Copy of Dr. Robert Herwick’s ‘The Limitations of Medical Science in the Solution of Social Problems
I have reproduced this essay by Dr. Robert Herwick, posting it here on the Goodshare.org website, … for its concise and informative comparison of the historical development of two contrasting ways of conceiving of medicine; i.e. the Hygiean view of medicine with its orientation to the cultivating the sustaining of balance and harmony, and the Aesculapian view of medicine with its orientation to the eliminating of ‘attacking pathogens’.
To a large degree, these two approaches parallel the split in physics with the Hygiean view corresponding to modern physics and the Aesculapian view corresponding to Newtonian physics. While the ‘field’ view of modern physics invokes a 4+ dimensional reality, the ‘material’ view of Newtonian physics invokes a reality constrained to 3 dimensions.
While the Aesculapian approach has become dominant in Western culture (along with Newtonian physics) because of its rapid action results (killing evil agents aka ‘pathogens’ can sometimes be done much more expeditiously than re-establishing balance and harmony ‘relationally’). If the system being ‘healed’ is NOT fully ‘independent’ of ‘other systems’ (if the system is in reality a web of relational interdependences, healing the (perceived as) individual system will constitute ‘suboptimization’. In this case, ‘health’ will only have meaning in regard to the overall suprasystem which is in reality NOT A THING-IN-ITSELF but a web of relational interdependencies, and the notion of ‘the correct/healthy functioning of an ‘independent system’ will not be meaningful. In other words, if humans are innately relational ‘humanings’ within the transforming relational continuum, optimizing the health of humans cannot be achieved out of the context of the health of the transforming relational continuum (e.g. the ecosystem) the humaning is included in. What is at play here is our ability to conceive of reality in a dimensionality that is greater than that of 3 dimensional objects in 3 dimensional space.
[Note: The use of the verb ‘humaning’ in place of the noun ‘human’ is, as with the use of ‘duning’ in place of ‘dune’, for consistency with modern physics (and Taoism) wherein nature’s forms are understood NOT as in intellectual-grammatical abstraction as ‘independently-existing things-in-themselves’, but as in our sensory experience, as relational forms in the transforming relational continuum aka wave-field. Herwick might have also made reference to the Peacemaker myth of the Iroquois where the peacemaker, Dekanawideh, does not seek to overthrow or exterminate the evil (pathogen) Adodarho, but to meet and find re-conciliatory harmony through mutually influencing relational transformation (through dimensional augmentation of the microbiome) that subsumes polarized tensions). Finding the hidden harmony in opposites is also Heraclitus’ theme (the mystery of the bow and the lyre wherein tensions are resolved through harmony; i.e. a melting and transcending of 3 dimensional figure and ground separation). That is, 3 D object based imagery of Western culture’s Aesculapian orientation that seeks to ‘identify and eliminate the pathogen’ is not the only metaphor available for addressing ‘dis-ease’ and certainly not an apt one where reality is the transforming relational continuum rather than the ‘injured and needing-to-be-healed’ ‘independent organism-in-itself’. An alternative is the 4 dimensional understanding as in duning where figure and ground are in a BOTH/AND rather than EITHER/OR relationship.
Allopathic social justice may seek to eliminate a Jean Valjean and/or a Robin Hood on the basis of their ‘pathogenic actions’ even though such actions will be seen, in the more comprehensive relational sense, as balance-restoring actions. When one is driving if a heavy traffic flow, avoiding developing congestive and conflict prone relational configurations can source one’s movements, such a source (where one puts one’s movement in the service of cultivating relational harmony) is external to the acting agent. If the re balancing attempt fails and a collision ensues, an individual that has put his movements in the service of trying to re cultivate harmony may be inappropriately identified as the source of a collision. It is ‘natural’ for people’s actions to be induced in the service of dissolving or nulling out a conflict-in-the-making. Such ‘selfless’ acts are ‘real’ and contribute to sustaining harmonious relational dynamics, however, since they do not associate with any explicit locally sourced ‘events’ they do not ‘go on record’. Relational dynamics can not only nonlocally dissolve imminent conflict, relational dynamics can nonlocally precipitate conflict (e.g. the dog that darts across the busy freeway and induces a long wave of braking and swerving that finally triggers a collision far from the incident, a nonlocal dynamic that will be reduced to ‘local’ terms of an identified perpetrator and victim.
