- Email: [email protected]
Introduction to: Heresy and orthodoxy in medical theory and research
ARTICLE IN PRESS
Social Science & Medicine 58 (2004) 671–674
Editorial
Introduction to: Heresy and orthodoxy in medical theory and research There has long been an interest in heresy and orthodoxy in medical theory and research, particularly in the development of the bio-medical model in the 19th century and the gradual exclusion of theories that did not conform to the new paradigm (Jones, 1985; Wallis, 1975). The emergence of Thomas Kuhn’s concept of paradigmatic change, combined with an increasing interest in social constructionism and postmodernism, resulted in the emergence of a number of scholars who questioned the objectivity of both medical and scientific knowledge (Kuhn, 1970). This symposium has undergone a troubled embryonic process originating long before the publication of the proceedings of the XIVth International Conference on the Social Sciences and Medicine which was held in Peebles, Scotland, 2–6 September 1996. In fact, it was at an even earlier meeting in October 1994 at the XIIIth International Conference, in Balatonfured, Hungary, that the first papers were grouped in one of the sessions. The main impetus for the continued interest in this broad theme stemmed from the enthusiasm of Professor Akile Gursoy. This collection examines a number of dimensions centering around Medical Orthodoxy and Heresy from a broad range of contributors, some with a medical training and others with a background in the social sciences. The cultural and ethnic diversity of the authors offers a rich mosaic of interpretations. Dean (2004) argues that orthodox beliefs constrain research to gain knowledge about human health and limit the effectiveness of health care services. Medical power relationships and dominant beliefs dictate the ‘‘correct’’ ways to conduct research. She examines how orthodox views about how to gain knowledge on human health have affected quantitative research investigations dealing with population health issues. The use of the whole methodological spectrum is the only course open (Scrabanek & McCormick, 1994).1
1 Scrabanek and McCormick’s work contains a brilliant disclosure of fallacies which masquerade as ‘‘scientific medicine’’. These include the Placebo Effect and the notion of ‘‘medical risk’’.
She is concerned about how we can attain correct ways of obtaining knowledge from socially constructed tenets and beliefs which are maintained by traditions developed in support of the orthodox model and by power relationships. Orthodox beliefs about health research are sustained by the dominant paradigm, including power relationships. The biomedical model functions like a traditional natural science, attempting ‘‘to isolate distinct and identifiable diseases which are causally produced by some underlying patho-physiological condition which can be isolated, verified and monitored’’ (Gillett, 1994, p. 1127). The emphasis is on the experimental manipulation of hypothesised causes, e.g., germs, genes, chemicals, or other substances that are easily isolated and monitored. The replacement of the concept of miasmas and vapours by the germ theory of disease (although these were all present together for many years) was not sufficient to explain the outbreak or course of infection in terms of micro-organisms. Health research into the immune system cannot confine itself to predictions made on a statistical effect, especially when we do not understand its more complex aspects. More often than not, the prediction is applicable only to group and not individual risk. Dean argues that the emergence of the biomedical model brought with it certain expectations as to how we are to conduct health research, including the random allocation of research subjects to experimental and control groups. However, predictions made on such a statistical basis are not sufficient to explain the causes of illness. Dean’s argument is that, when we display the weaknesses inherent in the traditional approaches or introduce new methods, we are regarded as heretical. This has the effect of reinforcing research’s determination to maintain both orthodox thinking and traditional methods rather than consider other, perhaps more valid, methods. Questioning the old ways now becomes heretical and innovation is stultified. Thus, traditional beliefs are defended, projects based on the traditional beliefs and methods are funded, and innovation is constrained, particularly in trying to understand the causal model. In this view, Engel’s (1977) plea for an effective biopsychosocial model is hindered by dysfunctional, false dichotomies which are a product of classical empiricism.
