The Medicine of Unreason

THE OPEN MIND
Guest: Dr. Gerald Weissman
Title: “The Medicine of Unreason”
VTR: 9/26/95

I’m Richard Heffner, your host on THE OPEN MIND. Some months back, the graduating class at Rutgers had me as its commencement speaker, which may have become a source of regret by the time I assigned it the task of combating the unreason that now so much threatens American life, American thought, indeed, the academy in America, as much as our politics.

I quoted from my students days the memorable 1943 Partisan Review Symposium, The New Failure of Nerve, by philosophers John Dewey, Ernest Nagle, and Sidney hook, in which Hook saw, a new disbelief in reason. One exhibited, as in Ancient Greece, as a rise of aestheticism, of mysticism, a departure from patient inquiry, a cry for infallible revelation, the refurbishing of theological and metaphysical dogmas about the infinite as necessary presuppositions of knowledge of the finite. Summing up his era’s failure of nerve, Hook wrote that obscurantism is no longer apologetic; it has now become precious and willful. Quite an unusually downbeat note for a commencement address, I’ll admit.

But three weeks later, the same theme surfaced with a vengeance at a rather heated meeting of the New York Academy of Sciences under the rubric The Flight from Science and Reason. With a couple of hundred worried scientists and doctors defending their faith in reason against the many new inroads being made by what The New York Times reported as faith healing, astrology, religious fundamentalism, and paranormal charlatanism. Nor was medicine immune. Though he said that most medical schools discount the claims of faith healers and practitioners of alternative medicine, my guest today, Dr. Gerald Weissmann. Professor of Medicine and head of the Division of Rheumatology at The New York University Medical Center, said that many medical schools lack the courage to stand by their convictions. Silence, he said, is easier in politically dangerous times. Medicine and science today, he went on, are being confronted by lunatics, fascists, and the practitioners of bizarre magic.

Well, having just read the galleys of Dr. Weissmann’s truly compelling new volume, Democracy and DNA, I’m enormously curious to ask him just why he believes that.

WEISSMANN: Well, I think to call everyone who believes in alternative medicine a lunatic is an extreme statement. But it’s very difficult to understand why, at the time when modern medicine has reached a remarkable level of sophistication and can help more people than ever before, that there’s more disappointment than ever before. So I guess that we’re experiencing what Crane Brinton once called the revolution of rising expectation, namely, things are expected to go so well, that when they go a little bit wrong there must be something wrong with the theory or the reason behind them.

HEFFNER: When you say when they go a little bit wrong, what has gone wrong?

WEISSMANN: I think, by and large, most people, when they feel sick or when they’re troubled, don’t confront another human being very often. They confront papers, they confront accountants, they confront conglomerates, and what are commonly known as health maintenance organizations, rather than individual doctors. That’s troublesome. In fact, most people would prefer the laying-on of the hand to the filling-out of a form. And that breeds a certain disenchantment with medicine. But that’s a symptom. The real problem is that, as we hit this millennium, the idea of Western reason as being the only way to arrive at melioration of society is under significant attack by advocates of religion, of various tribal urges, and above all, by people who are disenchanted with what they perceive to be the excesses of modern science.

HEFFNER: Well, you say – I was going to say, you concede the fact that…but it’s not a matter of concession – you say that you wouldn’t want to put all forms of alternative medicine in the same camp of unreason that you’ve just described. To what degree do you accept alternative medicine? What is there that you can embrace?

WEISSMANN: Well, look, the usual attitude ought to be that, I think, of a secular humanist such as I toward religion, that is to be tough on religion and soft on the pious. And so, I think one can understand why people would believe in astrology, why others worship crystals, and yet others think that the tickling of feet can cure their lupus erythematosis. That’s obviously not true. But it’s also true that modern scientific medicine, at best, knows about one or two percent of what there is to be known about the natural world of the body. That unknown leaves an enormous gap. The difference is we’re gradually creeping up from 0.001 percent, when life expectancy 150 years ago was 40, to the point where our life expectancy is now 80, and we’re only at two percent. Meanwhile, traditional practices, Sweden Borgen, mysticism, mesmeric hallucinations, Chinese traditional medicine, has not changed in those 150 years; Western medicine certainly has. It is our capacity to change, to alter itself, to change the course of this river of reason that makes us different. It doesn’t mean we know anything at all. We’re wildly ignorant. But that ignorance saves us. Very few physicians, properly trained and properly honest in their profession, will say to a patient, I’m going to heal you, when they really can’t.

