We instinctively believe that contemporary medicine is scientific and rational. That it earned its title of modern medicine through the rigor of reason, discarding ancient theories about disease. We think it has detached itself from the dark times of the Middle Ages and the medicine mocked by Molière.
However, there is a major difference between medicine and other domains of our modernity that have become rational through groundbreaking discoveries without controversy. For a paradigm shift to occur, there needs to be a significant event, a discovery capable of generating a conceptual revolution. In the field of medicine, the question deserves further exploration:
What is the foundation of modern medicine, when did it begin, and why? When did the significant rupture with the “pre-modern world” knowledge and practices occur?
The Beginning and foundation of Modern Medicine!
And everyone answers in unison that modern medicine began with Pasteur… Anything before that, from Hippocrates until then, is still part of antiquity. Of course, there is undoubtedly a before and after Pasteur. His era introduced a new way of thinking about and treating diseases that indeed swept away the past.
The end of the 19th century witnessed the demise of old ideas, such as the theory of spontaneous generation, which can be traced back to Aristotle. This makes Pasteur’s epic a historical and societal milestone. However, the real question must be more precise.
Does the “Pasteurian revolution” – since the term has entered common parlance – rely on truly revolutionary laws that constitute the foundation of modern medicine? Not so certain.
That Koch’s postulates, as the name implies, do not constitute a law. They have continued to evolve throughout the 20th century, based on new discoveries and obstacles to overcome. The concepts of theories and laws are different and do not overlap. That is why there exists both a law of gravity and a theory of gravity.
A law presents facts, showing things as they are, without seeking to explain or understand the internal mechanisms. In our example, the law describes a force responsible for the falling of bodies, whereas the theory seeks to explain WHY bodies fall and WHY gravity exists. This means that laws, from Archimedes’ principle of buoyancy to Kepler’s laws, have permanence over time.
Theories speculating on laws, on the other hand, can be dismantled. The question, therefore, is whether there are laws in medicine or only valid explanatory theories for a certain period, eventually surpassed. “It doesn’t matter,” say the champions of progress, believing that the essential thing is to move forward.
This position is undoubtedly very stimulating for pure research, intellectual interest, and love for science. However, betting on a hypothesis when lives are at stake, especially one’s own or a loved one’s, undoubtedly generates a legitimate amount of concern.
Relying on progress, which is constantly being contradicted, risks sometimes disastrous consequences for humans. This perpetual race forward is far removed from what a revolution is, and one must fear that “moving forward” in this case is synonymous with “going in circles.”
It was tempting to postulate the existence of a specific germ for each disease and to adhere to the idea that killing the germ would eradicate the disease. Unfortunately, things didn’t quite turn out that way!
The equation “one germ = one disease,” in terms of a broad and universal understanding of the mechanisms governing health, doesn’t hold up. Firstly, we don’t solely suffer from infectious diseases, far from it. Secondly, even when focusing on this extensively studied area – the pride of modern medicine – we are not all equal in the face of pathogens.
Not to mention that we have an additional problem to manage: that of multidrug-resistant germs.
Thus, Pasteur’s advances were unable to solve our fundamental problem: describing how we fall ill. And modernity is incapable of offering the only immediate practical benefit: recovering long-lasting health, that is, avoiding the relentless cycle of relapses and diseases caused by the “secondary effects” (iatrogenic) of modern medicine itself.
There has been no transition to a new era, there has been no foundation of modern medicine. In reality, if there has been a revolution, it has not been of a scientific nature. Since the modernity of medicine does not stem from the discovery of universal medical laws, where does it come from?
One sometimes-mentioned turning point is the production of the first chemical drugs. At the forefront is the famous aspirin, acetylsalicylic acid, synthesized by Felix Hoffmann in 1897. Launched on the market by Bayer, the iconic aspirin reigns among many other similar drugs, undoubtedly due to its incredible longevity.
Aspirin has been seen as a symbol of the transition to a more effective and radical medicine. The use of a concentrated synthetic product compared to extracted plant-based remedies that were used until then generally goes hand in hand with speed and potency of action. It can be conceived that the use of such substances has changed the face of medicine. However, this does not make it a major breakthrough.