0277-9536/03/$ - see front matter r 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0277-9536(03)00218-1
ARTICLE IN PRESS 672
Editorial / Social Science & Medicine 58 (2004) 671–674
Greco (2003) discusses the concept of ‘‘scientific ideology’’ as it appears in the work of the historian and philosopher of medicine Georges Canguilhem, whose work is becoming increasingly popular in English speaking countries. Canguilhem discusses the question of legitimacy and non-legitimacy in the history of science. However, the notion of ‘‘scientific ideology’’ is more than a dichotomy between science and false science and even more than that between orthodoxy and heresy. It serves to highlight, in the first instance, the specificity of both science in general and medical science in particular. Secondly, it enables us to challenge the customary sharp contrast between science and nonscience by setting the contrast in a sequence of time. In other words, the phenomenon of such a dichotomy is situated in a historical continuum and studied through time. Canguilhem perceives ‘‘scientific ideology’’ as pertinent to the historiography and epistemology of the study of medicine and the life sciences in general. Greco reviews Canguilhem’s definition of ‘‘scientific ideology’’ in relation to the contrasting philosophies of Thomas Kuhn and Gaston Bachelard. The nature of scientific ideology arises within the practice of the history of science, says Canguilhem, and the word ‘‘traumatic’’ takes on a more significant meaning, since changes in the flow of the practice of science are experienced and interpreted as a disruption in the very nature of reason. The question, ‘‘What is a scientific ideology?’’, Canguilhem tells us, arises in the practice of the history of science and is relevant to the theory of that subject. The word traumatic is therefore significant, since these changes were experienced and interpreted as a disruption in the very order of reason, calling for a reconstruction capable of accommodating the likelihood of a new disruption sometime in the future. Consequently, any inadequacies are those of reason, and scientific progress is the rectification of these inadequacies. This is the meaning which Bachelard understands as scientific development, i.e. the progress of rationalism, and consequently the history of science is ‘‘the history of the defeats of irrationalism’’ (Bachelard, 1951, p. 27). In the history of science, there are positive and negative episodes which assume their polar positions depending on whether they are perceived as contributions or obstacles from the standpoint of the present state of knowledge/reason. The provisional nature of the truth spoken by the practitioners of contemporary science means, naturally, that the value judgment it places on historical episodes is relative and equally open to correction. However, Bachelard’s position is not that of relativism and we cannot avoid pronouncing a value judgement. It is this interpretation of his work by some social scientists that Kuhn attempts to refute. What are we therefore left with? Is it merely the preference for one paradigm over another, one ‘‘way of
life’’ rather than another, merely a matter of choice? Canguilhem takes the line that Bachelard’s epistemology is particularly suited to mathematical physics and nuclear chemistry. In the field of genetics, it was Mendel’s research into the biology of ‘‘heredity’’ that showed up the work of his predecessors as based in ‘‘ideology’’ or pseudo-science. His work in the field of genetics is not the culmination of what had preceded it but an example of a ‘‘real’’ method that the previous ideologies had, either deliberately or accidentally, ignored. Modern scientific medicine’s claim to legitimacy is based is scientific knowledge and, more specifically, in the theoretical-inductive methodology which the latter espouses. This methodology, in the historical context of the 18th century controversy over Mesmer’s assertions, decidedly ended any claim to rationality which the ‘‘charlatans’’ might possess. However, Strengers (2000) argues that modern medicine does not have a monopoly in the healing process and that a cure in itself means nothing. She correlates the ‘‘placebo effect’’ in scientific medicine as a correlate of the charlatan. Greco also applies her analysis to the history of psychosomatic medicine and psychoneuroimmunology. Adib’s (2003) contribution traces the impact of the introduction of Western biomedicine into the Islamic world in the 19th century. In the 1960s, there was a renewed interest in ‘‘Islamic medicine’’ as an alternative to the ‘‘Western’’ model. Alongside the ‘‘orthodox’’ Western concepts, Islamic medicine has introduced some herbal remedies as well as faith-healing through prayer, although the efficacy of Quranic verses in the healing process has not effectively