Reductionism in medicine

Abstract

correspondence: *Pablo Young E-mail: [email protected] Available online: 23-11-2018 Bol Med Hosp Infant Mex. 2018;75:227-229 www.bmhim.com Date of reception: 19-04-2018 Date of acceptance: 15-05-2018 DOI: 10.24875/BMHIME.M18000046 We have read carefully the work of the Biologist Juan Emilio Sala published in the Boletín Médico del Hospital Infantil de México1. We agree with the author that complex thinking and holistic vision are superior to the pure reductionist look. We have found the contribution of both clinical cases as a clarifying mean to convey his idea. The author sets out in the first paragraphs that he intends to generate a debate in the ways of thinking of pediatricians and physicians. To us, he has generated it, so he has fulfilled his purpose. Although there are things which it is difficult to agree on, the debate raised through the argumentation opens the horizon for further improvement. In general terms, we observe a complete and complex analysis in line with what the topic deserves. We also believe, even from dissimilar ideological perspectives, that the first part of the article, based on very appealing sociological instruments, proposes an almost causal relation between the evolution of Adam Smith’s division of labor and the evolution of medicine. It seems to us more as a demonstration of the ontological reductionism that is being questioned in the article than a proof of a broad vision of a multifactorial, dynamic, and transversal phenomenon such as the thinking evolution in medicine. We can share or discuss the effects produced by the bourgeoisie or neoliberalism on the models of attention or in certain partial behavioral imprinting, but the generalization toward the complex thought of our art/science has very limited value. This simplification can lead us to insufficiently well-founded conclusions. Undoubtedly, we agree that the reductionism “excesses” pose a risk, but we believe that these risks are due more to the need for adjustment in certain perspectives than to a social consequence directly related to the different ideological currents, either liberal, Marxist2. Human knowledge is cumulative. At the beginning of time, humans could boast of knowing almost everything. As that knowledge became more complex by the sum of discoveries, their interrelation, and the appearance of countless hypotheses and critiques, each science was no longer a part of a whole and compartmentalization began3. We see this phenomenon in law, medicine, physics, biology, political science, and so on. As everything has become more complex, study and research become fragmented, but none of these parts forgets that it is a part of a larger universe that all sciences integrate. What would medicine be if we were all general practitioners and did everything (clinic, neurosurgery, and attended births), and what would happen if the biologists did not specialize? Would everyone know all about all the species addressed? The author, Juan Emilio Sala, is in favor of the “clichés.” He talks about the “Hegemonic” Medical Model (MMH, for its Spanish acronym) and the professionalization of medicine as if it was a good thing to return to the use of healing herbs and the practices of pre-Columbian medicine. Furthermore, in the medical activity carried out in the large health centers, especially in the United States, he imagines that patients are “jibarized,”