HEFFNER: But wait a minute, wait a minute. You say “very few physicians, properly trained, properly presenting themselves to their patients”, will say this. But the notion that doctors are gods, I mean, that’s not a function of HMOs, that’s not a function of meeting the conglomerate, that’s not a function of filling out forms; that’s something that your profession taught the civilian population long since. Wouldn’t that be a fair thing to say?

WEISSMANN: Doctors were considered more gods at the dawn of the bacteriological revolution between 1910 and 1940, before antibiotics. The books of the Aerosmith and Microponte era of doctors as gods who would usher in a new world of knowledge, and really it was a reflection almost pre hoc rather than post hoc of what medicine could do. That knowledge, that idea of the doctor as God, as the healer, was allied to scientific power. Now that we’ve gotten somewhat more powerful, but at the same time at the mercy of our own machines, the idea of the doctor as employee or the doctor as technician has crept into the culture, not only medicine, but the whole anti-authoritarian view of hierarchy in our society. So I think limiting discussions of medicine to what goes on in medicine and what has happened in medicine is, I think, limiting. And in this book I discuss the cultural aspect of what modern medicine, which I use the term DNA almost as a rubric for modern scientific molecular biology and bimolecular medicine, that drive toward understanding and healing is an aspect of our society. It’s an aspect of a changing, democratic, open and meliorist society. That’s quite different from doctors as gods.

HEFFNER: Now, when I read Democracy and DNA, I was terribly much aware – and having read very many of your other books, and being quite familiar with your point of view – I see this humanist. I mean, when you sit here opposite me, I think of all the times that Lou Thomas sat here and all the pleasure I derived from reading his books as a humanist doctor.

You mentioned Aerosmith. Now, do you mention Aerosmith with pleasure? With scorn? The role Aerosmith played in the inspiration, if not the training, of young men? And generally they were young men in medicine. What is your fix on Aerosmith?

WEISSMANN: Oh…

HEFFNER: Which I read and made me want to become a doctor.

WEISSMANN: Lancelot. It made me want to become a doctor. It was Legend of the Grail. A young man from the Middle West experiences practice, experiences epidemiology, sees the danger of medicine for money, conformity, and dullness, goes into research, is disappointed by some of the grasping aspects of research, fights disease in the trenches, watches his best friend die of the disease that he’s fighting, and goes off and does research that discovers, lo and behold, bacteriophage. He’s scooped. He handles that rather well, and goes off to do something else again, and to discover something that will eventually flow into the veins of a human being to help him. That’s what all of us wanted to do.

HEFFNER: Yes, but you said, too, that that is what contributed to the notion that doctors are gods.

WEISSMANN: Well, when that idealistic legend of the grail becomes institutionalized, we’re in trouble. What was so lovely about that book, which was written by two absolute wildly drunk, perseverant journalists, Decryfe and Sinclair Lewis, because Decryfe, of course, provided not only the background work but also the viso tergo, the animus against organized medicine, and the drive for individualism. That book had a life and vibrancy to it that is missing form a lot of corporate, or for that matter, hierarchical structures where doctors are gods or doctors are administrators.

HEFFNER: You used that phrase a moment ago, hierarchical structures. And I gather you do see the Sixties, Seventies conflict between young people and the hierarchy as somehow or other oozing into the situation in which doctors as authorities are being undermined now. Now, do you see this as part of the soil in which grows this new thing about alternative medicine?

WEISSMANN: Yeah, I think we have institutionalized an oedipal revolt in which millionaires, Aerosmith, the group, for example, these are multimillionaires chanting about how downtrodden and dumped-upon they are by the powers that be. But they are the powers that be. In fact, one of the remarkable aspects of our culture is that it is constantly screaming, the Bohemian myth of Baudelaire at the same time that they’re riding around in limos. And I find that bizarre. Because what has really managed to ameliorate the conditions of humankind has been the fact that people quietly, slowly working in laboratories, in courtrooms and police stations, and, for that matter, military barracks doing their jobs from day to day have lifted us slowly from medieval superstition. And so these punk-rock millionaires or, I may add, depressed academics who believe that the cartoons represent the equivalent of Goethe, these people are making a living in institutionalized oedipalism.

HEFFNER: Oedipalism. Tell me what you mean.

WEISSMANN: Well, many of the ideas, I think, in modern humanist criticism relate to what Harold Bloom calls the anxiety of influence. Just a restatement of the Freud oedipal myth. Tilling, Lionel Tilling, in Liberal Imagination, made the very good point that much of art is a response to the previous structure. So romanticism followed classicism, etcetera, etcetera. But nowadays the revolution is ensconced in the arts, and it’s spilled over into what I think ought to be exempt from this kind of attack, namely, the actual truths of science and reason and method.