challenged the dominance of Western health treatments within the Islamic world. In Western societies, it is difficult to separate the increase in lay participation in all levels of the decision-making process from the enormous increase in alternative medical practices. The increasing rejection of some conventional treatments has in many cases led to the biomedical model absorbing hitherto ‘‘unorthodox’’ concepts. However, in the Southern hemisphere, the offloading of the tenets of the biomedical model has taken place, and been subsumed under an imposition of European expansionist ideas, with the result that the symbolism of the biomedical model has been imposed on local health practices in the same manner as the imposition of ‘‘European Culture’’. Notwithstanding, traditional medicine, particularly Indian and Chinese, has seemingly rejected or resisted the Western model with the effect that the attention of scientists and lay people in the West has been drawn to these traditional treatments. The Ottoman Empire’s medical system declined from 1566, partly owing to the demise of the empire itself. To Islamists, the biomedical model appears unashamedly Western. The practice of
ARTICLE IN PRESS Editorial / Social Science & Medicine 58 (2004) 671–674
medicine in Islamic countries is inextricably bound up with the greater truth springing from the Coran and the Prophet’s Sayings (Hadith), the usual sources of Muslim theology and practices. Such a practice of medicine does not carry any adverse effects and may indeed be beneficial via the placebo effect. Unfortunately, such practices, not at present prohibited under Islamic law, include female circumcision and cauterisation. Islamic medicine places an emphasis on instructing Muslims on the correct and righteous attitudes to adopt whilst sick and the religious obligation attached to the sick role. Indeed, holy writ suggests that those who become sick are in no possible way responsible for their condition. Certain cures and practices are prohibited, such as medicines containing alcohol, tattooing the flesh, and having an abortion. If a patient’s illness is terminal, the injunction is not to inform them. Is modern Islamic medicine a viable alternative to the dominant biomedical model within the Islamic world? Evidence, says Adib, is difficult to come by, despite the Kuwait model of an Islamic Hospital where herbal treatments are administered wrapped in pertinent Coranic and Hadith verses. Most Islamic countries are poor, without access to classical biomedical care. In such areas, financial support has been provided to maintain the practice of reciting the holy words of Allah. Jones (2003) traces the development of the dominant biomedical model as it emerged from a number of other contenders in the 19th century. The social processes which shaped it and sustain it are no different from other social processes. In fact, there is a strong parallel in the development of religious orthodoxy with dissenting medical systems, which are based on different paradigms, being analogous to religious sects. The Galen paradigm was predominant in the field of medicine until the 16th century. The emergence of germ theory was met with a hostile reception by the Miasmatists and the two paradigms existed in uneasy tandem for some years. And yet, because a paradigm is essentially unprovable, the contest was couched in terms of a power struggle of one paradigm over another. From time to time, ideological challenges arise which run contrary to accepted doctrine. Science and medicine do not exist in a vacuum but are firmly rooted in the historical context of their day. Some of the accoutrements which medicine has acquired include power, autonomy, and control. The social construction of medical knowledge is explored using the examples of Craniometry, HIV/ AIDS measurement, and contagion and anti-contagion theories. Any claim to a special ‘‘objectivity’’ is rejected in light of the contextual nature of medical knowledge. Heresy and schism are seen as natural concomitants of socially constructed knowledge, functioning as providers of impetus and change, and as such to be welcomed as non-orthodox challenges. In a post-modern world we
673