Similarly, the perceived ‘vicious pathogen’ (e.g. clostridium difficile) may in Western medical science induce the bringing on of all manner of (anti-pathogen/anti-biotic) resources in pursuit of its elimination, but the single-minded focus on pathogen elimination may distract from the deeper reality that these so-called ‘pathogens’ are called into action by the ‘need’ to resolve relational imbalance. The real root source of the malady; i.e. relational imbalance, may ‘drop off the radar screen’ as ‘pathogen elimination’ takes over centre stage, as in the case of Jean Valjean, Robin Hood and c. difficile, all of which are acting only in the service of filling in for something that has gone missing. (i.e. the ‘excluded medium’ in EITHER/OR logic that is missing the ‘included medium’ of BOTH/AND logic). ‘Producer-product logic’ of ‘identifying the perpetrator’ will be hung like an Albatross around the neck of the first driver that is unsuccessful in avoiding the long chain of chaos triggered by a stray dog darting across the freeway. David Bohm’s example of ambiguity as to the source of the death of Lincoln also comes to mind.
The EITHER/OR reality of Western culture also has us thinking in such terms as ‘the birth of a new island’ (Surtsey).
The relation between BOTH/AND and EITHER/OR logic corresponds with the relationship between transformation and ‘Creation’; e.g; for the Western mind, ‘Surtsey’ is conceived in the intellect as the ‘birth’ of a new island entity rather than as our sensory experience would inform us is the manifesting of relational transformation;
Surtsey, a volcanic island approximately 32 km from the south coast of Iceland, is a new island formed by volcanic eruptions that took place from 1963 to 1967. It is all the more outstanding for having been protected since its birth, providing the world with a pristine natural laboratory. Free from human interference, Surtsey has been producing unique long-term information on the colonisation process of new land by plant and animal life. Since they began studying the island in 1964, scientists have observed the arrival of seeds carried by ocean currents, the appearance of moulds, bacteria and fungi, followed in 1965 by the first vascular plant, of which there were 10 species by the end of the first decade. By 2004, they numbered 60 together with 75 bryophytes, 71 lichens and 24 fungi. Eighty-nine species of birds have been recorded on Surtsey, 57 of which breed elsewhere in Iceland. The 141 ha. island is also home to 335 species of invertebrates.
This way of thinking; i.e. thinking in terms of the ‘birth’ of something has a simple inverse which, rather than something ‘coming into existence’ is something ‘passing out of existence’. These two abstract concepts expose the limitations of 3-D reality. Meanwhile our sensory experiencing of inclusion in the Tao is not limited by 3-dimensional geometry as Mach and others have pointed out. Therefore, there is no need to ‘dumb down’ relational transformation and speak of ‘the birth of a new entity called ‘Surtsey”, … we can instead acknowledge that the relational space we are included in (aka ‘the Tao’) is a relational space that is itself continually transforming. IT IS NOT A 3-DIMENSIONAL SPACE THAT IS GIVING BIRTH TO NEW ONTOLOGICAL 3-DIMENSIONAL ENTITIES AND EXPERIENCING THE EXTINCTION OF EXISTING 3-DIMENSIONAL ENTITIES. THERE IS ONLY A TRANSFORMING RELATIONAL CONTINUUM. The abstract concepts of ‘the birth of Surtsey and/or the ‘death’ of Atlantis are to do with the intellectual impact of our 3-D space name-labelling administration and NOT to do with the relational transformation of our actual sensual experience. In effect, there is no such thing as ‘Surtsey’-the-birth-of-an-island, there is only relational transformation.
In the essay, Herwick seems to capitulate to the excellent results of the pathogen elimination approach of Aesculapian medicine. However, such ‘apparently excellent results’ as measured in terms of ‘the eliminating of pathogens’, may show up very differently where one backs out of the language and grammar based ‘double error’ reality and understands reality, instead, in terms of the transforming relational continuum where there is no such thing as a ‘pathogen’ or ‘pathogen elimination’, these being the abstract artifacts of the ‘double error’ of language and grammar. Constructing reality with 3-D objects in 3-D space forces us to explain change in terms of the ‘birth’ and ‘death’ of 3D objects which has been intellectually/psychologically ‘concretized’ by language and grammar, holding at bey the sensory-experience affirmed reality of wave-field (resonance) based relational transformation.
