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4 Med., Health Care & Phil. 1 (2001)

handle is hein.journals/medhcph4 and id is 1 raw text is: LA Medicine, Health Care and Philosophy 4: 1-3, 2001. Editorial A return to biological thinking in medicine Each stage of the development of medical science has posed its own philosophical questions. Descartes, whose philosophical thinking also bordered on the problems of medicine, liked to compare phenomena of nature with man-made mechanical devices and in his Meditationes de prima philosophia (Descartes, 1641) he described the human organism 'as some kind of machine which is made up of bones, nerves, muscles, veins and skin'. It functions according to the laws of nature both when it is ill and when it is healthy 'such as a clock made up of wheels and weights does not observe the laws of nature less accurately, when it is badly made and does not show the right time than when in every respect it satisfies the desire of its maker'. Half a century later Locke (1690, p. 444) used a similar analogy, but he also added that unfortunately our ideas of the 'internal constitution' of phenomena of nature are as remote from the truth 'as a countryman's idea is from the inward contrivance of that famous clock at Strasbourg, whereof he only sees the outward figure and motions'. This was the origin of what may be called 'the clockwork model' of disease which up to the present time has guided generations of medical scientists, who saw it as their aim to find out more and more about the structure and functions of the human organism, and today we know much more about its 'inner constitution' than Locke could possibly have foreseen. The clockwork model has, of course, gradually been refined, as well expressed by Walter Cannon (1932) in his influential book The Wisdom of the Body in which he describes the human organism as an extremely complex self-regulating system. He was the originator of the term 'homeostasis'. The basic idea, however, remains the same. The human system is regarded as a complex physico-chemical 'machine' which follows the same laws of nature as man-made machines, and disease is regarded as a dysfunction of the machinery. The majority of papers which today are published in our medical journals can be fully understood within this paradigm. However, this analogy has its limitations. A clock or any other man-made machine receives its final form when it is made, and its constituents, including the atoms and molecules of which they are composed, remain the same from one day to the next. In contrast, the human organism grows from a fertilised ovum and most of its parts are re-created again and again all through life. Therefore, the clockwork model, no matter how much it is refined, cannot explain those diseases which originate because the genome is defective, because the growth process is disturbed or because the re-creation of tissues and organs runs astray for some reason or other. From this perspective it is not surprising that until recently medical scientists had little success explaining the riddle of cancer or the development of the degenerative diseases of old age. Now the situation is changing due to the advancement of molecular biology. The clockwork model also assumes that the human organism, like a man-made machine, is a closed system, but that is far from true. The human system is an open one in constant interaction with its environ- ment, and it is now known that such systems, which constantly receive and dissipate energy, are creative in the sense that they may undergo more and more complex structural transformations. The present devel- opment of complexity theory (including the theory of non-linear dynamics and fractal theory) in conjunc- tion with our increasing knowledge of molecular biology may provide a theoretical basis for exploring life processes which greatly transcends the traditional framework of thinking. Teleological thinking has always pervaded medi- cine. We increase the respiration rate during exercise in order to secure an adequate oxygen supply to the tissues, and produce antibodies in order to kill invading bacteria. Such statements seemingly contradict the fundamental belief that nature knows no purpose, but they have been exonerated by referring to evolutionary theory. That we sweat in order to lower the temperature is just another way of saying that some time in a distant past those ancestors of ours who started to sweat fared better than those who did not. This way of thinking is not new, but nevertheless teleological statements have always been regarded as slightly suspect from a scientific point of view. Scientists prefer to ask 'how' the organism functions rather than 'why' it functions

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