Monday, November 23, 2009

"Spirituality and medicine" - some thoughts (and an anecdote for good measure)

Recently, a group called the "World Christian Doctors Network" (WCDN) organised what seems to have been a pretty "serious" event attended by over 500 medical professionals - the 6th "International medical conference" (this can't actually only be the 6th medical conference ever ... but anyway ...) in order to discuss "Spirituality and medicine". The point of the event seems to have been to allow Christian doctors to get together and "share" anecdotes about instances of "divine healing" of their patients.
Perhaps they wouldn't put it exactly that way (i.e. my scare quotes) themselves - in their idiom, the aim of the conference was to give Christian doctors a platform where they could "objectively confirm and examine instances of 'healing by the power of God'".
(Note : the WCDN looks shady, but the stated aim of their conference is as good an example as any for my purposes here)

Now, I have absolutely no problem with a doctor being religious. Really, as long as she or he is competent within the context of the doctor patient relationship, that's all good with me. However, as soon as a doctor (and I mean real medical professionals here, not homeopaths and chiropractors) starts attributing spontaneous recovery to the power of God, then it's another story altogether.

The problem is that it almost certainly wasn't God's intervention that "healed" the patient. For every single one of these "miracle" cases we can be sure that there is some rational, scientific explanation for it. But isn't this is some scientistic hand waving on my part, I hear you say? I don't think so, and I'm actually making a stronger claim than this anyway, so lets assume, for the sake of argument that there is no possible way that we could ever explain a patients spontaneous recovery, surely this must count as a miracle?

Not at all, it should never be an option - for a doctor, at least - to declare a recovery a "miracle", even if the explanation lies beyond the reach of our current best, or even future best, scientific theories and methods. A doctor declaring a patients recovery a "miracle" is always a profound failure on their part as a doctor.
This is because even if it were the case that we would never find a reasonable explanation for the patients recovery, the notion that all diseases and cures are, ultimately, amenable to scientific explanation should be a regulative ideal of the medical profession.
To abandon this regulative ideal by crying "miracle" is to simultaneously abandon one's identity as a scientist, and - in my opinion - as a doctor. A doctor, in the moment that he or she declares something a miracle, is not being a doctor.

Since everyone seems so keen on anecdotes, let me present one of my own - and try to imagine what the outcome would have been if the doctor involved had merely thrown up his hands and declared this a miracle (The following, long, quote is taken from Robert Klee's "Introduction to the philosophy of science : cutting nature at its seams")

In 1956 in a Massachusetts hospital a man 51 years old was released and sent home to die. A large cancerous tumor had been removed from him, but a number of other malignant tumors had been found--all inoperable. The surgeons had sewed him up in dejected resignation and his case had been filed away. Twelve years later, incredibly, the same man, now 63 years old, showed up in the emergency room of the same hospital with an inflamed gallbladder. Some doctors might have concluded that the original diagnosis 12 years earlier had been in error and think no more of it, but a young surgical resident at the hospital named Steven Rosenberg was not like some other doctors. Rosenberg made a determined search of hospital records, even going so far as to get a current hospital pathologist to pull the original tissue slides of the patient's removed tumor out of storage and reexamine them. The slides showed that an aggressively malignant tumor had been removed from the man twelve years earlier (so it was a sure bet that the inoperable ones had been of the same aggressively malignant type). During the subsequent operation to remove the patient's gallbladder Rosenberg did a bit of exploring in the man's abdomen to see if the inoperable tumors from twelve years earlier had stopped growing. The man had no tumorsat all in the places his record from twelve years earlier located them.

To Rosenberg, the man whose gallbladder he had removed presented an absorbing mystery. How had a patient with multiple inoperable cancerous tumor survived for twelve years in the apparent absence of any therapy whatsoever?
Such "spontaneous remissions" were not unknown in medicine--they have long been a central obsession of trendy occultists and other kinds of miracle mongers--but Rosenberg wanted to know the detailed why of it. He wanted an explanation of it in perfectly natural terms. He wanted to know how the everyday physiological processes of the human body--in this case, the immune system of the human body--could produce such a remission. Where less curious persons might have shrugged their shoulders in amazement and thought no more about it, Rosenberg instead proceeded on the supposition that there had to be some structural physiological basis behind the patient's remission and survival for twelve years, a structural physiological basis that was consistent with the otherwise ordinary causal operations of the human body. Rosenberg wanted to know the causal details of that structural physiological basis. If he could find out those details, especially if they were quantitative details, then the possibility opened up of being able to manipulate the physiology of cancer patients so as to destroy their cancer.

