In
"Without Miracles" Gary Czicko describes three sets of
beliefs as to how biological features, whether structural or
behavioural fit their respective functions and specifically how
that fit came about . Two of the three turned out to be wrong.
Fit
by Providence is essentially the creationists posture. Things are
believed to be as they are because some all powerful source decreed
it so.
Fit by instruction is the mechanism whereby use and
disuse in one generation transmit or "instruct" their
effects to the next - the mechanism proposed by Lamarck. The
specifics of beliefs about the operation of this mechanism are
predicated on a common sense view of how use and disuse wil laffect
subsequent generations.
Fit by selection is the Darwinian
mechanism driven by random variation, transmission and differential
survival.
It
takes only little flexing to see these three mechanisms as the three
phases of decision making in many different disciplines though
focusing here on the care of the sick.
In
medicine originally treatments would have been determined by appeal
to supernatural authorities, in reality pronouncements of the
therapist's teachers and this tradition persisted for many a century
and indeed is still present. How to deal with a situation is well
described in dogmatic terms which the therapist meekly follows. Much
of (the appeal of) alternative medicine is predicated on
this.
Medicine as it learned something reproducible about
the human body (and mind) added to the traditional view the use of
common sense or rationale. This or that approach was proffered on the
basis that logically, in the light of current apparently relevant
knowledge, it ought to be the best approach. As science developed
this use of common sense became less "common" yet in the
end decisions were still based on what ought to be true rather than
anything we even remotely knew to be true. Some of course were true
despite a lack of convincing demonstration or confirmation. This is
analogous to Lamark’s inheritance of acquired characteristics for
in any analysis is the perception as what is or is not to be usefully
inherited is based on common sense, the fundamental mechanism at work
here and in decisions based on rationale, an elaborately informed
variant. These common sense interventions were and are transmitted
by teaching and training to this day. One should of course emphasise
that such common sense choices were informed by an exponentially
growing body of biomedical scientific observations. This however
still left most recommendations short of actual evidence of likely
benefit over alternative approaches.
Medicine, a core
element of Healthcare is now making the jump to a situation where its
recommendations are selected from a body of tangible experience,
recorded and counted in similar situations. Still not perfect but the
current best we have. This is the Darwinian mechanism- assorted
treatments are proposed, they are tried in controlled circumstances,
the best are used and transmitted to the next generation of
practitioners and the rest are discarded and largely forgotten -
they, the majority of proposals become extinct. The collection of
well selected approaches to assorted clinical situations is growing
but still far fom comprehensive leaving many patients to be advised
on the basis of rationale or dogma. The popularity of alternative
medicine indicates that for many patients with selected afflictions
this approach is entirely acceptable.