can no longer be sustained by ‘‘legitimate’’ accounts of what is ‘‘real’’ or what is ‘‘true’’. Martin (2003) addresses a number of issues. First, the question of why orthodoxy and heresy should exist is addressed in the context of assumptions about knowledge and conflict/co-operation. Comparisons are made with orthodoxy and heresy in politics and religion. Second, some models of orthodoxy and heresy in medicine are presented. The constructivist position is noted, namely that it is also necessary to explain the success of orthodoxy when it is ‘‘right’’ and the rejection of heresy when it is ‘‘wrong’’. The usual view is that the human immunodeficiency virus, HIV, is responsible for AIDS. But for many years, a few scientists such as Duesberg (1996), Maggiore (1999), and Hodgkinson (1996) have espoused the incompatible view that HIV is harmless and is not responsible for AIDS.2 Wolpe (1990, 1994) called this sort of challenge dissent and gave the examples of Peter Duesberg and, at the collective level, doctors practising homeopathy. Martin then looks at areas in which competition over an assumed unitary truth leads to the dynamics of orthodoxy and dissent/ heresy, trying to explain the rationale for adherence to orthodoxy of heresy. It is in the area of politics and religion that he looks for examples. Methods of domination and marginalisation are discussed. Finally, strategies than can be adopted by challengers to orthodoxy, in order to gain a hearing, are presented. He offers various examples to illustrate the frameworks canvassed. Gillett’s (2003) argument is that orthodox medicine works within a positivistic framework which is often intolerant of knowledge which does not arise from within its own very limited methodological paradigm. It canonises biomedical models and theories and the statistical means by which these are tested. Alternative medicine cannot meet these standards because it is holistic and individual in its orientations toward the understanding and treatment of human illness and requires its own ‘‘testing system’’. But in fact the dominant model also has problems with surgery as a subdiscipline where individualised caring solutions are important as well as other areas in which a narrow biomedical understanding is inadequate. These predominantly include areas in which wider social and economic concerns directly impinge on health care. Thus, we need a slightly more liberal interpretation of medical knowledge and discovery than the dominant religion of the prospective randomised double-blind controlled study and its ilk. He suggests that this wider conception is more in keeping with the Hippocratic ethos as a whole and with the idea of a healing praxis. 2
There are many more joining the camp of sceptics and there are highly sophisticated web pages arguing this position of dissent.
ARTICLE IN PRESS 674
Editorial / Social Science & Medicine 58 (2004) 671–674
This is an interesting collection from a group of people drawn from an international academic community who have kept this debate ongoing through two Social Science and Medicine conferences, one in Hungary and one in Scotland. Though this Symposium has been in the making for many years, its relevance to continuing debates surrounding the issue of heresy and orthodoxy in biomedicine is clear.
References Adib, S. M. (2003). From the biomedical model to the Islamic alternative: A historical perspective on medical practices in the contemporary Arab world. Social Science & Medicine, doi:10.1016/S0277-9536(03)00221-1. Bachelard, G. (1951). L’activit!e rationaliste de la physique contemporaine. Paris: Presses Universitaires de France. Dean, K. (2003). The role of methods in maintaining orthodox beliefs in health research. Social Science & Medicine, doi:10.1016/S0277-9536(03)00219-3. Duesberg, P. (1996). Inventing the AIDS virus. Washington, DC. Gillett, G. (2003). Clinical medicine and the quest for orthodoxy. Social Science & Medicine, doi:10.1016/S02779536(03)00224-7. Greco, M. (2003). The ambivalence of error: ‘Scientific ideology’ in the history of the life sciences, and psychosomatic medicine. Social Science & Medicine, doi:10.1016/ S0277-9536(03)00220-X. Hodgkinson, N. (1996). The failure of contemporary science. London: Fourth Estate.
Jones, R. K. (1985). The development of Medicalsects. In R. K. Jones (Ed.), Sickness and sectarianism. Aldershot: Gower Press. Jones, R. K. (2003). Schism and heresy in the development of orthodox medicine: The threat to medical hegemony. Social Science & Medicine, doi:10.1016/S0277-9536(03) 00222-3. Kuhn, T. (1970). The structure of scientific revolutions. Chicago: University of Chicago Press. Maggiore, C. (1999). What if everything you thought about AIDS was wrong? (4th ed.). Studio City, CA: American Foundation for AIDS Alternatives, Regnery. Martin, B. (2003). Dissent and heresy in medicine: Models, methods, and strategies. Social Science & Medicine, doi:10.1016/S0277-9536(03)00223-5. Scrabenek, P., & McCormick, J. (1994). Follies & fallacies in Medicine. Glasgow: Tarragon Press. Strengers, I. (2000). The invention of modern science. Minneapolis, London: University of Minnesota Press. Wallis, R. (Ed.) (1975). Sectarianism: Analyse of religious and non-religious sects. London: Peter Owen. Wolpe, P. R. (1990). The holistic heresy: Strategies of ideological challenge in the medical profession. Social Science & Medicine, 31(8), 913–923. Wolpe, P. R. (1994). The dynamics of heresy in a profession. Social Science & Medicine, 39(9), 1133–1148.