It would take Rosenberg a number of years to come up with a detailed account of that basis, but come up with it he did. Not only did he find an explanation in perfectly natural terms for the original patient's spontaneous remission, but using the theoretical account of immunological processes associated with that explanation he was able to design a complicated therapy that involves artificially growing cancer-killing immune cells outside the body. These cancer-killing immune cells, called LAK (lymphokine activated killer) cells, are injected back into the patient's body in an attempt to intervene and manipulate the patient's immune response to the cancer. Rosenberg and his colleagues have had a considerable degree of success at producing remissions with this therapy but only for specific kinds of cancer--particularly, kidney cancer and skin cancer. Apparently, knowledge of further structural detail is needed in order to be able to designLAK cells that are effective in other kinds of solid-tumor cancers.

Thursday, November 19, 2009

The skeptical Buddhist - enlightenment and rationality

Let me start by saying that I don't, in any way, intend this to be an apology for Buddhism.
However, I do have a soft spot for Buddhism in general. And I have a much better grasp of the principles of Buddhism than I do of any other religion, so it makes sense that I use Buddhism as a kind of case study.

Buddhism's public image is of a rational, moral, and open system of thought, the principle aim of which is to eliminate the suffering of sentient beings. And so we have the Dalai Lama engaging with neuroscientists, cosmologists, and high ranking political figures. We have FGS building temples across the globe (including a beautiful example here in South Africa). We have people like Guy Newland publishing books that are very much what we expect from philosophy, not religion. And we have a practice, namely meditation (particularly in it's secular forms), that seems to be pretty beneficial, and not require very much from us in the way of belief.

It looks to have all the benefits of religion - moral teachings, consolation, community etc. while having none of the downsides of the kind of religious systems we know here in the West. A lot of Westerners are attracted to Buddhism because of this image.

And, at it's best Buddhism is just like this.

The problem is, though, Buddhism at it's best seems to only actually exists in books.

By this I mean two things.

On the one hand, if one reads Stephen Batchelor (which I highly recommend), or D.T. Suzuki's books on Buddhism, one necessarily gets a lopsided view of what Buddhism is about, you're going to be getting large doses of Buddhist philosophy. And like philosophy as we understand it in the West, the philosophical practices within Buddhism are - for the most part - rational. But this philosophical aspect of Buddhism is only a tiny part of it, and anyone who shows up at a Dharma centre looking for long stretches of meditation punctuated by Socratic dialog is going to be sorely disappointed. Much of the day to day life of Buddhists are characterised by the same kind of supernatural woowoo rituals that characterise any other religious tradition. I know when I heard of one of my Buddhist friends burning little bits of paper every morning to "clear his Karma" (or something), I was horrified - this could not be a part of a rational religion.

On the other hand, Buddhists themselves tend to be exactly the same kind of petty, politicking, perverted, impolite people as we all are. Anyone who has spent any time with anyone involved in a Sangha (Buddhist community) of more than one person knows this. And this is what we should all expect, given the fact that they're just human. And, in fact, Buddhists themselves never really make the claim that they're perfect. It's just, once again, the "public image" that sets up this expectation. Most practicing Buddhists will admit their fallibility and imperfections readily and, usually, with a cheerfulness that's unthinkable for a Christian.

The first point is relatively benign, we can certainly live with it - at least, I could, especially if it was a genuine path to world peace, a healthy environment, and a three day work week. For these things I would happily spend my life prostrating and burning paper in front of Statues.

The second point is more problematic.

By and large, one of the big motivations for new Buddhists to practice is the "enlightenment" idea. Now, if any one's interested, I can go into this a little deeper in some posts later on, but from the outsider's perspective, "enlightenment" tends to look like something very mystical, and very important. Something very different from our mundane experience of life. "Enlightenment" is seen as something to be achieved (and, indeed, in some schools of Buddhism enlightenment is seen as being something that's only achievable over thousands of lifetimes - but Reincarnation and Karma is some nonsense I don't have time to get into right now).
However one conceives "enlightenment", Westerners coming to Buddhism are going to see it as a goal to be achieved. They are going to think of it as an endpoint for their practice. No matter how much someone like Seung Sahn stressed that "wanting enlightenment is a big mistake", Westerners are going to want enlightenment.
How do we seek/get enlightenment - well, generally through a teacher (who may or may not be enlightened him/herself).

