*This article is excerpted from the Foreword of Dr. Prioreschi's latest volume (Vol. III --- Roman Medicine) of his A History of Medicine, released this year.(1)
In the Foreword of the second volume of our work, A History of Medicine, we expressed the hope that the Foreword of the third would deal with more inspiring themes. Alas, this is not to be. In the last four years we have found no improvement in the academic landscape in general and in historiography of medicine in particular. In fact, the signs of decay in our society are increasingly visible in all fields. In view of the nature of this book, we will limit our observations to medical education and medical historiography.
Perhaps nothing is more symptomatic of the decaying of medical education than the status of the Oath of Hippocrates. In the Western world, the Oath, for centuries, was recited by medical students at graduation although, in recent times, many universities dropped it. In the late sixties, the students at Johns Hopkins asked that the old tradition be revived to give solemnity to the ceremony. Accordingly, in 1968 the graduating class recited the Oath. It was felt, however, that the text had to be changed to accommodate a modern world view. As a consequence, the traditional invocation to pagan gods was eliminated together with the reference to lifetime bond with the teachers. At this point, members of the faculty (of the faculty!) rose in arms, because the passage against abortion was not eliminated as well. Subsequent classes therefore recited an Oath that was further amended by the abolition of the clause proscribing abortion as well as that against the cutting of the stone. Once the game to attune the Oath to modern times was in motion, other amendments followed.(2) And so Johns Hopkins' well-meaning dwellers of academia pursued an updating and improving process similar to one that would replace the sling of Michelangelo's David with an assault rifle and his clothing with combat fatigues. The Hippocratic Oath now recited at Johns Hopkins is hardly recognizable.(3)
One would think this "improving" of the Oath of Hippocrates was a phenomenon caused by an aberration of judgment localized in time and place. Not so. Harvard's medical students decided to go even further and, with a display of sophomoric silliness (mercifully this was not suggested by the faculty), decided to re-write the Oath. In other words, it was not a question of updating the David, it was decided that the hopeless hulk should be replaced with the inspired production of a student committee. The result is something to behold. Perhaps the most valuable pearl deals with clear priorities unambiguously stated: "To serve others most effectively, I must maintain my own well-being." This was in the 1989 version. Perhaps somebody objected that "well-being" might be construed as a crass mercenary consideration, for in the 1994 version that sentence was replaced with the following one: "I assume these responsibilities knowing that their fulfillment depends on my own good health."(4) Other medical schools have of course followed suit and the Oath of Hippocrates is constantly being improved upon.(5)
When the Oath of Hippocrates has not been modernized it has been discarded altogether. Today's young physician has new and better beacons. It is just a coincidence, no doubt, that in the same number of the journal reporting the improvements on the Oath of Hippocrates discussed above, there was an article in which it was reported that 20 percent of the applicants for the Emergency Residency Program at the University of California at Los Angeles who claimed to have published articles or abstracts falsified their record, that 30 percent of the applicants to the gastroenterology fellowship at the University of Pittsburgh cheated concerning their publication credentials, and that those applying to the infectious diseases fellowship did the same.(6)
Indeed mala tempora currunt.
In the meantime, historians of medicine, in a desperate search for something new and original to say, rehash vacuous concepts, like doubts on medical progress and "whiggish"(7) historiography, that were so much à la mode a few years ago.(8) Here is a new and improved view of medicine and medical progress:
The historian's [of medicine] task, once these possibilities [namely that "the historical record is not just a story of progress" and that "there has been a successful struggle within human history against disease and death, but that medicine's part in that struggle has been marginal"] have been included, becomes complicated; the idea of progress can seem more a fantasy than reality..."Progress" begins to look too simple a story...needing to be examined with skepticism...To call into question a simple idea of progress...can sometimes be seen as doubting the purposes and longings of medicine itself, out of an unhappy combination of ignorance and spite.(9)
Even if we forget about any "unhappy combination," it is evident that the author misunderstands what scientific progress is. Also, without elaborating this point, I just want to point out that even if, as the author asserts, medicine's part in the "struggle against disease and death" had been marginal (an assertion that could be challenged), if he ever needed an operation for, let us say, a perforated ulcer, he would most probably prefer to have it done in a contemporary operating room (full of those doctors and machines that have contributed so little in the "struggle against disease and death") than in a good old medicatrina.
