What have been the major underlying errors in addressing this pandemic? I’m referring to the most profound reasons, the epistemological reasons from which all the others derive, that is, those that are at the root and at the beginning of knowing something.
In the following I cite some of our prevailing erroneous medical epistemology; some of them are well known:
- The idea that disease is a war.
- The myth of control that leads to loss of control.
- The myth of scientific objectivity.
- The myth of certainty for doctors.
- The myth of certainty for patients.
This is not a war
The metaphor of war against the disease, against cancer, and now against COVID-19, is very negative and counterproductive. And it relates to one of those big underlying errors prevailing in our medicine: That bacteria and viruses are very malicious and that disease comes from an outside full of alien enemies and from which we must defend ourselves.
“This damn bug”, “this son of the great …”, “we will win this war”, “together we will win” … All these small-minded warlike figures that are so propagated in networks and, what is even worse, by the authorities and sanitary establishment themselves, are neither scientifically nor educationally useful if we really want to build an adult and free society.
No, friends, the truth is that we are surrounded by viruses and bacteria, and we are “made” of those “bugs.” We have millions of bacteria in our body and, moreover, billions of viruses, most of which are beneficial and perform important functions in our body. We live with them. They are our “friends”. That‘s the reality.
Why then are these warlike comparisons used by government authorities in most countries? What is the purpose of using this militaristic iconography in press conferences in our country? Someone recently said, that in the end, using these warlike comparisons also means disdaining people who have lived or are still living in a context of war. Examples are not missing, even in the current time. A great disdain and epistemological error.
The myth of control that makes you lose control
Some speak of the nineteenth century as that of the romantic movement and tuberculosis as a representative disease, and of the 20th century and the beginning of the 21st century, as that of control and cancer. Once again, this myth of control, on which important assumptions have been based, has collapsed dramatically. There is the underlying idea that we as chosen creatures of creation can control and exploit all the resources of the environment and planet indiscriminately, because we think to be their owner and that we can therefore make of it what we want.
It is not that we haven’t had constant signals that indicate the contrary. And now a modest organism half alive had to come to knock us off the pedestal again. For me it doesn’t matter whether it was created in a laboratory or originates from natural causes. The explanations, both, the “alternatives” and the official ones, are not very convincing, although no of them should be discarded.
Nowadays, every company, state, individual or group without scruples can play the sorcerer’s apprentice with genes. Our idea of control makes us believe so. There are certainly more researchers committed to true progress and ethical values, but it takes all sorts to make a world. I wouldn’t be surprised if the virus was artificially manufactured with malicious intent or accidentally escaped from a laboratory. If something is technically possible, someone will be doing it somewhere.
On the other hand, this pandemic may well be a natural event, as Nature is capricious, (“chance” is the name we give to our ignorance). O it simply may have gotten tired of the “wet markets”, of the overexploitation of the environment, of the indiscriminate cutting down of forests.
It doesn‘t matter whether the origin is from laboratories or the bats. The fundamental reason in both cases is our idea of control thinking we were the new gods of genes or nature. When control is taken to an extreme, the result is often a loss of control that might surprise and scare us.
The myth of scientific objectivity
The idea of objectivity in science is not bad by itself as long as we see it in perspective and don‘t become rigid. Seeing it in perspective leads a good number of scientists to demonstrate that this supposed objectivity is not possible or is very limited (Einstein, Gödel, Heisenberg, Von Foerster.). The latter, Heinz von Foerster, summarizes it very well: “Objectivity is the illusion that observations can be made without an observer”.
In medicine, this supposed “objectivity” is even more questionable. We know that the predominant medical epistemology, despite having made undeniable technological advances, has remained stuck in paradigms that are two centuries old. There is no objectivity with regard to observing a phenomenon and altering it with our observation; it is that simple.
The idea of EBM (Evidence Based Medicine) is also good by itself but collapses like everything that becomes rigid. And it has collapsed, although its most recalcitrant followers do not recognize it yet. The clinical trial, be it double or triple blind (what a great metaphor!), is not capable of explaining the qualitative characteristics, the complexity of living beings.
Then there is the uselessness and falsity of many studies as pointed out by Peter Gotzsche, a cofounder of the Cochrane Collaboration. Also, pharmaceutical companies have “hijacked” EBM and turned it into another of their appendages, as described by Horton, M. Angell.
Doctors, there is no certainty
During these months of the COVID-19 pandemic we have seen what medicine really is: an empirical practice. Medications have been given that later proved to be useless or counterproductive. This has been influenced by the exceptional nature of the situation, of course, but also by the “fight” between laboratories to gain market share.
This is not to criticize my healthcare colleagues who have been on the front lines and facing the crisis, most of the time without adequate means. On the contrary, they have been true heroes and deserve the appreciation of the citizenry. I am very afraid, that when all this is over, they will be the main victims.
In medicine we live with uncertainty despite all our fictitious attempts to control, whether we like it or not. A certain degree of uncertainty is inherent in medical practice and can’t be foressen by protocols, guides, or rules of any kind. If we have ever thought differently, the pandemic has shown us the reality.
Patients, there is no certainty
I’m even more sorry to say to patients, that there are no certainties, no guarantees in medicine. You have been led to believe that medical professionals can face any situation succesfully. That there is a vaccine or drug for everything. But a modest virus from the family that produces colds, has made everyting stop.
Instead of educating people on this idea of medical uncertainty, politicians and the media continue talking about the miracle vaccine. And perhaps there might be a vaccine, I‘m not saying no, although no vaccine has been obtained for any coronavirus until now. And maybe it will be more effective and less controversial than that for the flu. However, as paradoxical as it sounds, it shows the EBM deficiencies of the vaccination campaigns.
And so we continue without involving citizens in the management of their own health. Have we really done everything we can with social distancing and masks?
Reflections for a new paradigm
I think that, since the world has stopped, it might be worth reflecting a little, as we do in the periods of convalescence after an illness.
Here are a few questions:
- How do we change our attitude towards the environment with everything which that entails?
- How do we act if we assume we are part of the planet instead of its owner?
- How do we live with uncertainty?
- How can we prioritize cooperation over competitiveness.
- How can we focus on socioeconomic conditions as the main causes of disease?
- Does disease really only come from the outside?
- How do vital circumstances, emotions, reactions and temporary susceptibility influence what we call the “immune system”, apart from the genetics.
- With a healthy diet, exercise, emotional understanding, how many drugs could we avoid?
- How to establish the “primum non nocere”?
- How to integrate holism in medicine without losing “objectivity” and for the benefit of the patient?
- How to deal with fear?
- Why shouldn’t we be treated as free adults who are responsible for our health?
- How can we be more tolerant, respectful and caring?