Regarding the Volatility of Evidence

                            

As discussed earlier, throughout history human society's understanding of scientific principles has largely been wavering. This presents a unique problem - how do we employ scientific principles while accounting for our partial understanding?

The solution - in my view - requires a review. Humans present their attempts to explain universal principles in the form of theories. The bases of these theories are mostly observational as in the case of Planck's Quantum Theory, but may also be purely theoretical - for instance, Einstein’s General Theory of Relativity. There is also induction, the generation of hypotheses from previously available data. Increasingly, computational models are providing for the analysis of data in ways previously not possible. 

Historically, periods of scientific progress coincided with periods of socio-economic upheaval - the Renaissance for instance. For this reason, most newly proposed theories were met with severe scepticism and rancour; but gradually got integrated into the scientific mainstream. What is a factor to this change is application. A model is an attempt to represent a hypothesis in a way that it can be applied or further studied. For example, orbiting satellites correct for time dilation produced by gravitational field differences, enabling Global Positioning System technology. This is not to say that factors are irrelevant; indeed, hypothesis testing through controlled experimentation remains the mainstream requirement, at least within the scientific community. Still, the practical applicability of an idea provides for the acceptance of that idea.

In this respect, medicine is a unique case study. The theory of humoral balance dominated the early days of medicine - which was as much a mystic pursuit as it was material. Still, figments of observation, analysis and experimentation can be noted here. For instance, the Chinese noticed the application of mouldy curd induced remission of boils. Today, we understand this to be due to the production of penicillin by the fungi present in the mould; penicillin is generally active against the organisms implicated in boil formation. There is nothing to indicate that ancients understood this; indeed, our own understanding is fragmentary. Still, scientific documentation of parameters, many of which are still evolving, allows us to navigate our inadequate understanding. Ignac Semmelweis, an Austrian obstetrician, noticed that the washing of hands between surgeries reduced the incidence of puerperal sepsis by 80%. In this case, however, his contemporaries didn’t accept his idea and he died, languishing in an asylum before his ideas were accepted two decades later. 

However, there are problems with this approach, particularly revolving around the directionality of causal and caused factors. Galen noticed that suppuration of a wound localised infection and correlated well with healing. Unfortunately, later healers, believing that suppuration was causal to healing, attempted to induce suppuration of wounds through the application of faeces and other toxic substances. The rationalisation of fever is another interesting study. During the phase of convalescence after infection, the sudden withdrawal of pyrogenic substances reduces the hypothalamic ‘Set Point’ leading to sudden sweating and flushing, followed by quick clinical improvement. In the pre-antibiotic era, this led to the belief that sweating causes clinical improvement, resulting in attempts to force sweating such as layering blankets atop the sick person. 

At the outset, it seems as if the only definitive method to avoid such instances is to study further, and since the goal is inconceivable, that humans will be lost in a loop of inaction should they search for surety. This may or may not be true, but there are ways by which we can reduce the fallibility of science. The universal principles that we pursue have always been the One, unchanging and unflinching to the notions of man. That Newton and the Greeks interpreted gravity variably, does not change the principle of gravity but only their reading of it. Drawing principles directly from the source might for the large part remain impossible, for we are limited in our capacity to comprehend. Notwithstanding, the unflinching nature of the universal principles, can guide us in our pursuit to apply scientific principles to guide our march to a humanitarian future.

To begin with, we have tools that the ancients never did. In the field of medicine, these are realised through the practice of Evidence-Based Medicine (EBM). EBM is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information. The practice of EBM tiers sources into rungs based on the biases that the use of these sources entail. 

The search for evidence does not always require a holistic understanding of the underlying concept. The almost unwavering presence of the Epstein-Barr Virus (EBV) in B cells of patients with endemic Burkitt’s Lymphoma has allowed us to postulate that the Epstein-Barr virus is oncogenic to B Cells. The hypothetical state of the mechanisms involved does not prevent our development of a vaccine as a prophylactic solution to EBV induced neoplasia. EBM also looks for the insight offered by a potential parameter. C-Reactive Protein (CRP) is, by accuracy and reliability, a better marker of inflammation than Erythrocyte Sedimentation Rate. Most modern studies and treatment plans thus employ CRP preferentially.

EBM assists circumnavigation of some but not all the ramifications of our incomplete understanding. Ultimately, all models are wrong, but some are useful. The usefulness of a model is to do with the needs of our present society. Accordingly, molecular diagnosis of the etiological agent of a presumptive viral infection is not mandated in most cases. Conversely, the incorrectness of a model is to do either with the incorrectness of the theory that birthed it or with insufficient extrapolation of the theory. The latter we may attempt to address but the former requires some deeper consideration. 

But, there is still hope. Humanity’s pursuit of science is not a wry theoretical consideration. Scientific pursuit has always been peppered with the nuances of the masses. Where mystical philosophers and authorities of science erred, a patent clerk born in a small German town did not. That patent clerk, none other than Albert Einstein, revolutionised the conception of gravity among other things with a fresh breath of thought. However, Einstein's thoughts became rigid as he grew older, with his obsessions over the unified field theory. The same can be said of Newton, the mind that spawned the Law of Motion and formulated the principles of calculus spent its final days dabbling in alchemy. The pattern here is that those ideas which dared to replace the old became those very ideas which were to be replaced. Chronologically, there is also society’s acceptance of an idea - Gregor Mendel’s proposed laws of inheritance languished in ignorance until the time of de Vries, Correns and von Tschermak. 

Consequently, the only definitive solution is to overhaul how we look at knowledge systems and their application. Philosophers over the ages have played with the notion of ‘The house of knowledge’. Children travel around the house, initially with the earnest hand of a guide and find well-formed sculptures. As they move around, the guides become fewer and the sculptures vague. Finally, the children find themselves being the sculptors of the unsculpted. While the actualisation of this idea may have been elusive for the good part of our history, we find ourselves, today, in a society where such overhaul is possible. 

‘Staring into the abyss

The little child wanders 

Into a bright flame

Guided by the hand

But never touching it’