Hypertension 1996 : One Medicine, Two Cultures

Toward an open medicine

Francesco Eugenio Negro
Specialisation course in reflexotherapy
“La Sapienza” University of Rome.

“Aurea mediocritas, in media stat virtus”: we have not kept the meaning of these terms which, if anything, appear defects, tending towards the weakening of things but today could they return to favour? Isn’t mediocrity, in actual fact, in its meaning of being median, the sense of otherness in science too? Is this the best way of expressing oneself? We will try to answer this question and to do so we will have to ask many others. It is possible that the pre-Socratic philosophers are still relevant? For the ancient Greeks, the “Being” included concepts that for us today are distinct and at times, in opposition to one another: the “thing” and its “representation”. That is, everything that reality articulates.
The tracks or the paw prints left by a dog is a sign or, better still, an “indication” of the dog. The word “dog” and its name (Argo, for example) are, on the other hand, signs of a different nature, they are called “symbolic”. The picture, the photograph or the video of the dog is “iconic” representations of the dog. Therefore, in reality we can have in reference to a single fact (the dog, in flesh and blood) various ways of representation: indications, symbols, and icon. The fact remains that none of us would mistake a representation for the object represented. Both daily though, and rational though in general, keep the world of signs very distinct from that of things. But things from a scientific point of view are not so obvious.

Semiotics, the science of signs, tells us that a sign is everything that stands for “something else”, which acts in relation to something that represents it. An object left deliberately in a wrong place to communicate something to another person is a sign, but a perfume, an article of clothing and the car are also signs. To put it briefly, we live in a world of signs. Everything can be or become a sign, even the dog in flesh and blood of the previous example can be, in its turn, a sign. Today we could say a status symbol or the materialised representation for the owner of the dog on the way he conceives himself.
Those two worlds, which at first seemed two completely separated worlds, the world of things and the world of signs, in the light of these brief reflections, show a reciprocal opening towards each other and mutual convertibility. Even what has become a sign can be transformed again into a thing. For example, a pebble collection in specific circumstances and to which I had given, there and then, the qualification of souvenir, and so of a sign, of that particular circumstance, some time later, due to my forgetting, may once again become a mute opaque object, a simple pebble. What has meaning is continually converted into common sense and this, in turn, into meaning.
This imprecision, in this original non-distinction, not given once and for all between things and signs, is conceived differently from thought according to the historical and cultural context. Newton’s apple that fell from the tree and the gravitational formula that it represents, would be, for a pre-Socratic ancient Greek, both “beings”, that is to say, on this side of their distinctions.
Two existences that belong to a single large order. Let us say that, for an ancient Greek, the thing is a being, but its representation is also a being.
Language is the ideal field in which to recover the traces of this pre-scientific way of conceiving. For example, the Neapolitan term “criatura” (child) refers, indistinctly, to the male or female gender of the child. It is not that the dialect in question does not allow, if one want, to distinguish between the two things. What is interesting to note is that the language does not necessarily reflect “one” way of articulating reality. In this case, the term “criatura” has allowed us to perceive the thought, of the ancient Greeks, that precedes subsequent actions of specification. In this pre-scientific period, the Greek did not yet distinguish, Platonically, the world of ideas from that of things and, all things considered, he was still relatively indifferent to the Aristotelian problem, already of a scientific nature, of classification b type and species.
With Plato, the world of ideas was divided from the “thing”; idea and thing have been separate up to the present day. Materialism and idealism. The same things that are born from separation. Theory and practice. Theory in Greek is sighting, talking aim, going towards, preparing to throw, the “theoresis”. Practice concerns the actual hitting. For ancient Greek, they are two necessary moments of the same “reality”.
At the time of the origin of Rome, there existed a “secret name” of Rome, known to only a few, so that the name of Rome could not be known and possessed by anyone wanting to become master of the city. The enemy was not to know and therefore be able to use the real name of the city. Owing the name already meant owing the thing. It coincides. Revealing my name is like giving a part of myself away. More recently, for example, taking a photograph of a Masai tribesman means, for him, taking away his soul. Would we give our address to a stranger? An engaged couple who split up want backs their letters and photographs! Is all this magic? Perhaps. This perhaps of mine is diplomatic. Because in many cases physics, after the quantum revolution, does not distinguish between what it represents and what is represented, it is not possible to show a real empirical fact corresponding to its symbolic representation. Certain “facts” of modern physics do not have empirical evidence. They are not realities “of thing” as was the case in classical physics, but “representative”. I cannot distinguish the empirical from the representative. What difference is there, then, between the “being” of the Greeks and the impossibility of separating the “representative” from the “thing”? Obviously we would not have arrived at science without the Platonic fracture, however, paradoxically, modern thought is returning to pre-scientific Greek thought.
Therefore it is not possible to separate the representative aspect from the “thing” aspect. This is what science tells us today. It is not a teleological or mechanically evolutionary science, where, starting from the bottom, we put one brick on top of another to reach the top of the wall. But a science, that can dance taking, where necessary, a step backwards too. Just as according to Chinese thought, which said that when teaching how throw a stone a long way, your hand had to go far back behind your shoulder.
Today science is more critical of his own knowledge. It has become relativistic. New knowledge can refute old knowledge. We can say that science takes itself less seriously. There is a certain degree of scepticism about its knowledge. And so there is less “dogmatism”. The world of “possibilities”, as Musil would say, has replaced that of the truth. “The man without qualities” is precisely the man prior to every subsequent determination.
But let’s try to put some order into this paper. We could exemplify, schematising in three levels of scientific consideration:

1. Level of informal assertion. An inductive level and not strictly theoretical. Therefore, intuitions, abductions (logical jumps); primitive, obvious terms, etc.

2. Theoretical level in a strict sense, therefore informal level, logical-deductive, mathematical modelling etc.

3. Factual level, empirical, experimental etc.

The scientist is characterised according to the level he frequents. For example, an epistemologist could belong only to the first level.
Those who work prevalently or exclusively at level 3 (experimental scientist) tend to take for granted the knowledge of the contents of level 1 or rather, they behave as those these were defined. Things also stand this way for those who work prevalently or exclusively at level 1 (metatheoreticians, epistemologists, etc.) carry out an informal study of formalised systems and questions evidence. Precisely evidence, that is to say what the operators of level 2 and 3 tend to take for granted.
Each operator tends to frequent and assume as criterion of demarcation between science and non-science, the priority of the characteristic feature. That is, in there own group. For example, for an operator of level 3, what characterises a scientific theory is the very fact of its being experimental. For some belonging to group 2, it will be its degree of formalisation and so on.
Consequently, the scientist’s work presupposes a series of contacts that are not scientifically or theoretically demonstrated, for example: force, movement, thing, body, life. Moving sands that would appear to belong more to pure philosophy than to science, as they are terms, which are broadly intuitive.
But this leads us to recognise, as Lakatos did for mathematics, that even the most formalised ad well tested theories are based in every case on indefinite terms, on evidence. Evidence that often, with time, is no longer considered such and that therefore implies macroscopic readaptations at theoretical level. Put in other terms, historically the great changes originate at level 1 which, as chance would have it, is the most open and least structured.
If we accept this idea of the priority of level 1 as far as changes are concerned and therefore so-called scientific progress, then we must be ready to accept a series of consequences. Above all, that science, a characteristic product for excellence of Western thought, is based on and depends on a series of intuitive representations. All this, however, does not make science any different from other system equivalent to it from the functional point of view belonging to other cultures. For example, magic would appear to be characterised by the presence of at least two levels: 1 and 3. Therefore a formalised theory (level 1) would appear to be missing, whilst it is shown on the other hand in alchemy. These observations do not aim in any way to state that magic or alchemy are scientific, but that this makes a science a science in the true sense, and it is not something as obvious as at times people would like to flaunt. For example, as already mentioned, the factual ascertainment, considered by many scientists and epistemologists as the true criterion of demarcation, would characterise not only technology, as an applicative area of science, but magic too.
Our technological medicine is not concerned with the problem of what a fact is. I am speaking of a medicine that, in the overwhelming majority of cases, is “technological”, referring to the thought of Kuhn, that is a medicine “normally” applied, not accustomed by statute to being doubted. Modern medicine often refers to itself in explicit terms as falsificationism but then equally as accurately it actually remains verificationist. It is sufficient to think of the request for analysis to “check” a diagnosis. The more the accent is placed on the formalised aspect and on the regulatory aspect, the greater the closure of the paradigm will be, independently of the system in question.
By all means, some grammars are more elegant, others less so. But this opinion arises from the fact that we compare them to ours.
Bet let’s look at what the philosophers say about science. A synthesis of the philosophy of science on the “criteria of demarcation between science and non-science” can be summarised as follows:

