Julian Assange
631 weeks of deprivation of liberty for telling the truth
631 weeks of deprivation of liberty for telling the truth
This text extends the debate on medical and health care decision making that was initiated around Evidence-based-medicine (EBM) with the carte blanche entitled: » the role of physician training and medical epistemology in the Covid 19 crisis ». The discussion continued in a second carte blanche, focused — as its title indicates — on a critique of the precautionary principle: « Precautionary principle or « risk of blame ? This was followed by the question of the destructuring of the health system with regard to the incapacity to recognize its own resources, a question introduced with a third carte blanche: » Globality, partnership, autonomy in health. When the emergency sweeps everything away, but reveals the essential! Still on our epistemological thread, we then addressed the issue of emotions in medical education: » Covid crisis and emotional intelligence: the missing link ».
By (1):
Florence PARENT, physician, doctor of public health, coordinator of the thematic group « Ethics of health curricula » of the International Francophone Society of Medical Education (SIFEM).
Fabienne GOOSET, Doctor of Letters, certified in ethics of care.
Manoé REYNAERTS, philosopher, member of the thematic group « Ethics of health curricula » of the International Francophone Society of Medical Education (SIFEM).
Helyett WARDAVOIR, Master of Public Health, member of the thematic group « Ethics of health curricula » of the Société internationale francophone d’éducation médicale (SIFEM).
Dr. Isabelle François, physician and psychotherapist, member of the thematic group « Ethics of health curricula » of the Société internationale francophone d’éducation médicale (SIFEM).
Dr. Benoit NICOLAY, physician, anesthesiologist, micro-nutritionist.
Dr Emmanuelle CARLIER, physician, pediatrician.
Dr Véronique BAUDOUX, general practitioner.
Jean-Marie DEKETELE, professor emeritus of the UCL and of the UNESCO Chair in Education Sciences (Dakar).
» During my five and a half years of medical training, a few things became clear to me. First, while doctors receive a lot of training in how to deal with medical emergencies, they are taught extremely little about how to avoid chronic disease and maximize long term health and much of what they are taught is wrong. Over those years, I think I received a total of three lectures about nutrition. In other words, three hours during five and a half years were spent learning about how to avoid chronic disease in the first place. »(2)
If it appears in medical school that very little importance is given to the emotional and sensory dimensions as we argued in our previous white paper, this blindness is repeated with regard to other dimensions of our beings. It is also about imaginative, metacognitive (or reflective), social, relational, but also vegetativedimensions.. .Why?
We must try to understand, in the true sense of understanding, that is to say, by having a lucidity on the structural determinisms (psychological and environmental) in place, the reasons for such a loss of potentiality in acting. This is reflected in the scientific literature, which shows a decline in emotional, relational or ethical skills, for example, during the years of study in medicine(3). And this is what the « post-Covid-19 » scientific literature will describe when the balance of the non-mobilization of our « vegetative souls » has been assumed.
For, » if Aristotle speaks of an « intelligible soul » allowing to differentiate the human being from the being of nature (plant) or from the living being (animal), he does it without discontinuity, in total integration, with the « sensitive soul » and the « vegetative soul », the one not going without the other at the risk of a rupture of the whole, of the globality, of the radical loss of a holistic vision « (4)
Indeed, one only has to consider the very long latency between the timid information dated May 22, 2020 from the Belgian Academy of Medicine about the interest of protecting oneself from Covid-19 by taking vitamin D(5) and its mediatization only in January 2021. Not far from a year after the beginning of the pandemic, the Academy has finally made the use of the vitamin effective on a population level and thus of preventive medicine, which is reflected in some popular newspapers(6). Nevertheless, we observe that the confusion remains when, in the wake of the opinion of the Belgian High Council of Health, which « considers that all this is of little use… », the mainstream media continue to relay the contempt shown by politicians and doctors for this type of approach to preventive medicine. This excerpt from one of many chat rooms (dated January 29) gleaned from a network reveals this confusion about which strategies or directions to pursue in public health.
