Info on Rational & Empiric Schools of Science

[Sheri Nakken]

Here is info on different types of science

Info on Rational & Empiric School

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Coulter Book Review
by Julian Winston
Reviewed by Julian Winston

Divided Legacy: A History of the Schism in Medical Thought
Volume IV; Twentieth Century Medicine: The Bacteriological Era (Volume 4)
by Harris L. Coulter

http://www.amazon.com/exec/obidos/ISBN% ... 3-2422523-
6162229
(If URL splits in 2, paste 2nd line to first in browser)
(This is the 4th volume .............I haven't read this one yet, have it
though)
The Center for Empirical Medicine, Washington DC and North Atlantic Books,
Berkeley, CA, 1995
Hardbound, 776 pages, $50.00, ISBN 1-55643-170-8

Can get the EXCELLENT THIRD (3rd) volume of the book at Amazon thru my
webpage link as used for $10-20
Divided Legacy: The Conflict Between Homeopathy and the American Medical
Association: Science and Ethics in American Medicine 1800-1910 - this is an
incredible volume........and highly recommend for all students of homeopathy

http://www.amazon.com/exec/obidos/ISBN% ... 3-2422523-
6162229
(if URL splits into 2 lines, will have to paste 2nd line to first)
or here
http://www.amazon.com/exec/obidos/ISBN% ... 3-2422523-
6162229
********

This review appeared in the June 1995 issue of Homeopathy Today - the
newsletter of the National Center for Homeopathy. I believe that this book
is more important than many people realize. It should be required reading
in ALL medical schools (where, I have been told, they teach little about
the history of medicine) - JW
----------------------------------------------------------------------------
----

This volume marks the last in the series that Harris Coulter began in 1973
as Divided Legacy: a History of the Schism in Medical Thought. The past
volumes (I. The Patterns Emerge: Hippocrates to Paracelcus; II. Progress
and Regress: Von Helmholt to Claude Bernard; III. Science and Ethics in
American Medicine 1800-1914) have provided us with a rich history of the
empiric tradition in medicine. If Harris had stopped there, he would be
remembered as one of the most influential authors in the field of medical
thought. But this new book moves him even higher. Like his other books,
this one is not easy going. Heavily annotated (there is a 44-page
bibliography), the text is thick with quotes and references that have to be
pondered. But Harris' skill is not only in the collecting of the
information, but in the assembling of it with such clarity, that the
denseness of the subject becomes transparent. I found myself moving through
the book as if it were a fast-reading mystery novel.

In some sense, I am certainly the wrong person to be reviewing this book.
The arguments that Harris sets forth need no proof for me-- I am one of the
converted. I would be curious to see what a conventionally trained
physician, who knows nothing of homeopathy and the empirical tradition,
would make of the book. Would the book be able to convince them of its
basic thesis-- that conventional medicine, as it has developed over the
last hundred years, is far from being the "science" it claims to be?

Over the last hundred years we have seen pieces of the problem. But what we
have seen is akin to the story of the blind men trying to describe an
elephant-- one feels the trunk and says, "it's like a snake," another feels
the leg and says, "it's like a tree."It is too big to see the whole, so we
each see only a small part. What Harris has done is to pull all the
disparate pieces together and show us the "whole beast" as it were.

In an interview I did with Harris (which was published in the 1995 issue of
The American Homeopath), he said that upon completing the three other books
in the Divided Legacy series, he put a box next to his desk. Every time he
came across any writing that had a bearing on the history of medicine, the
empiric/vitalistic debate, pharmacology, therapeutics, etc., he would toss
it in the box.

"I was afraid of twentieth century medicine," said Harris. "There's just so
much new knowledge in twentieth century medicine that I couldn't figure out
how to maneuver it. I couldn't learn everything there was to learn-- that
would be out of the question. And I didn't want to look like a damned fool
either. So I had to figure out a way of dealing with it that would minimize
knowledge of the highly technical areas of medicineI It took me many years
to not be afraid to tackle the subject."

