Thursday, January 6, 2011

Einstein Wanted Philosophy Taught in Med School

Two things compelled me to write this post— Dr. Kent Bottles’s post about becoming a “savvy healthcare consumer” and a Teaching Company course on Albert Einstein. Together, they highlighted for me the need to bring real philosophy material into the modern medical school. (If pressed for time, you are far better served reading Dr. Bottles's piece.)

I’m a bit of a philosophy junkie, and I realize that talk is especially cheap in a field as real-world and empirical as medicine. It’s hard enough to get ethics through the wishy washy filter. Yet, it’s the very empirical nature of medicine that necessitates a look at empirical philosophy and epistemology.

Dr. Bottles quotes Nassim Nicholas Taleb’s perspective of skeptical empiricism when describing his decision process regarding vitamin D recommendations. In his famous book The Black Swan, Taleb describes skeptical empiricism as a combination of Nietzsche’s intolerance of the bullshit stories we tell ourselves to make us feel good about ourselves, logical positivism’s demand for tangible evidence, and Popper’s insistence on falsifiability.

In light of new guidelines adopted by a federal health panel, Dr. Bottles decided to “Follow in the footsteps of Huet, Hume, Popper, Taleb, Ioannidis, and Freedman” and “stop taking Vitamin D.” In addition to Taleb, notice that Dr. Bottles directly references no less than four philosophers, including two classics that I recognize from standard philosophy fare— David Hume and Karl Popper.

Dr. Bottles’s post is an eminently readable account of how one navigates the exponentially growing field of medical knowledge. Throughout, he describes how he leans on philosophy to guide his thinking. Clearly, an informed medical student needs help guiding his or her thinking as well. The mere facts of a traditional medical education need to be augmented by a critical appraisal of the literature. ‘

But there’s a lot packed into “a critical appraisal.” Invoking a critical appraisal is akin to simply demanding that students be wise— easier said than done.

I think we can truly get at effective critical thinking with a discussion of philosophy. Bring Popper and Hume into the classroom, perhaps in the more accessible prose of Taleb.

If I may be so bold, I suggest that medicine is entering a stage that necessitates the separation of stories from data. With vast stores of information available with touches of a mobile phone, the key is penetrating thinking about this data more than retaining the facts themselves. Future physicians will be less reliant on the stories of superiors and far better served by rigorous thinking. This rigorous thinking needs to be presented early on in a physician’s journey.

The information is provided for us. We need rigorous training in rigorous thinking to navigate this information.

Admittedly, bringing Einstein in at this point is a bit of a leap, but his perspective is inspiring and it’s fun to posit a link between healthcare and physics. In his 1936 article “Physics and Reality” in the Journal of the Franklin Institute, Einstein wrote:

"It has often been said, and certainly not without justification, that the man of science is a poor philosopher. Why then should it not be the right thing for the physicist to let the philosopher do the philosophizing? Such might indeed be the right thing at a time when the physicist believes he has at his disposal a rigid system of fundamental concepts and fundamental laws which are so well established that waves of doubt can not reach them; but it can not be right at a time when the very foundations of physics itself have become problematic as they are now. At a time like the present, when experience forces us to seek a newer and more solid foundation, the physicist cannot simply surrender to the philosopher the critical contemplation of the theoretical foundations; for, he himself knows best, and feels more surely where the shoe pinches.”

Humbly, I would bet Einstein too would support philosophy in medical school.


Irvin Bussel said...

You are doing yourself a disservice by calling it philosophy. Med students think they are very smart. You know the bullshit lines... future professionals... achievers of academic success... insert silly deluded comment here. You know where I stand on medical education: it is a difficult and time-consuming feat that requires a certain caliber of intelligence but by no means brilliance.

I think what you want in medicine skepticism. Pardon me putting words in your post but that is what I took away from it. Most med students hear philosophy and think of their college pot head friends waxing poetically about the universe. Though they are bright and accomplished, very few learned to think critically. It isn't their fault because the undergraduate educational system is not in place for that. Research is the only experience in which I got a real taste along with the kick in the nuts that comes with true skepticism.

You know... that ability to reason and realize that you are the most easily person fooled by your own bullshit.

(Insert quotes from Feynmann, Sagan, etc here)

If you find a publishing body, I'd gladly develop another editorial with you on this topic.

Sorry for the rant. Back to medical microbiology. Mahalo and all that.

astupple said...

Irvin- I'm in COMPLETE agreement re: philosophizing potheads. But is there a way to engender empirical skepticism without requiring the crucible of bench work?

I'm suggesting a rigorous, no frills, relatively narrow in scope philosophy component, one that would hopefully be a little bit of a "kick in the nuts."

Next time, make sure you include some Feynman quotes. :)

Irvin Bussel said...

I by no means meant that research is the only way to gain skepticism skills. As you know, everyone in med school has research experience but few have the critical thinking ability.

In regards to a no frills lesson, you may enjoy this:

Short. Easy to follow. To the point.

I need a Chrome browser app that notifies me when a comment of mine has been responded to. I'm sure you know something. If you throw it up on twitter, I'd appreciate it.

Feynman quote:

The first principle is that you must not fool yourself--and you are the easiest person to fool.