Western medicine and Western politics are a major bastion of support for the 3-D figure-and-ground ‘dumb-down’ which rewards the perceived ‘sorcerers’ of good actions and developments and punishes the perceived ‘sorcerers’ of bad actions and developments whether microbes or men. Meanwhile, there is no ‘sorcery’ in a transforming relational continuum.
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Herwick, Dr. R., ‘THE LIMITATIONS OF MEDICAL SCIENCE IN THE SOLUTION OF SOCIAL PROBLEMS’
Conference sponsored by The Institute for Theological Encounter with Science and Technology (ITEST) in cooperation with The National Aeronautics and Space Administration (NASA) March 12, 1977 The Ames Research Center, Moffett Field, California The Goddard Space Flight Center, Greenbelt, Maryland The Lewis Research Center, Cleveland, Ohio)
Dr. Robert Herwick, M.D. is presently in private practice in San Francisco. He is also on the clinical faculty at the University of California, Childrens Hospital and St. Joseph’s Hospital in San Francisco. Dr. Herwick received his BA in German Literature at Cornell University and was enrolled in Phi Beta Kappa, 1964. He interned at Childrens Hospital in San Francisco in 1969, after receiving his M.D. at the Cornell Medical School in New York City. He completed his Residency in Dermatology at the University of California Medical School in San Francisco in 1972. From 1972 – 74, Dr. Herwick served as Major in the United States Air Force Medical Corps and Chief of Medicine at the Strategic Air Command Headquarters at Omaha, Nebraska.
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In seeking to examine the capabilities and the limitations of medical science in solving problems of social significance, one must begin by tracing the history of medicine as it recedes from its enlightened present into the darkness of ancient times. As with other historical inquiries, it is not surprising to find that perhaps fundamentally little is new … that recurrent themes and patterns are discerned which may at the same time provide a basis for optimism or disillusionment, depending upon one’s interpretation.
One of the most ancient concepts of health was that personified by Hygiea, the Greek goddess of health who watched over the corporeal welfare of the residents of Athens. Health was then based upon a unity with nature, a temperate lifestyle and the belief that good health was a natural attribute. Rather than treating the sick, Hygiea embodied the ideal of the preservation of natural health through living in harmony with nature. Slowly this ancient concept was replaced after the fifth century B.C. by the cult of Aesculapius, the son of Apollo and the god of medicine. Aesculapian temples were erected to which the sick were brought for mysterious healing rituals as well as for mineral baths, exercises (an early precursor of today’s physical therapy) and various unctions. The therapeutic ceremony, performed by the temple priest during a nocturnal trance in which a healing dream was interpreted, was not entirely dissimilar to “modern” Freudian or Jungian psychoanalytic practices. The salient point about the cult of Aesculapius is that it was a therapy of intervention, of combating a disease and seeking its expulsion from the body. The restoration of health was based to a large extent upon superstition: and at times almost charlatan mysticism which effected a magical cure together with an increase in the temple coffers. It is parenthetically somewhat disturbing that the staff of Aesculapius with its single snake has become the symbol of today’s medical profession. This becomes less objectionable, however, when one considers the often inappropriately used caduceus (that winged staff with two entwined snakes). This of course was the symbol of Mercury, the god of commerce and of thieves!
Throughout history this dichotomy of Hygienic health through natural harmony and Aesculapian healing by intervention eternally recurs. Hippocrates, the great Greek father of medicine, returned to the former tradition and stressed the treatment of the person as a whole, reflecting and participating in a natural order of natural health. The good physician assisted nature after the manner of “similia similibus,” treating like with like. An example of this would be applying hot compresses to augment the inflammation of a local infection. Hippocrates taught that the body was endowed with the ability to cure itself and that the outward signs of disease were laudable manifestations of this process. He brought the practice of medicine to the bedside where the physician carefully observed the clinical condition of his patient and sought to assist the natural process which he carefully observed and for the first time quantitated. The inner balance of the four bodily humors was first evaluated. Then a diagnosis and prognosis were offered and finally a homeopathic treatment was instituted to assist the body in reestablishing an inner harmony with the natural order. The very word “physician” based on the Greek root for “nature” reflected this understanding of the doctor’s role. This philosophy of non-intervention was carried forth into the Roman Empire and there are numerous examples of its influence. Tiberius advised that anyone who consulted a physician after the age of 30 was a fool, as he thereby demonstrated that he had not yet learned to account for his own life or body.(1)
The counter current of allopathic medicine, often based on the opposite principle of “contraria contrariis” (that is, attempting to counteract external symptoms by producing an opposite effect) was not buried with the ruins of the Aesculapian temples. It has reappeared throughout history and at times has coexisted to a remarkable extent with the natural harmony concept of Hygiea. The Gnostics of early Christian times developed rather elaborate rituals for the expulsion of disease. Disease by their understanding represented the adversary forces of evil over which a mystical salvation could be effected by the initiates. Their invocation with the word “abrucadabra” survives in the vocabulary of prestidigitators of modern times. To my knowledge this incantation is not in frequent use today by many members of the modern medical profession, no matter how heretical their personal philosophy.