1. Consensualists. Truth is by consensus. Something is “scientific” when the majority of scientists consider it true. Common sense beats reality. The earth was flat according to common opinion. This criterion is overcome by point two.

2. Verificationists. (Carnap, circle of Vienna, neopositivists, logical empiricists etc.). to be true, it must be possible to verify a theory.

   1. Probabilists. A theory is true when it has a high probability compared to one with fewer probabilities. Medicine uses strictly probabilistic tools (see the importance of statistics, of modular therapies).

3. Falsificationism. Popper refuses 1,2 and 2b. A theory may be false, although it has found a high number of verifications. Popper referring to 2b has shown that all theories are equally improbable. Therefore “criterion of demarcation” is falsificationism. Thus, in order to accept a theory, there must be the possibility of indicating at least a “potential falsifier”.

4. The scientist revolution. For Kuhn, the value of a scientific theory is measured by the capacity of a theory to replace, ex abrupto, a preceding theory, and this on the basis, unlike Popper, of non-rational elements. The “criterion of demarcation” is non-rationality.

5. Predictivism. For Lakatos, a scientific theory is such when it can predict new facts (or in contrast with pre-existing theories) and not only provide explanations a posteriori of known facts. That is, in predicts, it is predictive of as yet unknown facts.

Summarising, we could roughly divide the philosophers of science into a rationalist group and another, which is without doubting more irrationalist. The rationalists are Popper and Lakatos. Popper with his concept of falsification. Let’s let him speak “be audacious in the hypothesis and very severe in the falsification of my hypothesis”. But doesn’t believe falsification paradoxically verification? This is the thought of Lakatos, Popper’s pupil and also his critic. Popper and Lakatos is the centrist wing of this critical side of science. At more extreme end, we find Kuhn with his “logic of scientific discoveries” and Feyerabend with his “methodological anarchism”.
For Kuhn, the importance of a paradigm is measured in its capacity to replace the preceding scientific paradigm using a new language that speaks of “a different world” compared to the previous one. For Popper there is a ameliorative and cumulative progression: one theory is better than the other and therefore replaces it. For Kuhn on the other hand, the epistemic rupture between one paradigm and another is important. For Feyerabend science is not capable of proving anything. The scientist influences experiments. And from there? For Lakatos a negative fact, a falsification, does not destroy a theory. And this is true. How many times in the history of science have there been facts that openly refuse a theory (“nucleus”) but this was so well protected by subsequent layers (“protective belts”) that it was able to resist evidence for a long period, giving rise to subsequent postponements of the problem and therefore to new documentary facts. The modifiability of a theory says Lakatos on mathematics (a formalised science for excellence, let’s think of the others!) takes place due to a metatheoretic problem, which concerns what we have described of science under level 1. Level 1 that, therefore, also has dignity in other so-called non-scientific systems with level 3, factual, without having the formal level (level 2). These non-scientific systems in fact carry out equivalent functions, but they do not have the same status. Not all confuted theories have been eliminated. For example, homeopathy for some is confuted, for others (Popperians) it is not confutable (and it is precisely this that is believed to be its defect), in any case it does not appear to have been eliminated from medical practice. On the other hand, if I talk about an anomalous fact in medicine with treatments other than those of the “normal” paradigm obtaining a result, I produce a potential “falsifier” of the dominant medical theory. But this does not lead to the downfall of the dominant medical theory. How many times was the flatness of the earth confuted before the concept was eliminated! The falsifiers do not act deductively but inductively. Falsifiability is not discovered logically but at the metatheoretic level where there are no formalised systems. Lakatos places the accent on thought that has not yet been formalised, specialised, not deductive logic. He gives importance, even in mathematics, to “free thought”. Therefore in the history of science, there are not individual theories but successions of theories that Lakatos calls “programmes of research”. It is a feedback between conjectures, proof, confutation and predictions.
