The mythology of modern medicine--II. Cocoon of causalism.MV Kothari, LA Mehta
Dept of Anatomy, Seth GS Medical College, Bombay, Maharashtra.
Keywords: Animal, Causality, Clinical Medicine, Human, Mythology, Philosophy, Medical,
For pretty long, Modern Medicine (MM) has spun round itself a cocoon of causalism, the nature and the basis of which are best summed up by the adage post hoc ergo propter hoc -after this, therefore, because of this. Eat fat and occlude your coronaries , make love and give cancer cervix, or, have a prepuce to prepare for penile cancer. And so on, and so forth. The foregoing filaments of the causalistic cocoon may be good ploys to hide medical ignorance from an inquiring patient or public, but such facile assumptions have spelled or MM, intellectual bankruptcy, endless prescriptions and worse, proscriptions, and spawned experimental slaughter of innocent animals on an astronomical scale. MM, isn't it time to cure your body politique of the curse of causalism!
Before we spell out that MM's causalism is MM's confusion, a word or two on the why of its unending chronicity. Altruism and philanthropism aside, a medical person - of whichsoever -pathy - can be comprehensively defined as one who is convinced that he is wiser than the patient's body. Such an individual also gets primed with a loftly litany - Prevention is better than cure. (in MM, so much is talked about prevention, for there is precious little to talk of any cure). So the MM man sets out to prevent a disease by forestalling the cause from conquering the patient, or, to cure the disease by attacking the cause resident in the patient's body. As of today, the whole cause-hunt has been truly like asking a blind man to go into a dark room to find a black hat, which is not there.
Circa A.D. 1918, Bertrand Russell wrote an essay titled "On the notion of a cause" in which he declared in his inimitable style: "All philosophers, of every school, imagine that causation is one of the fundamental axioms of science, yet oddly enough, in advanced science such as gravitational astronomy, the word 'cause' never occurs….. The Law of Causality, I believe, like much that passes among philosophers is a relic of a bygone age, surviving like the monarchy, only because it is erroneously supposed to do no harm." The fact that causalism has survived, nay thrived, in MM betrays three possibilities: either MM is no science, or is not advanced, or is neither. Medical philosophers of the level of Smithers and Bufflet had to generalise that MM singularly lacks in biological scholarship. It is an arena of enormous affirmative action unbacked by any conceptual clarity.
Fuller puts down, as the earmark of causality, an invariant relation of events in which the cause must precede its effect and the effect must follow its cause, in time. 1t is this sense of must which distinguishes causal connection from coincidence." Further, Fuller emphasises, the effect must immediately follow the cause: "Causality can no more jump gaps in time than it can gaps in space." The invariant relationship that must prevail, but fails to prevail in most of the causalism of MM leads to the following questions
X causes Y
But why does Y
Occur without, and
Not occur despite, X?
A young lady, the wife of a physician-friend of the authors was detected to have an inoperable lung carcinoma. About her one could pose a question in Erich Segal's style: "What can you say about a twenty-five year old girl" who got lung cancer without having had a single puff any time? Fuller's tenets on causalism can be amplified by an epistemologic necessity called the Bombay Razor: Any proposition that A causes B must in the very same breath spell out why A often fails to cause B and why B manages to occur without A. Fuller's emphasis on no temporal gap between cause and effect must be appreciated in a wider context. Let us concede a situation in which everyone who only lived literally on fat of the land (ghee, butter and what have you) ends up with a heart attack after, say, n years. Yet fat cannot be incriminated for whatever else happened to these subjects during the interim n years including the mere proximity to a doctor stands as causal to the effect that is seen now.
MM may be diagnosed as having chronic causitis, a syndrome some features of which, and the remedy thereof, are detailed below.
Coursality, Not Causality
A zygote - the featureless cellula prima - ends up into a human being of 10 cells through what the embryologists call epigenesis - a perspectival proposition that allows a person's brain, biceps, or bladder to be integral parts of the phased, sequential development that, postnatally, unfolds as uniquely individualistic puberty, sexuality, menstruation, menopause, stroke, diabetes, cataract, cancer, death - all coursal but not causal in nature. Development, Dobzhansky aphorized, begins in the womb and ends in the tomb, all a part of DNA's Developmental, Nurtural, Annihilational repertoire resident in the genotype of every cell and manifesting as varied phenotype.
Herdity, Not Heredity
The rather useless but ubiquitous science of medical epidemiology thrives on the stability of probabilities like one in 1000 newborns having a cleft palate, one in 10 having a stroke, one in 5 having cancer, one in 33,000 having ALL, 2.6 in 100 being low in IQ precisely because 2.6 in 100 have too high an IQ-world over, generation after generation. The unswaying nature of such statistics should have taught us long ago that these phenomena occur in an individual level at the behest of the herd whereby its occurrence in one assures the freedom from it in the rest and vice versa.
