Category: Philosophy

A Life Well Lived

Next to my wife and family, medicine is my life. But can a life in medicine be a life well lived?

First some definitions. To me, the difference between life and death is consciousness, and consciousness is awareness and activity. Awareness and activity require memory of the past and projection into the future. Maybe you disagree with these definitions, but stick with me for a few minutes.

The arrow of time moves in one direction only. The past is unchangeable, and the future is unknowable. The point at which future turns into past is now, and now is where experience happens. Experiences are the elementary particles of life.

There are many kinds of experiences. Some experiences are trivial, others are profound, and many are mutually exclusive. Every life is filled with experiences, but which experiences make a life well lived?

Self-awareness—knowing who you are—guides the selection of experiences that separate a life without meaning from a life well lived. But you may not be who you think you are. For example, you are not the sum of your talents. A virtuoso is not just a musician—that would be sad, just as sad as a talented doctor who is only a doctor. You are not any degree, profession, certification, achievement, success, or accomplishment you may have earned. These are things you have done, not who you are.

You are not your personality. Personality describes a style comfortably worn, like a pair of jeans or a favorite coat. You are much more than what you wear. You are the core that your personality covers, the essence that is served by your skills and talents. You are who you are wired to be.

A life well lived is a life filled with experiences that resonate with who you are.

Filling your life with experiences that match your essence puts you in flow, the state of complete immersion in an activity, where time is distorted, and joy is maximized. This works regardless of your occupation. I spend a lot of my time at work in flow.

I share the talents of many of my colleagues—determination, persistence, stamina, pragmatism, independence, and the ability to think logically—talents suited to medicine. My Meyers-Briggs type is ENTJ, which makes me a bit atypical for a pathologist. My education and training took more than half the life I have lived so far. But none of these are who I am.

I am wired to help people have a better future. Many people are wired the same way, and it sounds grander than it is. I am wired for better, not for perfection. My scope is people in my reach, not every person on earth. This is who I am, whether I am a doctor, a neighbor, a husband, or a father.

I earn my living as a pathologist, and my professional life is filled with experiences that connect people with information they need to have a better future. My job takes me into worlds most people do not know exist. When I look in my microscope, I see colors, shapes, and beauty. I see heroes and villains, tension and resolution, turmoil and peace. In these fanciful places, I find what people need. I dig it out, distill it, package it, and deliver it, connecting people to it. It is satisfying work because it is consistent with how I am wired. Many times, I am arming someone on a hero’s journey, standing at the edge of the abyss. Many times, I am helping my colleagues do what they are wired to do. But my profession does not determine the value of my life; doing my job in a way that resonates with who I am is what makes my life fulfilling.

It is possible to have a life well lived in medicine, but not because it is a life in medicine. A life well lived in medicine is like any other life well lived. It is a life filled with experiences selected to match the core of being. Every life contains the promise of a life well lived. My potential for a life well lived will continue even if my life in medicine ended today.

But there is a flip side, a warning especially for those who share my profession.

A life filled with experiences that conflict with being is a life of dissatisfaction and dysfunction. Joy is lost. Boredom, anxiety, or both creep in. This is where burnout happens, and it happens in medicine—a lot.

When physicians focus on the past or the future instead of the patient in front of them now, when we think about our image, prestige, or money instead of helping others, when we blindly follow what others tell us to do instead of observing and drawing conclusions ourselves, when we are not true to who we are, we lose it.

We lose the promise of a life well lived.

Philosophy Science

The Art of Science

“When all was finished, it cannot be denied that this work has carried off the palm from all other statues, modern or ancient, Greek or Latin; no other artwork is equal to it in any respect, with such just proportion, beauty and excellence did Michelagnolo finish it.”
Giorgio Vasari, 1550

David, the breathtaking masterpiece by Michelangelo, represents the pinnacle of Renaissance sculpture, the result of countless hours in practice, planning, and observation of human forms. Carved from a single massive block of Carrara marble which had been discarded by other sculptors, Michelangelo’s creation embodies confidence and power. The body’s position, the facial expression, and even the veins popping in the neck all betray a determined youth on his quest to slay a giant. You can learn a lot of anatomy, physiology, and psychology by studying David. But nobody would confuse the statue with a living man.

And why not?

This statue never moves, it is twice the size of a man, and it feels like cold stone instead of flesh. Its proportions are wrong, perhaps intentionally so. Cut it open, and you will find dust instead of a beating heart. Michelangelo’s David is not a man. It is just a model that provides ways to think about man.

Science is like that. Like art, science is a creative endeavor. Scientists do not discover truth any more than Michelangelo discovered David inside the stone.