R. Kenneth Jones Queen Margaret University College, Edinburgh EH 12 8TS, UK E-mail address: [email protected]
Social Science & Medicine 58 (2004) 671–674
Editorial
Introduction to: Heresy and orthodoxy in medical theory and research There has long been an interest in heresy and orthodoxy in medical theory and research, particularly in the development of the bio-medical model in the 19th century and the gradual exclusion of theories that did not conform to the new paradigm (Jones, 1985; Wallis, 1975). The emergence of Thomas Kuhn’s concept of paradigmatic change, combined with an increasing interest in social constructionism and postmodernism, resulted in the emergence of a number of scholars who questioned the objectivity of both medical and scientific knowledge (Kuhn, 1970). This symposium has undergone a troubled embryonic process originating long before the publication of the proceedings of the XIVth International Conference on the Social Sciences and Medicine which was held in Peebles, Scotland, 2–6 September 1996. In fact, it was at an even earlier meeting in October 1994 at the XIIIth International Conference, in Balatonfured, Hungary, that the first papers were grouped in one of the sessions. The main impetus for the continued interest in this broad theme stemmed from the enthusiasm of Professor Akile Gursoy. This collection examines a number of dimensions centering around Medical Orthodoxy and Heresy from a broad range of contributors, some with a medical training and others with a background in the social sciences. The cultural and ethnic diversity of the authors offers a rich mosaic of interpretations. Dean (2004) argues that orthodox beliefs constrain research to gain knowledge about human health and limit the effectiveness of health care services. Medical power relationships and dominant beliefs dictate the ‘‘correct’’ ways to conduct research. She examines how orthodox views about how to gain knowledge on human health have affected quantitative research investigations dealing with population health issues. The use of the whole methodological spectrum is the only course open (Scrabanek & McCormick, 1994).1
1 Scrabanek and McCormick’s work contains a brilliant disclosure of fallacies which masquerade as ‘‘scientific medicine’’. These include the Placebo Effect and the notion of ‘‘medical risk’’.
She is concerned about how we can attain correct ways of obtaining knowledge from socially constructed tenets and beliefs which are maintained by traditions developed in support of the orthodox model and by power relationships. Orthodox beliefs about health research are sustained by the dominant paradigm, including power relationships. The biomedical model functions like a traditional natural science, attempting ‘‘to isolate distinct and identifiable diseases which are causally produced by some underlying patho-physiological condition which can be isolated, verified and monitored’’ (Gillett, 1994, p. 1127). The emphasis is on the experimental manipulation of hypothesised causes, e.g., germs, genes, chemicals, or other substances that are easily isolated and monitored. The replacement of the concept of miasmas and vapours by the germ theory of disease (although these were all present together for many years) was not sufficient to explain the outbreak or course of infection in terms of micro-organisms. Health research into the immune system cannot confine itself to predictions made on a statistical effect, especially when we do not understand its more complex aspects. More often than not, the prediction is applicable only to group and not individual risk. Dean argues that the emergence of the biomedical model brought with it certain expectations as to how we are to conduct health research, including the random allocation of research subjects to experimental and control groups. However, predictions made on such a statistical basis are not sufficient to explain the causes of illness. Dean’s argument is that, when we display the weaknesses inherent in the traditional approaches or introduce new methods, we are regarded as heretical. This has the effect of reinforcing research’s determination to maintain both orthodox thinking and traditional methods rather than consider other, perhaps more valid, methods. Questioning the old ways now becomes heretical and innovation is stultified. Thus, traditional beliefs are defended, projects based on the traditional beliefs and methods are funded, and innovation is constrained, particularly in trying to understand the causal model. In this view, Engel’s (1977) plea for an effective biopsychosocial model is hindered by dysfunctional, false dichotomies which are a product of classical empiricism.
