Tag Archives: Science

From Medieval to Modern Medicine: A Journey of (Not So Straightforward) Progress.

During a recent(ish) podcast, in which Peter Goble and I discussed issues surrounding the experience and management of pain, I suggested that the distinctions between mind and body – which have existed in modern medicine – are beginning to be broken down; that scientific medicine was embracing holistic ideas and practices with more than mere lip service. This, in part, has been in response to the apparent rise of ‘holistic’ or ‘complementary’ therapies (I say ‘apparent rise’ because I think that therapies offering alternatives to the mainstream have been popular in one form or another for a very long time). Despite harbouring some doubts about such theories, usually regarding their underlying theories or their general efficacy, I have long thought that the tendency to treat the ‘whole person’ rather than focus solely on specific diseases is a good one. If we take lung cancer, as one obvious example, then it’s right to say that it’s a disease that can be identified in one area of the body and treated locally. If it’s found early enough it can even be surgically removed and the patient can be ‘cured’.  All of this can be achieved without much thought for the individual involved, but it shouldn’t be. There are many reasons why a holistic approach should accompany (or rather form part of) the medical approach. A person’s lifestyle or environment can be manipulated to aid recovery, or even help reduce the risk of getting lung cancer in the first place, and the person’s emotional needs should also be considered. Getting lung cancer is not just a physical event; there will likely be considerable emotional effects too – which, like physical symptoms will be different for each individual.

Such things are increasingly being contemplated and acted upon by the medical community, which is interesting when one considers that the humoral model had been doing this for centuries, before being rejected roughly 200 years ago, by the scientific model.  From the 10th to the 19th century CE the established medical orthodoxy was based, almost entirely, on the ancient ideas of thinkers such as Hippocrates, Aristotle and Aelius Galen.  This system was based on the belief that the human body consisted of four fluids (or humours): Yellow Bile, Pure Blood, Black Bile and Phlegm.  Each humour had unique properties and were related to such factors such as Aristotle’s four elements andThe_four_elements,_four_qualities,_four_humours,_four_season_Wellcome_V0048018 the four seasons of the year.  So, the properties of Yellow Bile were considered to be ‘hot and dry’ meaning that it was related to the ‘element’ fire and the summer season.  Phlegm, on the other hand, was ‘wet and cold’ and thus associated with ‘water’ and ‘winter’.  Each person had an optimum ratio of these four humours, which was specific to them; personality, emotion and physical condition were all determined by this ratio (or complexion).  One’s health was the product of one’s complexion; if the ratio of humours became deranged then ill health would follow.  Factors such as environment, food or the position of celestial bodies could all alter the amount of each humour.

Diseases were not thought to be specific entities in of themselves.  Every incidence of disease was specific to the person who was suffering, and thus treatments were tailor made to address the specific conditions that were responsible.  If a set of symptoms were thought be caused by a surplus of Yellow Bile, then any treatment would have the opposite properties of cold and wet.  Such treatments could include a prescription to change the properties of ones environment or diet, as well as for medical concoctions and surgery.  By considering psychology, physicality, lifestyle and environment as deeply interrelated factors, thereby focusing on the whole patient as an individual, humoral medicine was truly holistic.  It was impressively versatile too; from Christianity, through the emergence of human dissection, to the enlightenment, challenges to the ancient system came from many sources.  Often, such challenges would be integrated into the existing theory.  God became the primary cause of disease, causing it and allowing it to spread as a punishment for sin, and new treatments based on chemical experimentation were added to the long list of remedies and concoctions.  What did not change, and what was not readily challenged within the mainstream, were the core ideas of the classical scholars.  It was widely believed that the work of those such as Galen could not be bettered, only expanded upon (although this too was a matter of debate).  Even when human dissection showed that anatomy differed from what Galen proposed (Galen only dissected animals) it was frequently assumed that the anatomist, not Galen, had made a mistake.  Some scholars would even alter their descriptions to fit the Galenic sources.  Mainstream medicine spent over 1000 years being based on a, largely, unchallenged appeal to authority.  Those who dared practise outside of its dogmatic sphere could find themselves the unfortunate victims of persecution.

A combination of factors (theoretical, technological, political & social), occurring up to and throughout the late 18th to the mid 19th century, eventually led to the decline of this long lived classical theory.  The emergence of increasingly scientific medical theories led to a general shift in focus from the patient – as an individual to be treated as a whole – to a specific part of the body or an external, disease causing, entity.  As such the patient, in many cases, came to be viewed as an incidental part of the disease process.  That’s not to say there was a clearly defined shift from the ways of the old to those of the new; there rarely is.  Nor was there a move from a wholly holistic practice to one where such considerations were completely absent.  Nevertheless, the medical community was becoming increasingly specialised and all to often the human being was becoming lost in the detail.

