Ideas and the Scientific Method

May 2013
Ivan Obolensky

Joshua James is a scientist, a Doctor of Pathology (disease). In this hypothetical example, he has observed a particularly nasty illness and has constructed a hypothesis as to how he thinks it functions. He has based his hypothesis on several long-term sets of observations. He has been experimenting with a vaccination for several years and feels justified in claiming he can effectively prevent this disease from killing a large portion of the population with the vaccination he has developed. There were no observed major side effects so far.

Because of the potentially disastrous economic and public health effects an outbreak of this disease would create, the vaccination is expected to be mandated by law once it becomes available.

Although this is a hypothetical situation, it is not out of the realm of possibility and brings up the question: Does government have the right to vaccinate its citizens by force if necessary for “the common good”?

How should we resolve such issues?

In a general sense, humankind seems to be, in aggregate, a history of conflict and competition. Ideas, even good ones, seem to magically create their own opposition. Opposing and conflicting points of view vie for dominance inside groups as well as inside the minds of individuals. The subject of health is no exception.

Why humans get ill has been a potent topic of human interest since humankind came into existence. There have been myriads of remedies, untold numbers of explanations, and billions of ideas expressed on the subject. Over the last 500 years, the search for the sources of human disease and ill health has been augmented by science and the scientific method. The success has been noteworthy.

We have given science and the scientific method credence because it gets at the fundamental nature of existence. The method allows us to develop formulations of the world that appear to be correct and useful. The technology that has arisen around us over the last few centuries is the proof.

So what is science? By definition it means knowledge but also according to Webster, “knowledge covering general truths of the operation of general laws, esp. as obtained and tested through scientific method…”¹

The “scientific method” has been around for some time; yet closer examination finds there is no exact formulation as to what it is exactly.

The current literature outlines it only as follows:

Ask a question
Do research
Construct a hypothesis
Test it by doing experiments
Analyze results and draw conclusions
Report your results so others can verify²

In and of itself, it does not seem extraordinary, but when put to use as in the discoveries of Robert Koch (considered to be the founder of modern bacteriology) it is effective. Koch is known for identifying the specific sources of cholera, tuberculosis and anthrax. His research led to the formulation of Koch’s postulates. These are a set of principles that conclusively linked a specific pathogen to a specific disease. They are:

The suspected causal organism must be consistently associated with the disease.
The suspected agent must be able to be isolated from the infected organism or culture.
When a healthy organism is inoculated with a pure culture of the suspected agent, the symptoms of the original disease must develop.

To this set was added a fourth by E. F. Smith in 1905:

The same pathogen must be re-isolated from the infected organism.

Koch won the Nobel Prize in 1905 for his research in tuberculosis.³

It should be noted that although this rigorous test should be able to conclusively isolate disease carriers and did at the time, these postulates have had to be modified to some degree to allow for such things as asymptomatic carriers (those that carry the disease but display no symptoms) and to allow for the fact that some infectious agents such as prions (a protein in a misfolded form that causes mad cow disease) cannot be grown in cultures as prions are not alive per se.⁴

This simple but powerful outline contains the fundamental principles behind the pathogenic or germ theory of medicine.

Three hundred years ago the Miasma theory of disease was still prevalent. The theory held that diseases such as cholera and the Black Death were transported by bad air commonly known as Miasma. From this came ideas that are prevalent even today such as: don’t open the windows at night because it’s unhealthy, to its opposite: open the windows so the unhealthy air can leave.

Prior to this, the predominant idea behind Western medicine was that of the Four Humors which had been forwarded by Galen, a Roman physician who died in 200 AD. His concept was that certain fluids (namely blood, yellow bile, black bile, and phlegm) in the body and their relative balances were necessary for physical and mental health. Imbalances of any one over the others corresponded to changes in human temperament. Galen thought that blood was created and not re-circulated and that it could stagnate in the extremities. Further, he believed that blood was the dominant humor and by monitoring it by bloodletting, for instance, the body’s balance could be restored.

This concept was based on still earlier fundamentals set forth by Hippocrates of Greece (460BC- 370BC) some 600 years earlier. He defined health as the equilibrium of the different parts and sickness as the disturbance of the equilibrium.⁵

Additionally, Hippocrates founded homeopathy. He is said to have used small amounts of Mandrake root to cure mania because large amounts produced mania. The basis of homeopathy is that ingesting small amounts of ingredients that trigger symptoms in a healthy person cures those suffering from the same symptoms.⁶

The achievement of equilibrium and balance in the body as synonymous to health has been one of the longest held and most deeply-seated beliefs in human history.

It has also been at the core of one of the most epic struggles of the human mind: whether to believe that disease is the result of germs, or if it is the result of imbalances in and around the body. We know that this battle is epic because it is still ongoing, even today. The germ theory of disease is the theory behind the oldest “modern” methods of disease control: the vaccine.