Initially praised upon its release due to effective marketing, it was later shunned for its risk of bleeding and kidney damage. However, it has been rehabilitated for other newly studied virtues. Like many other substances, it is cyclically abandoned and then returned to, depending on fads, contradictory publications, and pressure from pharmaceutical companies.
This lack of permanence and stability erodes the aura of rationality in medicine. Tablets and pills primarily reveal, through their commonplace use, the beginning of mass medicine, with its panaceas and one-size-fits-all treatments. Medication becomes a consumable item that is widely marketed, sold on every street corner, and purchased massively by an ever-growing clientele.
Everybody started looking for the magic pill that would erase life-style related chronic diseases, taking this as a foundation of modern medicine. Thus, what aspirin represents is not only a change in scale in medicine but also the creation of a flourishing market. In fact, modern medicine will align itself with the pharmaceutical industry from this period onwards. It quickly becomes its determinant: modern medicine and the pharmaceutical industry will henceforth be inseparable.
This deadly combination is, in fact, the root cause of our current health problems. But apart from this fact, there is still no fundamental change on the horizon. Neither the product nor the market is a scientific foundation or a sign of rationality. Therefore, we must look for something else. Will modern medicine be better defined by its shiny technology?
Foundation of Modern Medicine: Futuristic X-rays, and so on
Another possible justification for the modernity of medicine is scientific discoveries that find therapeutic applications. For example, the discovery of X-rays in 1895 by the German physicist Wilhelm C. Röntgen, an eminent scientist who received the Rumford Medal for his work, followed by the first Nobel Prize in Physics.
This is undoubtedly an illustration of cutting-edge technologies useful for exploring the human body and the sciences and techniques serving health. Very well. But this is only an application, sometimes not very successful, of a discovery in the therapeutic field. Too often, technique, machinery, or protocols are confused with the art of medicine.
The extension of the senses through technical refinement, from the stethoscope to the microscope, and yet another therapeutic approach do not imply a paradigm shift. That would be confusing the tool with the use made of it.
Thus, the latest digital advancements do not necessarily improve the chances of recovery, especially when early detection enabled by these new technologies leads to a cascade of new problems such as medical wandering, overdiagnosis, and overtreatment.
This well-known fact in oncology is manifested differently by COVID-19 tests today. But still, there is no change on the horizon regarding the question of the rationality of medicine.
Where are the laws that govern health?
Medicine lacks universal, demonstrated, and indisputable therapeutic invariants that align with its raison d’être. When we claim the transition from obscurantism to rationality, it must be through the masterful update of laws that form the basis for claiming a revolution in medical science.
However, there is no rational explanation for how humans fall ill. There are no indications of the actions to prevent illness or quickly restore one’s previous state of health. Nourish correctly and avoid toxicity are the only cardinal rules, with no fixed laws defining exactly what those rules exactly are.
One could argue that the absence of such laws is the original sin of medicine, a sort of conceptual flaw that underlies many current issues. Instead, we witness a constant reshuffling of prevailing theories and associated medical practices.
To draw a comparison, imagine if mathematics education restyled the Pythagorean theorem for our young students every two or three years based on the latest statistics! It is simply inconceivable.
Many authors have extensively discussed the transition from one belief system to another: the theory of humors or the notion of evil spirits being replaced by modern bacteria and viruses. However, this exchange does not entail any conceptual novelty.
Neither treatments, techniques, nor the constant reference to science have revolutionized medicine. There remains an immense void. If there is a rupture, it is confined to discourse alone. The Pasteurian revolution lies in the references to prevailing theories and the use of therapeutic practices.
Nevertheless, it does not provide irrefutable evidence of how human beings react, fall ill, and heal. There are no laws, and there are no cures either. With hindsight, we now know that Pasteur and Koch won only a few battles but certainly not the war against microbes. In reality, the long-term outcome is negative.
The problem was simply ill-posed, and the revolution remains to be accomplished. Current events prove it: we are dumbfounded and powerless as officially recognized procedures, increasingly deemed ineffective, are promoted, if not potentially mandated, accompanied by more frequent medical interventions. Those are based on more and more standardized protocols. Individuality evaporates in front of the so-called rational medicine.
Thus, there have been evolutions without revolution. The introduction of rationality into medicine has not led to better health or better protection of populations.
