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Chiropractic Journal of Australia : CJA March 2013
Chiropractic Journal of Australia Volume 43 Number 1 March 2013 21 the solar system.21,22, Francis Bacon (1561-1626) declared that Man had been created by God to interpret and hold dominion over nature. It was therefore Man's duty to study natural science and Bacon equated knowledge with power. The word 'knowledge' derived from the Latin scientia, so science was power.23 Rene Descartes (1596-1650) established a philosophical basis for this new understanding of science. He delighted in the ‘certitude’ of mathematics and ‘… judged that no solid superstructures could be reared on foundations so infrm …’ as the philosophies that had preceded his time.24 Rejecting 'as absolutely false' all opinions that he supposed had any ground for doubt, he developed four logical precepts that he reasoned would enable him to arrive at absolute, certain knowledge.25 The second and third of these required reduction of the matter in consideration into simple parts and then thinking from that.26 Descartes' described his cogito - ‘I think, therefore I am’ - as the frst principle of his philosophy, and, from that, argued that his mind, by which he was what he was, was 'wholly distinct' from his body.27 That body, and the rest of the universe, were regarded as purely material non-vital objects, so all the physical world and its related events could be understood as machinery, created by God and subject to His mechanical laws. These concepts reinforce the reductionism, separation of mind and body, materialism and consequent mechanism that are so much a part of the modern Western medical model, and so different from traditional chiropractic and Eastern views. According to Pellegrino and Thomasma, 'Cartesianism is the unspoken philosophical substratum of contemporary medicine -- the source of its great strengths and equally of its defciencies.’28 Descartes’ determination that fxed and absolute knowledge and laws existed and were knowable was then built upon by Isaac Newton (1642-1727), who further developed the linear cause and effect method of explaining the material world and the mechanical worldview.29 According to Channel, this perspective, the 'clockwork universe', is characterised by the belief that the universe functions like a machine, particularly a clock. Observed phenomena can be explained as inert, passive pieces of material interacting with other pieces of matter through contact or forces. Change is the result of these interactions, which are governed by predictable mathematical laws. Thus all phenomena can be comprehended by reducing complex problems into smaller parts and analysing them, and the whole can be explained by understanding its parts. These perspectives were also applied to the anatomy and physiology of living things, so mechanical concepts were used to explain activities such as respiration, circulation and thought.30 The living organism as a mechanical system remains the model for much of thinking in science today, including medicine, notwithstanding the discoveries of quantum physics. Palmer acknowledged this model, at least at one stage of his career. In 1906 he was quoted as follows: 'A human being, like inanimate machines, should be examined occasionally, if any part is found to be displaced, adjust it, using as much good sense so as you would in repairing a watch, organ or steam engine.'31 THE DOCTOR AS MECHANIC According to Lipton, this model posits that disease or dysfunction can be understood at the microscopic level as an effect of a malfunction in one of the steps of a chain of chemical processes. At the microscopic level, for example, if a drug molecule can be developed to replace or repair the problem step, a cure can be expected.32 At the macroscopic level, clogged arteries resulting from poor living habits can be ‘fxed’ by replacing them surgically with arterial tissue harvested from elsewhere in the body. The philosophical model at the basis of Western medicine can then be represented as follows. The human can be understood as a living machine. The heart functions like a pump, the kidneys as a flter, the brain like a computer, and the nerves like telephone wires. This body machine can best be understood and its problems treated by breaking it down -- reducing it, in Cartesian fashion, into systems, organs, tissues, cells, organelles and molecules. The human in a condition of injury, dysfunction or disease therefore needs a ‘mechanic’ to ‘fx’ her. The doctor acts as that mechanic, actively and heroically using the powerful products and procedures of medical science and technology to repair on the patient -- to 'cure' them. The patient is the passive recipient of treatment, or, as it is euphemistically termed, 'healthcare'. Standardisation is important in facilitating the work of the medical mechanic. Established, standardised causes of diseases lead to standardised diagnoses and the standardised treatment protocols referred to as clinical practice guidelines.33,34, Many considerations arise from this model. It requires the maximisation of similarities between individuals and minimisation of their differences. This enables medicine, in conjunction with science and technology, to be practised on a basis of mass production, similar to that in industry, as mass medicine. Something called 'healthcare' can be commoditised, sold and delivered through a 'health care delivery system' by 'health care providers'. One attends to one's health by purchasing products and services from others. Further reductionism would lead to specialised approaches. Chemists might regard the body as a chemical factory, and seek to understand it and its malfunctions as aberrations in the production or elimination of molecules. Synthetic chemicals could be manufactured and sold for use in intervention in these problems. Such an approach might lessen the desire for understanding of the broader underlying causes of disease conditions and the addressing of them. Physicists could view the body in terms of its atomic structures. Ionising radiation, magnetic forces and ultrasound waves could be used to visualise internal structures and for treatment involving the destruction of pathological tissues. Engineers could be the most obvious Cartesians, and view the body as a collection of mechanical structures. Surgery could be used to open the body and to repair, remove or replace parts of it, while it is 'stopped' by anesthetic.33 An orthopaedic surgeon has bluntly summed up the reductionist, mechanist and materialist approach: 'So there is no doubt, let me state very clearly: back pain is a physical problem … Back pain is not a psychological problem. Back pain starts with a physical problem in the back … Back pain is a mechanical problem. It is mechanical in the sense that symptoms arise from the musculoskeletal system …’ After reviewing orthodox (Western) medicine's century- long efforts to fnd ‘… a structural cause for low back pain MECHANIC OR GARDENER RICHARDS
CJA December 2012
CJA June 2013