Georg Ivanovas From Autism to Humanism - systems theory in medicine

2. The medical paradigm and the anomalies of ‘Normal Medicine’

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2.1 The medical paradigm

What is our medical paradigm? Is it what the Journal of the American Medical Association, the New England Journal of Medicine, the Lancet, the British Medical Journal and all the other similar journals present? In a way yes. They create a standard by only publishing papers that (on a meta-level) fulfil the expressed and unexpressed criteria how medicine should be. This has been called a „publication bias in situ“ (Phillips 2004), something far away from an ‚evidence based publishing’ (Tite/Schroter 2006).

However, “the process (of selecting papers) has been designed to benefit authors not readers. The authors need to get their work published in order to gain academic credit, promotion, and the next grant and often don't care whether anybody reads what they write” as the former editor of the British Medical Journal admitted (Smith R, 2003c). On the other side, in order to be published, the authors write (on a meta-level) how medical journals want papers to be. It is a recursive process that, in effect, creates the paradigm of medical journals. "As a result, there is a danger of evidence-based medicine to pursue what is possible and available rather than what is relevant” (Maeseneer et al, 2003)

Often the result is not what physicians need. There is a “10/90 gap, whereby less than 10% of health research is concerned with the conditions that account for 90% of global disease, (and this) may well be a 1/99 gap when it comes to health information” (Smith 2004e).

That is, research does not investigate what physicians encounter, but what scientists are funded for. And they are funded for subjects that are often published. “Systematic reviews follow the priorities of established market economies rather than global priorities” (Swingler et al 2003). By this, published medicine does neither match nor represent practiced medicine.

As medical journals provide a strange collection of results, unrelated in inner meaning and unrelated to medical practice, mainly in a boring manner (British Medical Journal 2004a) every practitioner has to find his own way through this jungle. He creates his own style, a mixture of theoretical knowledge, para - universiterian tradition, own experience and mom’s advice, something that has been called the ‘unofficial model’ (Uexküll 2001). It is important to understand that this is not accidentally so. It is, as will be proved, an unavoidable consequence of the current medical paradigm.

Some decades ago Bleuler called this kind of approach as ‘the autistic-undisciplined thinking in medicine’ (Bleuler 1962).

May be this accusation seems to be too strict, at first. But using a modern definition of autism – “impaired language, social and communicative deficits, repetitive and stereotyped behaviors” (Powell 2004) – Bleuler’s claim is strikingly correct for the current medical paradigm. Despite the obvious fact that medical language and behaviour is often impaired and with communicative deficits (chap. 1) there is also an epistemological reason to compare medical science with autism. Reductionism (chap. 2.1.a) excludes by definition the relational aspects (chap. 3.7), depriving scientific medicine from a sound semantic structure (chap. 3.1). Just as some autistic persons are able to say the phone book by heart but are unable to make a phone call (as in the film Rain Man), the knowledge of facts is useless when not integrated in a semantic context. This phenomenon has been described as savant skills where the ability to process local information plays a key role (Happé/Frith 2009).

The repetitive behaviour is the attempt to solve a problem with the same approach that has lead to the difficulties, where the idea prevails “that science is curative – that enough… information will bring about the resolution …” (Whitaker cited in Roberto: 467). Such a situation is found when a ruling paradigm is not able to acknowledge its own shortcomings and to accept a new view (chap. 3.10).


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