Narrow-Minded Empiricism

Now, one of my “oughts.” We ought to pay more attention to the empiric data than we do. As I have tried to do this, I have discovered that the empiric data is often thin, subject to various interpretations, and varying. The consensus as to the proper treatment of peptic ulcer disease, of acute myocardial infarction, and many other things have changed drastically since I entered medicine. We call these changes “advances” but sometimes you get to see the indicator needle swing not 180 degrees, but 360 degrees. What is more, our empiric information, even when it is accurate, sometimes expresses a narrow-minded or one-sided view of reality. The way we think of the causes of diseases in medicine betrays that we are very prone to be materialistic reductionists. We seek those causes which are tangible and visible and which are reduced to their smallest elements, such as biochemistry.

As example, what causes gonorrhea? We are taught in medical school that gonorrhea is caused by Neisseria gonorrhea, a gram negative coccus. The answer is only partial and, if allowed to stand in that form, leads into a narrowness. Most commonly, sexual intercourse is also involved. More than that, it is normally required that the sexual intercourse be that in which at least one of the partners has had intercourse with one or more others who had the germ. The coccus is a sine qua non for the disease, but other features are also required: (1) Sexual intercourse. (2) Sexual partners in that intercourse who have had intercourse with others. In fact, though the germ appears to be rather readily infectious, for the disease to continue its propagation among humans requires that sexual intercourse be considerably afield from monogamy.

Without these additional causal features, gonorrhea might actually disappear even without treatment as the infected persons died out without passing it on. Throughout my lifetime – I am about as old as penicillin – there has never been a time when we did not have a chemotherapeutic agent effective against Neisseria gonorrhea. Throughout my lifetime, however, the prevalence of Neisseria gonorrhea has varied and often has been much higher than when I was a child. Thus, the view that Neisseria gonorrhea causes the disease is incomplete. It doesn't work by itself. It is, dare I say it, narrow-minded. In addition to the bacterium is also required that sufficient numbers of the population believe that it is appropriate to engage frequently in non-monogamous sexual intercourse, and who act on that belief.

Medical ethics has been bound down by an inflexible, narrow-minded habit of viewing problems in their most materialistic terms. We feel comfortable dealing with bacteria in our patients' genital tracts, but not with the belief systems in their minds. Excuses are offered, such as, “You don't really think that people are going to suddenly become monogamous, do you? That's impractical.”

Though that is supposed to be an unanswerable rhetorical question, I submit that it is eminently answerable. First of all, it misrepresents the broader viewpoint. No, people won't “suddenly” do much of anything, as a whole. Secondly, if antibiotics have failed to perfectly eradicate gonorrhea, certainly parallel efforts working on the belief system needn't be expected to produce perfect results. Finally, I remember when the belief systems made a difference. In regard, therefore, to causes of disease, consider what causes heart disease, emphysema, AIDS, alcoholism, trauma. Do we think of the causes narrowly? Do we think of fried foods, cigarettes, the HIV particle, ethanol, or motor vehicles and firearms? If so, why? Even if we do not regard ourselves in medicine as capable of making a difference in the larger conceptualizations, do we obstruct others in society who are willing to take that approach?


Excerpt from "Counseling Persons with Questions on Medical Ethics"