Exigence, Not environment (exigentia = demand, pressure, want, requirement)
There works in the most modern branches of medicine the rule of thumb assumption that whatsoever cannot be attributed to genes or herdity must have been caused by environment. This done, man (i) forgot to love and revere the environmental elements that sustain life, (ii) learnt to fear air, sunshine, food, sex, (iii) failed to see that even in the most smogladen metropolises so man-made "since at least the 17th century," civilisations have prospered, and people have progressively lived longer and healthier, and lastly, (iv) man lost sight of the fact that all environments unsullied by man's industry and exigency are pristinely health-giving. Holding environment as causative is mankind's cunning to be the judge, jury and the executioner when in reality it alone is the culprit.
For ghee-gourmets, there is some good news around. Cholesterol-causalism has bitten the dust, for whatever was the alleged gain against CHD has been more than offset, by disastrous disadvantages: "During the past three decades or more, in chasing the phantom of cholesterol, we condemned ghee and coconut oil as atherogenic saturated fats and replaced them with so-called cholesterol-free kindly-fat-for-the-heart. Paradoxically, this change has resulted in a sharp rise or epidemic of not only coronary artery disease but also of diabetes mellitus and other disorders of insulin resistance,. Vive le cholesterol, chapati soaked in ghee, and all other gourmet's delights.
Burch has raised his cudgels against smoking as the villain behind lung cancer, and has demonstrated, statistically, that those who smoke have a lower incidence of brain and bowel cancer as compared to those who despise Lady Nicotine. In the whole preventive game, MM has made an average human being lose a great deal of his joie de vivre, spontaneity, and many a small, convivial bliss of life to give him in return nothing but hollow statistricks. Surely penny-wise, pound-foolish.
Patient, Not the Doctor, Knows Better
Alex Comfort, English gerontologist more famous as a sexologist, has portrayed medical men as the anxiety-makers and has praised the astounding resilience of a common man to rid himself of this MM-foisted illness by successful, admirable ingenuity:
My doctor has made a prognosis
That intercourse fosters thrombosis
But I'd rather expire
Than abstain, and develop neurosis.
"The Lament of a Coronary Patient”
Fischer, the eminent Harvard physician arrived at a conclusion that many a diabetic survives by stealthily eating the bread that his physician has denied. Antia, prefaces his 5th edition on dietetics and nutrition by candidly declaring that our forefathers (rather foremothers) knew a great deal better and more on balanced dietetics than all the texts, tables and statistics of MM put together.
All societal pleasantries, courtesies and convivial sharing involve items - tea, coffee, spirits, tobacco, betel leaf, sex -that MM has found fault with. It is indeed to mankind's credit that it gives to MM a double-ear hearing that effectively bypasses the inhibitory cortex.
Empathy, Not Xaccuse
Causalism conveniently cooks up a chain of events wherein the patient is seen as the willing accomplice and hence fit to be accused of a misdeed. Solzhenitsyn and Cornelius Ryan, the eminent literary men, faced such j’accuse for the cancer they had had. Pickering deplored that MM has not yet been liberated from medieval idea that illness is the result of a sin that must be expiated by the mortification of the flesh.
The death of causalism should drive home the lesson that in the occurrence of intrinsic diseases like heart attack, stroke or diabetes, the sinner and the saint are not treated differently by biological forces. The long list of cancerologists who died of cancer and cardiologists who succumbed to coronary should kindle in the medical man's heart the flame of empathy for a fellow being in suffering.
Humility, Not Hubris
Rushdie in the closing part of The Satanic Verses describes, in a Bombay setting, the visit by a cardiologist 'dripping with self-esteem." Cause as the substratum of the course of an illness makes MM unduly assertive, arrogant, action-oriented, Mr. -Know-all. They behave like the Queen in Alice in Wonderland - ordering the beheading of this cause and that, as a means to prevent/cure an illness.
In the midst of utter intellectual bankruptcy scientists are still dreaming of spotting the cause, curing the cause. A recent issue of Science traces cancer to be a faulty, oncogene bel 2 which can be set right to enforce the regression of a cancer. Ambroise Pare's 1 dressed the wound God healed the wound has no chance in the arena of hubristic MM.
There are a number of other areas in MM that need a non-causal perspective to set right MM's illness. The utterly inhuman slaughter of animals for laboratory could be reduced to one-tenth of what it is now if causalism is dropped. Microbes as a menace have fostered antibioticism that has produced global immunodeficiency that, in all likelihood, has allowed the Darwinian emergence of the hitherto dormant HIV problem.
In the final analysis, causalism with its attendant cure-all-ism is MM's knee-jerk response to a wide variety of biological phenomenon. And that is decerebrate, spinal medicine.