Smallpox was one of humankind’s greatest scourges. The expression of the disease is worse than most horror movie special effects. It is believed to have emerged in human populations around 10,000 BC. By the 18^th century it routinely killed 400,000 people in Western Europe annually and has been the cause of some 300 to 500 million deaths in the 20^th century alone. Counting the deaths through all the centuries it has been in existence is a number that is many times larger.

Edward Jenner, a county doctor in England, discovered that inoculating people with the lesion fluid from cow pox, a disease common to milkmaids, resulted in protection from smallpox. His conclusions were published in 1770. The results of his inoculations were extraordinarily effective and form the underpinning of modern vaccinations. Acceptance of his discovery grew slowly but inevitably. It was a major achievement, perhaps one of the greatest in human history in terms of lives saved. The profound effect on those living that no longer had to endure the possibility of lifelong scarring if they survived the disease is yet another outcome that is underappreciated.

The British parliament awarded him the modern equivalent of some one million dollars. He was given honors from Oxford and Cambridge, as well as Harvard University.

Yet despite the inoculation’s good work, there grew up in the 1830s a vocal anti-vaccination movement. Many working class Britons viewed the compulsory vaccination laws (which were passed in 1821) as a governmental attack by the ruling class. Non-traditional medicine viewed vaccination as destructive while anti-vivisectionists of the time (who opposed the use of animals for experiments) joined forces with the anti-vaccination movement. There was a substantial backlash against the government.⁶

The British government’s view was that government had the right to immunize the population for the common good. This thinking was based upon the earliest really effective use of Western governmental authority when it was used to battle the emergence and re-emergence of plague. This started with special health commissions set up in the Italian city of Venice and then in Florence during the Black Death of 1348. The health commissions were made up of the leading citizens. Their main duty was the enforcement of existing sanitary laws such as the removal of “infected persons” from the streets. Both cities tried to stop travelers coming from infected places and to isolate the goods they brought with them. Full quarantine came slightly later. The Duchy of Milan in the late 1300s ordered local hospitals to take in the infected, created temporary shelters, and enforced segregation of those diseased from those who were well. In 1399, they also set up the first regular registration of deaths in order to monitor the approach and progress of a disease by demanding the notification of all illness and death. Central to survival of a plague-invested city was the systematic surveillance and segregation of the population in order to isolate and halt the progress of infection. It also became necessary to utilize force in order ensure that orders were carried out. Whether this was the sole reason for effective control of the disease or whether the virulence of the plague decreased over time is a question not easily answered. Nonetheless strong community measures to restrict infection were effective, and quarantine is still used today.

In spite of the success of these policies, by the 1600s there was widespread protest as the actions and government mandates interfered with private lives. In 1708 a sanitary cordon around Konigsberg by the Prussian government was taken down in the face of widespread protest that the cordon killed more people than the plague itself since all contact with the outside world including the supplying of food was halted.⁷

The idea in Western government of restricting the freedoms of citizens for the greater good was founded on and justified by the need to control disease, specifically plague. This eventually found its way into law. In 1905, when the US Supreme Court in Jacobson v. Massachusetts ruled that the need to protect public health through compulsory smallpox vaccination outweighed the individual’s right to privacy. From this foundation it became possible to restrict other freedoms provided it was for the common good.

Today we are still exploring this same issue but in another sense: how much restriction of personal freedom is too much restriction? What if increased incursion into privacy through surveillance and search reduces the quality of life to such an extent as to not be worth the incremental increase in public safety? By what measures can we tell that too much is too much; or too little is too little?

Our culture is based on the competition of ideas and interests. These can easily lead to violence. One of the scientific method’s greatest achievements has not been simply the results such as our technology and infrastructure, but the acceptance by disparate groups of often unsettling ideas, not by force but by argument, logic, and demonstration: the hallmarks of civilization.

Science. (1981) Webster’s New Collegiate Dictionary 150^th Edition. Springfield, MA: G&C Merriam
Using the Scientific Method to go Green (2011, March 9). Retrieved May 20, 2013 from http://proud2bgreen.wordpress.com/2011/03/09/year-to-year-energy-usage-comparison.
What are Koch’s Postulates? Retrieved May 20, 2013 from http://phytopath.ca/education/kochspostulates.htm
What is a Prion? Retrived May 20, 2013 from http://www.news-medical.net/health/What-is-a-Prion.aspx
Deans, E. (2011) The Humoral Theory of Disease – Ancient Western Medicine. Retrieved May 20, 2013 from http://evolutionarypsychiatry.blogspot.com/2011/06/humoral-theory-of-disease-ancient.html
Stern, A. M. & Markel, H. (2005) The History Of Vaccines And Immunization: Familiar Patterns, New Challenges. Retrieved May 20, 2013 from http://content.healthaffairs.org/content/24/3/611.full
Slack, P. (2012) Plague, A Very Short Introduction. Gosport, GB: Oxford University Press.