Cultura & Medicina

Dava Sobel (New York City) y la socialización del conocimiento científico

La escritora estadounidense dedicada a la divulgación científica, durante varios años como freelance escribió en la sección de neurociencias de The New York Times. En una entrevista que le hicieron en Barcelona (El País de Madrid, 17/03/2019), sostuvo que hay conocimientos que pueden comunicarse automáticamente como es el caso de una sonda espacial, pero existe un tipo de ciencia que necesita previamente validación e intermediación. Dice que la competencia entre científicos ha entrado en una nueva fase y puede ocurrir cualquier cosa. Refiriéndose al nacimiento de los dos bebés modificados genéticamente (China), sostiene que la cultura científica está cambiando. Quien hizo ese experimento con células germinales sabía los riesgos y las incógnitas que hay, pero siguió adelante.

¿La comunicación relevante debe hacerse exclusivamente en inglés?

Las principales revistas de medicina del mundo así como los congresos internacionales emplean como idioma único el inglés. Desde hace prácticamente un siglo el inglés se impuso como el idioma de la comunicación científica, desplazando al alemán y también al francés. El tema fue analizado en el último Congreso Internacional de la Lengua celebrado en Córdoba    (Argentina), del 27 al 30 de marzo de 2019.

Si bien no se trataría de una competencia entre las lenguas en el ámbito científico, hay quien opina que los países hispanohablantes (600 millones de hablantes) deberían hacer más ciencia si quieren incrementar su uso en los papers, pero también hay quien sostiene que esto atañe más bien a las ciencias duras, ya que en el caso de las ciencias sociales y humanas el comportamiento sería diferente y existe la tendencia a publicar en español.

Algunos críticos sostienen que los artículos científicos en las revistas de impacto tienen una lógica anglosajona, y que un artículo de baja calidad publicado en inglés vale más que un buen artículo publicado en español. De todas maneras, no hay duda que los que quieren publicar en revistas científicas de alto impacto deben hacerlo en inglés, porque además el mercado del mundo académico se maneja en inglés y rechaza el español.

Integración de conocimientos

Prof. Dr. Roberto M. Cataldi Amatriain (Buenos Aires, Argentina). Del libro Current Medicine: Conflicts and Dilemmas. Internal Medicine, Bioethics, Clinical Research, Medical Education and Public Health. ICIM, Buenos Aires, 2011

Medicine was not born as a scientist’s discipline, as in the beginning of  humanity  Magic was king. Many diseases and their therapies or mitigations were interpreted from a magic vision. This also can be seen at present in certain situations, today when wizards, magicians, shamans and quacks try to compete with the doctors, promoting their activity across the press and television, in many occasions successfully. But Magic and Science always coincided in that they sought to dominate Nature. Clearly the difference between both is methodological, as Magic  does not accept neither experience nor tests (unavoidable steps in scientific methodology).

The myth and the ritual, were always present. The myth, being transmitted from generation to generation without self-criticism. The cosmovision of the myth is pre-scientific and its attitude is receptive thought . Today we know that when we try to demythologize, the situation becomes very complicated.

 In ancient Babylonia there existed a medical caste that had penal and civil responsibilities, according to the reading of Hammurabi’s Code. In this document which has a strong constitution, a clear demonstration exists of how 3700 years ago already there existed a juridical regulation of the medical act (medical right).

Nota: el primer ejemplar fue entregado en la Biblioteca de Alejandría (Egipto)

The relation between the doctor and the patient was always paternalistic (classic model). An asymmetric relation, since the doctor would represent the role of father and the patient the son’s role. The doctor´s justification is: the individual when sick turns into an ” incompetent mulberry bush “. This model has not disappeared, though from the 1970´s a change has given place to a increasing degree of autonomy.

Today the doctor must report, must answer – within his abilities –  all the questions that the patient ask them. The patient can accept what has been proposed to him, or can refuse, or even request the opinion of another doctor (second opinion). The patient therefore is seen as an adult, mature and in a responsible relationship, though it is not free from conflict. The symmetry of this relationship is not perfect, because the relationship is established between a sick man, that looks for professional help and, the doctor, who is qualified, has expertise, and is trained to help.

The search for precision and for efficiency has been driving force behind the introduction of mathematics in Medicine and, lately, the introduction of algoritmia, though we must not forget that it was Hipocrates who introduced numbers into Medicine. Algoritmia constitutes the symbolic expression of logical investigation of reason. Algorithms were created to solve arithmetical problems. The graphical representation is the flowchart, which allows the separation into elements of a problem in its fundamental steps and this enables us to perform a detailed analysis, with a view towards looking for the best way to find a solution. The computer has turned into an important tool for producing these algorithms, but we must not overlook that the microprocessors were made to solve mathematical problems rather than logical problems.

Algorithmic thought, when applied to Medicine, is useful to take decisions in  emergency situations. However the axis of methodology – from the times of hipocratics – continues to be the method of hypothetical-deductive thought.

Aldous Huxley, when referring to integral education, mentioned the experience of his grandfather as the head  of the University of London at the end of the 19th century. His grandfather tried to add humanistic information to specialized scientific information and, across a historical vision, he tried to coordinate both the scientific studies with the humanistic ones. Besides, there were related programs wich included the hundred most important books. The experience failed. Huxley realised that the ideal integrated education, demanded that it be based on human basic problems. The treatment of the integral education demands the assembly of information from different disciplines that are isolated and its necessary to construct “bridges” between all these disciplines.

The problem of integrating knowledge has not yet been solved. There is a divorce between both the scientific and the humanistic culture.  It is necessary that they articulate, complement and reach an integrated synthesis. Neither the  decision to separate the theory from the practice, nor the establishment of compartments between the different disciplines constitute a coherent idea. If the education does not encourage good interdisciplinary relations it will be difficult for the student once graduated to integrate the knowledge and, they will have serious difficulties at integrating his reality as a doctor and his own.

Specialization is a consequence of the Renaissance, since it derives from the “Discours de la Methode” of  René Descartes. From the Middle Ages up to the present there is an increasing interest in the specialisation in all the fields of knowledge. Concerning  Medicine, the complexity of the technologies for diagnosis and treatment has divided the work, which has become professionalized. After the Second World War, specialisation is prioritised in the organisation of Medicine. Many authors have criticised the excessive specialisation, the fragmentation of Medicine, and the lack of synthesis in the vision of doctors.