Our scientific approach
First: One way to, in simplistic way, express the difference between scientific and clinical focus is that
(a) science focus is mainly to falsify (According to Karl Popper, https://en.wikipedia.org/wiki/Falsifiability) data while
(b) clinical aim is to validate individual´s interventional processes.
Often also distinction between deduction and induction is discussed but often abduction is forgotten … see https://lifelessons.co/critical-thinking/deductiveinductiveabductivereasoning/
Science focus mainly on nomothetic levels and clinical work ideographic https://en.wikipedia.org/wiki/Nomothetic_and_idiographic.
A problem is if clinical work is controlled/decided/fixed/determined by nomothetical based science, where individuals are not “cared about”. Sometimes we say, it is evidenced based. In fact also very much, especially lifestyle related diseases and mental problems are not researched well (methodologically) or at al (economically and methodologically motivated). Evidenced based practice is a try to meet “ideographical needs” but will not be discussed here, only “our version IBED, Individual Biopsychosocial Evidenced based Documentation” (see below – in brief)
Then: “Medicine .. is not an exact science. It is an applied science, and its practice is an art” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3190445/see e.g. also https://www.huffpost.com/entry/medicinean-inexact-science_b_59e14ad4e4b09e31db975902 ..) Also, except we have assesses to incomplete “knowledge base”, there is a difference between medical science per se and its practiced in individuals in real world who vary between and within individuals over time and situations as well as also scientists – who are also human beings in a real world with variation in their personality as well knowledge- and practice competences!
And more – about complexity: Evolution of our brain (reptilian, mammalian and human parts, see e.g. https://www.interaction-design.org/literature/article/the-concept-of-the-triune-brain) concerns complex, not well understood integration of also two different codes (languages), see e.g. https://www.instructionaldesign.org/theories/dual-coding/ which together constitutes our basic platform for evolution of minds, consciousness, perception, elaboration, rational analysis, problem solving .. That is our point of departure to realize that evolution of science and its understanding is a matter of integrating of the above. Moreover, as we try to express science in terms of reductionistic paradigm (https://www.dictionary.com/browse/reductionist) – first recently realized cannot cover real world complexity – we limit our way to understand real world complexity which also is the focus of medical basic and applied science.
The above impossible? Perhaps, but we still need to urgently deal with diseases and mental problems, that is, suffering individuals requiring best possible supporting aid provided by humanistic societies!
The good new is that the above complexity has always been the medicine platform which gradually increase in evolution of knowledge and practice at last also trying to deal with real world from a biopsychosocial-cultural paradigm enabling to grasp the complexity – that is the goal of biopsychosocial medicine, a scientific approach first mentioned formally by George Engel, 1977 (http://globalization.anthro-seminars.net/wp-content/uploads/2016/11/Need-for-a-New-Medical-Model-A-Challenge-for-Biomedicine.pdf). NB we are in the beginning of the beginning but not yet really accepted in traditional reductionistic, pharmacological focused medicine!
Further good news is that our extremely complex, not well understood brain can deal not very bad with limited knowledge – something we are trained at least as long as human part of our brain has been developed, that is last 300,000 years. That means that rational thinking needs to be integrated with (limbic/mammalian) based intuition and personal /shared!) experiences. This means also that clinicians skills are not uniform good (or bad) but vary in a varying way between clinicians over situations and time! Something that is not much realized by many BUT – again good news – something with Artificial Intelligence can have constructive impact on given integration of human and artificial intelligence are construed in an effective, emphatic, caring way!
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, …
|Philosophic paradigm||Critical rationalism||Different paradigms get different consequences|
|Scientific paradigm||Biopsychosocial medicine||Different paradigms get different consequences|
|Focus||Idiographic AND nomotetic||Need to go from specific to general – see e.g. Donald Fiske´s argument|
|Method||Traditional AND IBED*||Needed * Individual. Biological Evidence based Documentation|
|Data analysis||Sophisticated, systems integrated||Human brain based analysis must be integrated with Artificial intelligence based|
|Focus for analysis||Biopsychosocial reality||Man is living in real world|
|Intervention focus||Biopsychosocial tool box||People/patients need education and training, a manual and supervision|
|Documentation||Traditional and IBED||A prerequisite for a sound knowledge and empirical development|
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.