What does Popper’s lesson takes us? Even if Lakatos took a step ahead, Popper leads us to believe less in dogmatism, to return to that world of the “being” of the ancient Greek and of the “aurea mediocritas”. For Popper, at the basis of everything there must be obviously, the “standard of intellectual honesty”. There does not exist an “absolute” criterion of intellectual honesty to establish the condition of truth of a theory, which on the other hand depends on the “criterion of demarcation”, in its turn historically and culturally variable. What is, in short, our error? Overlooking the consideration of inductive principles. We have seen that the changes in the paradigm or programme of research take place prevalently at the level of informal theory.
More often than not then, a theory is not eliminated by another more powerful theory, but by a thought that considers subjects that cannot be proved, but which have the force of changing the worldview.
There are cultures outside the West that do not speak the language of our formal systems, but in fact present inductive principles that are not qualitatively different from ours. They are, precisely, different grammars, with their own traditions of thought and a factual collation of their own. These medicines, such as acupuncture, have their own metatheories, using this term in the philosophic meaning, as does homeopathy, without however entering formal system. The two methods, homeopathy and acupuncture, resemble one another in this epistemological context.
Can a therapeutic style have recourse to more than one grammar? Does the contamination of one therapeutic grammar by elements of another represent an error? If I answer these questions affirmatively, I support Western scientific-technological medicine, but it is also true that I state the closure of a system, with the consequent non-consideration of those anomalous facts that contrast with the consequent non-consideration of those anomalous facts that contrast with the dominant theory.
The other grammars are not to be observed with a “principle of openness” which must be able to evaluate the specification of the paradigm in the individual case and therefore the best use for that subject. The problem of the correct referral of the individual case to a paradigm is common to all existing grammars. This is the art in therapeutics. Theoretical paradigm and practical case, in an idea which is not teleological and evolutionist of science that wants to divide the world into highs and lows, a minimal evolution and a higher evolution, once and for all harmful for the individual patient. Two heuristic evolutions, progressive and conservative. For Lakatos, the enrichment must be explainable. In certain cases the paradigm cannot be explained. There are cases, which are exceptions in medicine, that medicine does not explain. What is to be done? Is the scientific methodology to be eliminated? No. Then don’t only specify the paradigm but be able to open it and enrich it. Put alongside practice a difference of theory. Dogmatics refuse the unknown for the know and remain in the paradigm. I have to realise the unknown. The cases that confute theories exist and these do not cause the downfall of theories. They have to be examined. If the theory collapses, it is eliminated. So keep our paradigm but with the idea of opening it. Both opening and closing are useful. Both have to enter Popper’s “myth of the frame”.
So a “predualistic” thought that brings us back to the median where the archaic leads us back to non-extreme forms.
In short, “the edge of science”, the border of what is scientific knowledge and what is not, is not, as Giorello says, established once and for all, but changes in time, because the flexibility of the criteria with which we evaluate theories is not of any lesser importance than the conquests obtained in mathematics or the empirical sciences. Michel de Montaigne said “even the pyramids fluctuate”.
For Lakatos, the current form of dispensation of God is science, understood a network of audacious conjectures, open-minded criticism and effective techniques.
And so, in conclusion, an open science, far from dogmatism. Hippocrates, the father of our “grammar” states two principles “similia similibus curentur” and “contraria contrariis curantur”. In his school of Kos he applied these indifferently according to the cases. The referral of an individual case to the paradigm. This concerns, both those ho think they are in “science” and those who consider themselves alternative. Division into groups creates a “scientific racism” that is totally unproductive.
Freedom is the greatest gift we have. For Popper “the fashionable thinker is usually the prisoner of his own conformism”. Just as the “expert is a slave to specialisation”. So knowledge depends on disagreement. To end with, Popper says: “I may be wrong and you may be right but through a common effort we can come closer to the truth”.

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Edited by Aldo Campana,