemicals (neurotransmitters). Although it is generally stated that antidepressants have no severe side effects, such frequently prescribed medications as adapin or doxepin can provoke pathological conditions such as orthostatic hypotension, tachycardia, ventricular arrhythmias and even lead to breast cancer.
The European medicine is gradually adopting the approach of “maintaining health of the healthy” and supporting natural resources of the organism to help it to return it to its stable conditions. For example the oncological immunotherapy with medications such as, e.g., Keytrouda (Pembrolizumab (formerly MK-3475 and Lambrolizumab) is focused on strengthening the body’s natural immune system impelling it to attack and destroy the cancerous cells, rather than trying to destroy the malignant tumor by means of dangerous chemical drugs that come with serious side effects.
With no intention to diminish the achievements of the contemporary medicine, one has to accept that it is lagging behind positivistic sciences in understanding human organism as a cohesive complex system with tight interplay of its related parts.
The mainstream of physicians are still treating a disease vs. treating a patient to maintain her/his health. This approach often leads to wrong diagnostics, medical errors and serious side effects that endanger patients.
True there are a lot of achievements performed with the help of modern medical (in fact physical) technologies such as X-rays, CT, MRI, PET screening, pulsed lasers, proton therapy or other advanced procedures. But the majority of such technologies should be applied carefully and by thoroughly trained staff since they are still based on invasive methods that disturb health and can be harmful for a patient.
“Great expectations” are connected with the development of sophisticated body sensors designed to convert the body physiological characteristics such as pulse rate, blood pressure, ECG (electrocardiogram), EEG (electroencephalogram),) PPG (photoplethysmogram), ENG (electronystagmogram) and EMG (electromyogram) signals, local thermal (infrared) emission, skin wetness, etc. into sequences of electric pulses and further into digital signals that can be processed by some central unit, at present by a computer or a smartphone. By collecting biological feedbacks from an individual organism in a noninvasive way, body sensors may help physicians to transit from the illusive intuitive descriptions of arbitrary selected symptoms, to objective and measurable manifestations of a health status.
The physicians of the future will require a new type of education which will help to overcome traditional pitfalls of medicine. The new type of medical knowledge will encompass multiple areas of natural sciences such as physics, chemistry, and biology to address the fundamental laws of the human organism viewed as a complex biological system (a metabolic reactor) rather than adhering to fragmented clinical methods. We see the emergence of such a converged knowledge already with the development of new branches of science such as, e.g., bioengineering, bioinformatics, computational biology, etc. that are already opening new opportunities for medicine and healthcare. Until this knowledge fusion fully happens medicine, according to William Olser, one of the founding professors of Johns Hopkins Hospital, will remain “the science of uncertainty and the art of probability”.