THE NATURAL SCIENTIFIC
METHOD IN THE CONTEMPORARY MEDICINE
Renato COCCHI, a neurologist and a medical
psychologist.
Summary.
In the contemporary medicine, both
official and alternative, the natural scientific method has still its room and
its specificity. Since it grounds on the result, the clinic, the epidemiology,
the rehabilitation therapies, new medical or surgical treatments, which do not
have any comparison possibility, they are all fields where it becomes the only
suitable.
The possibility of quantitative treatment
of data, when well picked up, allows application of the plain statistic, and
comparisons validated with statistical tests.
This is even a common base that may allow
the dialogue between the official allopathic medicine and the alternative
medicine.
Key words: Natural scientific method,allopathic medicine,alternative
medicine,data,quantitative treatment.
Home Page
/ / / Pagina
iniziale
Introduction: The
discovery of the SARS.
Dr. Carlo Urbani, the Italian physician who
first individuated the SARS, was called as expert of infectious illnesses of
the WHO, section of Hanoi, from the French hospital of that city. He confirmed
the suspect that the colleagues of that hospital had, to be facing to a
different illness from the usual, done by an avian para-influenza virus. He did
arrange at once a series of emergency measures.
" Dr. Urbani's temperament and
intuition and the strong trust he had built with Vietnamese authorities were
critical at this juncture." (1). Unfortunately, within fewer weeks, Dr.
Urbani and other five persons of the assistance and care staff of this little
private hospital died because of the SARS.
According to Emanuel (2), the experience of
the SARS has taught us at least four lessons.
"First, by providing a test of the
capacity of each part of the public health system, from national to local and
hospital responses, it has better prepared the world for the anticipated and
much-feared next real pandemic.
Second, SARS has reemphasized that from
housing, sexual practices, and slaughtering techniques to health care capacity,
the situation in other, especially developing, countries affects us. Global
cooperation is necessary not only for justice but to ensure our own health.
Third, despite trends toward commercialization,
easier lives, and self-centered individualism, the response of health care
professionals to SARS reaffirmed dedication to caring for the sick even at
great personal risks as the core ethical principle of medicine.
Finally, SARS also emphasized the importance
of the duty of health care administrators and senior physicians to rapidly
institute procedures to maximize the safety of frontline physicians and
nurses."
Over these "four lasting lessons "
there is at least a fifth one that had scarce relevance. The discovery of the
SARS did not follow the use of the experimental scientific method, which many
physicians believe as a synonym of "the scientific method"(3).
If about Dr. Urbani intuition has been
mentioned (in old time medicine it was termed "the clinical eye")(3)
nothing is said about the health staff of the French hospital of Hanoi. They
first had the suspect to have facing something of different and they called for
help to the section of Hanoi of the WHO. Their suspect arose because "a
patient had presented with an unusual influenza-like virus." (1).
Intuition and suspects may be suitable
premises to formulate hypotheses and to apply the experimental scientific
method, but they are not only this. By themselves, they can drive to remarkable
scientific acquisitions even without any experiment. The discovery of the SARS
is not an isolate case. I do not believe that when raged the epidemic, someone
had even only the idea to apply directly, to the affected patients, control
groups, cross-over, double blind and all the fine procedures as typical of the
experimental scientific method. In spite of that, they went on. Perhaps it will
be well to try to understand the reason of this course.
It may be interesting look for understanding
which mental operation dr. Urbani has done, an operation in the field of
not-rationality, otherwise said intuition.
The comparison between the syndrome
para-influenza of the actual case and all what he had sedimented in some
(visual?) memory as for these syndromes led to an intuitive clinical judgment
of disparity. Now something of different happened.
Then, in him, the rationality had at once
taken back the upper hand. "For the next several days, he chose to work at
the hospital, documenting findings, arranging for samples to be sent for
testing, and reinforcing infection control." (1).
The Dr. Urbani's intuitive ability was an
exclusive feature of him? Or this was and is common, even if in a different
degree, of all the physicians that do the clinical way? If we answer positively
to the second question, we are already in presence of something that we
continuously use. Nevertheless that, by itself, has only a share with the
experimental scientific method.
We may say at once that is the matter of the
natural scientific method "which was the exclusive base of the astronomy,
till the throwing of the first artificial satellite" (3).
Of course this is the modern name for
pointing out an ancient practice. The Babylonian astronomers were already able
to foresee the eclipses, for which, beyond the sky observation by the naked eye
with an astrolabe, they already applied mathematical calculations.
The natural scientific
method in medicine.
"The scientific method has four steps,
1. Observation and description of a
phenomenon or group of phenomena.
