Randomised trials: the case for science in medicine.

Abstract

It is quite apparent to me that very few people understand the meaning of the word “epistemology”. It may be difficult to pronounce but it is quite easy to understand. Epistemology is the study of the growth of knowledge, or “how do we know what we think we know”? What I would now like to try to get across is that scientific philosophy is not a rarefied activity indulged in by retired physicians who have nothing better to do with the remainder of their lives; rather, it is a very important aspect of medical education and medical practice. I will illustrate this by describing aspects of the growth of philosophy and how this has an impact on our everyday practice. I would like to start off with Aristotle, the Greek philosopher who was the father of inductivism. Inductivism is another word that is frequently used but not clearly understood. Simply put, inductivism is the process by which you generate a hypothesis and then seek corroborative evidence to prove that your hypothesis is an expression of the truth. The history of medicine is littered with the tragic failures of this philosophical approach. Galen, a second-century physician, was the master of inductivism in medical practice and his malign influence led to 1600 years of sterility. This sterility was not merely an inhibition of medical progress; it also included the perpetuation of barbaric and useless treatments such as that of bleeding and cupping, the panacea approaches for most ills up until the early years of the past century. To this day, you will meet contemporary inductivists pacing the marble corridors of ultramodern high-technology hospitals, introducing and perpetuating dangerous therapies without having the intellectual honesty to seek anything other than corroborative evidence in support of their ideas. I would now like to take you 1000 years further, to the birth of the deductive process in medical science. William of Okam was a thirteenth-century English monk, and his famous aphorism “Entiae non multiplicandum necessitatum” describes the philosophical underpinning of the modern approach to medical diagnosis. A loose translation of the Latin would be that on observing multiple phenomena you should try to explain your observations in terms of the simplest underlying cause. Thus, the whole process of diagnosis is the eliciting of symptoms and signs from the patient, and instead of coming up with multiple explana- tions for them we apply Okam’s razor to postulate a single causal explanation with multiple epiphenomena.