During the middle ages phlebotomy, or blood letting, enjoyed a great popularity: the penultimate example of “contraria contrariis.” The rationale for this was to divert toxic materials from one organ to another and thence out of the body: a rather primitive concept until one considers the present day therapy for Porphyria Cutanea Tarda, a dermatologic abnormality of hemoglobin metabolism. This therapy consists in fact of repeated phlebotomies to divert excessive heme precursors from the liver and bone marrow. In the past decade this has been recognized as unquestionably the treatment of choice in this disorder and is used in every major university and teaching hospital in the western world. Phlebotomy also survives today as standard therapy for Polycythemia Vera and Idiopathic Hemochromatosis. These provide rather striking examples of the aphorism taught to medical students studying pharmacology: “Be not the first by whom the new is tried, nor yet the last to lay the old aside.” Medical practices in the middle ages such as blood letting were based to a great extent upon ill-founded dogma perpetuated by the rigid scholasticism into which medicine had fallen and numerous unsubstantiated and even harmful remedies were carried forward unchallenged. There survived, nonetheless, a viable kernel of effective treatment based largely upon practical results rather than pathophysiologic theory.
The physician of the fourteenth century, by contrast, used very little such rational empiricism, but become more and more preoccupied with the grandeur of such external trappings as prescribing drugs by ceremoniously pointing them out at the pharmacy with his baton. His excellence by our “scientific” standards and his proximity to the patient’s bedside waned in inverse proportion to the majesty of his flowing robes and elaborate costumes.
With the coming of the Renaissance, man was again elevated to a position deserving of the center of human thought and with this came a regeneration of the classic espousal of the harmony of nature and of disease as a temporary disequilibrium in this harmony. Great advances were made in anatomy by Leonardo in his quest for accurate representation of the human body in his sculpture. As physicians returned to the Hippocratic teachings lost in the scholasticism of the middle ages they regained their position of social esteem and shedding their magisterial robes again became educated and cultured members of society. In the seventeenth century Galileo pioneered the scientific method which become the cornerstone for all modern science. The discovery of new methods and tools proliferated during the next hundred years as the microscope, blood transfusions, obstetrical forceps and new surgical instruments took their place in the physician’s armamentarium.
The doctors of this enlivened period again began to drift away from the patient’s bedside to such enterprises as Anton Mesmer’s tub of sulphuric acid with its iron bars to conduct healing magnetic forces into his diseased and gullible patients. Despite temporary dalliances such as this, the Romantic era of the late eighteenth century lured physicians back again from the laboratory and its paraphernalia to a de-scienced and perhaps overstated concern for the natural state of man. Rousseau taught that all sickness was the result of deviation from the natural state; that a return to this basic harmony was the goal of all medicine. The scientific era had now gone full circle. It had worshiped in the temples of science and dabbled in external contrivances in seeking the key to health. Now such events as the discovery of Tahiti in 1767 fueled a new quest for an idyllic happiness almost to the exclusion of all “extraneous” aids. Hygiea returned triumphant and Aesculapian intervention had again fallen from power, this time, however, only temporarily. The romantic fervor could not be indefinitely sustained, nor could scientific discoveries be repressed by the noble savage, and the Age of Reason supervened.