"The work that we did on the two vaccination books (DPT: A Shot in the Dark
and Vaccination, Social Violence, and Criminality) clarified my thinking on
immunology. Then the work on the book on the controlled clinical trial (The
Controlled Clinical Trial: An Analysis) showed me something else about the
theoretical structure of allopathic medicine. And what I found out to my
very pleasant surprise was that the approach that I'd adopted from the very
first word of these four volumes in the Divided Legacy series-- which was
the division between the empirical and rational way of looking at things--
was totally applicable to the twentieth century. I shouldn't have been
surprised by that, but I was. I thought that 'I can't have that kind of
luck,' but I did, and I treated the 20th century in the same terms as I
treated all the other centuries. And it doesn't look like a forced
argument. I think it develops rather naturally."

(Briefly, the Empirical school was based on the idea that observation and
experience lead to theory, and the body posessed an "engergetic essence" or
"vital force" while the Rationalist School developed practice from
theories, reduced components to parts, and that the body was mechanical in
nature. As used throughout Harris' books, the division between the Empiric
school and the Rationalist school is the division between vitalism and
reductionism.)

The first section of the book discusses the developments that took place in
the latter part of the 19th century. The work of Virchow had reduced all
phenomena of life to movement at the cellular level. The work of Claude
Bernard further reduced workings of the body to a series of operations that
could be explained in terms of physics and chemistry. And Pasteur, Behring,
Metchnikoff, Ehrlich, and Koch were all developing their theories that led
to the rise of the science of bacteriology. When I was about ten-years old,
one of the most impressive books I read was Microbe Hunters by Paul
DeKruif. Now, years later, after reading Harris' book, it is interesting to
come back at the information from a new viewpoint and to understand the
complexities that were not discussed in the book-- which I now realize was
a one-sided look at these "saviours" of modern medicine: Pasteur with his
rabies vaccination, Ehrlich with Salvarsan-- the "magic bullet" to cure
syphilis, and Koch with his vaccine for tuberculosis.

Of all those working at the turn of the century, the most influential
seemed to be Ehrlich. He began his work with a dissertation in 1878 on the
theory and practice of Histological Staining. All of Ehrlich's ideas were
developed while he was working with aniline dyes-- and lead to his
assertion that medicines act through physical contact with target organs.

The work that was being done at the turn of the century reads like a
fantasy. Everyone was trying to find "reasons and mechanisms" to explain
the functions of the body, and theories were being proposed with daily
regularity.

But as each theory was proposed, the empiricism that was reflected in
homeopathy was in the background. At each turn, when the "model" began to
get overly complex and the thinking began to turn toward a vitalistic
explanation, all parties backed away quickly from even considering
explanations which lay in THAT direction. The doctrines of Contraries as
expounded by Ehrlich and Koch, resulted in a two tier doctrine of diagnosis
and therapeutics. The patient's "signs" revealed the disease "cause" and
also the "physiological action" of the medicine; this was the substance of
"general pathology" and seen as "scientific." The "symptoms," on the other
hand, being produced by the patient's idiosyncrasy, fall under "special
pathology" and were not "scientific."

"A new paradigm was needed, and Ehrlich put it together based on the
ready-to-hand technology of aniline-dye manufacture. Henceforth, research
on the 'physiological action' of medicines fell under traditional
pharmacology'-- a 'purely biological' or 'purely theoretical' science
'without any concern for practical application.' Research on healthy
animals (said Ehrlich) may reveal the toxic effects of medicinal
substances, but never their curative powers."

As Harris says, "Ehrlich updated and refurbished seventieth-century
iatrochemistry, reformulating it in the vocabulary and concepts of the
dye-stuff industry. Thenceforth the relationship between the remedy and
patient was patterned on that between dyes and the materials they color."

And "while Twentieth Century Rationalism has dropped some of his [Erlich's]
wilder embellishments, his categories still remain in place... there is the
same attempt to differentiate medicines which act on 'symptoms' from those
which act on 'cause' even though the 'cause' cannot be defined or
identified and cannot be distinguished from the symptoms."