I’m not going to argue that this process shouldn’t have happened.   The tendency to specialise and focus on diseases as distinct entities and specific parts of the body has given us incalculable benefits.  If faced with the prospect of a Tuberculosis outbreak, I’ll take the scientific explanation and subsequent course of action over that of a humoral practitioner any day.  Similarly, if I ever need complex cardiac surgery and I’m given the option of a surgeon that is warm, kind and empathetic with an above average mortality rate or a sociopath with a rude, unpleasant bedside manner, who has a very low mortality rate, I’ll take the latter every time.  Of course, it would be much better if I could have a surgeon who combines the best of both.  This might be a bit idealised, and it would be unrealistic to expect every practitioner to experience and radiate the same levels of empathy, just as one could not expect every surgeon to have the same technical skills, but that does not mean it shouldn’t be aimed for.  A surgeon would probably not think much of the notion that they should always endeavour to become as technically skilled as they possibly can be, but the suggestion that the same principle should apply to bedside manner might not always be met with enthusiasm.  I think that it’s an oversimplification to claim that patient’s are viewed merely as objects rather than individuals but there is some truth to this, as demonstrated by this very funny video (which is only funny because there is more than a whiff of truth, and familiarity for anybody that works in an operating department).  I’ve even fallen into such language myself:

‘Are we doing the abscess next’?

Although I’m glad to say, that in my experience, I’ve always (rightly) been pulled up on such utterances by a colleague:

‘We are not “doing an abscess”, we are treating a person who has an abscess’.

I think that there have been many improvements – from wider environmental and lifestyle concerns to the understanding that our physical or psychological conditions cannot always (if at all) be considered in isolation from each other.  Pain management services (in Britain, at least) are a good example where services are being integrated, but there is still a long way to go.  The provision for the psychological well being of those staying in hospital, for example, is often inadequate (a situation potentially made worse if you also happen to suffer from a mental illness) – of course a positive emotional experience will not fix that broken hip, but it may well assist in your recovery and help prevent you form developing a new founded, and avoidable, phobia of hospitals.  There are obviously financial and logistical factors at play here, which can be hard to overcome – but this is not an excuse for the wider needs of patients to be neglected.

Modern medicine has many advantages over humoral medicine.  It is demonstrably more effective at preventing and treating disease and it is not based upon such dogmatic appeals to authority.  Clearly, there is dogma and there are appeals to authority, but due to the requirements for evidence and expectations for innovation, such dogmas are short lived – perhaps lasting a generation or so, but falling far short of the 1000 years that Medieval medical orthodoxy managed to exist.  However, the shift away from the old ideas probably went to far and our focus became too narrow, meaning, in some respects, we have spent the last 200 or so years rediscovering some of the valuable ideas which had become obscured.  The Middle Way Philosophy is unapologetically inspired by many, sometimes apparently incompatible, sources; a ‘magpie’s nest of influences’ made up from those aspects of other ideas which, after critical analysis, have been deemed useful.  Good science and, by extension, good medicine also does this, but all too often there is hesitation, often borne from suspicion of ideas that do not fit neatly into the current orthodoxy.  There are plenty of ‘alternative/ complementary’ therapies that are widely popular and don’t hold up to scientific scrutiny.  To dismiss them all, in their entirety, because of this may be a mistake.  Yes, such and such therapy might not treat what it says it treats, in the way that it claims, but that doesn’t mean there is no value to be found.  If a GP prescribes a contraceptive pill, it will almost certainly work (if used correctly).  As far as I know there is not a Homeopathic equivalent to the contraceptive pill, but the extended consultation that one is likely to receive from a Homeopath could provide many other benefits that GP could not hope to achieve in a 5-10 minute consultation.  We shouldn’t be uncritically open to all ideas that come our way, or to the ones that are currently in vogue, but neither should we dismiss them out of hand (even if one aspect has already proven unhelpful).  This is not easy to do and we will continue to take wrong turns, just as we have in the past.  However, in general, I believe that we will continue to move in something like the right direction, albeit in a haphazard, uneven and uncertain fashion.  I also believe that the five principles of the Middle Way, and the wider philosophy that emerges from them, are well placed to help us avoid many of the hindrances of the past.