For example, Sir Isaac Newton did not discover the law of gravity; he invented it. His model replaced Aristotle’s 2,000-year-old idea that things fall because they seek their natural place in the universe. Newton proposed that bodies attract each other in proportion to the product of their masses and inversely to the square of the distance between them [F_g = G(m₁m₂)/r²]. Both ideas explain why a cannonball dropped from a tower goes down, but only Newton’s model explains why the moon hangs in perpetual freefall around the earth.

Newton’s invention is elegant and useful, even taking men into space, but it is not true. For example, Newton’s model fails to explain the wobbly orbit of Mercury. To correct the deficiencies of Newton’s theory, Albert Einstein invented a model of gravity in which objects bend the unified field of spacetime, pushing them towards each other. Although Einstein’s Theory of Relativity explains the paradoxical orbit of Mercury, even his invention has shortcomings. In the subatomic world of Fermions and Bosons, Einstein’s theory just doesn’t work.

A model does not have to be universally true to be useful. Despite its many limitations, science does two things incredibly well. First, it shapes what you believe by informing on what is not true. This is because the scientific method is an iterative process that tests ideas against independent observations. Second, brilliant scientists compile observations into theories of various aspects of the universe. In this way, scientists and artists have much in common. Both create models that provide ways to conceptualize the complex, stimulating new thoughts and ideas.

Scientific models should not be confused with truth. Truth is all around you, in nature. Scientific models are ways to think about nature when you close your eyes, when your viewpoint is obstructed, when you cannot see nature clearly. Scientific models are merely shadows like the ones on Plato’s cave. The Allegory of the Cave described the art of science long before scientific principles were articulated.

2021 Philosophy Science

Belief and Knowledge

I am not a scientist, but I love science. I am not a theologian, but I love theology and the effects of spirituality on my life. Just like I am a practitioner of pathology, I am also a practitioner of faith. I am enriched by both.

Religion deals with matters of belief. Science deals with matters of knowledge. Both address the big questions of life—”Why are we here?” “Where are we going?”—but from different perspectives. One is not a backstop to the other. Beliefs are not morally inferior to knowledge, just as knowledge is not morally inferior to beliefs. Both are important, but they live in different realms. Innocently confusing science and religion leads to superstition, ignorance, or harmful conclusions. Deliberately confusing science and religion is a deception that robs us of material and spiritual treasures.

Falsification is a key distinction between belief and knowledge. A scientific claim is falsifiable, meaning it must make a prediction that can be tested by experiment. If experimental results are not what the claim predicts, then the claim is false. But if experimentation supports the claim, it’s not necessarily true; it simply might be true. The scientific process is a last man standing game. The longer a claim stands, the more likely it is to be true. At some point, when an idea becomes more likely than anything else, we call it knowledge. But knowledge is, and always has been, what is most likely true, not what is certainly true. We can only have scientific certainty about what is false.

Lack of certainty isn’t the only limitation of knowledge. There are scientific horizons, and we cannot see what’s on the other side. For example, the universe is most likely expanding, but expanding into what? We cannot know. If the universe is expanding, then it must have been smaller before, and even smaller before that, and so on until it’s a tiny universe holding all matter and energy. But what happened before that? We cannot know. What’s outside the event horizon of light, or the gravitational horizon of black holes? Does our physics work there? Can alternate universes coexist? We can hold beliefs about these things, but these questions are not in the realm of science. We have no applicable knowledge because we have no power to observe.

Science has significant limitations. We can never be certain about what science tells us, and there are some questions that are not open for scientific investigation. Religion also has limitations, but different ones. Religious claims do not have the requirement of falsification. Omnipotence is the ultimate answer for all religious questions. When there’s no experiment that can demonstrate an idea to be false, it cannot be science, but it can be religion. Science requires falsification; religion requires faith. Faith and beliefs are good things. They give us hope, purpose, and compassion. Science cannot.

Despite its limitations, science is a powerful tool that augments our understanding of reality. We cannot rely on science to give us quick answers, so during this pandemic, we must have faith—lots of faith. But we also must speed science along by testing as many ideas as possible, all at the same time. A pandemic response that clings to ideas which are demonstrably false and dismisses competing ideas without experiment is not based on science. It’s religion pretending to be science, and it’s dangerous. There are three explanations for nonsense disguised as science: foolishness, greed, and evil. I fear that all three are now hopelessly entangled.

Religion and science have important roles in our fight against the pandemic. Understanding the difference between them is a protection against deception. When someone says, “believe in science,” beware of fraud. Your life, your liberty, and your sacred treasures are at risk.

