Perspectives in Biology and Medicine

PERSPECTIVES IN BIOLOGY AND MEDICINE Volume 36 · Number 3 · Spring 1993 THE CONTRIBUTION OF SCIENCE TO MEDICINE JAMES MCCORMICK* Medicine is not science, and it is certainly not art. Medicine's primary function is social. All societies from the most primitive to the most sophisticated (most civilized seems increasingly inappropriate) recognize medicine men, who are seldom women. Medicine men who are believed to be able to diminish both the discomforts and the hazards of our journey from conception to the grave. Science makes a contribution to this primarily social function in three ways. It provides a body of relatively secure knowledge. Second, some of that knowledge has been applied to develop technologies, technologies which have had a major impact upon the practice and effectiveness of medicine. Last, science offers to medicine a way of thinking. Knowledge That body of knowledge which we now possess as a result of science is not forever fixed and unalterable but a best approximation, an approximation which has yet to be refuted. In relative terms, that is by comparison with the recent past, the growth of this knowledge has been remarkable. By contrast, in absolute terms we remain ignorant. This was expressed by Lewis Thomas when he remarked that "the ship of biological science is under way, but only just." We know so much more than our predecessors that we may be deluded into thinking that we know a great deal. Unfortunately the This paper is based upon the Mayne Lecture given in the School of Physic, Trinity College, University of Dublin. *Department of Community Health, Trinity College, University of Dublin, 199 Pearse Street, Dublin 2, Ireland.© 1993 by The University of Chicago. AU rights reserved. 0031-5982/93/3603-0828$01.00 Perspectives in Biology and Medicine, 36, 3 ¦ Spring 1993 315 medical profession, in fulfillment of its social function, pretends to knowledge when it is imperfect or even nonexistent, and is reluctant to confess and to stress the depth of its ignorance. The growth of understanding has demonstrated that what appears, in the first instance to be simple, turns out to be complex. Clotting at one time was the conversion of fibrinogen to fibrin: it still is, but it is a great deal else besides. Medicine in its need to be responsive and activist oversimplifies, but unfortunately, as Mencken remarked, every complex problem has "a solution that is simple, direct, and wrong." Popper has pointed out that "the more we learn about the world and the deeper is our learning, the more conscious, specific, and articulate will be our knowledge of what we do not know, our knowledge of our ignorance" [I]. What is known defines the extent of the unknown, certainty the extent of uncertainty. The Application ofKnowledge The utility of knowledge is its application to practical purposes. Much the greater part of medicine's useful and practical knowledge, pace Stokes, Graves, and Mayne, derives not from physicians' observations of patients at the bedside but from the laboratories of the natural sciences, physics, and engineering. Such knowledge has been used to develop technologies, from effective drugs and vaccines to sophisticated imaging devices, which have revolutionized the practice of medicine. The main impetus to these most useful developments has come, not from physicians , but from commercial interest and the possibility of profit. Technology illustrates that it is in no way necessary to have any knowledge of science to benefit from and to use its discoveries. In driving a car, watching television, or prescribing antibiotics, ignorance of engineering or biochemistry is little disadvantage. Science as a Way of Thinking Bertolt Brecht's Galileo states that "The chief cause of poverty in science is imaginary wealth. The chief aim of science is not to open a door to infinite wisdom but to set a limit to infinite error." The stance of science is doubting, uncertain, and sceptical; it is this which offers the possibility of "setting a limit to infinite error." Ian Chalmers noted that science is antiauthoritarian: It is because scientific method actively fosters uncertainty that it must inevitably be subversive of authority. ... If authorities are to be effective propogandists for their diverse practices and causes, then unlike scientists, they need to know what...