A richer understanding of medicine
WHAT is medicine? We recognise it in all societies past and present. But the nature of medicine differs so greatly from place to place and time to time that it’s difficult to offer a single answer. So what is it that we see in common between a traditional healer’s throwing of bones and the cardiologist’s incisions?
One of the answers that often seems to be implicit in what we say and think about medicine is a curative thesis: medicine’s goal is to cure the sick.
But if the curative thesis is true, then most medicine throughout history – as well as much contemporary medicine – isn’t medicine at all. Much medicine was and is ineffective, or at best partially effective. The curative thesis leads to a dismissive attitude towards the past efforts upon which any current medicine is built, as well as failing to promote profitable collaboration between traditions.
A second idea is an inquiry thesis about medicine: although the goal of medicine is to cure, its core business is something quite different.
That “something” has to do with inquiring into the nature and causes of health and disease. The idea is that we don’t necessarily expect someone to be able to cure us. We will accept that they are a medical expert if they can show an understanding of our ailment, often by issuing an accurate prognosis. Perhaps they won’t have a complete understanding, but they should somehow be engaged with the larger project of inquiry into the nature and causes of health and disease.
The inquiry thesis offers a way to understand the history of medicine that makes it more than a tale of quackery and gullibility. It also provides a way to understand medical traditions practised outside the West.
The inquiry model of medicine lays the ground for fruitful and respectful discussions between medical traditions that doesn’t descend into an untenable relativism about what works.
The curative thesis faces a difficulty that I believe it cannot overcome. We do not define an activity by its goal alone, unless it has at least some success in that respect.
Yet, taking a historical perspective, something of this kind has been true of medicine for much of its history, before it developed a serious curative arsenal. Historian of medicine Roy Porter has remarked that the prominence of medicine has lain only in small measure in its ability to make the sick well. This was always true, and remains so today.
What, then, could be the business of medicine? I propose that the business of medicine is understanding the nature and causes of health and disease, for the purpose of cure.
The core of the argument is simple: what could medical persons be good at doing, that relates to the goal of cure without achieving it? The most likely candidate is understanding.
As with the curative thesis, there are several objections to the inquiry model.
It is obvious that many doctors either don’t (fully) understand what they treat or, if they do, don’t (successfully) communicate this understanding to the patient. Who, then, understands? The answer is that understanding isn’t a binary. You can partially understand something. You can be on the road to understanding it better by inquiring into it. The idea is not that medicine is a sack full of answers, but rather that it is an ongoing effort to find answers.
Another objection is that so-called understanding is often bogus, and that medicine is as unsuccessful in this regard as in cure. This fails to account for the historical record, which – at least for Western medicine – is precisely a case of understanding without curative success. And, just as false scientific theories have contributed to developing scientific understanding, so false medical theories have provided a foundation for what we now accept.
Medicine is an ancient and complex social phenomenon, variously seen as art, science and witchcraft. These visions share the goal of curing disease. But it is too crude to think of medicine as being only in the business of curing, since in that case, few doctors would be in business.
The distinctive feature of medicine is that it tries to cure by obtaining some understanding of the nature and causes of health and disease: by inquiry, in short. This understanding of medicine permits a healthier dialogue between proponents of different traditions, and enables a non-defensive perspective on areas where we remain sadly lacking in curative ability.