Rational medicine is a myth
Therefore, the transition to modern medicine has been declared. It is indeed accepted, as if by “decree,” that medicine is now scientific and rational. However, there have been no major discoveries.
By comparison, the saga of Galileo and Copernicus, as officially told, dramatically changed the face of the world. They upheaved consciousness, leveled knowledge, making any challenge or regression impossible.
The term “Copernican revolution” has passed into everyday language as a synonym for a paradigm shift. Very few dispute that the Earth revolves around the Sun or claim the freedom to think that the Sun revolves around the Earth. Reasoning in such a way does not yield practical results.
In other words, there has been no Copernicus of medicine, no indisputable tipping point towards modern medicine accompanied by equally remarkable therapeutic outcomes.
On the contrary, it is precisely because no evidence has emerged that modern medicine does not have unanimous support. The crucial difference from other fields lies in the reality of patients. As the conventional saying goes, patients prefer to be cured in a non-scientific manner rather than suffer or die rationally.
Across different times and places, there have been various ways of practicing medicine, and enough patients have found them satisfactory to demand them. In fact, the act of falling ill, the necessity of being treated, and the development of skills to do so did not await modernity.
The demands for therapeutic freedom are correlated with the dissatisfaction of both patients and physicians. While medicine is criticized, it is not for its theories but for how it treats patients and its poor outcomes in chronic disease treatments.
The propaganda of rationality.
Rationality in medicine is a myth that must be meticulously maintained to prevent its own inadequacy from being revealed. This systematic recourse to propaganda serves to solidify a semblance of rationality.
Just observe how “Science” and “Rationality” are constantly reiterated by the medical pundits. Journalistic commentators seem to have the word “charlatanism” constantly on their lips and readily wield it at the slightest opportunity. It is simply a language tool aimed at silencing any criticism.
Rational medicine, lacking strong arguments, settles for authoritarianism. But there are limits to everything. The shortcomings of rationality in medicine have monstrously manifested themselves during the saga of the coronavirus.
Defying the teachings in medical schools, patients are not treated but healthy individuals are isolated; vaccination takes place without waiting for the end of the epidemic, even among pregnant women; the elderly are relieved to the point of euthanasia.
It is enough to leave one perplexed. No self-respecting physician can accept this.
The physician comes to the aid of the patient
Modern medicine is in crisis. What justifies its alleged superiority is a power play and posturing, not significant therapeutic achievements or laws. But the modern physician is equally trapped.
They must face a significant challenge: the ability to abandon the prestige bestowed upon them by their “rational” attire—which the patient never demanded—and truly align themselves with the patient’s interests. Theoretical advancements have diverted attention and obscured the heart and purpose of the medical profession, but they have not eliminated it. It is indeed a praxis that the patient needs, certainly not a justification.
Because the patient is not participating in a scientific competition; they “only” seek relief from their suffering, the restoration of their health, and sometimes desperately seek the means to achieve it. To reassure ourselves, we must remember that focusing on the art of healing is a timeless necessity that has always inspired those who could respond to it.
They are more numerous than we think (some of the resistant ones quietly resist). The nature of the relationship that is built over time between physician and patient, which is completely excluded from the strict scientific experimental field, is an asset not to be neglected.
Conscientious and rigorous physicians have done and will continue to do what they know: welcoming the complaint and conscientiously treating patients they know, who, in turn, have maintained their trust in them.
We should never forget that by simply being taken care of, patients see their positive outcomes better by up to 30%. Called the placebo effect, this has been measured scientifically: that someone deemed to be a doctor would simply take their hand and tell them that “everything is going to be all right” can be a cure in itself.
That is why the refusal of doctors to even see their patients during the COVID crisis tells us that we have entered what could be the final phase of the so-called ‘modern medicine’: Telling patients not to come, that nothing can be done, that they have to wait until they reach a critical state to call for medicine…
This happened for the first time in the history of medicine. During the Middle Ages in Europe, there were Plague episodes during which the virus would kill 30 to 50% of the population. Despite their absolute ignorance of the causes of the disease and absence of treatment, doctors, nurses, and priests never refused to go meet their patients…
This is an important part of medicine: if the body is self-healing, then a big component of medicine is bound to non-materialistic processes. That is because our human medical intervention probably are not more than band-aid .