"The doctrine of contraries is the inescapable corollary of the Rationalist
dream that the physician can fashion medicinal substances to carry out his
will and desire; it is so instinctive as rarely to be subject to criticism
or analysis... The doctrine that medicines 'compete' 'antagonistically' for
a 'site' on the wall of the cell of a host organism is the child of
Darwinism and of Rationalist confidence that the action of medicines can be
determined otherwise than by testing on healthy humans. 'Antagonism' or
'contrariety' in its various forms remains to this day the guiding
principle of rationalist-allopathic medicine."

Koch noted in 1890 that medicines that seem to retard the growth of the
tuberculosis bacilli in vitro (in the test tube), often remain without
effect when applied in vivo (in the body). This conceptual stumbling block
has been the thorn in the side of contemporary medicine-- that the
medicines work differently in the BODY than they do upon the bacteria alone.

With all this as a starting point, Harris takes us on a roller-coaster ride
through the major concepts of the standard medical model-- host resistance
and immunity; the disease entity; infectious diseases-- and through quotes
from conventional medicine's own literature which show how their "...
boundaries disappear into the gloaming, like the Cheshire Cat, leaving
behind nothing but the smile."

His use of contemporary authors' words makes some of the points very
clearly. For example, on page 208 he quotes Lewis Thomas who said: "Disease
is still a mystery. We don't know how bacterium cause disease. We know, for
instance, that epidemic meningitis is caused by a microorganism called a
meningococcus, but we have no clear idea as to how it works, nor do we know
why some people develop meningitis while others have nothing more than a
mild respiratory infection."

After the decline of the major epidemic diseases, medicine turned to the
non-infectious diseases where there were even greater problems defining the
disease "entity." Again, Harris quotes others, and the ideas presented from
these varied sources can be seen as a totality-- probably for the first time.

Writer Alvan Feinstein said, in 1967: "No other branch of natural science
is so imprecise in defining the material exposed to experiment. Although no
uniform standards have been ratified and disseminated, it is commonly
believed that rigorous criteria are invariably present. The clinicians'
capacity for intellectual self-deception is illustrated by the widespread
acceptance of this delusion." Dr. Michael Halberstam is quoted: "Mrs. Ruth
LaMotta is a 53-year-old patient of mine with one husband, one job, three
children, and countless pains. One week her throat hurts, another her back.
She is plagued by colds which prevent her from working. She thinks her
sinuses might be infected. She feels tired and is sure she has the 'flu.
Her eyes get 'weak all over' at work, and she is afraid she has glaucoma.
Mrs. LaMotta is sure her body is gravely ill. I am sure it isn't."

There is an assumption that the elements of the body interact with one
another by following the laws of physics, chemistry, mechanics, and the
like, and the number of mechanisms is limited. Says Lewis Thomas: "Nature
is inventive, I grant, but not so inventive as to continue elaborating
successions of brand-new impenetrable disease mechanisms. After we have
learned enough to be able to penetrate and control the mechanisms of
today's diseases, I believe we will automatically be well-equipped to deal
with whatever new ones turn up."

By halfway through the book, Harris has led us through the philosophical
underpinnings of modern medicine. The next section, 250 pages, is devoted
to a description of the Empiricism and Vitalism in 20th century medicine--
Homeopathy, Chiropractic, Osteopathy, and Naturopathy. He doesn't tell us,
as homeopaths, things we didn't know about our science. Perhaps to someone
unfamiliar with homeopathy something might be learned from this section,
but, to me, it seemed less "together" than the rest of the book.

Harris then discusses the ways in which vitalism slowly influenced
conventional medicine through immunology and allergy treatments (although
always seen from a rationalist perspective), and the introduction of many
homeopathic drugs into allopathic practice during the late 19th and early
20th centuries. Harris points out that more than 100 of the 474 medicines
listed in a typical textbook of allopathic practice in 1918 were also found
in homeopathic texts.

Conventional medical texts recommended Aconite for 'croup, quinsy, sore
throat, severe colds, asthma due to exposure,' yet by 1953 it was described
as having no therapeutic value. Harris attributes this abandonment of many
of the homeopathic drugs to the closeness of the therapeutic and toxic
doses-- which is problematic if one refuses to use potentized medicines. He
presents a case of an American allopath who, in 1978, treated complicated
migraines with the opium based papaverine, and said that the "basis for
therapeutic effectiveness remains obscure." But a look at the description
of Opium in any homeopathic materia medica would show the similarity of the
remedy to the problem.

