History Matters October 27, 2023
Western Historical Foundations of Medical Science part II: paradigm shifts are phenomenological
Scientific Positivism
Auguste Comte (1798 - 1857) gives us “scientific positivism” which only a few may know as a philosophical concept but almost everyone will recognize as familiar because it still forms the bulk of mainstream American cultural ideas about science— though most experts in all fields of knowledge have rejected “positivism” for almost 100 years! Scientific positivism is the idea that by the use of reason and logic alone from sensory experience, we acquire knowledge; and this scientific knowledge is fairly linear and progressive, no metaphysical shadowed existence or layers of multiplicity. Scientific positivism may have some seeds from Plato who described the conflict between philosophy and poetry, or Aristotle who found poetry as having “no useful function”.
Combined with American characteristics of individualism and exceptionalism, the lone in-dividual American may believe, now using the internet and programs like Chat GPT, that they can be as good as any expert if they want to be. Facts and “scientific truth” are found in math, physics, chemistry, biology, and in a more complicated way, astronomy and sociol-ogy. This progressive ordering of knowledge from reason and technology creates a kind of “religion of humanity” in which metaphysics and other ways of knowing such as theology, intuition, and introspection are not wrong, they are just meaningless conversation because they can not be proven scientifically. If Aristotle was a seed, the Enlightenment was the soil for Comte’s positivism of science.
To repeat, this “positivist” view of scientific knowledge, including medical knowledge, has taken a scholarly beating the past century, and almost all experts in various fields of knowledge find this view reductionistic, unrealistic (idealistic), and frankly arrogant be-cause it is unaware or dismisses the prominent role of bias and phenomenon.
Paradigm Shift and Bias
Thomas Kuhn is an American philosopher who is perhaps best known from his 1962 book “The Structure of Scientific Revolution” when he introduced popularly the idea of “paradigm shift”. One can think of “paradigm shifts” as proving that scientific “ways” of thinking have “structural bias.” You cannot make rational assumptions independent of pre-existing theo-ries and those theories are shaped by frameworks that are always incomplete if not com-pletely inaccurate.
These paradigm shifts are hardly every the caboose of a long train of rational thought, but are often if not usually phenomenological. Phenomenological is simply a fancy term for “we don’t really understand how it happened”. Perhaps we use words like “accident”, “random
variation”, “chance” or even “divine intervention.” because in giving a name to uncertainty that makes no rational sense, it brings us some control, and with control, a modicum of safety against what we do not know. Whether the discovery of bacteria as “animalicules” under a lens, the discovery of penicillin from a dirty lab from holiday as the first of antibiot-ics, and how it was mass produced from a rotten melon a scientist found at the market, or the discovery of the helical structure of DNA from a dream, or the discovery of vaccination from an illiterate slave, or even the discovery of the endothelium, the largest and most im-portant organ in the body, just 40 years ago by a mishap in the lab— paradigm shifts ap-pear to be more divine oracle than measured beaker.
Regardless, the acceptance that “scientific methods” and “ways of knowing medical sci-ence” are paralyzed inside partial views of “science” that are frozen in historical epochs that cannot see outside of themselves, until a cataclysmic and often phenomenal shift takes place in viewing the world. Kuhn convinces us that bias is undesired, but inevitable. The whole reason the modern scientific method exists is to minimize bias, but when we under-stand the fragility of a paradigm, the bias is never minimal, but appears as a giant we never saw. To think that we contemporary folk have progressed beyond such mistakes unlike our prior historical predecessors requires a historical blindness that no real scientist would ac-cept as anything but hubris, if not outright stupidity. Einstein said, “Science without episte-mology is in so far that it is thinkable at all— primitive and muddled.”
Construct Theory & Bias
The next popular iconoclast to a positivist view of medical science, is Daniel Kahneman, the Nobel Prize winner, who published his book, Thinking, Fast and Slow. Kahneman presents something called “construct theory”. What Kuhn does to scientific epistemology and smash-ing its presumed rational progressive structure, Daniel Kahneman does to the individual human brain and decimates the idea by using scientific experiments that we are predomi-nantly rational creatures. We do not think rationally the way that we think we do. The indi-vidual brain is surprisingly irrational, and by using its logic as a mask for the actual face of emotion, there is no way for the scientific observer to be impartial. Bias, explicit and im-plicit, is the infection in every society, and in fact in every individual thought that prevents “science” as we think of it today from ever being healthy. This is not relativism. There is a working body of good functioning medical knowledge; it is just not as good, true, and beau-tiful as it believes it is. Bias is the sin of science. We are far from free of it. In fact, COVID-19 if it proved nothing else, is the birth of a new paradigm (actually a re-birth of an old one) we are entering where “every person is there own doctor” “common opinion is as good as any scientific expert” and bias is not an accepted reality in most discussions.
The Interior Way of Humility in Truth
The Enlightenment not only brought about the hypertrophy of reason without the full awareness of bias, it also turned science and theology and philosophy and all of life into
math. Everything ultimately had an answer that was either right or wrong. We are still sub-ject to this binary way of thinking. The either-or simplicity is certainly more efficient for the brain’s metabolism. But just because it is efficient and practical, and even self-preserv-ing and satisfying, makes it no more true. The individual brain does not perform well at facts. Material measurements however objective they may appear are still measured by a human hand and the person that made the instrument. Empiricism as a system towards all truth is dead wrong. But neither does this leave us with relativism, in which there are no truths, and maybe no substantial obdurate facts.
There are always more than two choices. And contrary to our more efficient and pragmatic grading methods, there is hardly ever “one best answer” because everything is subject to context which is complicated. So medical science today lives in a changing but identifiable geography between “if we don’t have the objective facts to prove it, then it is not worth the energy to consider and discuss it” and “you can prove anything you want with statistics and the experts keep changing their minds.” In the interior between these two diametric poles of scientific positivism and philosophical relativism is the humility of truth that accepts the nuances of paradigm and construct theory. This is I think summed up best by Einstein who said, “There are two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” I might add that you can end up living your life in one way that allows for both.