Rationalism, Empiricism, and Evidence-Based Medicine: A Call for a New Galenic Synthesis

“We don’t know whether most medical treatments work, and we know even less about whether they cause harm – new study” 

We don’t know whether most medical treatments work, and we know even less about whether they cause harm – new study (The Conversation, June 17, 2022) outlines the problem: 

Only one in 20 medical treatments have high-quality evidence to support their benefits, according to a recent study. The study also found that harms of treatments are measured much more rarely (a third as much) as benefits.

Patients and doctors – and anyone who pays for them – need to know that medical treatments are safe and effective, but it’s an open secret in the medical field that not all treatments, including ones that are commonly used, are safe and effective.

Doctors and medical researchers have reasons for the medical treatments and procedures that advocate and carry out. Tradition and their medical training support the reason or rationalism supporting the mainstream medical profession. 

Unfortunately for doctors and most of their patients, empirical support is missing for most medical procedures. For example, type 2 diabetes is considered by most doctors a chronic condition and is treated with medications and eventually insulin injections. Yet in the real world, dietary changes can reverse type 2 diabetes (or put into remission). My 80 year old neighbor, Chuck, was overweight and diagnosed with type 2 diabetes. His doctor advised cutting way back on carbohydrates. After two years his new diagnosis was that his diabetes was gone.

The decades of training and tradition that informed the “rationality” of diabetes treatment failed when tested empirically in the real world with diabetes simply reducing carbohydrates. Dr. David Unwin and coauthors published their empirical results in What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss (BMJ Nutrition, Prevention & Health, June 28, 2023).

The 2023-24 NCFCA Lincoln-Douglas debate topic, Resolved: rationalism ought to be valued above empiricism (link to EthosDebate page), could be applied to medical and health procedures. And one place to start would be Galen.

In Rationalism, Empiricism, and Evidence-Based Medicine: A Call for a New Galenic Synthesis, William Webb argues:

Thirty years after the rise of the evidence-based medicine (EBM) movement, formal training in philosophy remains poorly represented among medical students and their educators. In this paper, I argue that EBM’s reception in this context has resulted in a privileging of empiricism over rationalism in clinical reasoning with unintended consequences for medical practice. After a limited review of the history of medical epistemology, I argue that a solution to this problem can be found in the method of the 2nd-century Roman physician Galen, who brought empiricism and rationalism together in a synthesis anticipating the scientific method. 

My presentation at the Liberty International conference (YouTube link) drew from the research and writings of University of Texas biochemist Dr. Roger J. Williams. Dr. Williams a leading researcher in nutritional bio-chemisty and also a popular author. His textbook Biochemical Individualism is still in print and his many other popular books were reprinted across up to ten editions (for Nutrition Against Disease). More on Dr. Williams on this Univ. of Texas webpage.

Dr. Williams cites not only the real-world success of nutrition-based “therapies” in addressing various medical conditions, he researched and published on the biochemical processes involved, the reasons why improving diet to provide nutritionally dense foods resolved many chronic health problems.

The Nutrition Coalition argues that much or most of the current federal dietary guidelines lack robust support from real-world research, especially Randomized Control Trials (RCTs):

A look at the disputed science on:

In Rationalism, Empiricism, and Evidence-Based Medicine: A Call for a New Galenic Synthesis, Dr. Web reviews the history of Evidence Based Medicine (EBM):

Beginning in the 1990s, EBM emerged as a “new paradigm” for teaching clinical medicine that emphasized decision-making based on empirical evidence from controlled, randomized studies. The expectation was that such a paradigm would replace anecdotal experience, tradition, and—interestingly, from an epistemological perspective—reliance on deductive reasoning from mechanistic theories rooted in the basic sciences. In this article, I argue that a widespread lack of training in philosophy and the history of medicine has resulted in the application of EBM-based principles and approaches in ways that privilege empiricism over rationalism. Taking the position that insights from both of these epistemological traditions are necessary in medical practice, I argue that proponents of EBM should pursue a synthesis of rationalism and empiricism and thereby adopt a more epistemically balanced and historically conscious approach.

Dr. Webb also offers “A Brief History of Medical Epistemology” relevant for debaters:

A great deal of the history of philosophy can be viewed as a contest between those who emphasize deductive reason in the quest for knowledge (the “rationalists”) and those who emphasize sensory experience (the “empiricists”). As intellectual endeavors, medicine and biomedical research are no different. Many of the specific problems about knowledge in these fields are extensions of problems concerning human knowledge in general.

So we must turn to both reason and the real-world. But the struggle continues.

From Alexander Pope’s An Essay on Man: Epistle II:

Know then thyself, presume not God to scan;

The proper study of mankind is man.

Plac’d on this isthmus of a middle state,

A being darkly wise, and rudely great:

With too much knowledge for the sceptic side,

With too much weakness for the stoic’s pride,

He hangs between; in doubt to act, or rest;

In doubt to deem himself a god, or beast;

In doubt his mind or body to prefer;

Alike in ignorance, his reason such,

Whether he thinks too little, or too much:

Chaos of thought and passion, all confus’d;

Still by himself abus’d, or disabus’d;

Created half to rise, and half to fall;

Great lord of all things, yet a prey to all;

Sole judge of truth, in endless error hurl’d:

The glory, jest, and riddle of the world!

Alexander Scourby reading the above and other Alexander Pope selections.