Medicine's perception of reality – a split picture: critical reflections on apparent anomalies within the biomedical theory of science

Abstract

Escalating costs, increasing multi-morbidity, medically unexplained health problems, complex risk, poly-pharmacy and antibiotic resistance can be regarded as artefacts of the traditional knowledge production in Western medicine, arising from its particular worldview. Our paper presents a historically grounded critical analysis of this view. The materialistic shift of Enlightenment philosophy, separating subjectivity from bodily matter, became normative for modern medicine and yielded astonishing results. The traditional dichotomies of mind/body and subjective/objective are, however, incompatible with modern biological theory. Medical knowledge ignores central tenets of human existence, notably the physiological impact of subjective experience, relationships, history and sociocultural contexts. Biomedicine will not succeed in resolving today's poorly understood health problems by doing 'more of the same'. We must acknowledge that health, sickness and bodily functioning are interwoven with human meaning-production, fundamentally personal and biographical. This implies that the biomedical framework, although having engendered 'success stories' like the era of antibiotics, needs to be radically revised.

Origins of heath inequalities: the case for Allostatic Load

“…The presented connection between allostatic load and the phenomenon embodiment ) is highly concordant with our thinking (Getz, Kirkengen, & Ulvestad, 2011;Kirkengen, 2001Kirkengen, , 2010Kirkengen et al, 2015;Kirkengen & Thornquist, 2012;Mjolstad, Kirkengen, Getz, & Hetlevik, 2013;Thornquist & Kirkengen, 2015;Tomasdottir et al, 2014;Tomasdottir et al, 2015;Vogt, Ulvestad, Eriksen, & Getz, 2014). The interrelatedness of human biology and biography has long been evident to experienced doctors in general practice (GPs) who encounter individuals over time across varying circumstances and stages of life (Kirkengen, 2005).…”

Reasoning, evidence, and clinical decision‐making: The great debate moves forward

“…Explicitly addressing the philosophical commitments of Evidence‐based Healthcare (EBHC), Sietse Wieringa and colleagues note that the early EBM movement had “a strong modernist agenda.” Early work in EBM aimed to “purify” clinical reality, assuming “a dichotomy of objective ‘evidence’ from nature and subjective ‘preferences’ from human society and culture.” This agenda was identified from the outset and criticized by contributors to this journal over the years, and in line with the arguments of these critics, Wieringa et al argue that the “shift” to this notion of “purified” evidence has proved impossible, because “evidence in clinical decision‐making is relentlessly situated and contextual.” Citing Latour, they state that “the EBHC community needs to reconsider the assumption that science should be abstracted from culture,” and they begin to outline what they take to be the “far‐reaching” implications for clinical reasoning that such a recognition would have. In contrast to authors such as Seth Thomas, who argued in a recent edition of this journal that there is no need for a “philosophical overhaul” of EBHC to enable it to accommodate a person‐centred approach to clinical practice, these authors note that “the starting point for clinical practice” needs to be “the unique, individual patient, not abstracted truths from distant research studies.” A brief communication from Amy Price and Ben Djulbegovic resonates with these arguments, focussing on how the term “evidence” is “interpreted across languages and cultures” and noting (again in line with contributions to this journal and other work on person‐centred care over the years) that the assumption of shared meaning of a contested term can lead to confusion and miscommunication.…”

“…The various psychotherapy schools “have distinct ethoses which are constituted by normative claims.” The whole purpose of psychotherapy is to “improve the quality of life for those affected by psychological distress or illnesses,” and this enterprise hinges on the assumption that some ways of living are preferable to others. It is consequently impossible to understand or meaningfully evaluate practices in psychotherapy without directly engaging with questions of value, employing such irreducibly normative concepts as “character, virtue, ethical dilemmas, and notions of the good and righteous life.” Their concluding section explains very clearly that this involves much more than merely noting that a patient has “certain values or preferences,” effectively linking their argument to calls for a much more serious revision of the “modern” philosophical framework in order to make sense of practice …”

“…17 Early work in EBM aimed to "purify" clinical reality, assuming "a dichotomy of objective 'evidence' from nature and subjective 'preferences' from human society and culture." This agenda was identified from the outset and criticized by contributors to this journal over the years, [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] and in line with the arguments of these critics, Wieringa et al argue that the "shift" to this notion of "purified" evidence has proved impossible, because "evidence in clinical decision-making is relentlessly situated and contextual." Citing Latour, they state that "the EBHC community needs to reconsider the assumption that science should be abstracted from culture," and they begin to outline what they take to be the "farreaching" implications for clinical reasoning that such a recognition would have.…”

“…Their concluding section explains very clearly that this involves much more than merely noting that a patient has "certain values or preferences," effectively linking their argument to calls for a much more serious revision of the "modern" philosophical framework in order to make sense of practice. 65,68,[75][76][77] Elisa Arnaudo considers the problems that arise from our current understanding of pain, with a particular focus on complex pain conditions such as fibromyalgia. 35 She argues that it is a form of "epistemological dualism," on which the physician's objective stance is unable to account for patients' subjective experiences.…”