Picture: The four elements, four qualities, four humours, four season. From Wellcome Library, London (CC BY 4.0), via Wikimedia Commons


The MWS Podcast 50: Michael Brooks on the role and state of science

The science writer Michael Brooks holds a PhD in quantum physics  and as well as authoring several popular science books including, The Secret Anarchy of Science,  the bestselling 13 Things That Don’t Make Sense and At the Edge of Uncertainty, he’s also written the novel Entanglement. In addition, he’s a journalist and broadcaster. He regularly writes for the Guardian,  he’s a former feature editor of the New Scientist magazine and writes a weekly column for the New Statesman.  Michael is here to talk to us about the state and role of science today, how one goes about doing good science, some pitfalls to avoid and what the future may hold for this fascinating field of human endeavour.

MWS Podcast 50: Michael Brooks as audio only:
Download audio: MWS_Podcast_50_Michael_Brooks

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Science and the Middle Way (An Objective Model)


“We especially need imagination in science. It is not all mathematics, nor all logic, but is somewhat beauty and poetry.” Maria Mitchell, astronomer, first female member of the American Academy of Arts & Sciences (quote and picture from Geozilla)

Science has a problem.  For all it’s wonderful, bewildering and sometimes terrifying discoveries (discoveries that have shaped the world that we live in, as nothing before has) science is treated with contempt and mistrust while at the same time (and often from the same source) being worshipped as the miraculous and supremely authoritative fruits of superhuman individuals – ruthless rationalists, seemingly void of normal human responses.  There are countless examples of this, from the MMR scandal and the climate change debate to the seemingly daily claims of cancer cures that adorn the front pages of our favourite tabloids (one would be forgiven for wondering how it is possible that anybody could even develop cancer any more)!  My suspicion is that the problem is borne and perpetuated throughout society, from schools and media to the scientific community itself.

I am not a scientist, most of my understanding of science comes from reading populist science books and so I offer no authority on the nuances of the scientific method.  My intention here is not to suggest possible alternatives to any part of the scientific process, suffice to say there are many dissenting voices and my guess is that any major shift will come – as it has in the past – from within the community itself.  What I will attempt here is to explore the perception of science, as it is presented and understood by what I believe is a large proportion of the population, whilst simultaneously suggesting a more objective (in the Middle Way sense of the word) model, that I hope will avoid dogma, still allow and possibly assist –  science to continue doing what it does best.

I have broken the process of science into five incremental stages, which can be put into three distinct groups of differing levels of public perception.  As can be seen in the scienceberg template stage 2diagram provided, the stages (which are numbered 1 – 5) form a triangle which rises up through the levels of perception (lettered a, b, c).


This level contains the first stages of the scientific process, which are rarely publicized and are little understood by much of the public (Michael Brooks claims that this is how many scientists wish it to remain).

Stage 1 – People

Science, like art, begins with human beings, and scientists, like artists, are not only capable of wondrous creative leaps but also of jealousy, dishonesty, romance, delusion, dogma and the whole spectrum of human vices and virtues.  Yet the public perception of scientists seems to be of robot like boffin’s, working together with ruthless rationality and poise.  While science appears to maintain a dogmatic status-quo that is beyond challenge, individual scientist must be as competitive and ambitious as the rest of society.  While the established order jealously guard their hard won theories, the young upstarts must surely be desperate to instigate revolution.  These revolutions do happen, but they are rare and require exceptional creativity.  Relativity, The Big Bang Theory and Heisenberg’s Uncertainty Principle all turned contemporary scientific thought upside down – their instigators all challenged the institution, and won.  To the scientist that proves that the speed of light is not the universal speed limit – a Nobel prize, world fame and the drinks are on you!

It is easy to stereotype scientists in the way that I have described above, or indeed as wild haired genius’s, but the reality must surely be more balanced.  Scientists come in all flavours which means that they can hold differing philosophies and have conflicting religious beliefs, enabling them to tackle problems from alternative points of view – which can only have a positive effect on the process of scientific endeavour.

Stage 2 – Enquiry/ Discovery

Much of this has been covered above, although not all scientific enquiry can result in the revision of commonly held thought.  Most of it is likely to be relatively mundane and most of it is also likely to be unsuccessful – in that results will be negative.  Nevertheless, it is at this stage that individuals and groups can really let their creativity and imagination go wild and this is where the maverick has a chance to shine.  It is worthy of note that the three theories that I cite above, most likely started life as ‘wacky’ ideas that were rejected by much the scientific community.  The majority of fringe hypotheses and unconventional theories are likely to fail, but their exploration should still be encouraged.  It is from here that the next major advancement is likely to come.

Level – b:

It is this level that I believe is the most visible, and it is these stages that many people seem to regard as ‘science’.  Again, Michael Brooks argues that many scientists want it to stay that way.