These citizens’ voices have sometimes been structured in white cards addressed to the government: » (…) studies are accumulating which indicate that a deficiency in vitamin D favors the development of the severe form of the disease: it is therefore necessary to set up, without further delay, a large information campaign recommending to everyone to supplement their diet with vitamin D. This is a very simple and inexpensive measure that can have a very substantial effect on the morbidity and mortality associated with Covid-19. It is important to remember that the after-effects of Covid-19 are significant not only for the individuals and their families, but also for the public health care budget. So what are we waiting for to take this simple step? Have we forgotten that prevention is easier than cure? « (7)
Favouring an early or, in this case, preventive treatment, quarantining, confining, making people wear masks, closing schools and sports centers, even parks, mountains and cliffs, vaccinating, etc. are all decisions that have not mobilized the scientific debate in the same way (in order to deepen this criticism, we can refer here to our carte blanche on the use of the precautionary principle).
This highlights what could be called two drifts or — at least — two reductive epistemological orientations, historically and culturally situated, of medicine. One, positivism, and the other, reductionism, to be linked more specifically to the very definition of Health. We have already addressed these epistemological drifts and their impact on medical and health decisions in previous white cards focused on our » intelligible souls »(first white card) or on our » sensitive souls « (fourth white card). In order to complete the analysis, we question, through this white card, the decision in the light of our » vegetative souls ».
In order to analyze this broadening of our problematic from an epistemological point of view(8), let us return to the WHO definition of health: « Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
In addition to the documented importance of sport (with proper adaptation) in the overall prevention of immune and stress(9)The effectiveness of trace elements such as zinc, as well as the benefits of vitamins D and C, have long been proven in viral diseases with a strong immune impact.(10). However, during the Covid-19 pandemic, prophylactic or preventive measures of this nature were not considered, except with lip service, with a form of condescension. Thus, when scientific arguments, even those based on evidence from a positivist science perspective, are available, it seems that the medical world, relayed by the major media, does not care about them.
Is it because of prejudices relating to more global, holistic approaches to care, including a certain preventive medicine, based on the resources of the person and his or her natural environment, that, paradoxically, the decisive judgement(11) is not then mobilized? In this case, would the latter be presented as a discriminatory judgment linked to prejudices of values as regards scientific knowledge or evidence-based medicine?
Indeed it is indeed about values These are the values that define our relationship with medicine, health and our environment in general. A perspective of medicine as solely curative or bioclinical, involves a certain use of decisive judgment, associated with technical, curative and measurable acts according to scales or coverage rates (vaccinations for example) giving a quantified visibility, generally, immediate. With finesse, on an epistemological level, we can also analyze here a quasi-ontological divergence between preventive medicine based on vaccination and that based on micronutrients and our diet. The resources mobilized are extremely different and allow us to question ourselves…
Would the intake of trace elements and vitamins be of a different nature? Less valuable because close to the common sense of our grandmothers, while these, paradoxically, left in large numbers without having taken any, because not protocolized, while the protocol had become the standard of absolution!
What differentiates these two methods of preventive medicine, in addition to the proximity with our grandmothers(12), is that one does not integrate in the same way the person himself, reified subject of the vaccine but also holder of own resources that it is a question of developing…
Thus, we have observed that the documentary film entitled « Ill-Treated »(13), while not lending itself to a conspiratorial vision of the crisis, has nevertheless been severely judged by the media and boycotted, even scorned, by the traditional medical world(14).
The interest of this film lies however, and mainly, in a will to express our » vegetative soul « , to allow it to bloom, to come to the world as long as it is time! If we were to apply the well-known saying: « never waste a good crisis », it is in particular with regard to this integrative aim that we would be particularly successful in the long term.
