Saturday, December 10, 2022

Chance and necessity revisited

Jacques Monod viewed molecular biology as justification for a mechanistic and deterministic view of life, which he elucidated in his best seller Chance and necessity. The book influenced me when I was an undergraduate at Cambridge University doing Part I Medical Sciences in 1970-2. It was only when I switched to Religious Studies for my Part II that I realised that a reductionist and positivistic view of science was at least open to question.

Monod argued that living beings are chemical and self-constructing machines. He acknowledged that “our understanding of the mechanisms of development is still very imperfect” (p. 52). Nonetheless he was clear that the “process of spontaneous and autonomous morphogenetic is based on stereospecific recognition properties of proteins”. I’m sure it is, but the question is whether proteins “animate and build living systems (p.52)”? Contra Monod,  I’ve come to accept Kant’s view that life cannot be explained in mechanical terms (eg. see post on my Relational Psychiatry blog).

Even though the scientific and professional establishment tend to agree with Monod, it’s not just the human sciences, but also biology, that need to be anti-reductionist (see eg. another post from my Relational Psychiatry blog). The implication for psychiatry (see my Relational Psychiatry blog passim) and for medicine in general, is that it is not person-centred enough.

Thursday, June 30, 2022

Sustaining the NHS

Sajid Javid in the introduction to his keynote speech to Policy Exchange on 'Digital transformation in health and social care' said "The truth is that our health and social care system is following an unsustainable path that is too often not delivering for patients". He went on, "At the start of this century health service spending represented some 27% of day-to-day public service spending. By 2024 it is set to account for 44%. ... But can we really say we've seen an equivalent improvement in outcomes?"

Obviously this rhetorical question was meant to be answered in the negative and I would agree. I've said before (eg. see previous post) that overmedicalisation of society has created too much medicine. This situation is ironic as the currently fragmented and dysfunctional NHS has also inflated demand so that it cannot cope. The NHS needs to relearn to concentrate on priorities. There needs to be a shift back towards meeting need rather than demand.

The BMJ has recently called for a reset in its campaign against too much medicine (see editorial). A rushed article of mine 'The limits of psychiatry' was published (with several fairly minor errors eg. picture of Alfred rather than Adolf Meyer) in a BMJ theme issue in 2002 highlighting the dangers of too much medicine. As the recent editorial says. "Evidence for the damaging effect of overdiagnosis and overtreatment continues to grow". And as it concludes, there needs to be a move from "rhetoric and scattered evidence to actionable evidence and measurable impact".

Sunday, May 29, 2022

Peter the Great was no saint

Commentary in Politico suggest Vladimir Putin is no Peter the Great because he has failed to stop murder and rape in Ukraine. But this tapestry of Peter shows him looking pretty pleased with the carnage of the Battle of Poltava in Ukraine in the background.

Battle was raging between Russian forces and the army of Charles XII of Sweden, marking the beginning of Russian hegemony in Northern Europe.