One of the fascinating characteristics of our time is that no matter how preposterous the latest view accepted by the cognoscenti is, sooner or later it will be followed by an even more absurd one. Every time one is tempted to feel we have reached the limit that a society can tolerate while maintaining its seriousness, a new incredible position is not only taken seriously by the same cognoscenti but is often implemented by officialdom as well. All this with an air of seriousness and with a feeling of accomplishment that is truly bewildering.
Until now, much of what is called contemporary art was an example of the above (the approval of officialdom shown by grants to artists); most recently, however, the process seems to have invaded a field that one might have considered impervious: science.
I quote here from my presentation as an invited speaker at the Congress of the European Society for Philosophy of Medicine and Health Care on the island of Cos in September 1995:
As we all know, science transcends national and cultural boundaries and, as a truly multicultural endeavor, is based on contributions from men and women of all races, creeds, and national origins. In addition, science, alone among human undertakings, shows an astounding characteristic: the capacity for continuous progress; the poetry of Dante may not be more beautiful than that of Homer, but there is no doubt that we know more astronomy than Aristarchus. Science alone, among human endeavors, builds on past achievements and generates more and more knowledge, more and more discoveries, more and more technical improvements in a progressive and seemingly unending fashion. Medicine, as a science, participates in this progress and humanity is the beneficiary of our improved capacity to combat diseases.
We are all so familiar with the progress of science and technology, including medicine, that it would be pointless for me to enumerate even the most dramatic aspects of it. Yet...incredible as it may sound, these facts have been challenged, these evident truths have been declared falsehoods. The existence of scientific progress has been rejected, the objectivity of science denied...and even ridiculed. And this not in pub gatherings where, after a few glasses, minds may become foggy, but in exalted intellectual circles, in those respected bastions of knowledge of Western Civilization that we call universities, in our scholarly meetings, in our academic journals.
The existence of the phenomenon is well recognized. The letter of invitation to the Nobel Conference held at the Gustavus Adolphus College in Minnesota in 1989, contained the following reference to the problem:
As we study our world today, there is an uneasy feeling that we have come to the end of science, that science, as a unified, universal, objective endeavor, is over...We have begun to think of science as a more subjective and relativistic project, operating out of and under the influence of social ideologies and attitudes --- Marxism and feminism, for example. This leads to grave epistemological concerns. If science does not speak about extra-historical, external, universal laws, but is instead social, temporal and local, then there is no way of speaking of something real behind science that science merely reflects.(10)
Another letter of invitation, this one for a conference held in December 1991 at the Massachusetts Institute of Technology under the title "Progress: An Idea and Belief in Crisis," stated that "the idea of progress" is predicated on the belief in reason and material advancement. The value and validity of both of these have now been seriously called into question. It is this situation that has produced a crisis in belief.(11)
This crisis is the result of a now fashionable notion that is held in some intellectual circles, namely that science is not what we believe it is, that is, the objective, severe, investigation of the physical world, but is instead an arbitrary construct made up by the whims (usually despicable) of the individual scientist. This idea is a centerpiece of postmodernism,(12) a movement that claims that the scientific paradigms of Western Civilization...are obsolete and that new and improved paradigms (based on multiculturalism, feminism, Afrocentrism, etc.) should take their place.
The movement has acquired stature and reputation in certain university circles and it is accompanied by a large body of literature that is often taken seriously although written by authors who have no idea of the subject that they are discussing. Gross and Levitt, in their book Higher Superstition, note:
Thus we encounter books that pontificate about the intellectual crisis of contemporary physics, whose authors have never troubled themselves with a simple problem in statics; essays that make knowing references to chaos theory, from writers who could not recognize, much less solve, a first-order linear differential equation; tirades about the semiotic tyranny of DNA and molecular biology, from scholars who have never been inside a real laboratory, or asked how the drug they take lowers their blood pressure.(13)
For those who consider postmodernism a new and improved intellectual insight, science is culturally determined, that is to say, its discoveries do not reflect external reality but the prejudices, beliefs and biases of a given culture at a given time. As a consequence, the Second Law of Thermodynamics has no more cognitive value than the latest fashion in clothing and, in general, science is not more valid than any other construct, that is to say, astrology is as valid as astronomy, alchemy as chemistry, witchcraft as medicine.
