Paradigm

Our aim is to promote a humanistic attitude to medicine where knowledge implementation and its individual implementation are of priority concern! Medicine is too important to leave for specialists who are not also generalists while medicine needs get rid of simplistic, naïve reductionistic way of thinking (paradigm) and focus on understanding human real-world complexity – a biological, psychological, social-cultural and ecological one. To complex you might say – but that is real world.

Following in the footsteps of Bernard, Engel, R.S. Lazarus and many others, I will try after 20 years of work according to their argument (below) for a substantial change in health care services for a development as below.

My perspective on the development of biopsychosocial, lifestyle related health in principal is;
1. A biopsychosocial knowledge medical platform (although not much developed since 1977) where applied psychophysiology (see e.g. www.appb.org) is a foundation pillar
2. Biopsychosocial medicine, life style analysis and interventions are basically education and individuals´ guided self-activities based on a multifaceted perspective (Title of my dissertation 1986 was “Cognitive and Cardiovascular Assessment of a Multifaceted Treatment Package for Negative Stress”, where treatment was group education and self-activities). NB this is for diseases and problems related directly or indirectly to individuals´ lifestyle behaviors.
3. Intervention strategy is (see also above) education and self-activities (with a tool box contenting food, breathing, movements, psychosocial strategies) and supervision where therapy is only done when education and supervised self-activates are not enough to meet IBED (see below) predicted development.
4. Documentation is based on Individual Biopsychosocial Evidenced based Documentation, IBED which is further developed using analyses based on integration of human and artificial intelligence (case based reasoning and other AI-tools) approaches which become an interactive reference library for life style diseases (not yet ready and need much, much work – and before we will try to do it manually as good as possible) for support to individuals, scientists, clinical, social workers, politicians, patients, …

In sum;

Different paradigms can be compared with different ideologies behind different political parties. In at least medical sciences science is discussed as something unified which is not the case – at least not outside pharmacological medicine.

A few quotations if relevance;

“There may well be no definitive characteristics of science and, indeed, if there were they would probably change from one time to another. Strictly, ´science´ means ´knowledge´ but what has come to mean in the modern western world is knowledge acquired as a result of employing empirical methods (Valentine, 1982, p. 6). Specifically about observation, measurement and experimentation as well as experimenter bias effect, “Rosenthal (1967) has argued that unintended covert communications from the experimenter to the subject, which affects the subject’s responses, is the norm rather than the exception (Valentine, 1982, p. 69). Vallentine, E. R. (1982). Conceptual issues in psychology. London: Allen & Unvin.

“Our theories, beginning with primitive myths and evolving into the theories of science, are indeed man-made, as Kant said. We try to impose them on the world, and we can always stick to them dogmatically if we so wish, even if they are false (as are not only religious myths, is seems, but also Newton’s theory, which is the one Kant had in mind). But although at first we have to stick to our theories – without theories we cannot even begin, for we have no­thing else to go by – we can, in the course of time, adopt a more critical attitude towards them. We can try to replace them by some­thing better if we learned, with their help, where they let us down. Thus there may arise a scientific or critical phase of thinking, which is necessary preceded by an uncritical phase” Karl Popper, “Unended Quest”
ISBN: 9780415285896, Routledge, London, 1976, p. 64).

NB See also Quotes from Three Worlds, Karl Popper, The Tanner Lecture On Human Values. Delivered at The University of Michigan, April 7, 1978, http://blog.rudnyi.ru/2012/06/three-worlds.html

“Data without a theory is empty. Theory without data is blind” (I. Kant)

“Paradigmatic thinking often lead man (as e g scientists) to exclude areas of research/relevance, including particular findings and/or theories/rational that does not easily fit into the paradigms of today. A paradigm is a set of believes about reality that seem self-evident and un-changeable. This is the more or less explicit platform where theories and hypotheses are generated/extracted/emerging. Paradigms are needed for effective work but if regarded as “facts” and the scientific truth it can lead individuals (e g scientists) to defend their view-point against rational evidence or fight back new evidence while not fitting into the own paradigm (Kuhn 1957, The Structure of scientific Revolution)

Bernard: “..“.. If we break up a living organism by isolating its different parts it is only for the sake of ease in analysis and by no means in order to conceive them separately. Indeed when we wish to ascribe to a physiological quality its values and true significance we must always refer it to this whole and draw our final conclusions only in relation to its effects in the whole” (Bernard, 1865) in A Despopoulos & Silbernagl (1991) Color Atlas of Physiology: N.Y.: Thieme.

