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"SCIENCE"* IN THE PRACTICE OF MEDICINE: ITS UMITATIONS AND DANGERS AS EXEMPLIFIED BY A STUDY OF THE NATURAL HISTORY OF ACUTE BRONCHIAL ASTHMA IN CHILDREN WILUAM ROEi There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy. [Hamlet l:v] Is it not possible that modern humanistic man, excited by the success of the scientific method, and exalted by his liberationfrom the absurdities of medieval thought, has been carried away into a new period ofdogmatic folly only a little less absurd than that which preceded it? Could he be making a gigantic mistake? [Alister Hardy, The Spiritual Nature of Man] Introduction There was a time when physicians of the Western world possessed sufficient humility, courage, and integrity to accept the fact that certain forces which were obviously of vital importance in the maintenance of the health of their patients, being intangible, could not be accurately The author thanks his colleagues Drs. B. Hardie Boys, H. Kingston, T. Parr, and D. Carroll, under whose care many of die patients in the study were admitted; die house surgeons and nurses who bore the brunt of the immediate responsibility for patient management ; the physiotherapists for their valuable contribution; and the general practitioners of die Nelson Province, without whose tolerance toward die heretic in dieir midst die study would not have been possible. Thanks, also, to the staff of the National Health Statistics Centre for their invaluable assistance. ""'Science," defined in the restricted terms in general use in contemporary medicine, namely, diat body of knowledge acquired by the application of die scientific method—die experimental testing of hypotheses. tConsultant Paediatrician (retired), Department of Paediatrics, Nelson Hospital, Nelson , New Zealand. Address: 30 Moncrieff Avenue, Tahunanui, Nelson' New Zealand.© 1984 by The University of Chicago. AU rights reserved. 003 1-5982/84/2703-0394$01 .00 386 I William Roe ¦ Science in Medical Practice defined and hence were not amenable to investigation by the scientific method. As a consequence, the practice ofmedicine was divided into die art and the science, the former being considered no less important than the latter. With the passage of time, however, and especially in the twentieth century, the art has suffered neglect and even denigration, while the status accorded the science has steadily increased until it has now acquired an aura of holiness which bodes ill for its future and for the future of mankind. In certain quarters, especially in academic circles, medicine is actually regarded as a science, with the implication diat anything not scientific has no place in medicine. Thus has been created a serious imbalance between these two components. By starting from a false premise, a superstructure has been created which is, to a not inconsiderable degree, an iatrogenic fantasy. The primary function of medicine has been transformed from a service to patients to a vocation and avocation for medical and paramedical personnel (see later); iatrogenic disease has become a major problem [1-5] and medicine has become big business [6-10]. An urgent need exists to correct this imbalance, to restore the ari of medicine to its former status. This is unlikely to occur without appreciation of how the current situation developed. Nor is it likely to occur until we recognise the absurdity and danger of the consequences of this imbalance. This paper offers an hypothesis to explain the manner in which the situation arose and, by means of a study of a specific disease, illustrates this absurdity and danger. Man, the Mythmaker No more than a superficial acquaintance with anthropology, ethnology , or history is required for it to become apparent that die need to indulge in fantasy is deeply ingrained in man. Indeed, it seems the most distinctive (and perhaps the most dangerous) characteristic of that species of the genus Homo we conceitedly label sapiens is not his wisdom but his reluctance to admit to ignorance. Rather than do so, he is prone to posit an hypothesis and, all too frequendy in the absence of supporting evidence, comes to believe it. Thus are myths created. Prior to the sixteendi century, the hypodiesis most frequendy invoked to explain all manner of mysterious phenomena was God. The importance man attached to this...


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