It is difficult to believe that, for example, in one of our leading journals of the history of science, we can find a recent article (written by invitation), that contains the following:
[The Greek tradition] excludes...[the] sciences of astrology, divination, magic, and other so-called superstitions...[according to] my definition of science...astrology and certain "learned" forms of divination, magic, alchemy, and so on are "sciences..." It pains me to hear some scientists, who have not considered seriously the subject, denounce astrology as "unscientific" when all that they mean is that it does not agree with their ideas about the way the universe functions and does not adhere to their concept of a correct methodology.(14)
In the meantime, in the field of history of medicine, the elementary mistake of confusing medical science with heath care delivery is repeatedly made and prominent members in the field, no longer interested in how medical science developed, approve only of the study of how social forces impinge on medicine. As a result, among historians of medicine, the fashion today is to ask such questions as "What is the character of the relationship [between doctor and patient] in terms of social class and power? Who controls whom?"(15) It is evident that although the historical study of the relation between doctor and patient (and other socio-cultural topics) is of interest, it should not replace, let alone be confused with, the study of the history of medical science itself.
While individuals oscillate between silliness and confusion, the government of the United Sates has made a valiant effort and taken definite steps to be on the side of silliness: in 1992, the Congress of the United States established the Office of Alternative Medicine (OAM) at the National Institute of Health (NIH) with a budget of $2 million, which, in 1994, was raised to $3.5 million and to $6 million in 1995.(16) Among the officially stated goals of the OAM we find the study of:
Structural manipulations and energetic therapies. Examples are acupressure...reflexology, rolfing, therapeutic touch, Qi Gong.(17)
Acupressure must be something like acupuncture without the discomfort of the puncture; reflexology must be a new and improved medical science based on reflexes; therapeutic touch is a democratic version of the imposition of hands: instead of relying on the healing power of the king it utilizes the healing power of anybody who taps "human energy fields," whatever they may be; Qi Gong must be an oriental medical paradigm; and I don't know what rolfing is. Some of the grants announced by OAM for 1994 were for the following purposes: therapy of cystic fibrosis by dance, treatment of Parkinson's disease by Ayurvedic herbals, and treatment of drug abuse by prayer.(18)
Indeed, a mindless new notion of what science is all about seems to have reached government bodies. Most recently, the State of New Jersey's "New Jersey Project" includes a "guideline" for the improvement of the curriculum in higher education. The guideline explains that "much previous scholarship has offered a white, male, Eurocentric, heterosexist, and elite view of reality," and, citing the words of a feminist historian of science, states that male scientists violate nature as if it were a helpless female in the clutches of a violent male:
Nature was female, and knowledge was created as an act of aggression --- a passive nature had to be interrogated, unclothed, penetrated, and compelled by man to reveal her secrets.(19)
It must be underlined, ladies and gentlemen, that this document emanates from an official government agency. Possibly that government was inspired by the pronouncement of a noted American philosopher of science who thinks that Newton's work on mechanics reflects patriarchal, exploitative Western thinking, and therefore should be called "Newton's Rape Manual."(20)
If this kind of thinking --- let us call it that --- were all concentrated in the United States all this would be a joke at the expense of "those naive Yankees." However this is not the case; this disease affects not an isolated country but Western Civilization. Here are examples from England and France. In a two-volume cooperative work associated with a prestigious English institute of history of medicine and entitled "Companion Encyclopedia of the History of Medicine," we find:
In the biomedical definition [that is, in Western medicine], nature is physical...Thus special place is given to the role of seeing...which continues a powerful influence of ancient Greek culture...The psychological, social and moral are [considered] only so many superficial layers of epiphenomenal cover...This radically reductionistic and positivistic value orientation is ultimately dehumanizing.(21)
The author is right in the first part of the quotation. Indeed, in the Greek tradition, nature is physical; indeed, in the Greek tradition, in examining the patient, we consider it very important to see (and, he could have added, to palpate, to auscultate, to test, to measure); indeed, in the Greek tradition, we do not recite incantations, we do not perform dances, we do not try to propitiate the spirits or the gods. In the second part of the quotation, however, the author obviously confuses medical science with health care delivery and, as he finds the latter wanting (with some justification, perhaps), he comes to the conclusion that the objective, empirical approach to disease, one of the great achievements in the history of medicine, is dehumanizing!