The second section ends with a discussion of how allopathic medicine views
Hering's Law of Cure. Case after case is presented where a suppression of
the external caused a deeper internal problem.

Patrick Hall-Smith is quoted: "There is a significant but poorly understood
association between [ichthyosis-- a skin disease] and eczema, asthma, and
hay fever." Says Harris: "Allopathic dermatology is aware that internal
conditions are often externalized on the skin, but this information is not
put into a dynamic context."

The third section focuses on the pharmacology of contraries and its
consequences. Harris spends time on the idea of the "receptor site" where
each cell is assumed to have receptor sites on the walls corresponding to
the types of drugs that can be administered. The drug molecule was tailored
to fit the specific cell or organ.

This leads to the doctrine of contraries-- drugs which are, for example,
calcium antagonists or channel blockers. "That the body's dynamism, blocked
by contrary medicine, may seek some other outlet does not ordinarily occur
to the Rationalist thinker." Referring to the receptor site as an "elegant
doctrinal construction" of which none of the elements can be demonstrated
in practice, Harris says that by "being incoherent, receptor-site theory
cannot be described coherently. When doctrinal difficulties are overcome by
adding new assumptions, the resulting structure cannot be grasped in any
logical way-- like pre-Copernican astronomy, where deviant orbits of
planets and comments were incorporated into existing knowledge by positing
new epicycles...

" It is through these arguments that Harris shines. Saying that the concept
of a receptor site is a "doctrinal and economic necessity," he continues:
"The demand that the disease 'cause' and the drug interact chemically via
physical contact placed pharmacology under the dominion of chemistry,
introducing the external explanatory criterion so beloved by rationalist
thinkers. Pharmacology was thereby taken away from physicians-- now deemed
incompetent to negotiate the theological subtleties of receptor-site theory
and lacking the material resources to pursue such research...

"In fact, the 'receptor-site' does not exist. It is a phantasm, a
'perception of something that has no physical reality,' a mere figment of
the Rationalist imagination." "Most allopathic pharmacology," says Harris,
"is not explicable in terms of the receptor site... in fact, Hahnemann's
suggestion that drugs act by mere contact with the patient's organism is
far more scientific and realistic than the whole phantasmagoria of
receptor-site theory. The abortive allopathic encounter with metal
colloids, which were never thought to form a chemical bond with the tissues
but acted by mere contact, momentarily opened the door to this way of
looking at pharmacology but was quickly rejected because it called into
question the discipline's whole doctrinal basis."

The doctrine of Contraries is discussed in terms of adverse reactions--
"side effects," as we call them (although the expression "side effect" is a
misnomer, since these effects are themselves "direct" effects of the
medicine, even though undesired), rebound effects, and the dangers of
overuse of antibiotics-- all supported with statements from conventional
medical literature.

Pointing out that Rationalist theory encourages multiple prescribing
because there could be a different drug for each causal mechanism, Harris
quotes Leighton Cluff, who reported in 1967, that the average patient in a
teaching hospital received from ten to twelve different medicines during
their stay-- some got as many as 50.

Harris then discusses another aspect of the doctrine of contraries-- drug
disease and chronic disease. The examples are numerous and frightening:
Serpasil decreasing sex drive; Aldactone (spitonolactone), a diuretic whose
literature cautions, "unnecessary use of this drug should be avoided," yet
it is prescribed millions of times a year; juvenile onset diabetes which is
often generated by the whooping cough vaccine, hence the "enigmatic" rise
in this disease that reflects the expansion of the use of the DPT vaccine;
and many others.

Section four of the book deals with the issue of medical reform. First,
Harris describes the structure that needs to be reformed - the
institutionalization of "medical rationalism" where the United States has
set the pace under the banner of "scientific medicine." Harris suggests
that the stress on disease categories and mechanistic approaches that
culminated with the setting up of the Natiuonal Institutes of Health as the
Division of Research Grants has accentuated the tendency to think in the
language of disease entities. This bias has marked federally supported
research projects ever since.