Indeed, in this film, it is about consider not only the importance of early treatment in the disease and the essential role, in this respect, of ambulatory and proximity medicine, in connection with the sickperson (carte blanche 3), but also all the preventive and promotional sphere of health, in direct correspondence with the WHO definition of health. It speaks, through professionals with extensive experience in these fields of health research and action, about the crucial preventive role of vitamin D(15) and documents it in terms of (otherwise randomized) studies that are explained to the audience(16). The preventive importance to be given to vitamin C in particular situations, but also to trace elements such as zinc in particular, is clearly argued for the listener. A consideration, in the truly global sense, of all the resources of nature, including human beings as a part of it (part of the whole in the Pascalian sense of the term), opens up the vast field of knowledge from phytotherapy, gemmotherapy, aromatherapy, essential oils and all the openings offered by naturopathy(17). Perhaps closer to us for some, it would be a question of looking at nutritherapy, micronutrition and dietetics, whose impact on chronic pathology, prevalent in our Western societies, is well known, thus making a link with the testimony of Dr. Sebastian Rushworth at the beginning of this carte blanche.
It is also knowledge coming from people, sometimes doctors or researchers, but also writers, philosophers and citizens, who have undertaken unpublished (in-depth) excursions into the activity(18) to « digest(19)the one to « fart ».(20) or « managing your pain(21) that it is now a question of consider, because to paraphrase Bessel van der Kolk: « The body forgets nothing. »(22) This is also what our immune system reminds us, which we can count on as long as we continue to expose it regularly to environmental agents, including viruses. A totalitarian hygienism (excess of barrier measures) prevents or at least reduces this exposure and can weaken its performance. In children, immunity is acquired daily. The decrease in exposure to infectious agents and the increasing use of antibiotics would reduce the learning and adaptive capacities of immunity.
This is not to oppose prevention through vaccination. This can be reflected with reason (reflective judgment(23)). As Linus Pauling (among other personalities who have tried to sensitize the medical world) points out: »( …)you must instead give your body the substances it knows, that it uses regularly… and that it lacks to function optimally!
The perspective being that of giving equal importance to internal resources, specific to the person, in more immediate proximity with a nature from which one emerges, rather than privileging only those, external, chemical, produced by the pharmaceutical industry. It is necessary to understand the nature-culture continuum on an ontological level, like a Möbius knot, so as not to lose the fragile balance of life by breaking all our ties.
» He who loves nature is the one whose sensations, inner and outer, are still exactly adjusted to each other; he who, in the hour of maturity, has kept his childlike soul. His relationship with heaven and earth becomes part of his daily diet « .(24)
If it is better to take precautions to stay healthy than to cure a disease as the popular saying goes, joining the basic principle of traditional Chinese medicine, it appears that our western medicine, positivist, does not manage to integrate such a vision. Could this be a sign of a disease in our epistemology?
Our constructions of Being based on conceptual dualisms — reason-emotion — or ontological dualisms — body-spirit, nature-culture -, found our borders and our mental territories, separate what coexists temporally, scatter our emotional, bodily, rational, vegetative identities not facilitating the centering, the spatial balancing, here and now Also, let us remember that :
» The feeling of what is is not everything. A deeper feeling emerges and manifests itself in the depths of the conscious mind. It is the feeling that my body exists and is present, independent of any object with which it interacts, like a solid rock, like the raw affirmation that I am alive {…} I call it primordial feeling. « (25)
This is precisely what reflective judgment allows, to regain a foothold in the here and now, in the here and now , outside of any fetishism of the object (and of objectification) proper to reifying and too exclusively productivist logics. The latter, undoubtedly unconsciously — engrammed(26) — (which in no way diminishes the seriousness of the fact), deny the process of elaboration, always a singular manifestation of the original movement and, potentially, but exclusively, a source of Life and Meaning(27).
It is also such a perspective that will allow a more harmonious relationship between man and machine, between doing and technology, because from the monkey or the flint(28)It is indeed in the good use of the one and the other, in the sense of a praxis(29) and thus of an ethics, that an emancipation aim can be played.