And then in a book written by two sociologists, one belonging to French and the other to English academia, we have the assertion, made in all seriousness, that "scientific activity comprises the construction and sustenance of fictional accounts..." and that the "production of papers is acknowledged by [scientists]...as the main objective of their activity."(22) In addition, one of the two authors, a sociologist, in an incredible article in which he presumes to analyze Einstein's theory of relativity, writes:
[Einstein's] obsession with transporting information through transformation without deformation; his passion for the precise superimposition of reading; his panic at the idea that observers sent away might betray, may retain privileges, and send reports that could not be used to expand our knowledge; his desire to discipline the delegated observers and to turn them into dependent pieces of apparatus that do nothing but watch the coincidence of hands and notches; even his readiness to jettison what common sense cherishes provided the equivalence of all metrological chains saved.(23)
After such elegant and profound prose, you may also be interested in knowing that, in the same paper, the analysis of the text of Einstein's Relativity, the Special and the General Theory, is said to show that the book "could well be titled: New instructions for bringing back long-distance scientific travelers."
Einstein seems to be one of the main targets of the postmodernists who seem to be bent on a mission to correct his "mistakes." In case you believe that the velocity of light is a universal constant you must realize that, on this point, Einstein stands corrected by Derrida:
The Einsteinian constant [i.e., the speed of light] is not a constant, not a center. It is the very concept of variability --- it is, finally, the concept of the game. In other words, it is not the concept of some thing --- of a center from which an observer could master the field --- but the very concept of the game.(24)
It is incredible that such intellectual inanity should be taken seriously.
If we wanted to continue with European examples, we could also quote from Foucault, Lyotard, Baudrillard, and other enfants terribles of postmodernism. I am sure examples from other Western countries could be found. The few mentioned are, in fact, chosen from a multitude and are only a few moans of an asinine wind blowing on our cultural ramparts. How strong is this wind? Will it become a hurricane and destroy our civilization and our science, which, rooted in Greek paradigms, have risen to such heights? Undoubtedly postmodernism, as many "isms" that have come and gone before, will also disappear like a cloud that blots the sun only for a short period. The worry is how much damage it may do in the meantime.
The stated goal of the postmodernists is to create a new science, their own science (free from the shackles of Eurocentric, paternalistic, sexist, and racist tradition). This idea of a new, improved, and easier science has a striking similarity to that of the "Cargo Cults."(25) These, as you may remember, were practices that developed in some Pacific islands especially after Second World War. The aborigines observed that the soldiers of the belligerent armies could bring cargo planes and ships full of all kinds of food and marvelous machinery simply by sitting in front of some special boxes that they called radios and by talking into them. After the war, soldiers, radios, and cargos disappeared but the aborigines thought that they would build their own boxes that would call the goods in. They built airstrips and warehouses,(26) took cardboard containers, applied to them knobs and paper dials, sat in front of them and talked into them. Cargo did not come. Similarly, having noticed the extraordinary results achieved by science, the postmodernists, multiculturalists, etc. have decided that all that they have to do is go through scientific motions and the results will come. Scientific results, like the cargo planes of the Cargo Cults, will not materialize.(27)
An element that seems to have contributed to the pathogenesis of postmodernism is sensus culpae, a feeling of guilt. This is not the first time in history, of course, in which some individuals, laboring under a feeling of guilt, have tried to escape into dreams in which a condemnation of human activities, seen as sins, was the main theme. In the Middle Ages those individuals were called flagellantes. Marching in grim processions they lashed themselves for the sins of their society and of the Classical World. They were eventually overcome by the light of the Renaissance, which, once again, brought to bear the paradigms of Greece.
The flagellantes are among us again,(28) they want to atone for the sins of Western Civilization. Its most serious sin, according to these latter day flagellantes, is science because science is knowledge and knowledge is associated with power, and this, they insist, is an attribute of a paternalistic, sexist, Eurocentric, etc., society. We must be sure that this movement toward medieval obscurantism does not grow further to produce serious damage to science and to our heritage...
It would appear that we are slipping backward into the pre-scientific era, toward the unexplained and the mysterious, toward alchemy and astrology, toward a world where the rigors of science are rejected in favor of knowledge identified with belief rather than empirical observation, in other words, toward the obscurantism that the Scientific Revolution, we thought, had forever left behind.