HEFFNER: Yes, but about these truths, you soft-peddle your concern about alternative medicine. I’m not going to quote you in The New York Times again. Isn’t there something for contemporary medicine to learn from alternative approaches? We’re not talking now about mysticism. Where is that line to be drawn between what you can and what you cannot gain from alternative medicine?

WEISSMANN: Well, let me…I think the trouble is that one tends to lump the, quote, alternative medicine as being another area of knowledge that our Western, rational, inquisitorial mind – and it’s truly an inquisition in which facts are put in a crucible and tested – that method is only a method. Science isn’t going to give you ultimate truth, but it sure can prevent you from can’t and unreason. The alternative methods that are popular in our time are visions of the internal, that’s internal visualization, Chinese medicine, iorvadic medicine, African tribal medicine, herbal therapy, aroma therapy, crystal therapy. Now, if all of those are all right, there’s real problem.

HEFFNER: Why?

WEISSMANN: Because, now I’m saying, if they are to be all right, there’s a problem.

HEFFNER: Yes.

WEISSMANN: Because they’re mutually contradictory. And they all demand what even their practitioners would call, quote, an associated belief system. For example, iorvadic medicine is practiced, essentially, by people who believe in the iorvadic myths. Chinese medicine has a long traditional belief system associated with it. They’re like religions, which, by definition mutually exclusive. The same God is not both Yahweh and Mohammad. So these belief systems have absolutely irreconcilable differences underlying them.

HEFFNER: But you know, Lionel Trilling was your teacher, and you admire him enormously. Lionel Trilling was my teacher, and I admired him enormously. I gained from him, I thought, my understanding of the nature of the liberal imagination, was that it could encompass all of these. And you say they’re mutually exclusive.

WEISSMANN: No. There’s a difference, I think, between understanding, A) why people would seek alternative medicine, B) the poetic and social utility of those, and C) the testing and validation of those when it comes to human medicine. Let’s go further. In order for me to bring something that I have made in the laboratory that I believe to be very healing, based on my deepest conviction, I have to take it, A) to a venture capitalist, B) we then have to construct a company. C) We then have to go to the FDA. Phase one: we see whether, in fact, it’ll hurt anyone. Phase two: we have to see whether it is useful for the indication that we think it is. And phase three: we now have to see whether, in double-blind, controlled studies, it is better than what is already on the market. But all of the alternative medical practices which have been around for three or four centuries have barely gotten past phase one. So I would suggest that, although there’s a great move to put many of these ideas to a test, no one from any group that I know is willing yet to put it to a double-blind controlled study.

HEFFNER: What does that mean for the John Q. Public, Joe Citizen, in terms of getting medical assistance? You talk about meeting the demands of corporate America. You talk about the division between individual doctors and patients. What does it mean?

WEISSMANN: Well, I think, by and large, we’ve gotten to a point in our society where the wildest fantasies of Nineteenth Century socialism have been realized. With the exception of a few pockets – and they’re deep indeed – of poverty in the cities, the bulk of Americans, at least, in this country, have goods and services, including medical services that the Nineteenth Century socialists and meliorists would have died on the barricades for. Things are provided for human beings, and medicine is provided for human beings, despite the lack of access in many areas, that could only have been dreamt of in the Nineteenth Century. What hasn’t been provided, of course, is one-to-one comfort. And I think that’s one of the reasons that people look to alternatives. Because, to a large degree, the pastoral function of the physician, the laying-on of hands and the giving of verbal reassurance, has been displaced by the rude machines that make things so powerful. But for Joe Public, if you’re sick, go to a doctor, and take the rude machines. It’s better than the laying-on of hands of a shaman. When you have chest pain, you want to get something that’ll dissolve the clot. You do not want God hovering over you and telling you you will be better. I strongly suggest calling 9-1-1.

HEFFNER: You know, you’re right. But I think you’re wrong, too. Because you’re speaking as a doctor, you’re speaking as a trained scientist. Bob Michaels, the dean at Cornell, would say to me when I was searching for a doctor: Listen, I don‘t want a guy who has a good bedside manner. I’d like that, but what I’m more concerned with is the fellow who knows best how to deal in the operating room or anywhere else with my problem. That isn’t the way the rest of us think, doctor. I mean, you do know that, don’t you?

WEISSMANN: Oh, absolutely. And one of the remarkable aspects of the new machinery that we’ve put together that can save lives is that each machine we’ve invented has removed the doctor’s hand from the patient’s shoulder one more. That’s a real problem we have to face.