Furthermore, after the Flexner Report in 1910, the individual states
developed legislative "Medical Practice Acts" which limited those able to
be licensed to those who came from the allopathic institutions. "Within the
licensed (allopathic) profession the muscle of the American Medical
Association and its network of state and local medical societies was
wielded against internal dissent by homeopaths and other physicians who
disagreed with the narrowly doctrinaire policies imposed and enforced from
above. And as self-appointed keepers of the gates through which pass all
purveyors and suppliers of auxiliary medical services-- nurses,
radiologists, technicians, assistants, and the like-- allopathy has
extracted tribute from each."

Underlying this control, however, was a theoretical void. Medical
Rationalism in medicine, says Harris, "... is not well adapted to a
scientific understanding of the living organism." And it is "not a valid
scientific guide to the practice of medicine, the training of physicians,
or the allocation of research funds."

Describing modern medicine as a discipline that has vast arrays of
equipment at its disposal, Ian Stevenson characterizes the field of
medicine as having made the mistake "of thinking that when a phenomenon has
been described it has been explained."

"Allopaths," says Harris, "maintain that they seek only 'facts,' ignoring
that 'facts' in a science are inseparable from theory, that there can be no
'facts' without a governing hypothesis. The attempt to assemble 'facts' in
the absence of a theory or hypothesis has generated that 'vast hopelessly
fragmentary science of the human body' which today is in crisis."

"But to allopathy, all talk of 'theory' smacks of the seventeenth or
eighteenth centuries, or 'sectarian' medicine. In 1924 the AMA's Judicial
Council demonstrated its dislike of medical theory in branding as
'sectarian' anyone who followed a 'dogma, tenet, or principle based on the
authority of its promulgator.'"

Said writer Lawrence L. Weed in 1974: "Medical knowledge is passed along
like Norwegian songs or in the Middle Ages, doctors singing ballads to each
other in the hospital lobby and in those show-and-tell rounds. They believe
what they want to believe; nowhere else is there more hallucinatory
fulfillment than in medicine." Following this, Harris discusses the search
for the "theoretical structure" (or lack of it) which is seen through the
training of the physicians themselves. Harris says very little through this
part-- letting the words of others issue the judgement:

"The student is fogged in facts... does not see the patient as a whole. He
lacks necessary guiding principles for applying what he has learned. The
student has been working very hard to master subjects, such as the finer
points of gross anatomy and organic chemistry, that in later years he will
blissfully forget." -- Michael Crichton

"We have different doctors for asthma, diabetes, cancer, and brain tumors,
because the knowledge of the specialist in one of these diseases has no
bearing on another. Had we a grasp of underlying principles in medicine, a
physician would feel at ease in any of these conditions. "-- Ian Stevenson

"The GP is only a pimp for the Specialists."--medical school dean

"... the teaching was directed at the recognition and identification of
disease. Therapy was an afterthought, if it was mentioned at all"-- Lewis
Thomas

"The average case notes have become almost verbless and are often little
more than an index of conventionally chosen sets of physicals signs sought
for in every case. How rarely is the eye, as it transverses these deserts
of nouns and of plus and minus signs, refreshed by some flash or
originality of observation or presentation. I suggest that what would
revive our clinical nosography is a return for refreshment to the clinical
writings of forty or more years ago."-- F. M. R. Walshe, in The Lancet, 1956

"We train researchers first, practitioners second. Those who enter practice
are usually our second-rate students... I feel we shouldn't waste our time
on them." --staff physician at a teaching hospital, 1969

"Instead of giving the ill they cannot cure a name, these physicians give
the ill they cannot name a drug."-- Harry F. Dowling 1963

"The chance that the average patient will get the right drug, in the right
amount, at the right time, is on the order of 50 percent." --Dale Console
to Congress in 1969

And to this last, Harris points out that Lawrence Henderson, in 1910, said
"If the average patient visited the average physician, he would have a
fifty-fifty chance of benefitting from the encounter." Have we progressed
in the last 85 years?