1. Prioreschi P. A History of Medicine, Volume III, Roman Medicine, Omaha, Horatius Press, 1998.
2. McHugh P. R. "Hippocrates à la mode," Nature Medicine, II, v, 507-509, 1996.
3. For the latest version, see: Paul R. McHugh, "Hippocrates à la mode," Nature Medicine, II, v, 507-509, 1996.
4. McHugh P.R. "Hippocrates à la mode," Nature Medicine, II, v, 507-509, 1996.
5. Our medical school also has decided to upgrade the Oath. No input from faculty was needed: it is to be assumed that some administrator did it with no problems at all. The results are there to be seen.
6. Kedar I. "Medical students lie to get ahead," Nature Medicine, II, v, 505, 1996.
7. A reference to the English and American political parties of the eighteenth and nineteenth centuries and used, in the context, with the contemptuous meaning of "conservative," "old-fashioned," "outdated," and such.
8. See, for example, Guenter B. Risse, "The History of Therapeutics," in: Essays in the History of Therapeutics, edited by W. F. Bynum and V. Nutton, Amsterdam, Rodopi, 1991, pp. 3-11.
9. Neve M. "Conclusion," in: Lawrence I. Conrad, Michael Neve, et al., The Western Medical Tradition: 800 BC to AD 1800, Cambridge, Cambridge University Press, 1995, pp. 477- 478.
10. Quoted by: Gerald Holton, Science and Anti-Science, Cambridge, Harvard University Press, 1993, pp. 142-143.
11. Quoted by: Gerald Holton, Science and Anti-Science, Cambridge, Harvard University Press, 1993, p. 143.
12. Under the general label of "postmodernism" we lump all the "isms" that, in various measure, claim that the intellectual paradigms of Western Civilization are not valid: cultural constructivism, deconstructionism, multiculturalism, perspectivism, radical feminism, radical environmentalism, etc.
13. Gross P.R. and Levitt N. Higher Superstition, Baltimore, The Johns Hopkins University Press, 1994, p. 6.
14. Pingree D. "Hellenophilia versus the History of Science," Isis, LXXXIII, 554-563, 1992.
15. Risse G.B. "The History of Therapeutics," in: Essays in the History of Therapeutics, edited by W. F. Bynum and V. Nutton, Amsterdam, Rodopi, 1991, pp. 3-11.
16. Marshal E. "The Politics of Alternative Medicine," Science, CCLXV, 2000-2002, 1994.
17. "Exploratory Grants for Alternative Medicine," NIH Guide, XXII, 12, March 26, 1993.
18. The Scientist, VIII, 5, March 7, 1994, p. 1.
19. The Wall Street Journal, July 10, 1995, p. A12.
20. Holden C. "Reason Under Fire," Science, CCLXVIII, 1853, 30 June 1995.
21. Kleinman A. "What is specific to Western Medicine?" in: Companion Encyclopedia of the History of Medicine, edited by W. F. Bynum and Roy Porter, London, Rutledge, 2 vols, 1993, I, p. 18.
22. Latour B. and Woolgar S. Laboratory Life: The Social Construction of Scientific Facts, London, Sage, 1979, pp. 71, 235.
23. Latour B. "A Relativistic Account of Einstein's Relativity," Social Studies of Science, XVIII, 3-44, 1988.
24. Derrida J. "Structure, Sign, and Play in the Discourse of the Human Sciences," 267. Quoted in: Paul R. Gross and Norman Levitt, Higher Superstition, Baltimore, The Johns Hopkins University Press, 1994, p. 79.
25. Gross P.R. and Levitt N. Higher Superstition, Baltimore, The Johns Hopkins University Press, 1994, pp. 40-41.
26. "Cargo Cults," in Encyclopaedia Britannica, 1971.
27. It is of interest that the wickedness of the "European" is considered a datum both in cargo cults and in postmodernism. See: "Cargo Cults," in Encyclopaedia Britannica, 1971.
28. See: P. Prioreschi and T. Coffey, "De Metu et Culpa," Vox Latina, XXIII, 360-361, 1987; Paul R. Gross and Norman Levitt, Higher Superstition, Baltimore, The Johns Hopkins University Press, 1994, p. 161.
Dr. Prioreschi is a Professor of Pharmacology and an Assistant Professor of Medicine at Creighton University in Omaha, Nebraska, and the author of History of Medicine (Omaha, Nebraska, Horatius Press, 1995.) His address is Creighton University, School of Medicine, Department of Pharmacology, Division of History of Medicine, California Plaza, Omaha, NE 68178-0001.
Originally published in the Medical Sentinel 1998;3(5):179-183. Copyright ©1998 Association of American Physicians and Surgeons.