0277-9536/03/$ - see front matter r 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0277-9536(03)00218-1
ARTICLE IN PRESS 672
Editorial / Social Science & Medicine 58 (2004) 671–674
Greco (2003) discusses the concept of ‘‘scientific ideology’’ as it appears in the work of the historian and philosopher of medicine Georges Canguilhem, whose work is becoming increasingly popular in English speaking countries. Canguilhem discusses the question of legitimacy and non-legitimacy in the history of science. However, the notion of ‘‘scientific ideology’’ is more than a dichotomy between science and false science and even more than that between orthodoxy and heresy. It serves to highlight, in the first instance, the specificity of both science in general and medical science in particular. Secondly, it enables us to challenge the customary sharp contrast between science and nonscience by setting the contrast in a sequence of time. In other words, the phenomenon of such a dichotomy is situated in a historical continuum and studied through time. Canguilhem perceives ‘‘scientific ideology’’ as pertinent to the historiography and epistemology of the study of medicine and the life sciences in general. Greco reviews Canguilhem’s definition of ‘‘scientific ideology’’ in relation to the contrasting philosophies of Thomas Kuhn and Gaston Bachelard. The nature of scientific ideology arises within the practice of the history of science, says Canguilhem, and the word ‘‘traumatic’’ takes on a more significant meaning, since changes in the flow of the practice of science are experienced and interpreted as a disruption in the very nature of reason. The question, ‘‘What is a scientific ideology?’’, Canguilhem tells us, arises in the practice of the history of science and is relevant to the theory of that subject. The word traumatic is therefore significant, since these changes were experienced and interpreted as a disruption in the very order of reason, calling for a reconstruction capable of accommodating the likelihood of a new disruption sometime in the future. Consequently, any inadequacies are those of reason, and scientific progress is the rectification of these inadequacies. This is the meaning which Bachelard understands as scientific development, i.e. the progress of rationalism, and consequently the history of science is ‘‘the history of the defeats of irrationalism’’ (Bachelard, 1951, p. 27). In the history of science, there are positive and negative episodes which assume their polar positions depending on whether they are perceived as contributions or obstacles from the standpoint of the present state of knowledge/reason. The provisional nature of the truth spoken by the practitioners of contemporary science means, naturally, that the value judgment it places on historical episodes is relative and equally open to correction. However, Bachelard’s position is not that of relativism and we cannot avoid pronouncing a value judgement. It is this interpretation of his work by some social scientists that Kuhn attempts to refute. What are we therefore left with? Is it merely the preference for one paradigm over another, one ‘‘way of
life’’ rather than another, merely a matter of choice? Canguilhem takes the line that Bachelard’s epistemology is particularly suited to mathematical physics and nuclear chemistry. In the field of genetics, it was Mendel’s research into the biology of ‘‘heredity’’ that showed up the work of his predecessors as based in ‘‘ideology’’ or pseudo-science. His work in the field of genetics is not the culmination of what had preceded it but an example of a ‘‘real’’ method that the previous ideologies had, either deliberately or accidentally, ignored. Modern scientific medicine’s claim to legitimacy is based is scientific knowledge and, more specifically, in the theoretical-inductive methodology which the latter espouses. This methodology, in the historical context of the 18th century controversy over Mesmer’s assertions, decidedly ended any claim to rationality which the ‘‘charlatans’’ might possess. However, Strengers (2000) argues that modern medicine does not have a monopoly in the healing process and that a cure in itself means nothing. She correlates the ‘‘placebo effect’’ in scientific medicine as a correlate of the charlatan. Greco also applies her analysis to the history of psychosomatic medicine and psychoneuroimmunology. Adib’s (2003) contribution traces the impact of the introduction of Western biomedicine into the