HEFFNER: You say “have to face”. Have to admit? Or have to face and do something about?

WEISSMANN: Both.

HEFFNER: But how can we do something about it? There are 260 million of us in this country.

WEISSMANN: I understand that. But it is also true that, when I look at the way our young physicians are trained, I’m thrilled. The bulk of students coming in from the last five or six years – and there’s been a real reversal – are spectacular, upbeat, and very, very interested in human values. I think we’ve revived an upbeat, liberal culture in the sciences and in our medial schools that we certainly do not have in our colleges of the arts. The professional textural critics, who are frequently angry with each other, than with opponents of trench warfare, have nothing to do with the kind of generous spirit that I see in young physicians. And I think that the next generation, many of whom are very excited about the idea of primary care and patient contact, are going to change some of the, or are going to alter this kind of quiet antagonism between the machine and the patient.

HEFFNER: Marshall McLuhan said that we tend to march ahead into the future looking through a rear view mirror. So you’re suggesting that our criticism is dated?

WEISSMANN: It may be. (Laughter) The McLuhan line reminds me of the classic definition of an Austrian, who is a person who looks forward with fond anticipation, to the past.

But seriously, I think that there’s a trend that I see now in medical school teaching and in the culture of medicine is more humanist and much more related to what happens to people. This is not to the neglect of molecular medicine. That goes hand-in-hand. And I think right now in medicine we’re in the quatrocento. This is the time of our Leonardos and Michaelangelos. Perspective has been discovered, and we’re doing the Sistine Chapel of molecular biology. This is the accomplishment of the last two or three decades. Nothing else in the arts, nothing else in our culture can even match it, by my lights. And in this book I try to point out how the Nineteenth Century was waiting for this sort of breakthrough.

What’s fallen apart is the socialist and the humanist side of the liberal imagination.

HEFFNER: Well, that is what’s so interesting. Because in your new book, I see it as you do, the Nineteenth Century waiting. But the laying-on of hands now, what will happen to the scientific developments that you emphasize so, that you applaud so, if we now spend…We can’t do everything at once. Does that mean that those who will lay-on hands, then new generation of doctors, will be less scientifically oriented than you and your generation?

WEISSMANN: That’s a very good question. And I’d hesitate to make a prediction. But if past experience goes, I’d say that it’s possible to do both. That if we keep our eye on the ball you can play both sides, you can both bat and catch. I think that it’s remarkable how many of the more spectacular students I’ve seen can do both beautifully and continue to do so when they’re in practice. That the scientific knowledge and human experience go hand in hand. And very frequently people who are not good at one are not good at the other.

One of my previous books was called The Doctor with Two Heads. A lot of doctors go around with two heads. A lot of scientists go around with two heads. I do not think that can be said too easily about the community of the arts.

HEFFNER: But, you know – and we just have a little over a minute left, and then you’re going to stay where you are and we’ll do another program – but doesn’t this notion, this optimism, fly in the face of the necessities that we say spring out of medicine in your generation and before then, that doctors didn’t carry water on both shoulders, or didn’t have two heads?

WEISSMANN: That’s the downside. What’s remarkable is that you and I are speaking here, both of us, and many of our contemporaries, having suffered diseases which 30 years ago would have prevented us from being here at all, the bulk of people who I see complaining, and groups of elderly faculty arguing about the invasion of science in their lives, the terrible things, the dehumanization of science, in a room filled with pacemakers and on digitalis and calcium channel blockers, and crying for some new kind of humanism and knowledge form the external world, especially that of Asia or Africa, I am astonished.

HEFFNER: Yes, you are astonished, Doctor, but at the same time you’re looking for that yourself. And you talk about the laying-on of hands.

WEISSMANN: Well, I should have thought that one of the ways that we have in Western society continue to lay-on hands is to believe in the liberal imagination, which is the idea of Western rationality. It’s an awful good culture, and for some it may even be a spectacular religion.

HEFFNER: Well, let’s let it go now with the liberal imagination being our last words. Stay where you are, Dr. Weissmann, and we’ll continue THE OPEN MIND in just a moment.

Thank you very much.

And thanks, too, to you in the audience. I hope you’ll join us again next time too. And if you’d like to share your thoughts about today’s program with Dr. Weissmann, please write to THE OPEN MIND, P.O. Box 7977, FDR Station, New York, NY 10150. For transcripts send $4.00 in check or money order.

Meanwhile, as an old friend used to say, “Good night and good luck”.