With the Industrial Revolution came unsanitary crowding and frightening increases of communicable diseases such as typhoid and smallpox, and with these there came a demand for social reform. This reform, it must be carefully noted, was based upon the Hygienic ideals of the Romantic era rather than occuring as a direct consequence of the intervention of scientific theories. It is the thesis of biologist and Nobel laureat Rene Dubos in his book “The Mirage of Health” that the dramatic decline in European death rates that began in the nineteenth century was the result of these social reforms and preceded the introduction of the germ theory(2) and other medical advances. It is a universally uncontested fact that the increase in life span documented during the past 200 years is almost entirely a function of the decrease in infant mortality which is in turn almost entirely the result of increased hygiene. It has been demonstrated that 90% of the total decline in combined mortality from scarlet fever, diphtheria, whooping cough and measles between 1860 and the present occured before the introduction of antibiotics.(3) One of the leading opponents of the germ theory, chemist Max von Pettenkofer, was almost singly responsible or a fivefold drop in typhoid mortality in Munich in the late nineteenth century. This he did by convincing the town authorities that on an aesthetic basis it would be more desirable to divert the cities sewage from upstream to downstream.(4)
A brief look at the incidence of modern epidemics will perhaps dispel any illusion that the gates to Elysium have been thrown open before us by vaccines, antibiotics and modem medical techniques. Taking measles as an example, one sees this viral infection of negligible importance in 1785. By 1804 it had increased to such an extent as to equal the death rate from smallpox. By 1840 measles had declined and was replaced by scarlet fever as the primary infectious disease. By 1915 the death rate from measles had climbed again, this time to outstrip the death rate from smallpox, scarlet fever and diphtheria combined. Since that year its incidence has steadily declined.(5) In Europe leprosy and plague reigned in the fourteenth and fifteenth centuries, syphilis in the sixteenth, smallpox in the seventeenth and eighteenth, scarlet fever, tuberculosis and measles in the nineteenth. The great influenza pandemic of 1918 killed 20,000,000 people world wide. That specter was raised again only this year. Paradoxically as the incidence of a disease decreases, its virulence may increase because of less natural immunity. This was the case with poliomyelitis during this century: better sanitation meant less exposure to the virus during early childhood and a fall in the overall pool of antibodies with a marked worsening in the severity of the disease for those unfortunate few who did encounter the pathogen during later childhood. The Salk and Sabin vaccines are now therapeutically adding to this antibody pool, but as one disease is “conquered” one asks of history whether another will not inexorably rise up to take its place. Such is Dubos’ “mirage of health.” At this very moment in history, helicopters are flying smallpox vaccine into Ethiopian villages and public health experts fully expect to have seen the last case of smallpox on the face of the earth this spring. This is no small accomplishment as smallpox has literally raged epidemically for all recorded time. Records of it go back to 1122 B.C. in the Tcheou dynasty. With such statistics it is tempting to believe that twentieth century man has finally wrested fire from the gods and has begun to immolate all diseases, one at a time, upon the alter of the temple of Aesculapius. Tempting, that is, if considered without the benefit of historical perspective.
The greatest danger of our present scientific medical Weltanschauung is not, however, simply a mistaken optimism about the eradication of a finite number of disease entities one at a time. It is rather that it constitutes one of many bases upon which the subtle erosion of man’s personal responsibility for his own life is precariously founded. Disease has come once again to be looked upon as something extraneous which has fallen upon man and must be expelled, rather than as a necessary manifestation of an inherent disharmony in a fallen universe. The responsibility for being sick is shifted from the individual to the doctor and worse, to the medical establishment. A cure is demanded, if not of the physician then of the goddess of Science whom he vicariously represents. If the World Health Organization can successfully eradicate smallpox in a ten year campaign, one demands the some for cancer, diabetes and heart disease. Understanding illness as a complex disharmony affecting an even more complex individual, read “human being,” has in many cases been temporarily set aside in the frenzied search for specific etiology and then for its curative antithesis. The pendulum has again swung back to healing by “contraria contrariis.”
