Flexner versus Osler

Medical education suffers to this day

William Osler (1849 - 1919), left, and Abraham Flexner (1866-1959), right.  Public Domain, via Wikimedia.
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In the early part of my Mises Institute talk I expressed the following:

…under the dual influence of ideological empiricism, which was widespread among prominent scientists, and social progressivism, which was flourishing in many Western nations at that time, medical licensing laws incorporated and embedded the machine model into medical education, turning it into a quasi reality.

The convergence of interest between the social progressivists and the ideological empiricists, which led to the Flexner report and to the enactment of licensing laws, is further treated in an outstanding paper by Alfred Tauber, who was professor of medicine and philosophy at Boston University School of Medicine.

The paper, entitled “The two faces of medical education: Flexner and Osler revisited,” contrasts the radically different views these two men held about medicine.  It is ironic that the victorious viewpoint would be the one pushed by Flexner who, as Murray Rothbard put it, was “an unemployed former owner of a prep school in Kentucky…sporting neither a medical degree nor any other advanced degree.”

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From reacting machine to acting person – part 2

Greek mask (person), Louvre Museum.  Photo By Marie-Lan Nguyen - Own work, Public Domain
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This is part 2 of my paper presentation at AERC 2016 at the Mises Institute. Find part 1 here and the audio here.

Slide11I would therefore like to entertain an interpretation of health rooted in the view that human beings are persons acting purposely, persons who select means to achieve chosen ends, which is the framework of praxeology.

Under a praxeological framework, I would distinguish external means such as land, labor, and capital, which are generally the concern of economic theory, from internal means, such as the physical and mental conditions of the person that allow him or her to pursue chosen ends.

Health, then, may be defined as the state that is present when a person’s physical and mental conditions allow the pursuit of his or her chosen ends.  Disease, then, is the absence of health.

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From reacting machine to acting person – part 1

Claude Bernard and his pupils. Oil painting after Léon-August Lhermitte. Credit: Wellcome Library, London. Wellcome Images
via Wikipeida CC BY 4.0) 

Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
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This is the transcript of a paper I presented at the Austrian Economics Research Conference at the Mises Institute. I have included the slides below and you can hear the audio here.

The title of the paper is “From reacting machine to acting person: a praxeological interpretation of the patient, his health, and his medical care.”  For more info on praxeology, see my previous article here.

I have split the presentation into two parts. This is a very condensed talk, covering a lot of ground, but I will elaborate on various points I make in the paper in the ‘progress notes’ section of this website over the next few days and weeks.

Thank you for reading and for any feedback you might have.

The elephant in the room in healthcare is that there is no precise definition of health.  I believe that this ambiguity plays a major role in our perennial healthcare crises, and I am hopeful that Austrian insights can be helpful.

Here is the outline of my talk.

I will first identify the two dominant modes of thinking about health in modern Western societies.  I will show that those conceptual modes are counterproductive to fostering health, both economically and medically.  I will then propose a praxeological interpretation of health, and sketch the possible benefits and ramifications of that interpretation.

Slide3The dominant mode of thinking about health in Western societies owes its origins to René Descartes who, at the beginning of the scientific revolution, proposed the machine concept of the organism.  Descartes’ proposal was a radical departure from pre-existing notions which were rooted in the idea that organisms have essences and natures.  Instead, he proposed that every material body is an assemblage of tiny particles moving mechanically according to physical laws.  In the case of plants and animals, God directs the laws and the motions.  In the case of humans, the mechanical bodies are under the control of a separate human soul acting like a “ghost in the machine.”

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Kahneman versus Klein on medical decision-making

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I just finished reading Daniel Kahneman’s bestseller Thinking, Fast and Slow.  Regular readers of this blog will probably surmise that I don’t share the Nobel prize winner’s interest in cognitive biases (not that they don’t exist, of course).