Islamic world in the 19th century. In the 1960s, there was a renewed interest in ‘‘Islamic medicine’’ as an alternative to the ‘‘Western’’ model. Alongside the ‘‘orthodox’’ Western concepts, Islamic medicine has introduced some herbal remedies as well as faith-healing through prayer, although the efficacy of Quranic verses in the healing process has not effectively challenged the dominance of Western health treatments within the Islamic world. In Western societies, it is difficult to separate the increase in lay participation in all levels of the decision-making process from the enormous increase in alternative medical practices. The increasing rejection of some conventional treatments has in many cases led to the biomedical model absorbing hitherto ‘‘unorthodox’’ concepts. However, in the Southern hemisphere, the offloading of the tenets of the biomedical model has taken place, and been subsumed under an imposition of European expansionist ideas, with the result that the symbolism of the biomedical model has been imposed on local health practices in the same manner as the imposition of ‘‘European Culture’’. Notwithstanding, traditional medicine, particularly Indian and Chinese, has seemingly rejected or resisted the Western model with the effect that the attention of scientists and lay people in the West has been drawn to these traditional treatments. The Ottoman Empire’s medical system declined from 1566, partly owing to the demise of the empire itself. To Islamists, the biomedical model appears unashamedly Western. The practice of
ARTICLE IN PRESS Editorial / Social Science & Medicine 58 (2004) 671–674
medicine in Islamic countries is inextricably bound up with the greater truth springing from the Coran and the Prophet’s Sayings (Hadith), the usual sources of Muslim theology and practices. Such a practice of medicine does not carry any adverse effects and may indeed be beneficial via the placebo effect. Unfortunately, such practices, not at present prohibited under Islamic law, include female circumcision and cauterisation. Islamic medicine places an emphasis on instructing Muslims on the correct and righteous attitudes to adopt whilst sick and the religious obligation attached to the sick role. Indeed, holy writ suggests that those who become sick are in no possible way responsible for their condition. Certain cures and practices are prohibited, such as medicines containing alcohol, tattooing the flesh, and having an abortion. If a patient’s illness is terminal, the injunction is not to inform them. Is modern Islamic medicine a viable alternative to the dominant biomedical model within the Islamic world? Evidence, says Adib, is difficult to come by, despite the Kuwait model of an Islamic Hospital where herbal treatments are administered wrapped in pertinent Coranic and Hadith verses. Most Islamic countries are poor, without access to classical biomedical care. In such areas, financial support has been provided to maintain the practice of reciting the holy words of Allah. Jones (2003) traces the development of the dominant biomedical model as it emerged from a number of other contenders in the 19th century. The social processes which shaped it and sustain it are no different from other social processes. In fact, there is a strong parallel in the development of religious orthodoxy with dissenting medical systems, which are based on different paradigms, being analogous to religious sects. The Galen paradigm was predominant in the field of medicine until the 16th century. The emergence of germ theory was met with a hostile reception by the Miasmatists and the two paradigms existed in uneasy tandem for some years. And yet, because a paradigm is essentially unprovable, the contest was couched in terms of a power struggle of one paradigm over another. From time to time, ideological challenges arise which run contrary to accepted doctrine. Science and medicine do not exist in a vacuum but are firmly rooted in the historical context of their day. Some of the accoutrements which medicine has acquired include power, autonomy, and control. The social construction of medical knowledge is explored using the examples of Craniometry, HIV/ AIDS measurement, and contagion and anti-contagion theories. Any claim to a special ‘‘objectivity’’ is rejected in light of the contextual nature of medical knowledge. Heresy and schism are seen as natural concomitants of socially constructed knowledge, functioning as providers of impetus and change, and as such to be welcomed as non-orthodox challenges. In a post-modern world we
