By Dr David Laing Dawson
Are these just competing yet equally valid ways of understanding our world and our selves, our health and our illnesses, treatments and cures?
There are two moments of clarity in my education that stand out in my mind. The first occurred during, I think, my second year of medical school. The second during a last year of residency training. I will talk about the second moment first because it reveals something very fundamental about science, perhaps the most important characteristic of a scientific way of thinking about things.
A wise colleague, a born teacher and storyteller, a scholar who always conversed in thoughtful sentences and paragraphs, told a story about a German physician who lived in a small village hundreds of years ago. This historic physician had, according to my teacher, the first recorded scientific thought in Western Medicine. Now, I have no way of knowing if this is true or not, and in what year it happened, and so because of the very nature of this discussion, I will present this story as apocryphal.
The story is that in this man’s village there was a girl who lived but did not eat. To live and yet not eat is clearly a miracle. The mother told the priest, the priest told the bishop, and soon people came from far and wide to behold the miracle of the girl who lived but did not eat. The village doctor asked himself this question: “How do we know she does not eat?”
He invited himself into this family’s home to observe for 24, perhaps it was 48 hours. And what he observed, of course, was the young woman, though not eating during the day, would come down to the pantry to eat after midnight.
This is the question we need to put to every bit of quackery, miracle cure, exotic treatment, cherished belief, and story told to us. “How do we know this to be true?” “How do we know this wheatgrass diet cures cancer?” “How to we know that house is haunted.” “How do we know that insanity increases when the moon is full?”
Sometimes it is easy to answer that question and sometimes not so easy, especially when money and prestige are at stake. But it is the important question. “How do we know pulling the goalie in the last two minutes of a hockey game helps more often than it hurts.” Curiously, even here with an abundance of statistics to support pulling the goalie early in a tie game, coaches remain reluctant. Whatever we are being told – how do we know it to be true?
The first moment occurred in Medical School. The professor of psychiatry was giving a lecture to the class of 60. Only ten minutes into his lecture one of the yahoos in the class, to the amusement of his buddies, challenged the professor of psychiatry. “Sir,” he inquired, “Psychiatry is not really scientific, is it?” They bantered a bit, the student grinning at his friends, the professor developing his own wry smile. Then the professor said, “Perhaps Mr. Jones would like to explain to the class the nature and philosophy of science?” Of course Mr. Jones could not do this. Whereupon the professor closed his lecture notes and proceeded to deliver an hour talk on science, the history of science, the philosophy of science, the methods and methodologies of science. And I realized, at that moment, that though I had studied chemistry, physics, biology, and physiology at advanced levels, no one had ever explained actual science to me. What it is.
And from this I must assume that few others have ever attended such a lecture, and that it must be a very small segment of the population that actually understands the fundamental ideas of a scientific way of thinking. Which are, if put very succinctly:
Observe (a phenomenon, a claim)
Hypothesize (an explanation, a cause, a mechanism, a likely result)
Test (design an experiment to test this hypothesis)
There are caveats to this of course. Observation should be as objective as possible, while understanding objectivity is not a common human trait. One should formulate one’s hypothesis based on current scientific knowledge of the universe and leave any leaps past this to the Einsteins and Hawkings in our midst. Testing can range from mind experiments (based on current scientific knowledge of how things work), observation of outcome, to particle accelerators to double-blind large population outcome studies. And repeat (replication) to rule out compounding variables and observer bias.
For example, the claim that a diet of raw carrots, wheat grass and a positive attitude cures leukemia is contrary to all we know to date scientifically about leukemia; a hypothesis of how it would work requires new laws of physiology and cell growth, and testing such a hypothesis would require a (probably unethical) large comparison study of three populations: no treatment vs. current medical treatment vs. a wheatgrass diet.
On the other hand, those placebos you are taking to ward off colds and flu viruses are probably doing no harm.