This is what Corine Pelluchon also expresses when she affirms that another model of development is possible: » It requires a complete overhaul of our representations, of the way we think about the place of humans in nature and how we interact with others, including animals. » (30)
« And when your gaze penetrates long into the depths of an abyss, the abyss also penetrates into you. »(31)
This body, this materiality of the world which is ours, or at least for which we have a share of responsibility in what it happens (and makes happen by this very fact), requires to understand it in all its dimensions, a capacity for complex thinking(32). This includes the ability to « problematize » in the sense developed by Michel Fabre(33). However, this is precisely what we could call the « Nietzsche paradox ». That is, the propensity for our own thought, by the elaboration of narrow and reductive frameworks (those which allow the determining judgement, and all the more that this one is limited to the positivist science and not to a plural science(34)), locks up our body, closes our mind, despises our emotions…and loads the camel(35) of an ever heavier weight, proportionally distancing, like a funeral march towards the mirage of the horizon, its perspective of emancipation. Such is the modern man.
Thus, and always in harmony with our definition of health and its perspective of globality, it is not so much a question of « curing » as of « preventing » and « accompanying ». We will not return here to the failures of this accompaniment and the loneliness of the dying discussed in our carte blanche on emotions.
The deep and numerous epistemological fractures, endogenous and specific to the medical and scientific worldare mirrored in society which, a fortiori today with the expansion of knowledge coming, paradoxically, from the neurosciences, is in search of more plenitude of its being-in-the-world.
Karl Popper, however historical representative of positivism has, in a « plea for indeterminism(36)The author concludes that this « indeterminism itself is not sufficient » and specifies, as Le Moigne does in a commentary, « that it is necessary to postulate a « causal opening » of the « world 1 » of physics on the « world 2 » of psychology and on the « world 3 » of the human spirit and its productions (ethics, aesthetics, society). Worlds 1, 2 and 3 of which it is also necessary, beforehand, to postulate an ontological reality. »(37)
Let’s be saved, let’s find again the animality of Aveyron, such the sensitive and vegetative soul lost while Aristotle had never glimpsed separately this one and that one, the intelligible, certainly proper of the anticipating and planning man.
The attempt to move away from uncertainty, as an aim of a medical world becoming more and more aseptic or protocolized, is contrary to the biological state of our beings that the Covid 19 crisis came so brutally to remind us.
« Despite enthusiastic predictions that technological innovation will pave the way for the artificial womb and eternal life, it is still true that every human being is born from the body of his or her mother and that every human being dies. « (38)
Hence this increasingly prevalent paradox, revealed in broad daylight with the Covid health crisis, a detrimental detour of our own mental and theoretical constructs necessary to manage uncertainty (experimental medicine, evidence-based medicine; sensitivity and specificity tests; calculations of prevalence, incidence, predictive value, probability; Bayes’ theorem; likelihood ratios; statistics; law of large numbers…) towards the utopia of management by certainty(39)The fear of the Covid, amplified by the media(40), even instrumentalized, has reinforced this fear.
Thus, this health crisis is not so much revolutionary as « revelatory », according to the formula of the philosopher Paul Virilio (1932–2018).
But to what extent are we, as physicians and caregivers, aware of this orientation?
This fundamental reflection, both epistemological — as regards the opposition between scientists and empiricists — and definitional — as regards the notion of health — emerges with Covid in 2020 as a public health issue, which has become collective(41)This is a major issue, at the basis of conflicts of values which are situated in a « thought of the basement », reminding us that « our body is not other than a building of multiple souls ».(42).
In fact, once the confusion is cleared up, this is the debate that should not be missed.
This one opposes today in an exacerbated way: the knowledge to the practice, the intelligible to the sensitive, the culture to the nature, the technique to the clinic, the universal to the particular (context), the general to the singular (Subject), the stability to the instability, the order to the disorder, the formal to the informal, the security to the riskthe hospital (central structure) to ambulatory care (peripheral structure), the causal (explanatory) approach to disease to the global (comprehensive) approach to the person, mechanistic medicine to holistic medicine, and.., in finethe imaginary from certainty to uncertainty.
« I will make the diet serve according to my power and my discernment for the relief of the sick. »
Hippocrates
