We have a widespread belief that science has made us more healthy and extended our lives. It is hard to dispute this. Is it possible that science has also helped some negative things to infiltrate our way of viewing health care? How could that be? There are things that have been being criticised about our system of scientific thought for at least 50 years that get little or no attention. In particular, one man, the late Robert Rosen, has raised questions that seem to be ignored rather than answered by the scientific community. Rosen's last book:Essays on Life Itself can help us see the problem as he saw it. He was a prolific writer and his bibliography is worth studying for more detail.bibliography One of his greatest contributions was a rephrasing of Schroedinger's ill posed question "What is Life?" to "What is the difference betwen an organism and a machine?" which I have written about elsewhere. Some points from his last book raise some serious questions about the way science frames questions about health care.
To set the stage, Rosen pointed out that modern science's successes are also its largest limitation when the entire complexity of nature is taken into account. This all has to do with the use of an approach to understanding nature called "reductionism" or more precisely, Cartesian reductionism. Closely coupled to this idea is another legacy of Descartes, the machine metaphor. Finally we also owe to Descartes the mind/body duality that flies in the face of mind/body interactions as we now understand them. In my first three diaries on world views I & II and Umberto Eco. I, II, Ubert Eco. I spoke about these matters in the context of my latest work which is published in a volume I edited devoted to work based on Robert Rosen's inspiration.The alternative to Descartes' mechanist/reductionist view of living systems is best presented in Rosen's view of complex systems as being distinct from machines. One side issue is that the Cartesian picture underlying most of modern science is dualisticly coupled to, not opposed to, religious philosophy. But that is another story. What I want to focus on here is the very different way complexity science leads to a strategy for health care in contrast to the system we have which is largely based on Cartesian reductionism and mind/body dualism.
I will not be quoting Rosen but once for his writing can be difficult. Instead I will substitute my interpretation as I have since his death in 1998. My web page gives access to all of these writings and more of others' as well.
How does complexity theory's view of the living system lead to a different view of Health Care from the Cartesian view?
Here is a short list:
- Mental and physical heath can not readily be separated.
- Drugs are not magic bullets. They all have many effects and the idea of "side effects" is misleading.
- The interaction of the systems we use to teach about the body are more complex than this division into systems would indicate.
- The living organisms survives by continuously tearing itself down and rebuilding. No machine is designed this way.
- The whole is more than the sum of its parts. Something is lost every time we try to understand it by reducing it to its parts.
- The term "molecular biology" is an oxymoron. Biology is the study of life and there is no life at the molecular level. Clearly molecular biology has value, but a more holistic approach is needed to deal with systems biology.
- Biology is more general than Physics and will always be able to tell us things about material systems that physics can not. Again this has to do with the need for a systems approach for complex reality.
- The terms "artificial life" and "artificial intelligence" are misleading. They should be called "machine simulation of life" and "machine intelligence".
- Computer models of living systems have an inherent weakness in that they must use the machine metaphor. Complex systems are not able to be simulated by a computer.
The next is in Rosens words more directly:
In complex systems ontology and epistemology are generally very different. Our contemporary science, which has concentrated almost exclusively on epistemological issues, accordibly gives very little purchase onontological aspects when the two are different. Thay is why the origin of life problem (or, for that matter, the origin of anything problem) is so hard.
Since medicine in its diagnostic mode involves essentially epistemology, whereas in its therapeutic mode it involves ontology, the separation of the two in complex systems becomes a central matter.
Indeed the entire concept of craft changes completely when dealing with complex systems. For we cannot generally approach them by simple means. There is a sense in which complex systems are infinitely open; just as with any infinite thing, we cannot exhaust their interactive capacities one at a time. In particular, the simple control cascades previously mentioned will generally not break off; hence, magic bullets of this character will not generally exist.
I do not expect to convince anyone here. It is a deep topic. If I have at least raised the question of whether or not our knowledge of complex systems has at least opened the door to another look at the way we deal with health matters I will feel like I have done something. The matter is important and I hope it can be discussed in further detail.