2. Formulation of an hypothesis to explain
the phenomena. In physics, the hypothesis often takes the form of a causal
mechanism or a mathematical relation.
3. Use of the hypothesis to predict the
existence of other phenomena, or to predict quantitatively the results of new
observations.
4. Performance of experimental tests of the
predictions by several independent experimenters and properly performed
experiments".(4)
The first three steps form the natural
scientific method. The addition of the fourth step gives the rise of the
experimental scientific method. Therefore, if anyone believes that it exists
scientific medicine only since it has publicly got the "experimental
scientific method" - and for convenience of reference, since 1865, after the
printing of the book of Claude Bernard (5) - he would do an affirmation much
unwisely. It would be equivalent to say that from the Corpus Hyppocraticum
(V-II BC century) to the 1864, to limit ourselves to the medicine running in
that part of the world that is call as the western one, there was not any
scientific acquisition in medicine.
I have already mentioned that the clinic, as
the diagnosis of the single case, does not pertain to the experimental
medicine, even if it was surely substantiated by it. Besides the clinic, the
epidemiology too does not take part of it. Epidemiology is the sum of single
cases concerning a population, even when it not succeeds to reach with safety
the incidence level but simply that of the prevalence referred to the investigated
sample.
On a short stop, I shall remember that the
exit polls, for the forecast of electoral results, are a prevalence evaluation.
They have their base on a limited population, but selected with the best
criterion for representing the general population. Still a time, nothing to do
with the experimental scientific method.
Till the end of the '70 in USA there was an
absolute official refusal to accept the acupuncture as a scientific medical
practice. So, although this one had over 3000 years of history and a doctrinal
corpus much well established. They believed it as a singular placebo.
Only by the "sham acupuncture"
(done by false points, outside the traditional points of the Chinese meridians)
in subject used as controls, it has found that the acupuncture was and is an
effective therapeutic technique. Its officially validation with the
experimental scientific method did not absolutely change it for the better.
It worked already first and since a great
deal of time, though its traditional theoretical explanation is still much
debatable. However a thing is the result ( It works - it does not work) already
computable (1 or 0), an other one
is the related theoretical explanation ( It
works because . . . ). This last depends on the knowledge level and of the
world vision of historical time when it had it. An other thing still, finally,
is its communication to other people, mainly to the medical colleagues.
In medicine something can work, and well
too, even without that there is an explanation of because it does it. Since
over one hundred years the acetyl-salicylicilate works, and it is only since
about 20 years that we discovered at least one cause (It stimulates the
prostaglandins).
Beyond the medicine, ours ancient
progenitors reached several very scientific results (EG. selection and
cultivation of the food plants; domestication of the animals) about 8500 years
BC, in the area of the Fertile Crescent and in the Mediterranean coasts (6).
The experimental scientific method, published by Galileus in 1632, was still
far. On the other hand, the discovery of the Jove's satellites, made by the
same Galileus, did not surely happen by using the Experimental Scientific
Method. The Jove's satellites are still there, and their discovery was a truly
scientific result.
To return to the medicine, great
pharmaceutical firms finance explorations to tribes with poor or any contacts
with our civilization, to know from the local medicine-men which are the
curative plants used and for which troubles. They not only look for saving time
and money in the research, which so will be already directed for taking the
active substances out (7).
They give for asserting that we may have
medical scientific knowledge discovered outside the experimental scientific
method.
The natural scientific method has in its
grounds the mental mechanism of the induction. This has for assumption that if
something is true in many observed situations, the same should be true in
similar situations, even if not still observed.
We may start from here and employ statistic
procedures, even significance tests, usually not parametric ones, to widen or
to define better a series of our preceding ideas. Now we know that the
statistic methods are not something of opposite to an analysis based on the
study of the cases. These two approaches are complementary, since they
integrate each other.
Our brain has abilities to reach new
knowledge by accumulation and comparing, using the neuronal mechanisms of the
similarity (8) and of the opposition (9), memorizing then the result. It has
done it and it does it in many fields,
inclusive that of medicine.
In medicine, which is even a profession, the
tendency to attribute to himself results that can be transformed into success
and wealth was never an unlikely event.
During the famous epidemic the Black Death,
in the years 1348-1351, no remedy allowed. So because its cause was unknown,
and the galenic theory of the four humours and of the corruption of the air (
the "pestiferous blow") did not help to understand the origin and to
address to some efficient therapy. Nevertheless, there were persons claiming
not existing merits.
Dionisio Colle, a Bellunese physician,
recommended the use of fragrant essences to purify the air as a prophylactic
remedy. He wrote that he was "able to maintain many in life and preserve
them from the Black Death" (10).