673
can no longer be sustained by ‘‘legitimate’’ accounts of what is ‘‘real’’ or what is ‘‘true’’. Martin (2003) addresses a number of issues. First, the question of why orthodoxy and heresy should exist is addressed in the context of assumptions about knowledge and conflict/co-operation. Comparisons are made with orthodoxy and heresy in politics and religion. Second, some models of orthodoxy and heresy in medicine are presented. The constructivist position is noted, namely that it is also necessary to explain the success of orthodoxy when it is ‘‘right’’ and the rejection of heresy when it is ‘‘wrong’’. The usual view is that the human immunodeficiency virus, HIV, is responsible for AIDS. But for many years, a few scientists such as Duesberg (1996), Maggiore (1999), and Hodgkinson (1996) have espoused the incompatible view that HIV is harmless and is not responsible for AIDS.2 Wolpe (1990, 1994) called this sort of challenge dissent and gave the examples of Peter Duesberg and, at the collective level, doctors practising homeopathy. Martin then looks at areas in which competition over an assumed unitary truth leads to the dynamics of orthodoxy and dissent/ heresy, trying to explain the rationale for adherence to orthodoxy of heresy. It is in the area of politics and religion that he looks for examples. Methods of domination and marginalisation are discussed. Finally, strategies than can be adopted by challengers to orthodoxy, in order to gain a hearing, are presented. He offers various examples to illustrate the frameworks canvassed. Gillett’s (2003) argument is that orthodox medicine works within a positivistic framework which is often intolerant of knowledge which does not arise from within its own very limited methodological paradigm. It canonises biomedical models and theories and the statistical means by which these are tested. Alternative medicine cannot meet these standards because it is holistic and individual in its orientations toward the understanding and treatment of human illness and requires its own ‘‘testing system’’. But in fact the dominant model also has problems with surgery as a subdiscipline where individualised caring solutions are important as well as other areas in which a narrow biomedical understanding is inadequate. These predominantly include areas in which wider social and economic concerns directly impinge on health care. Thus, we need a slightly more liberal interpretation of medical knowledge and discovery than the dominant religion of the prospective randomised double-blind controlled study and its ilk. He suggests that this wider conception is more in keeping with the Hippocratic ethos as a whole and with the idea of a healing praxis. 2
There are many more joining the camp of sceptics and there are highly sophisticated web pages arguing this position of dissent.
ARTICLE IN PRESS 674
Editorial / Social Science & Medicine 58 (2004) 671–674
This is an interesting collection from a group of people drawn from an international academic community who have kept this debate ongoing through two Social Science and Medicine conferences, one in Hungary and one in Scotland. Though this Symposium has been in the making for many years, its relevance to continuing debates surrounding the issue of heresy and orthodoxy in biomedicine is clear.
References Adib, S. M. (2003). From the biomedical model to the Islamic alternative: A historical perspective on medical practices in the contemporary Arab world. Social Science & Medicine, doi:10.1016/S0277-9536(03)00221-1. Bachelard, G. (1951). L’activit!e rationaliste de la physique contemporaine. Paris: Presses Universitaires de France. Dean, K. (2003). The role of methods in maintaining orthodox beliefs in health research. Social Science & Medicine, doi:10.1016/S0277-9536(03)00219-3. Duesberg, P. (1996). Inventing the AIDS virus. Washington, DC. Gillett, G. (2003). Clinical medicine and the quest for orthodoxy. Social Science & Medicine, doi:10.1016/S02779536(03)00224-7. Greco, M. (2003). The ambivalence of error: ‘Scientific ideology’ in the history of the life sciences, and psychosomatic medicine. Social Science & Medicine, doi:10.1016/ S0277-9536(03)00220-X. Hodgkinson, N. (1996). The failure of contemporary science. London: Fourth Estate.
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R. Kenneth Jones Queen Margaret University College, Edinburgh EH 12 8TS, UK E-mail address: [email protected]