Kahneman, like most social scientists, generally espouses an empiricist’s outlook on the human mind (the Humean mind…).  For him, decisions are essentially a matter of calculation, and he documents the many ways we fool ourselves, and the many ways we can fall short.  In that respect, the book is very interesting and often amusing.

Of course, one benefit of the research Kahneman has conducted with Amos Tversky is to poke holes in the flawed model of the world as made up of fully rational and selfish “Econs” as Richard Thaler put it.  That model underlies much of mainstream, neoclassical economic theory.¹

What I found most interesting in Kahneman’s book is chapter 22, which deals with expert intuition, and whether it can be trusted.  In that chapter, Kahneman candidly discusses his differences with Gary Klein, for whom he shows much respect.  I wrote about Klein and how his insights can help us think about medical decision-making in my post “How experts really decide.” (more…)

A prospective medical student asks for advice

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A prospective medical student wrote me this, and below is my response: (more…)

Thoughts on the trustworthiness of the healthcare system

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The media periodically report tragic stories of parents who, for one reason or another, shun the medical system and, as a result, allow their children to either die or endure severe complications.

One such story came out yesterday regarding young parents whose toddler became sick.  Instead of seeking medical attention, they took the advice of a naturopath over the phone.  The child was misdiagnosed and treated with so-called natural remedies despite showing signs of deterioration and lethargy, although at times he appeared to get better.

After a two week period of persistent symptoms, the toddler took a turn for the worse.  By the time the parents brought him to the hospital he had sustained profound, diffuse brain damage.  There is no detail on what his exact diagnosis was, but it stands to reason that the child would have been better off if brought to the hospital or to medical attention much sooner.  The parents are facing criminal charges. (more…)

Peer-review and science’s funding problem

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I enjoyed listening to Theral Timpson’s podcast interview of Jason Hoyt yesterday.

Hoyt is the co-founder of Peer J, an open access publisher that is also encouraging biologists to post pre-prints.  Peer J offer pre-print hosting for free and is one of those entrepreneurial companies that is trying to find a remedy for the widely perceived science publishing gridlock.  Hoyt gives good insights about some of the challenges present in that world.

A couple of years ago, Hoyt also co-wrote an article for Scientific American in which he traces back the history and evolution of science publishing.  Amazingly, peer-review of papers was not mandated by most journal until the 1970’s. (more…)

An introduction to praxeology and Austrian school economics

A primer for physicians and healthcare professionals

Hohensalzburg fortress, Austria via Pixabay, public domain)
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A couple of weeks ago, I presented a paper about health and medical care at the 2016 Austrian Economics Research Conference, which was held at the Mises Institute.  I will be sharing the content of the talk in the next few posts, but given that I use some terms and concepts borrowed from that school of thought (e.g., “praxeology”), I thought that I would first take the opportunity to give a brief introduction to Austrian economics for those unfamiliar with it.

Brief history

Austrian school economics refers to a school of economic thought whose adherents generally share similar views on methodology.  The originators of that school were mid-to-late nineteenth century Austrian scholars whose economic ideas were in opposition to the ones dominant in Germany at that time.   The term “Austrian school,” given in disparagement by members of the German Historical School, stuck.  The German school has disappeared, but the Austrian school remains vibrant today.

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Podcast interview: Mendelspod

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A couple of weeks ago, Theral Timpson kindly interviewed me for his Mendelspod science podcast (an excellent show, especially for those interested in cutting edge biotech matters).  We talked about philosophy of science and medicine.  I really enjoyed the conversation, and I hope you will too.  The link is here.

A guide to top medical journals

A primer for healthcare journalists

Image source: Pixabay
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Charles Ornstein is an award-winning healthcare journalist who recently wrote an article in the Boston Globe about an ongoing controversy regarding a top medical publication.  Yet Ornstein still wonders about the current status of medical journals:

To help answer Mr. Ornstein’s query,  I have asked the editors of top medical journals to submit responses to a simple questionnaire.  Here are their answers.

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