Journal of IiME Volume 2 Issue 2 www.investinme.org P Plluuss ççaa cchhaannggee,, pplluuss cc’’eess tt llaa mmêêmmee cchhoossee ( (ccoonn tt ii nnuueedd )) dysfunction, has remained continuous throughout the time since Hippocrates, and undoubtedly before, since the essential situation has remained the same- a sick patient being tended to by a healer. At the time of Hippocrates, there were 2 adjacent medical schools in Cos and Cnidos, each of which emphasized different approaches to handling the archetypal situation of a clinical patient (Klinikos (Gk meaning bed), presumably with a physician attending to an individual non-ambulatory patient more seriously ill) (2,3). Both types of physician dealt with symptoms, but one group took the nominalist stance that is all they had to deal with (presumably based on the assumption that symptoms are a natural prelinguistic form of language), this is the stance that symptoms have no intentional reference - that is they were not about anything but themselves- and should be dealt with at that level, by “symptomatic” remedies. The opposite realist position is that symptoms tell you about disturbances in an underlying causal reality which you have to learn to interpret properly. Both schools took the distinction between appearance and reality seriously, but the Cnidians felt that the appearance was the reality (nominalist) the surface symptoms were the level to address. They analyzed symptoms as entities in themselves exhaustively, directing their therapies at what we call “symptomatic” measures rather than at any underlying cause of the symptoms. The Coans emphasized that symptoms were the surface appearances of an underlying unmanifest causal reality, towards which therapy should primarily be directed in the form of remedies and regimen to affect the humours, which names the dynamical causal forces they expected to be involved. The Cnidians emphasized a diagnostic search for static symptom clusters (what we now call syndromes) which were readily apparent to the observer, and could Invest in ME (Charity Nr. 1114035) be studied as entities in themselves as to incidence, arrangements, etc. and could be examined by what they considered to be scientific methods (presumably those of Aristotle, since Aristotle’s father was a prominent Cnidean physician, and somewhat similar to our natural history). The Coans, including Hippocrates, emphasized a method of prognosis, the real time search for evidence for less accessible underlying dynamic causal processes which they took to be causing the symptoms, (a realist position, which is also favoured by modern scientists and over which a recent war of attitudes has been fought, called the science wars (4). The realistic attitude certainly drives most research that is necessary to discover the causal network underlying ME/CFS, but given the current strategy prominent in the UK to emphasize a nominalist, at least on the surface, using a static “research” definition to discourage causally directed research and instead empiric methods to study (and also to promote and later institutionalize) nonspecific acausal therapies based on Cartesian body-mind dualism, one wonders about their motivation (see 5). Unlike the NICE strategy, the prognostic search for evidence of underlying cause in individual patients is essentially dynamical, emphasizing change in the symptom severity and configuration as evidence for change in the underlying causal network that is assumed to be underlying these surface manifestations. In this approach any changes in the surface symptoms are assumed to be due to changes in the underlying causal network, and not in the symptoms themselves. This leads to an ambiguity in the assessment of clinical results, since symptomatic remedies can mask underlying causal change, and therapy directed against the underlying cause can result in symptomatic relief as part of the therapy. Note that the evaluation of both surface symptomatic and deep causal therapies depends on a reliable estimate of (continued on page 21) Page 20/74

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