[original article by Alessandro Furia]
Life is short, but (medical) art is long
Since its earliest origin in Ancient Greece, Western Medicine has been characterized by the union of two completely opposite fields of knowledge, Art and Science. Just like the two mortal enemies of Chinese mythology, the tiger and the dragon, who are doomed to fight without ever having the chance to win or lose, it often happens that Science fights Art in order to win and vice versa. Still, if we look at the etymology and the original meaning of these two words, we can understand how both of them are necessary to the birth of what has often been defined as a new Medicine.
The word “Art” is used to translate the Ancient Greek “téchne”, which can be interpreted in various ways on the basis of its numerous semantic nuances. Plato helps us with the interpretation of the word in his Protagoras by having the eponymous character tell the Promethean myth in a rational key. According to the sophist, when Prometheus stole the fire and gave it to mankind, he also provided men with the technical ability (téchne) which is necessary to light a fire. A fundamental feature of technical ability lies in the fact that it can be taught and passed on from one generation to the other.
Further evidence of the fact that this “didactic” aspect lies at the basis of the medical practice, we can quote the original version of the Hippocratic oath, in which, besides the prohibition to carry out kidney surgery (an hideous job which had to be performed, of course, by surgeons), there is a particular stress on the fact that a physician has an obligation to teach his own disciples/pupils, something which has been forgotten by nowadays professionals. Moreover, the Latin word dottore (which derives from the verb docere, “to teach”), literally means “the one who teaches”.
How can we better define this technical medical ability? We can say that it is the sum of experiences and knowledge deriving from the observation of various patients. The clinical method, which derives from an “artistic” concept of Medicine, consists in a “Sherlockean” kind of investigation: just like the famous detective, a doctor collects data and pieces of information through observation, using what he has found to get to a diagnosis, the keystone of the entire process.
Though this may seem similar to what scientists do, what distinguishes clinical method from scientific method is the fact that one (and only one) individual is judge and executor of the whole process, whereas in contemporary science individual interpretation must be approved by a community of peers (what is generally called peer review).
As it is often underlined by medical science purists, the problem with the clinical approach is that man, who is fallible, cannot have a valid knowledge for every single patient, without forgetting that, because of its depending so much on the quality of the physician, the clinical method could bring to extremely wrong conclusions, as mistaking a red eye for fatal hepatitis.
As long as Science is concerned, Medicine always had a “scientific side”, though this may sound anachronistic. We must remember that at the beginning “science”, as a first form of philosophy, was a procedure which aimed to find the very first cause of things and to substitute magical-religious thought with logos.
This is why, in his On the sacred disease, Hippocrates defied epilepsy’s divine nature.
With the help of contemporary scientific method, Medicine has been able to proceed fast in a relatively short period of time. Though achievements are uncountable, we may say that the development of biology as a rigorous science has been the fundamental basis for the study of human physiology, necessary to our understanding of body functionalities. Another fundamental scientific field of study is represented by statistics, thanks to which the concept of causality has been introduced in medical studies with a certain degree of exactness, thus allowing, for example, to establish a connection between cigarette smoke and lung issues.
The union of scientific and statistical method has brought to the development of a new approach called evidence-based medicine (EBM); the aim of this new approach is to create some sort of “universal” Medicine, with rules and guidelines used to perform diagnoses and cures on every patient on the bases of criteria which are no longer subjective, but statistically valid or at least approved by a community of experts.
This vision, which we might call reductionist given its tendency to reduce the complex systems of “man” and “disease” in a simple sum of many parts, has conquered almost all this field of study, contrasting in an almost more evident way with the clinical method.
One reason behind the growing power of this new trend is the developing of technologies which allow us, for instance through the analysis of big data, to make such procedures as genomic sequencing much faster and more precise, in a way which not so long ago was complete fantasy.
Particularly active in this field are the so-called Neurosciences: their aim is to replicate the functioning of human brain with supercomputers (that is, computers with a high computing power). This is what the Human Brain Project is trying to do, besides attempting to the application of these new instruments to create diagnosis and prognosis models for neurological diseases.
There is someone who not only claims that the clinical method, thus defeated, should be completely abandoned, but also that the professional physician will become a figure of the past, once artificial intelligence will have taken its place with its better abilities in the application of diagnostic algorithms.
The first claim can be argued on the point that reductionism does not prove efficient in front of its natural enemy, i.e. emergency (that phenomenon because of which a complex system can have properties which are unexplainable on the basis of its single components only), which is at the basis of many biological issues, like the mind. Moreover, the boasted scientific exactness of many tests fails in front of the fact that there is a thinking being who interprets their results.
With regards to the second claim, we might point at the fact that the aim of artificial intelligence is to be undistinguishable from human intelligence. However, this means, ironically enough, that despite their high I.Q., the artificially intelligent robots will still be characterized by a deeply human feature: the fact that we make mistakes. This implies some practical and ethical issues: who is responsible if the machine goes wrong?
If therefore we cannot really get rid of the human (or semi-human) component, the best solution should be this: the scientific method should provide the physician with those instruments which will reduce his or her possibility to go wrong, without having the intention to take his or her place (which might sound a bit anti-scientific, sine it implies a certain degree of ignorance on the subject).
If things go in the opposite way, we will witness the end of Medicine and not a new beginning.