It was worse to an other braggart, a certain
Andrea from Padua, surgeon, who affirmed that he has recovered more of one
hundred sicks from the plague. The Medical College of Venice fined him by
thinking that such patients recovered by chance and not following his art (10).
One risk of the natural scientific method in
medicine was clearly pointed out by the Medical College of Venice. Among the
positive results following a treatment we need to separate the caused results,
from the casual results. Not always the post hoc is surely propter hoc, which
is to say: not always a relationship of temporal dependence is even a
relationship of cause and effect.
Today we became still more cautious. Among
the casually positive results we need to separate those due to the placebo
effect from those independents also from it, for higher individual resistance
(different "individual substratum"). The first one is a variable that
can be nullified by the experimental scientific method, while for the second we
are still on the high seas (3). Allen Roses, a geneticist (ll-13) proposed to
establish the genome of all people who must take a drug therapy. So, since the
fact that 90% of drugs seem to work only in 30-50% of patients because of
individual differences. This proposal seems of difficult realization in a short
time.
If however we can set up an experiment, do
not do it would be a fundamental error which can drive to a wrong theory following
hypotheses derived from observations.
These are the limits of the natural
scientific method in medicine - and I should have forgotten some - but it has
even an unusual merit.
The natural scientific method founds first
on the observation and on the study of the single patient. The relationship
between the physician and the patient is more complex, being the patient
considered in his oneness. Different is the point of view. He is a person with
an illness, and not an illness - as the prominent element -, in a person. It
seems a word game, but protocols, or guidelines of therapy are features of the
second point of view.
Excluding the acupuncture, about which I
have said over, all the so-called alternative medicine does strongly claim this
better physician-patient relationship. Evidently, it is a characteristic much
appreciated by the same patients, if we consider the success the alternative
medicine is having.
As a little superficial explanation, we can
assert that in the alternative medicine the physician works, in part, like a
placebo.
I already wrote that the clinic and the
epidemiology are fields of normal application of the natural scientific method.
It is in use too in the field of rare
illnesses, which can be collected and described case by case and grouped for
comparing the cases. Each of them was described often from a physician who has
seen only his case. It is the only method that fit in the rehabilitation. In
the psychotherapy, if we agree that it has to anything to do with the medicine,
the natural scientific method is the only one that could serve. In new medical
or surgical procedures that do not have any alternatives, we can use only this
method to valuate the results.
This is even the only one that may be
applied for the scientific research (if it was of interest) during private
activity. To enroll paying patients in a control group treated with a placebo
would be absolutely not proposable.
The data collection and
the communication.
To pick up of the data, it needs that we
want to do it, and to know which are the data to pick up. We must do this last
not only in a current perspective, but possibly, even in a future one.
It is easy to pick up gender, age,
geographical origin, presumptive or established diagnosis, established therapy,
outcome. This is not only to do for good result cases, but for all. Except the
established therapy, and the result, all the other data are fixed. But the
therapy can be collected quantitatively as daily average dosing, standard
deviation and range. The variability of the result can have rating with a
Guttman's scale with four-five steps, from "null" to "full
positive," or similar.
These data are all tractable quantitatively,
and they can give us much of the information, even if not derived from the
experimental scientific method. They can inductively drive to theories, or at
least to work hypotheses, to be verified with experiments, when possible.
It is a least data collection, which does
not differ both in the official allopathic medicine and in the alternative medicine.
What varies is the fact that this picking up has indeed done. If for the
hospital this is always true, and it
does part of the institutional routine, in the public medicine, mainly among
general practitioners is already less diffused. In the allopathic private
practice or in alternative, now this is an exception.
If one does it, it may be different the
collection of symptoms not still well classified. They, in future perspective,
could have precise relationship with the illness (in allopathic medicine), or
with the singleness of the patient (in alternative medicine).
More of 28 years ago, I observed that
certain depressed children had the tendency to play with more little mates. I
picked up initially the symptom in its context, then I described several cases
of it and I tried a psychodynamics explanation. With a colleague, we first
published it (14).
In the hospital, nurses every day measure
both the blood tension and the cardiac frequency of the patient. The two
medicines could appraise these symptoms. Their explanation could be different
according to the point of view. For the allopathic medicine the illness varies
both the blood tension and the cardiac frequency. For the alternative medicine,
patients vary these two parameters according to a personal answer to the
illness.
At the beginning, however, for both, there
is a value related to a mercury short column, and a pulsating frequency in the
time of a minute.
If then both the medicines wanted to pick up
even qualitative data, concerning only emotional, psychological-relational and
social aspects (15-16) nothing forbids it. Nevertheless, the bridge of the
natural scientific method is well wider, much more tested and much more
informative and scientific, even if with his limits. Above all, it is immediately
comprehensible by both sides.