The book concludes with a repeat of the theme that carries through the
other books that Coulter wrote-- the conflict between rationalism and
empiricisim-- and the social and economic impact of these modes.

"Empiricism accepts hetereogeneity as an irreducible fact of medical life,
facing up to the fact that patients and 'diseases' come in a staggering
variety."

"Rationalism, on the contrary, seeks to mitigate this harsh reality by
forcing the varieties of disease states into procrustean pigeon-holes of
'entities' accepted by the given day and age."

Harris suggests that the time consuming nature of homeopathy (and other
branches of empiric medicine) as well as the heavy burden that is placed on
the practitioner to be ultimately responsible for "finding the right
remedy," become a serious drawback of the system. His views are echoed by
the grand homeopath, John Henry Clarke, MD, who said: "If all the allopaths
were to be made into homeopaths, we would not be better off. However much
they might believe in the Law of Similars, they would not be able to
practice the art until they have given their heart and soul to the study of
itI It was really with the weakness of human nature that Hahnemann was
confronted, and it is the same problem that confronts us at the present day."

The use of "disease name" suggests knowledge of the "cause." Says Harris,
"Because the explanation is in terms of 'mechanisms' to which only the
physician is privy, it elevates the physician's status in the patient's
eyes and alleviates many anxieties. The sociological significance is not to
be underestimated; that their scientific content is minimal is
unimportant." Eric Cassell, in 1986, suggested that "professional coherence
is engendered by doctrinal coherence."

The general principles of allopathic theory, Harris maintains, which at
first glance seem clear enough, dissolve into thin air when closely
scrutinized. Unfortunately, the therapeutic doctrine enabling the physician
to treat the most patients in the time available will usually command his
allegiance.

But the reality, as the The Washington Post pointed out in 1979, was
simple: "The most conscientious doctors-- those who rely most heavily on
careful physical examination and take the patient's detailed history, and
take the time to guide and explain, and hear their patients out-- earn the
least. The charges for pure time are always less than the charges for
procedures."

Furthermore, the current doctrine holds that no "disease" is the result of
lack of exercise, nutrition, nor the over-consumption of therapeutic drugs.
The existence of one or another "disease" is always and invariably ascribed
to the absence of drugs for that disease. One of the economic consequences
of this thinking is that we are now caught in a rising spiral of medical
costs.

In the end, believes Coulter, Empiricism and Rationalism are contrasting
ways of organizing medical services with vastly different economic
consequences. So are there answers? What Harris proposes as a first step is
the repeal of the Medical Practice Acts on which Rationalism's monopoly of
power is founded. "Rationalism cannot be considered a science." Such a
recommendation suddenly brings one back to our shared reality. True, it
would shake the very foundations of the medical system. But to DO IT would
require an uprising by the populace on the scale of the American Revolution.

We have to take it one step at a time, and slowly convince people that
their good health is not best served by the medical system that is
currently in place. If we could move rationalism from the place it is now,
it would, says Harris, "make the physician a less tempting target for the
producers of drugs. They could do what they should be trained to do-- tend
the sick. And then the public could decide which type of treatment it
prefers."

So there it is. It has been said. In four volumes, over twenty years,
Harris has traced the evolution of medicine as no one else has done. It has
been said that history is written by the "winners." That is certainly true
of all the books you can buy on the history of medicine-- except this one.
It is a book everyone should read and ponder. It certainly describes "the
Emperor's clothes."

And, it is full of quotable tidbits. My favorite was on page 409. George
Bernard Shaw called upon Sir Almroth Wright -- a noted allopathic
physician-- to look into homeopathy.Wright expressed complete incredulity.
Shaw remonstrated with him. "Look here," exclaimed Wright, "the thing is
absurd and impossible; let me put it this way. Would you, Shaw, trouble to
get out of your chair if I called from the next room, 'Do come in here and
see what I have done-- I have turned a pint of tea leaves into pure gold.'?"
"Certainly I would,' replied Shaw.

And those of us who use homeopathy, with all it's rational inconsistencies,
would get up also.