Stage 3 – Established Theories

This stage really represents the current scientific thought of any given time.  It is this thought that is often presented, in schools, the media and elsewhere, as unquestionable fact (which is actually stage 5).  In the scientific sense this is where the facts are, but this word causes problems and is misused by scientists as well as non-scientists.  The word ‘fact’ in this context should always be accompanied by a ‘with our current understanding’, which in most cases it (sometimes silently) is – even if it is only lip service, paid by a seemingly dogmatic individual.

That there can never be any fact that is 100% validated is a reality that is often exploited by those that wish to challenge current scientific thinking, and this can have serious consequences.  Climate change is a good example.  When ever a scientist makes a prediction, there is always an element of doubt, and sometimes these predictions prove to be wrong or inaccurate.  From a scientific point of view this is fine, but this inherent uncertainty enables those that have conflicting agendas to exaggerate the margin of error to devastating effect.  The same tactics are also employed in the creation/ evolution debate.

While it seems to me that stages 2 & 3 must directly inform each other (in a kind of feedback loop), it is important that they remain separate in terms of advancement to level 4.  Challenges to any scientific theory should be encouraged, but those challenges that determine or alter the application of science, without the appropriate evidence must be treated with caution.

Stage 4 – Application

This is where established theory is employed for practical purposes.  Our whole society can seem like it is the result of stage 4.  There are bridges, aeroplanes, computers, electricity, medicines, films, recorded music – the list is endless.  For many, this is science; putting a man on the moon and microchips – but this is only the result of a long, and (despite my simplification) complex process.  Many people expect science to be useful, and it often is, but that is missing the point.  Science should come from a curiosity of the universe that we live in.  Many theories never have a practical application, or at least don’t during the lifetimes of those that discover them, and that is fine.

Stage 4, although often the accumulation of the stages that precede, is no more important and a scientific journey should not always be expected to arrive at this destination – even though it can obviously be worth it when it does.  Additionally, It should be noted that not every application of scientific discovery is always desirable!

Level – c:

Although this level can never be reached, claims are sometimes made, or misunderstood to have been made that would fit here, and for some this is where science already resides.  This level can often be confused with, or thought to be a part of, level – b.

Stage 5 – Absolute/ Unquestionable Claims

Stage 5 represents the logical conclusion of any scientific exercise, which is to fully understand the universe, even though this aim is unachievable.  While it is regarded as an unattainable ideal, of which the journey towards is worthy in itself, it can be useful as a point of focus.  Nonetheless, it can be problematic, especially where it is claimed that a final and unquestionable truth exists.  I would suggest that in many cases, where it appears there is a claim that would be at home in stage 5, there has actually been a misunderstanding that has resulted from the language used to describe claims in stage 3.  The speed of light is a good example of this.

One can often hear scientists saying that it is impossible for anything in the universe to exceed the speed of light, and this sounds very much like an absolute claim.  At school it is taught as such and the media treat it as such, they are mistakenly presenting it as a stage 5 claim.  However, when a scientist makes this claim there is, in most cases, the additional ‘given our current understanding’ and ‘if you are suggesting otherwise then show me the evidence’, the problem is that these are usually presumed, and therefore unspoken statements.

As human beings, there are undoubtedly individual scientists that believe that some of the claims of science have reached stage 5, but as long as science in general does not then I do not see this as much of an issue.  Some scientists also believe in God while others don’t – which similarly does not cause me concern.

From the perspective of the Middle Way I think that it is important to view science as a whole, which along with the arts and philosophy forms part of an even greater whole.  I think that when one places too much focus on any individual stage then misunderstanding will arise and science will suffer.  The only stage that I am unsure of is number 5, for me it is fine as a motivating but unobtainable goal, but I suspect that others might differ in this.

Level – c (stage 5) aside, the current trend of focusing mainly on level – b should be disregarded, and I would like to see levels a and b combined, which a Middle Way perspective should achieve with little effort.  Of course for the early stages to be better understood they need to be much more visible, and this will ultimately come down to the efforts of the education system, the media and the scientists themselves.

This is clearly a simplified model.  In reality there is much overlap between the stages and the order is not set in stone – as I mentioned above there is an obvious feedback loop in effect between levels 2 and 3.  I have also negated to mention the ethics of science, which is already an ongoing debate.  Some seem to believe that ethics only exist in the application of science, but I would suggest that the reality is much more complex.  Ethical considerations, in varying forms (owing to stage 1), seem likely to exist and to play an active role at every stage of the process – perhaps this is something that the Middle Way Society can explore in greater detail at a later time.