2021 Philosophy Science

Stop Calling It Science

Medicine is my professional life. Science is the language of medicine, or at least it used to be. I’m not a scientist; I’m a practitioner. But I love science, just like I love ideas. Ideas separate humans from other living organisms, and ideas are often played out in the arena of politics. I am not opposed to politics, but I am opposed to deception. It is deceptive to hide behind the label of science to cover political actions.

I don’t believe today’s misuse of science is accidental. Those doing it are too smart and too well educated to make that mistake. Phrases like “follow the science” and “scientific close call” give an air of legitimacy to policies that are driven by agenda rather than facts and knowledge. Counter examples are ignored; theories are not allowed to be disproven.

Today’s orthodoxy is defined by elite high priests who possess secret gnostic knowledge. Scripture is what the priests say it is. Ordinary people have no access their secret data. Opponents of orthodoxy are labeled heretics, and some are vilified as examples to those tempted to stray. There are rites that involve the letting of blood, and these rituals must be repeated periodically to maintain continued salvation. Mass demonstrations of faith by believers prove their devotion to a movement that promises a second coming of pre-pandemic life sometime in the distant future, even though exactly when and how that will happen is vague. Occasionally, human sacrifice is required to appease the gods, but those chosen for sacrifice must not complain. The lambs must accept their fates willingly. There can be no dissent. Heterodoxy is not permitted in a nation whose motto is “In Science We Trust.”

This is not science; this is religion. Despite the first amendment to our constitution, our country is being turned into a theocracy, worshiping at the altar of “scientism.” Scientism is being used as a tool to advance a political agenda, not a scientific one.

Science is a process that establishes our best understanding of truth by disproving all that is false. Someone says, “I have an idea,” and other scientists set out to prove it false by experiment. “If your idea is true,” the experimenters say, “then my experiment should work out this way; since it worked out that way instead, your idea must be false.” Experiments never prove an idea true. “Scientific truth” is a probability not a certainty. It’s subject to revision when someone invents a better idea, shifting our understanding into a new paradigm.

Skepticism is integral to the scientific process. When doubt is not allowed, it may be many things, but it’s not science.

2021 Ethics Philosophy Science

A Physician’s Descent into the Abyss

Post author By Kevin Homer, MD
Post date October 4, 2021
11 Comments on A Physician’s Descent into the Abyss

Next to my wife and family, medicine is my life. I go to work in a hospital almost every day, and while I’m there, I’m focused on the patients whose blood, fluids or tissues come to my attention. I give them the very best I can, not perfectly, but humanly. Many patients aren’t aware that pathologists exist, but if you’ve ever been on a Hero’s Journey involving cancer, you know who I am. I was there at your jumping off point. I’m the one who signed your biopsy report, giving you the information needed to face the monsters of your quest. I’ve never personally experienced cancer, although both my wife and I have fathers who did, but I see cancer up close daily, and I frequently encounter those on the cancer journey.

Here’s a short summary of the Hero’s Journey. A hero candidate is called out of ordinary, mundane life to go on a quest. The candidate initially resists but is eventually drawn to the edge of the abyss and outfitted for the journey. Descending into the darkness, the hero enters a fantastic, dream-like world where rules of ordinary life don’t apply. Think Star Wars, Alice in Wonderland, or Odysseus in Hades. Real dangers are encountered, and sadly, not all heroes survive. But those that do come back to the ordinary world changed, and they share their wisdom with the generations. Joseph Campbell’s masterful articulations of the Hero’s Journey demonstrate that this formula transcends cultures and epochs. Cancer survivors know what I’m talking about because they’ve been on a Hero’s Journey.

Although I don’t feel much like a hero, COVID has sent me tumbling out of my ordinary world into an abyss. My pre-pandemic world was based on trust. Physicians are taught to think for themselves, but to doubt themselves at the same time. More than anything else, our education and training teach us that we just don’t know enough. There’s always someone smarter or intellectually more energetic, someone who dives deeper or stretches broader than we can ever hope to do. Yet there’s something about this humiliating self-awareness that gives us the tools we need to help those in the ordinary world with their ordinary health problems. We frequently consult trusted references, colleagues, and experts, and as we do, it slowly begins to make sense. Experience gives us confidence, and that confidence is transferred to our patients. Physicians become the handles patients hold onto when the earth drops beneath their lives.

The pandemic has changed all that. Physicians feel compelled to take sides. You either stand with most of your colleagues and friends, medical associations, and trusted institutions like the FDA and CDC, or you stand with what has made sense to you throughout your career. The pandemic has made this an either-or proposition. Like 1984, it’s a battle between your thoughts and the thought police; you either participate in the Two Minutes Hate enthusiastically, or you risk vaporization.