Can you see what the problem is?

The teacher/lama/guru/Roshi/Shifu in Buddhism is an authority figure that is given an immense amount of power over their students for reasons that are, almost by definition, not accessible to the student. The teacher can ask things of the student without reason, and their will will be accepted because the student cannot (yet) understand the workings of the enlightened mind. I have personally seen the fierce devotion that a teacher can elicit from their students. And one need only do a little search online (for opinions on Michael Roach, for example) to see how heated the debates over teachers can be.

The point is not that all Buddhist teachers are corrupt - the Buddhist teachers who I have met have all been very kind, very intelligent, and very humble people. The point is that the student/teacher relationship in Buddhism is liable to be abused - and it has been abused. (read these for examples). Furthermore, this relationship is open to abuse insofar as (the particular brand of) Buddhism requires us to believe something that can't be verified. Sure, we can eventually get enlightened, but it may take several kulpas. This is irrationality at its best, and this irrationality opens up the possibility for abuse. I'm not saying that this is in any way the general case - just like it's not the case that every Catholic priest is a child molester.

This leads to a more general point I'd like to make about the role I see Buddhism playing in the future of humanity and the west in particular. Having spent a lot of time reading about Buddhism the last ten years or so, I don't think that - as a religion - it has very much to offer us - that is, I don't think there would be much to gain by us all taking refuge. I think that certain meditation techniques that come out of the tradition have some potential therapeutic applications. I also think that the Buddhist philosophical tradition may have some useful insights - as an example, Fredrick Copleston suggests we read Dogen as a kind of proto-phenomenologist, and in doing so we may learn from his explorations of the ordinary mind. But the appropriate attidude towards the philosophical aspects of Buddhism should be the same kind of attitude we take towards Hellenistic philosophy, that is, being sympathetic to their aims, but deeply skeptical about their conclusions.

If you want rationality, if you want profundity, you needn't look any further than your own back yard (or local library). Read some moral philosophy. Read some books on science and mathematics. Read Proust, James, and Nabokov. If you want to meditate, get hold of Jon Kabat-Zinn's books and spend some time on your living-room floor. You certainly don't need to seek out a teacher with a funny name to meditate (although Kabat-Zinn's name is pretty funny).

Way safer is to become a well-read, meditating atheist than becoming a Buddhist. At least you wont need to give an inch of rationality for some vaguely defined, but impressive sounding word.

Friday, November 6, 2009

Carnival of the Africans #12

In case you didn't know (and I realize I'm a little late on this) the latest 'Carnival of the Africans' is up at ionian-enchantment

Some notable entries - for me, at least - are Simon Halliday's post (one in a series that looks like it's going to be great) on Gender and Risk aversion , Doctor Spurt's discussion of whether music produced by computers has any value, and Michael Meadon's smackdown of Gene Callahan's opinion of Evolutionary psychology.

Thursday, November 5, 2009

Some useful reading in and around Moral psychology

I hope to finish up a fairly detailed post on some issues in Moral psychology in the next week or so.
So, in leading up to that I thought I'd do some lazy linking to some important resources you can find online.

First - two papers from Jon Haidt
The emotional dog and it's rational tail - this is the paper in which Haidt first sketched out his Social Intuitionist Model of moral judgment.
- a review of Moral psychology, a valuable resource for anyone coming to the field for the first time.

you may also want to take a look at and, for those of you with the bandwidth (unlike myself, who is struggling over iBurst at the moment), you might find Haidt's presentation at TED interesting.

Next, to get an idea of the different theoretical perspectives on emotion in general by taking a squizz at de Sousa's excellent entry on emotion at the Stanford encyclopedia of philosophy.

Finally, if you think you might be interested in my future blogs on moral psychology, you might want a little background on the so-called "emotions of self assessment", like Shame and embarrassment - a useful discussion, from a psychological perspective (to which I hope to add a more "philosophical" perspective) can be found in Tagney, Stuewig, and Mashek's Moral emotions and moral behaviour.

Happy reading.