The pretension of using the blind double
even in alternative medicine as the minimum "scientific" requisite
(17), is a coarse conceptual error for the official medicine. It is like to
force a person without a leg to run the 100 metres, but it is also a useless
complaint of the alternative medicine.
Within the voluntary medical communication
for colleagues, beyond the choice to communicate, we need also that the
statement data are comprehensible by the receivers and potentially verifiable.
In this, the official medicine has a well
longer and diffused practice. If it wants it, the alternative medicine won't
have any difficulty to lead in the conditions to do the same, with the limits
already said. The necessity exists, because often there are patients that turn
alternatively to the one and to the other.
Conclusions.
In the contemporary medicine, either
allopathic and alternative, the natural scientific method has still his place
and specificity.
Since it founds on the result, the clinic,
the epidemiology. the rehabilitation, innovative medical or surgical
treatments, which do not have any possibility of comparing, are all fields
where it has exclusive pertinence,
The possibility of quantitative treatment of
the data, if well picked, allows day applications of the plain statistic and of
tests, usually not parametric ones.
This is even a common base that should
favour the dialogue between allopathic medicine and alternative medicine.
References.
1) Reilley B. Van Herp M. Sermand D, Dentice
N. SARS and Carlo Urbani. N Engl J Med. 2003, 348: 1951-1952.
2) Emanuel EJ. The Lessons of SARS. Ann
Intern Med. 2003, 139: 589-91.
3) Cocchi R. Occorrerà recuperare la nozione
clnica di "terreno individuale"? Lo Spallanzani 2003, 17: 19-22.
(English text: <www.stress-cocchi.net/Speculation4.htm>
4) AA.VV. Introduction to the Scientific
Method and Astronomy. University of Rochcster. Rochester N.Y
1996.www.teacher.nsrl.rochester.edu/phy_labs/ AppendixE/AppendixE.html.
5) Bernard C, Introduction à ì'étude de la
médecine expérimentale. J.B. Baillière et Fils. Paris 1865,
6) Diamond G. Guns, germs and steel. The
fates of human societies. W. W. Norton and Co., New York 1997.
7) Maxwell N. Witch doctors apprentice: Hunting
for medicinal planis in the Amazonia. (3rd Edit.) Citadel Press 1990.
8) Cocchi R. Meccanismi "logici"
nella acquisizione del linguaggio verbale: Una ipolesi esplicativa
neurofisiologica degli ipercorreltismi. Riv Neurobiol. 1982, 28: 162-90.
(English text: <www.reversebrain.net/domin10.htm>.
9) Cocchi R. Dominanza emisferica imperfetta
e comportamenti cognitivi: Considerazioni speculative. Riv Ital Disturbo
Intellet. 1994, 7: 55-61. (English text:
<www.reversebrain.net/domin1.htm>.
10) Bergdolt K. Der Schwarze Tod in Europa.
Di Grosse Pest und das Ende des Mittelalters. C.H.Beck'sche
Verlagsbuchhandlung, Muenchen 1994.
11) Roses AD. Pharmacogenetics and ihe
praciice of medicine. Nature 2000; 405: 857-65.
12) Roses A. Pharmacogenetics: Personalised
SafeSy and Segmenied Efficacy. Summary of thè lecture given by Dr Allen Roses
on 31 March 2003, on the occasion of the launch of ihe Academy Forum,
www.acmedsci.ac.uk/forum_roses.htm
13) BBC News. Drugs "don't work in many
people" 2003 http://news.bbc.co.uk/go/pr/fr/-/l/hi/health/3299945.stm
14) Cocchi R. Fava E. Su un particolare
sintomo di depressione infantile: la scelta prevalerne o esclusiva di compagni
di gioco di età inferiore. Neuropsichiat InfanL 1976, 177-178:301-308.
15) Strauss A, Corbin J. Basics of
qualitative research. Technique and procedures for developing grounded theory.
1990 Sage Publications, Thousandu Oaks, California. Usa.
16) Giacomini MK, Cook DJ. Users' guides to
the medicai literature: XXlII. Qualitative research in health care A. Are the
results of the study valid? Evidence-Based Medicine Working Group. JAMA. 2000,
284: 357-362.
17) Coulter HL. Divided Legacy. A History of
the Schism in Medical Thought. {4 volumes). Berkeley, North Atlantic 1975-1994.
First printed in Italian on Lo Spallanzani 2004, 18: 31-36.
Posted on internet on 11 September 2004. Copyright by Renato
Cocchi,2004.
Author's address: Dr. Renato Cocchi, Via Rabbeno, 3
42100 Reggio Emilia
e-mail: renaiococchi@libero.it
Home Page / / / Pagina iniziale