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Perhaps We Don’t Know Crap…
Rudolf Virchow is one of my few heroes. He was born in what is now Poland in 1821, and died 80 years later after a remarkable career in medicine (which he chose, because he viewed his voice as too weak to be a pastor). He was the first to describe such diseases as leukemia, embolism, spina bifida, and many others. He was one of the few academics of his era who was openly critical of Charles Darwin and the resulting eugenics, describing Darwin as an “ignoramus.” Lacking modern scientific techniques of electrophoresis and isoelectric focusing, he pioneered modern techniques of autopsy. He is widely credited with making the science of medicine less wizardly and more scientific. He was always a step ahead of his colleagues, regardless of the consequences of his outspoken criticisms of his contemporaries. He was widely criticized in his day, although many of his theories have proven to be more valid as we learn more about biochemistry, genetics, and so on.
In 1856 Dr. Virchow said, “Inflammation is the cause of atherosclerosis”. How he figured this out with the tools he had available, I’m not sure. But there is significant evidence available today that suggests that he might be right. The “pleotrophic benefits” of statins refer to their ability to reduce risk of heart attack even in those in whom they don’t change their cholesterol numbers. Statins are potent anti-inflammatories. Is that how they work? Maybe. Maybe Dr. Virchow had a point. We’re still not sure. So now, after more than 150 years, we have a name for his description of atherosclerotic disease, if not an understanding.
There are a few hundred different coronaviruses out there. Why is COVID-19 so deadly? I’m not sure. Why is the delta variant so problematic? I’m not sure. How did Virchow figure out what inflammation is? I’m not sure. But I know this: We don’t know crap. About crap. And I’ve decided that Dr. Virchow knew a lot of crap. About crap. Perhaps I could teach him a few things, given my understanding of modern science. Or perhaps I couldn’t. Perhaps I should temper my modern arrogance. Or perhaps I shouldn’t. I’m not sure.
Why do some of my patients die of pneumonia, while others get a sinus infection? I’m not sure. Why do some people have a stroke with a BP of 135/84, while others smoke cigarettes and die of old age at 102? I’m not sure. Why did my mother die young of some random cancer while complete losers live to be 100 despite years of self-abuse? I’m not sure.
Although I’m not sure it matters. I went into medicine hoping to understand all this stuff. And the better I get at my job, the more it’s clear that I don’t know crap about crap. So I read more Virchow. And I drink bourbon.
It helps. I guess. Although I suspect Dr. Virchow is chuckling somewhere. I suppose. I’m not sure.
Dr. Virchow said, “Medicine is a social science, and politics is nothing else but medicine on a large scale.” I have often wondered why leftists try so hard to gain governmental control of medicine. Perhaps Virchow understood. Perhaps he understood a lot. I’m not sure.
The more I study any field, the more it becomes obvious that I don’t understand. The less I know about any field, the more arrogant I become in my conclusions about that field. This seems odd to me. Although not, perhaps, to Dr. Virchow.
I have my own opinions about masks, vaccines, statins, ACE inhibitors, aspirin, infectious disease, leukemias, organ transplants, auto-immune diseases, bipolar disease, atherosclerotic disease, aneurysms, valvular disease, chronic sinusitis, and so on and so forth. And I’m sure I’m right. I presume that doctors 200 years from now will be referring to me as an accepted source, even long after I’m gone.
But perhaps they won’t.
Perhaps I lack the insight of a primitive doctor born well before my time. Or perhaps not. I’m not sure.
I am forced to decide. On each patient that walks into my office. I do the very best I can. And surely I’m right.
Right?
As we’re faced with difficult decisions, perhaps we would be well-advised to maintain a certain degree of humility. A degree of humility that does not come naturally to people in general. And not to politicians. And certainly not to doctors, specifically.
We do the best we can. And we hope that others do the best they can. And we hope that we all learn from the process.
Arrogance is not necessarily wrong. But lack of humility is wrong. Or, at least, it is dangerous.
Dr. Virchow understood this. He viewed strong centralized power structures as inherently dangerous: “Medicine is a social science, and politics is nothing else but medicine on a large scale.”
We do the best we can. But we must remain perpetually vigilant to the limits of our own hubris.
Politicians, and doctors, and humans in general – we struggle with such things.
But we keep trying. Those who came before us lacked our perspective, and our virtue. So we know better, right?
Right.
Unless we don’t know crap. About crap.
That is a possibility which we ought to consider.
