by Gian Franco Gensini
The relationship between “thought and medicine” has always been difficult. Ivan gives us the opportunity to reflect on the “provincialism” of some of our national discussions. The undertaking of rethinking our scientific medicine is an uphill and almost always very demanding road. But in all fairness I don’t think there are alternatives.
June 16 –
The latest book by Ivan Cavicchi “The unmatched science” in my opinion it is a real “work” of great importance and relevance. A work that, more than all those that preceded it, rigorously and precisely interprets the crisis situation of our scientific medicine, showing us above all the way to go.
The relationship between “thought and medicine” has always been difficult. Ivan gives us the opportunity to reflect on the “provincialism” of some of our national discussions.
A work to be disseminated and made known to all
In my opinion, Cavicchi’s work should be made known and widely disseminated because, on the problems of scientific medicine and the problems of the medical profession, such lucid, relevant, profound analyzes are not found in the remarkable literature in circulation, but above all there is no idea and a medical project like the one that pragmatically Ivan has been proposing to us for years.
Having such a thought on medicine in our country makes me as a doctor and as a proud citizen, also because the many recipes that until now have come to us from overseas and from the Channel (think of medical humanities, EBM, choosing wisely etc.) and to which we have adhered, they have not always kept their promises, often proving culturally weak, scarce and incomplete. Above all, it is not up to the challenges of a medicine of rapidly increasing complexity.
With Ivan, of course, one can agree or not, but what he proposes to us, this time as always, is a true and profound thought, that is, studied with care and ready to be used and applied on the field.
The example of evidence A few days ago in this newspaper I read an article on the “alleged” crisis of the EBM which reminded me that just two years ago I had the honor again in this newspaper, to open the forum “Scientific evidence in medicine”. The opportunity was provided by a prophetic book by Cavicchi which I defined, with two interventions on QS, a turning point book or, as the English say, a real “breakthrough”.
“Salute Internazionale”, our qualified online magazine directed by the highly esteemed Gavino Macciocco, ignored both the book and the forum, but two years later translated an article from the BMJ “The illusion of evidence based medicine”which bounced off our computers as if it were a great and startling revelation and has been laudably reprized by some commentators.
Cavicchi’s reflections on the problem of evidence were actually anticipated already 20 years earlier in another book that I would define as a great field of confrontation and challenge, a real icebreaker, and which was the first timely response to the risk, which Cavicchi already at its inception, it defined as “administered medicine” the one triggered by Law 229 and which imposed on doctors the obligation of appropriateness, an obligation that will greatly contribute to creating the famous “medical question”.
The crisis of medical reason
With “The incomparable science” we definitely go beyond the reflection on scientific evidence, finally we are sailing on the open sea and come to terms with what any philosopher would define “the crisis of medical reason”.
After this latest book by Cavicchi I challenge anyone, even the most rigid and backward of conservatives:
- to deny that there is and always will be a crisis in scientific medicine,
- to explain the medical question without explaining its connections with the medical crisis,
- to explain this paradox of our time that is the distrust of an entire society towards the most powerful science we have,
- to explain that medicine is just a science,
- to explain that the crisis of medicine can be overcome without a second thought.
This latest work by Ivan appears as the product of at least 30 years of hard and constant exploration and reflection.
With this work he clearly indicated to us:
- what our problems consist of,
- where we should get our hands if we wanted to solve them.
It is stated that …
Other esteemed colleagues have written in Cavicchi’s book that there is not a single chapter of it that does not fascinate you and that does not catch you and that does not convince you, but to me for my mental structure, in particular it struck that part more operational in which Cavicchi with his refined pragmatism pretends to have to write a resolution and prescribe the necessary changes to medicine, that is, those that would serve us to positively exit the crisis.
Cavicchi using the ritual formula of a resolution “it is arranged that …” takes the responsibility of telling us what we should change in the paradigm, in the doctrine, in the discipline and in the practices.
No one has done a similar job internationally.
No one has proposed to deduce from an unparalleled science an equally unparalleled legal status of the physician.
An anti-provincialist reflection
In order to write this article, I confess that besides Cavicchi’s book, I also read all the authoritative comments on the “Peerless Science” published in this Journal.
Without hurting anyone, indeed by making my previous reviews my own, I must however say that the reflection that struck me most was the decidedly more anti-provincial one. That is, that of Giovanni Brandi, a renowned oncologist and Director of the School of Specialization in Oncology in Bologna.
Brandi proposes to us, completely against the current, an interpretative thesis of great interest:
“If we owe to Claude Bernard the invention of experimental medicine as a mechanistic, analytical model, and therefore the architrave of our current scientific medicine, we undoubtedly owe to Cavicchi the theoretical framework of medicine as an unparalleled science”.
Both Bernard and Cavicchi, Brandi is right, in the end do the same basic operation which is to deduce medicine from non-random scientific cultural social assumptions, interpreting their own historical time and space.
Bernard two centuries ago deduced experimental medicine using the culture of his time and therefore positivism. Cavicchi in the third millennium does essentially the same thing, that is, he defines science as incomparable but in a post positivistic sense. While the first infers medicine in a reductionist sense (facts count), the second infers medicine in a decidedly anti-reductionist sense (beyond the facts there are events and relationships).
But neither of them had the urgency of a practical necessity: that is, to invent a medicine suitable for their own historical time. So both of us are grappling with a crisis, not to be solved, but to be accomplished. Crises, writes Cavicchi, with logical and linear precision, to be resolved must be accomplished, that is, they must respond to the previous changes that created them with other changes.
The “unparalleled science” is therefore the “non-provincial” answer that today, Bernard, would give to the crisis of medicine if he lived in the third millennium.
Conclusions
What to say? In the meantime, congratulations, or better, “chapeau” to Cavicchi. But above all thanks. The undertaking of rethinking our scientific medicine is an uphill and almost always very demanding road. But in all fairness I don’t think there are alternatives.
Three things are safe for me:
- medicine can’t afford the luxury of staying put on Bernard,
- to rethink medicine we need an intelligent thought in the etymological sense, that is, able to choose, read each otheramong the many options such as that of Cavicchi,
- we have a great and urgent need for this thought, but to use it and make it grow and evolve we must all be able to be not only welcoming but interactive with what is moving in the world in this now inevitable direction, but all to understand and map, freer head and free from deteriorating provincialistic tendencies.
Gian Franco Gensini
June 16, 2022
© All rights reserved
Other articles in Studies and Analysis