My trust in the CDC began to wane in May when, in contradiction to my education and training, the agency insisted on vaccination of COVID survivors. My trust was further depleted when I realized testing would not be used to guide vaccination decisions despite years of established pre-pandemic practice. Now, there is contradictory information published on CDC and FDA websites, and disregard for approval and authorization processes. Yet even the act of pointing out these discrepancies separates you from the herd like a calf in a cutting horse competition.

I have decided to stand for truth with the confidence instilled by my education, training, and experience, no matter what. There’s a lot in that “no matter what”—isolation, ridicule, coercion. But if you don’t have your thoughts, you don’t have your humanity. Humans are not required to believe alike, but they are required to believe. I am determined to crawl out of the abyss, humanity intact, back into the ordinary world, dragging as much trust with me as I can carry.

Maybe some of my colleagues will identify with what I’m saying.

2021 Philosophy Science

Is It Science?

How do you carve a statue of an elephant? Start with a block of stone and chip away everything that is not elephant. Science is like that. The elephant is truth; science is the chipping away. Scientists are the carvers, chiseling different parts of the stone block at once, testing and repeating each other’s findings, remodeling as new evidence emerges, and accepting the image that finally appears. Science is more verb than noun. It’s not the science; it’s just science.

You can’t predict what science will reveal hidden in the stone block. Even after the block is partially carved, you can’t be certain about important details that are still hidden from view. Science doesn’t reveal truth until scientists have finished their work, and that work cannot be rushed.

True science is open source. It invites questions, dissent, and transparency. True science is not condescending. True science can be understood by people with common intelligence. More than anything, true science is honest. When you identify misstatements, half-truths, or “believe me because I know better than you,” it doesn’t necessarily mean someone is trying to rob you, but it does necessarily mean you are not dealing with science.

And this is the point. Today’s intemperate rhetoric claiming to be science isn’t science at all.

I don’t have all the answers, but I recognize the absence of science in statements of leaders who say, “This is a pandemic of the unvaccinated.” The wisdom of universal vaccination, the benefits of vaccine mandates, the rejection of natural immunity have not been established scientifically. The use of ivermectin and hydroxychloroquine as prophylactics and early treatments have not been disproven scientifically. Yet there is an unrestrained rush to incorporate these ideas into the dogma of previously unimpeachable institutions and into our public health policies. It makes me sad. It makes me fearful for our future.

2021 Philosophy Science

Shouldna Taken That Shot

It was a heady time to be a scientist. Albert Einstein was still alive, and his special and general theories of relativity changed our understanding of the universe. Quantum physics predicted space travel and limitless energy. We had a brand-new theory of gravity, of space-time, of waves and particles, and of the atom. Vaccines had nearly wiped smallpox off the earth. We had penicillin, saving many lives and limbs. Science, it seemed, could conquer all. So, when your doctor said you needed a shot to prevent a miscarriage, you took an injection without question.

DES (diethylstilbestrol) is a synthetic estrogen created by Sir Charles Dodd in 1938. Cheap and easy to produce, pharmaceutical companies marketed DES for prevention of menopause symptoms in women. In 1947, the FDA approved DES for use to prevent miscarriages, and such use was advocated by an article published in the American Journal of Obstetrics and Gynecology. American obstetricians enthusiastically embraced the new drug as a cure for one of the most unhappy outcomes in their profession. Although some physicians questioned its effectiveness, DES continued to be commonly prescribed in the United States to women with threatened miscarriages until 1971.

That’s when a bombshell was published in the New England Journal of Medicine. The daughters of women who received DES during pregnancy had an unignorably high rate of clear cell adenocarcinoma of the vagina, an extremely rare tumor in women whose mothers had not received DES. That’s right—a drug manufactured and sold in the United States, approved by the FDA, prescribed as intended by licensed physicians—caused a rare cancer in young women. And not just clear cell adenocarcinoma. The daughters of women who received DES during pregnancy have higher rates of breast cancer, abnormal cells on their pap smears, anatomic defects in their reproductive organs, trouble getting pregnant, and problems during pregnancy. And not just the daughters—the sons too have increased rates of benign tumors and structural defects in their reproductive organs. Even the mothers are affected. Women who received DES during pregnancy have an increased risk of breast cancer. Does it stop there? Research is currently ongoing on the third generation, the grandchildren of women who received DES during pregnancy.

Clear cell adenocarcinoma of the vagina.

Although it’s not a story my profession likes to tell, the lessons of the DES tragedy must never be lost. Before we accept the opinions of experts, we must be mindful of the limitations of science. Before we are swept along with the crowd, we must recognize the possibility of unintended consequences. Before we act on conventional wisdom, we must think; think with our own brains, and make up our own minds. We must ask questions, critically examine data, and make judgements by what we know from experience. We must all be scientists now.

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