Engel, G.L. (1977).The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136

If we do not change the focus, the paradigm, the methodology, … and follow Lazarus, et. al suggestion; “Since appraisal, emotions, and coping patterns ebb and flow in a person’s changing commerce with the environment, a new type of assessment is needed that measures process and variation within individuals and across situations, as well as structure and stability” (Lazarus, Cohen, Folkman, Kanner & Schaefer’s, 1980, p. 113)” and use applied psychophysiology as a platform, we will not increase efficacy in health promotion, stress prevention, differential diagnostic analysis and biobehavioral treatment of negative stress – indeed , a disaster for society and man!

NB the below is to be more elaborated
Medicine is not an exact science (see e.g. * below)! Also, there is a difference between medical science and real world and especially individuals in real world – also scientists as well as clinicians are also human beings in a real world with variation in personality as well knowledge- and practice competences!

(* The below is not only in the eyes and mind of Bo von Schéele, “In times of such quandaries and befuddlement, uncertainty governs the hospital wards, and heaps of notes regurgitated in medical school seem to afford no fecund advantage. Yet, it is within these same times of ambiguity and uncertainty that medicine finds its inveterate thrill: to appreciate one’s knowledge, to understand its limitations, to connect the dots and, most importantly, to eventually find that last piece in completing the abstruse jigsaw puzzle that is the human body”. https://www.huffingtonpost.com/entry/medicinean-inexact-science_us_59e14ad4e4b09e31db975902?guccounter=1 – moreover; the fast knowledge development e.g. within epigenics will not be discussed here but at the Nature-Epigenics-Culture at this web site). George Kelly (personal constructs theory, 1955) shows (at least to me) that medical/psychology/sociology sciences concerns individuals in real world (or should do it if not focus on basic research) and real world is of concern for sciences as well.

At the same time perhaps one of the most important “things” for us, in our world views (Stephen Pepper, 1942, “World hypotheses: A study in evidence”. Berkeley: University of California Press. Reviewed in Journal of the Experimental Analysis of Behavior, 1988, 50, 97-111 – and also Stephen Covey, 1989 … ) and in personal paradigm (Protagoras … Thomas Kuhn, see more below) is points of departure to be able to functional relate and cope with an gradually increasing complex real world. A personal way to understand and function is extremely complex in our life (our habitat, cultural context) to navigate, scientist or not.

Often our emotions, non-rational attitudes based on experience, constitute our “driver license” for survival. Even if lifestyle related diseases and problem are not well understood and researched, we need to find out a kind of basic biopsychosocial-cultural-ecological platform from which we can navigate with some confidence. How we life our lives are significant/salient for our health development and life quality. Unfortunately, this is very little addressed by science in a multifaceted, multidisciplinary useful way –something very difficult to understand why it is not by an increasing number of us!

How come? Not of interests? For whom? Science? Politicians? For those of us who live a healthy and peaceful life? For most of us other people suffering of emotional driving forces/intelligence (which are not by individual or science well understood), sometimes as driving forces overriding conscious behaviors? Something that e.g. psychiatry tries to deal with – in confusion. Lifestyle medicine concerns not only the above, but “all if it” – variations between and within individuals in real world – with focus on life quality, health promotion and prevention/rehabilitation of life style related diseases.

The field is enormous – until now mostly of commercial interests for pharmacology interest. But gradually, we are pleased to see interests similar to the democratic forces against other profits power interest.