Perhaps limited government makes sense. Perhaps we should seek to reduce the impact of harmful thinking by reducing the power of our government to enforce compliance to current theories. Whatever they are. Perhaps it is the amplification of bad ideas that is more dangerous than the bad ideas themselves. Perhaps we should worship modesty more than arrogance. Perhaps we should respect the ideas of others as much as we respect ourselves. Perhaps we should remember that we may not be as smart as we think we are.
Just perhaps…
Published in General
I think I could respond to this. I often use the knowledge for what has always been. Specifically the brakes on my car. When I start it I semi-consciously listen to the engine, put my foot on the brake to active a switch that allows be to put it into gear and I wait for the cluck as the transmission engages. Then I press the gas and slowly back up and I press the brake to some to a stop. All this I do more or less consciously. But I never suspect that the brakes will not work. To be honest I’ve had a truck that due to a salt environment got brake line leaks a couple of times, and still the truck did come to a full stop due to the brakes. So while I know that brakes do on occasion fail, they have never, ever failed me. But I know that they work so I never second guess this.
I call this knowing that brakes work. At the same time also knowing with less certainty — based on my hearing and reading and deducing things from the the words of others, and adding this weaker-certainty knowledge to my own knowledge base, and extrapolating it — that they might not work in the future. This is not done deductively so much as intuitively and eventually unconsciously.
Knowing that the universe — according to common representations — created itself causelessly 14 billion years ago is a very weak form of knowledge, and in my view subject to easy dismissal or alternative, perhaps more justifiable, knowledge — to the degree that we can call any view about the origin of the universe knowing.
If my life and career were based on the presentation and defending string-theory to the world, or the determination of 10 dimensions, I might easily think differently. This is not to say that string-theory and the existence of 10 dimensions isn’t so, but just that I don’t have great cause to think so.
I will say one more thing. Some things, as you’ve mentioned, are logical necessities. For example the fundamental difference between truth and lies, or reality and unreality. For example, truth can stand on its own. I say the sky is blue, and it is the truth that the sky is blue. And there is nothing more needed. But if I lie and say that the sky is green, then this lie does not stand on its own but the lie only exists in contradiction to something else, to the truth. Therefore, so to speak, truth can exist in a void, but lies rely on that-which-is-true to such an extent, and definitively, that lies can never stand on their own. Lies only exist in contrast and as a corruption of something else, of the truth.
And so the truth necessarily, logically, preexists lies. And is therefore fundamental in a way that error is not.
But for me? Now? The truth is hard to know, and only partly knowable.
Hey, I’m supposed to be the Augustine around here!
Seriously, I dig. Good Augustining.
St. Thomas Aquinas is in the house. Have you read him? If not, I think you would find him very congenial.
Neither do the people defending string theory.
The late Milt Rosenburg had a physicist from Argonne National Labs on one time who cut up on string theory. He went into the gaps in knowledge and the general unfalsifiability of the whole rigmarole.
Man, I miss that show. And Milt.
Forty years ago my father gave me a translation of Aquinas [Dang! I think it was Augustine.] and I got as far as Christ in us and we are in Him. And I thought, that’s pretty cool: he just took the use of two prepositions literally, and thereby described all of time and space. Satisfied, I book the book down and have since meant to finish it. But by now I can’t find it.
High praise. thanks.
The philosophers are wrong and I have the bruises to prove it.
Philosophers also explain why you’re right.
My cynical side would amend or rather extend that to “and those very bright men invariably faced scorn and ridicule for years until their ideas were finally accepted by a community that then pretended to have believed them all along…
My father (PhD in Physics) used to do this to me every time I acted cocky and thought I knew something about how the physical world works. I never got beyond 2 or maybe 3 layers.
This is, of course, subject to so many caveats so as to make it a useless statement. To human eyes, the sky usually appears blue during daylight, though we know “in fact” that this is just a visual effect, and that in space the sky is primarily the absence of all light, and is perceived as “black.” But of course our eyes are only an instrument, and other eyes see different things than ours do, since some see color, while other instruments “see” what is not visual to us.
etc.
I am a religious fundamentalist who understand the text is telling us that it is our perceptions that form our own truth. This is not a position I held when I was younger: it is what the text has walked me toward.
I’m not sure how to interpret this. Are you speaking only of your perceptions of things, or of the things themselves? If it’s just about your perceptions, how does that help us, since your perceptions are your perceptions and not mine? A statement about your perceptions says nothing about my perceptions.
You’re ignoring the point.
What does that mean?