There are bound to be errors here, both in my understanding of science and my application of the Middle Way to it , and I accept that I may have missed my target.  As yet I have not discussed or shown these ideas to anybody but I hope that, if they are not as complete as they seem to me at the time of writing, they might still form part of a wider discussion about how the Middle Way Society might approach science and scientific issues in the future.

The Third Phase

The universe – and our brains – are complex. Western civilisation has passed through differing phases in its treatment of that complexity, but it seems from all the signs that we are on the verge of a new one. In my view that change is potentially Copernican – a major upheaval in our world-view equivalent to realising that the universe does not revolve around us.

In the medieval era, complexity was ignored because of the over-simplifications of the ‘enchanted world’ and its unresolved archetypes. We mistook projections of our psychological functions for ‘real’ supernatural beings. A supernatural world provided a causal explanation for the world around us that prevented us from needing to engage with its complexity. The medieval era was gradually succeeded by the era of mechanistic science, in which linear causal mechanisms took the place of supernatural ones. Although we began to get to grips with the processes in ourselves and the universe, this was at the price of over-estimating our understanding of them, because we were using a naturalistic framework according to which, in principle, all events could be fully explained.Clouds

We are now gradually moving beyond this into a third phase of intellectual development. In this third phase, we not only develop models to represent the universe, but we also recognise and adapt to the limitations of these models. We take into account not only what we know, but what we don’t know. The signs of this third phase have been appearing in many different areas of intellectual endeavour.

  • In mathematics and allied areas of science, there has been complexity theory and systems theory, which try to take into account the complexity of systems and the unpredictable ways in which complex systems operate, whether those systems involve the human brain, society, or global climate.
  • In psychology, cognitive bias theory has increasingly mapped the kinds of errors that lead us to think we know things that we do not. We now recognise increasingly why we are so inclined to over-estimate our own knowledge.
  • In cognitive science, linguistics and philosophy, embodied mind theory has revealed how much meaning, the building blocks of belief, is formed not by representations of the world, but by a bodily process that prevents us assembling direct representations of the universe.
  • Nassim Nicholas Taleb has charted how much our estimates of ‘probability’ simply do not take into account the limitations of the experience on which these estimates are based, so that we remain unprepared for ‘black swans’.
  • Iain McGilchrist, drawing again on the cognitive science of the brain, has charted the extent to which the representations of the left hemisphere of the brain can be built up in isolation from the right, giving us a deluded sense of having the whole picture.

These different types of recent work converge in telling us that we need to recognise the complexity and unpredictability of the complex systems we depend on – whether these are physical, chemical, biological, psychological, or social. Once we recognise how little we can actually predict the world, we have a reason to curb the arrogance of scientific naturalism and see it as an over-interpretation of the changing and fallible information we can gain by applying scientific method. The third phase of intellectual development is one that, at last, takes seriously the scepticism offered by Greek Pyrrhonians and Buddhists thousands of years ago. It does not abandon scientific theory or underrate its value, but offers more precise insights into its limitations.

The third phase has a dialectical relationship with the previous two. The thesis (the supernatural) conflicts with the antithesis (the natural). It is only by recognising the ways in which both of these address conditions that the other does not address that we can develop the synthesis, the Middle Way. The Middle Way, like the supernatural, recognises the limitations of our representations of the world, but like the natural, it also recognises the value of theory supported by experience in positively supporting those theories.

I think another aspect of the third phase must also engage with ethics in a way that none of the sources mentioned above do as yet. The first (supernatural) phase subordinated facts to values, so that we lived in a wholly moral world, whilst the second (natural) phase subordinated values to facts, so that ethics became relativised. The third phase needs to involve a recognition that facts and values are in practice interdependent, and that our ignorance of values is no worse than our ignorance of facts.

I do not want to try to predict the future. This nascent development of the third phase could still fizzle out and come to nothing. But the indications do offer some grounds for confidence that a third way of thinking is taking root. There will always be those who seem incapable of thinking beyond the terms of the first and second phases, or try to appropriate the third phase into one of the earlier ones. But their arguments may become increasingly irrelevant when the advantages of the third phase become better known and articulated.

The judgements we make under the influence of third phase thinking are different from those of the second phase because they can start to avoid the same arrogant disregard of uncertainty. They may at least help us cease making the same mistakes about the environment, about social intervention, about economic conditions or about our personal happiness. Fundamentally judgement in the third phase becomes a matter of balancing belief against ignorance, rather than merely an application of what is supposedly known.  No doubt the third phase may in turn be superseded, but it will nevertheless be an advance on what went before.