Ivan Illich speaks of the “medicalization of life” in his book “The Medical Nemesis.” For rich and poor, life is turned into a pilgrimage through checkups and clinics back to the ward where it started… this lifespan is brought into existence with the prenatal checkup, when the doctor decides if and how the fetus shall be born, and it will end with a mark on a chart ordering resuscitation be suspended.”(6) He observes that “unsick people have come to depend on professional care for the sake of their future health.”(7) Carrying this a step further, Paul Ramsey sees present day concern with various genetic techniques including cloning to eliminate diseases from future generations as treating “non patients,” i.e., the species or the gene pool rather than individuals.(8) Individual rights may be violated in the name of a higher eugenic goal of “a healthier mankind” rather than healthier men. The object of the healing art drifts further and further from the suffering individual and threatens to become lost in a misty realm of generalities and lofty causes. Clearly these questions must be answered, for in perfecting techniques to prolong an individual’s life, the process of natural selection ceases to operate and the overall incidence of heritable diseases, once limited by death before the age of reproduction, increases exponentially. A case in point is the incredible increase in the incidence of diabetes mellitus in the general population — an increase made possible by the use of insulin in literally saving the lives of juvenile diabetics, allowing them to reproduce and perpetuate their genetic abnormality. The exciting possibilities of DNA-recombinant engineering radically to correct the cause of diabetes on a chromosomal level releases the specter of mutant genes and their possible effect upon those now living.
Medical scientists today have been lead from one discovery, one triumph to another, inexorably further away from the patient’s bedside and from the Hippocratic ideal. Embued with the fervor of this new religion, the patient himself has in his faith in science literally chased his physician thither. The healer has often retreated to the inappropriate security of prophylactic laboratory tests (“prophylactic” in the sense of offering protection for him against the threat of malpractice litigation for failure to diagnose). In other cases he may have hidden himself behind a barrage of computerized fluoroscopes, radioisotope assays and electron microscopic analyses to avoid confronting his ultimate inability radically to cure. The profound anxiety stirred up by the realization of this limitation has become as untenable for the worshippers at the temple, the patients, as it has for its high priests. The flight from such a frightening realization further and further into the technologic strata betrays the society’s growing existential dilemma. The individual has increasingly abdicated responsibility for his own life in the great illusion that he has enhanced his ability to enjoy that life. He seeks no longer only the apple, but the entire tree. He has climbed a bit too far and too fast out upon a limb of that tree and he is frightened. To retrace his ascent is impossible and so he clings more tightly, more stubbornly to these branches and looks higher still for a resting place. Like Faust he has ventured so for and so high that in his bedazzlement he has risked losing his very self. Dubos expresses this quite well: “To discover, to describe, to classify, to invent, has been the traditional task of the scientist until this century; on the whole a pleasant occupation amounting to a sophisticated hobby. This happy phase of social irresponsibility is now over and the scientist will be called to account for the long-term consequences of his acts. His dilemma is and will remain that he cannot predict these consequences because they depend on many factors outside his knowledge or at least beyond his control — in particular on the exercise of free will by men.”(9) Obviously I cannot end on such a pessimistic note of what I see as a strong trend on the stage of modern medicine’s reenactment of the Aesculapian scenario. As with other oscillations of history, there endures a spirit of the healing art which is transcendent, the spirit of comforting a patient who suffers, a spirit which is nonetheless immanently present in the technology adopted by the healer. Technology cannot be dismissed with a nostalgic sentimentality, the Samaritan today would have rejected the pouring of oil into his patient’s wounds. We know today that oil impedes wound healing. One would not relish the prospect of treating bacterial endocarditis without penicillin or leprosy with sulfones, no matter how Hippocratic his concern for the whole patient. Given this spirit of healing, the awesome complexities of technology can be forged into remedies of inestimable value to be utilized by the good physician. Absent this spirit and Science, that foreboding temple priestess, usurps the physician’s role, transforms means into ends, and in the end displaces individuals as the rightful recipients of the healing art. Free man is thereby lead further out that limb at whose end is found the loss of yet another facet of his existential freedom: the ultimate responsibility for his own body.
-Arturo Castiglioni, “A History of Medicine,” Jason Aronson,
Inc., New York, 1975, p. 143.
-Rene Dubos, “Mirage of Health,” Harper & Row, New York,
1959, p. 23.
-Ivan Illich, “Medical Nemesis,” Pantheon Books, 1976, New
York, p. 16.
-Dubos, op. cit., p. 149.
-Ibid., p. 177.
-Illich, op. cit., p. 79.
-Ibid., p. 122.
-Paul Ramsey, “Fabricated Man,” Yale University Press, 1970, p. 101.
-Dubos, op. cit., p. 271.