Translation of an original post published in “Piratas de la Ciencia”. in spanish. Sorry for translation missunderstandings and style impoverishment.

We recently discussed with some emphasis the reality or unreality of things …

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We commented recently regarding relativity or not of scientific, unscientific and a-scientific knowledge and concepts …
From a medical point of wiew it would be very easy to defend how accurate is our way of interpreting reality and interacting with it. From a position as a “human being” is far more questionable to get to reach such a great conclusion.

NO
Scientific, the truth of our time, the apparently final and immutable, is solely the product of a very single way to address the reality: the scientific method. Hypothesis testing / verification, reproducibility … are the foundation of this way of classifying what is and what is not, what is true and what is fallacy.

It would be easy to appeal to logic to deny this assesment: A unique way, a single method to approach the truth “outside” the living being, must be in itself a limited way, deeply lacking in self-criticism, as it sometimes is. It may be only a way to avoid what is not understood.

In radiology, the visual perception of anatomical evidence by the visual sense, a finding that has not been tested in at least two projections is not admitted, by definition. Why should we validate individual truths matching one only way to tackle the environment as solid foundation for the interpretation of reality?.

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YES
When analyzing and checking a fact, when one experamentaly proof the relationship between two variables and contrasts the ability to repeat such an action with similar results in different geo-socio-demographic environments, it seems to reinforce the capability to assert that, what tested, what is claimed, is Truth.

NO
To affirm a truth does not mean that you can define or derive the content or interpretation of complex realities through it. The scientific method is important because it imposes the experimental basis but, regardless of this fact, we have been building over a century reality in terms of knowledge extracted form itself using this same method: when building reality based on science, science has to give Reality as the answer.

YES
Science, good science, by definition, should tend to be self-critical and can not but be cautious of attempting to reach complex conclusions derived from specific findings .

In this process of evolving it has its own mechanisms for generating knowledge and improving its ability to assess the context in which we are immersed, science is reaching new heights constantly.
Most recently and demanding (as long as I know), evidence-based medicine, asks very specific questions that receive very specific answers to a greater or lesser level of confidence of accuracy depending on the sources used.
The highest level of assurance would be given by the clinical trial, one study of true experimental design, and beyond, through meta-analysis of these studies, ie the conjunction of the different results obtained after the sistematic repetition of thereof.

That is, in the depths of the mechanisms of acquisition of Reallity, actually does exist a critical spirit, a way of developing our perception and therefore an implicit acceptance of itself limitations.

NO
As we say even the most reliable scientific studies won’t always give the same answers to the same questions, this method is clearly not infallible.
When we question knowledge based on “non-scientific beliefs (Western)” we should take into account the difficulties that the best of our methods of “perceiving” reality can not overcome.

We know that in our system of knowledge generation there are a number of systematic and routinary biases, rather faults, which vitiate any attempt to answer that can be derived from it.

An example that I find particularly instructive is the bias of non-publication of negative studies: this includes a conceptual problem (understanding a study like the way to check (mandatory) a simple hypothesis and not as an unilateral limited approach to a small piece of knowledge (whether finally a priori hypothesis is proved to be valid or not)) and a problem on the dynamics of generation of science, in a context in which must necessarily prevail production and progress. Without immediate application the acquired knowledge lose interest (and funding) in a very short term.
A recent discovery supports me in this challenge to the “real truth”. Gurus of “evidence based radiology” at European level recently commented in passing that they are currently working with “meta-analysis of meta-analysis”, an infinite path that could lead to fever pitch.

I find it appropriate to recall Nieztche’s quote in regards to the “tragic artist”, which, he says, is not pessimist but dionisiac, as being able to affirm life as a whole, with its comedy and its drama.

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I would say that these tragic artists more broadly reflect what they perceive that those who maintain a single record in their approach to reality (although those achieve second-leading range of expression and / or communication, that’s another story).
What does this have to do with me?

In one context, medicine, in which the taxable person (patient) is the indirect object of predetermined and, in many cases, not easily questionable external actions and decisions, should be recognized and communicated that our highly specialized job is based in a substantial evidence and supported by a century (sometimes millennium) of history, but it is “only” the best way we know through to “healing”.

Some of us, doctors do not recognize this fact. We are impelled by the responsability that the task imposes and the severity of the consequences which could be derived from our decisions and procedures to convince ourselves of the unquestionability of our knowledge.

On the other hand the role of the patient, constantly evolving, in which the subject is becoming less passive goes to the emergence of a critical spirit, more or less constructive, depending on the information obtained from various sources, not always the most convenient (see comment on the gorgeous Eva post).
Others prefer keeping a completely passive role in transferring the first person of singular to the doctor, who in the end, if only as a mediator, will manage his/her relationship with death, ie the clear limit (if not the only one known) of Reality.

Therefore, from the presumption of innocence as fans of religious magical thinking that gives us our professional standing as scientists, should not we remember for a few seconds a day the limitations of our position?

Jc

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