Can Rene Descartes (we mean Wes Streeting) fix the NHS?

Can Rene Descartes (we mean Wes Streeting) fix the NHS?

René Descartes (1596-1650) was a French philosopher, scientist, and mathematician.

He was one of the pioneers of Rationalism. This is principle that actions and opinions should be based on reason and knowledge rather than on ‘experience’, emotion or religion. It is actually the basis of what we now call science; and ‘modern medicine’ as part of that science. But what did Descartes think about medicine? How can those ideas help Wes Streeting fix a “broken NHS”?

Let’s go back. Descartes came from a medical family – his paternal and maternal grandfathers were both physicians – and it is possible that he studied medicine at Poitiers after he had finished at La Fleche.

He was largely unimpressed with medicine at the time,

as currently practised does not contain much of significant use“

.. and felt most honest medical practitioners at the time would freely acknowledge the gulf between what we knew then and what remains to be known. MyHSN would say this is still the case.

But, he felt, if medicine was refounded on proper philosophical and scientific principles,

we might free ourselves from innumerable diseases, both of the body and the mind, and perhaps even from the infirmity of old age”

The Description of the Human Body (composed in the winter of 1647–8 and published posthumously) began with the Delphic injunction to ‘know ourselves’. But the benefits accruing from that self-knowledge were identified as specifically medical:

I believe that we would have been able to find many very reliable rules, both for curing illness and for preventing it, and even for slowing down the ageing process, if only we had spent enough effort on getting to know the nature of our body“

Questioned two years before his death about the Discourse’s hints concerning the philosophically mediated prolongation of human life, Descartes’s confidence remained unshaken

it should not be doubted that human life could be prolonged, if we knew the appropriate art. For since our knowledge of the appropriate art enables us to increase and prolong the life of plants and such like, why should it not be the same with man?”

I.e. he was offering us some hope, via plants!

And in ‘The Passions of the Soul’ Descartes wrote that medicine,

as it’s practised today by the most learned and prudent in the art, does not depend on physics. They (doctors) are content to follow the maxims or rules which long experience has taught (this is empiricism, the antithesis of rationalism), and are not so scornful of human life as to rest their judgments, on which it often depends, on the uncertain reasonings of Scholastic Philosophy”

Three years later, he continued – i.e. implying, that in the meantime (until they knew what they are talking about!) – by repeating the same sentiments to Frans Burman when the young student asked him what foods one ought to eat and how one ought to eat them. We become our own experts on such matters:

So, as Tiberius Caesar said (or Cato, I think), no one who has reached the age of thirty should need a doctor, since at that age he is quite able to know himself through experience what is good or bad for him, and so be his own doctor“

Here Descartes was not apparently advertising the virtues of his new philosophical and scientific system; he was merely pointing out that if you were a wise and attentive man or woman, then medical expertise deserved no deference .. and noting that he himself was such a man.

Descartes and bottle water (hocus-pocus)

Descartes had no time for hocus-pocus.

Descartes was similarly sceptical about the composition of mineral waters and their exact medical effects. Spa waters were said to be ‘good for you’ – provided that they were taken at the right season – but the so-called miraculous spring at Hornhausen was likely to be dangerous because of its possible chemical composition:

There are many wretched people who broadcast its virtues, and are perhaps hired by those who hope to make a profit from it. For it is certain that there is no cure for all ills; but many people have made use of this spring, and those who have benefited from it speak well of it, while no one mentions the others.

However that may be, the purgative quality in one of the springs, and the white colour, softness and refreshing quality of the other, make me think that they pass through deposits of antimony or mercury, which are both bad drugs, especially mercury. That is why I would advise no one to drink from them“

What would Dr Descartes medical advice be?

So, if Descartes were your doctor, this is the sort of advice you would get:

• First of all, once you have got a sufficient knowledge [“OK OK .. experience!”MyHSN Ed] of your own body do not be led by medical ‘experts’ whose knowledge of your body is inferior to your own
• Eat sensibly. Be neither thin nor fat and a glutton. Go for a high-fibre diet: more vegetables than meat; avoid very spicy and salty foods
• Variety of food is good. Soup is very good. On the whole, let your appetite be your guide. Your body is probably telling you something – listen to it
• Do not drink too much
• Take exercise – in moderation
• Get plenty of bed-rest, and do whatever you know works best for you to secure a dreamless sleep
• Don’t get up from your bed too suddenly, and don’t try to think too hard for long periods or at times that might interfere with your sleep (no screens in the bedroom!)
• Don’t let yourself be browbeaten into agreeing to physicians’ fashion for heroic blood-letting; or for any extreme or bizarre treatments in general
• Take great care with newfangled drugs and treatments; especially those whose efficacy is uncertain, or may harm people.

And, above all .. cheer up. Avoid thinking about things that make you distressed; dwell on pleasant things and memories. Look on the bright side of life.

Descartes knew, when the rationalist rubber hits the road (i.e. we docs don’t know nearly as much as we claim) – we should fall back on recognisable and reasonable medical advice based on science (or at least logic until that science was done).

In other words, follow Rationalist thinking and believe things that are proven in science, not just a ‘good idea that should work’ or ‘slightly better than the previous treatment’. But until we have that level of proof (and so knowledge) follow what you body is telling you .. and above all, look after it!

OK OK. So how does this help Wes Streeting rebuild the “broken NHS?”

• Modern medicine – like medicine in 17th Century France (which was way ahead of British at the time) – is pretty simplistic; with a poor evidence base for what we do. Why?
• We don’t understand how the human body works normally (physiology), e.g
• We will not understand (or cure) cancer or inflammation (two abnormalities of growth) until we understand normal growth. So, in the meantime ..
• Focus on performance, in all aspects of healthcare; GP, hospitals, mental health and community/social
• And ask the public to ‘get to know their bodies’ (as Descartes advocated) and do what they can to maintain their health. Take responsibility for your own health. Don’t just look to the NHS (and ‘the government’) to ‘look after them’, and dig them out of holes.
• And don’t always believe the doctors (who still practice blood-letting!)