Science as a Humanist Guide in Medical Practice
Medicine is not just science; it is a practice imbued with philosophy.
Although a physician might claim that philosophy bores them, in fact they philosophize all day long. When reasoning well, they practice logic; when taking for granted that patients, nurses, and pharmacies exist outside their consciousness, they practice naive realism; when assuming that genes and viruses are real even when not perceived, they adopt scientific realism; when rejecting the hypothesis that diseases are of a spiritual nature and origin, they subscribe to a naturalistic worldview; and when providing help without certainty of payment, they practice a humanist moral philosophy. In summary, the physician philosophizes even without knowing it .
This profound reflection by physicist and philosopher Mario Bunge in his work "Philosophy for Physicians" synthesizes the inextricable relationship between both disciplines, a connection that runs through the history of thought but which in our era of extreme specialization we have forgotten.
Medicine and philosophy have been intertwined since their origins in ancient Greece, with figures like Hippocrates simultaneously advancing medical knowledge and philosophical thought 1 .
In recent centuries, an artificial distancing has occurred between these two forms of knowledge, with mutual distrust: many physicians view philosophy as impractical knowledge, while some philosophers consider medicine blind to humanities 7 .
Mario Bunge proposes for medicine an integrated philosophical system serving as a solid foundation for research and clinical practice.
Bunge holds a conception of the world as matter in motion, where biological and medical phenomena are material processes occurring in complex systems.
The Bungean physician adopts a scientific realist stance: assumes the world exists independently of our consciousness and we can know it through systematic, critical methods.
Medical practice should be guided by scientifically validated procedures and ethics centered on human well-being.
| Philosophical Component | Fundamental Principle | Application in Medical Practice |
|---|---|---|
| Materialist and systemic ontology | The world consists of matter organized in systems | Approach the patient as an integrated whole, not as isolated organs |
| Realist and scientistic gnoseology | Reality is knowable through rigorous scientific methods | Base diagnoses and treatments on contrasted evidence, not hunches |
| Scientific praxiology and humanist ethics | Actions should be guided by validated knowledge and humanitarian values | Prioritize patient well-being over commercial interests or conveniences |
Bunge proposes a systemic vision where the human body is understood as an organized whole, not as a simple aggregate of disconnected parts, overcoming the Cartesian dualism that still underlies much of modern medical thought 3 .
Bunge criticizes the existence of "two pharmacopeias: the effective one for the rich [scientific], and the illusory one for the poor [folk healing]" , defending instead a medicine that is scientific and socially committed.
One of the most fascinating analyses in "Philosophy for Physicians" is the discussion about the placebo effect, a phenomenon that challenges simplistic categories and reveals the complexity of medical healing. Bunge asks: are placebo effects imaginary? . The answer to this question is not simple and requires delving into experimental research.
The study of the placebo effect presents unique methodological challenges, as it requires designs that isolate the neurochemical effects of belief and expectation.
Random assignment of participants to active treatment, placebo, and control groups, without patients or evaluators knowing who receives what.
Develop placebo interventions identical in appearance to the active intervention (pills with same color, taste, texture; simulated procedures).
Evaluate outcomes using standardized instruments, validated scales, and when possible, biological markers.
Document expectations of patients and researchers to analyze their influence on results.
Research reveals that the placebo effect is much more than "imagination". Studies with placebo analgesia, for example, have demonstrated the release of natural endorphins in the brain, producing measurable and reproducible pain relief 3 .
These effects can be pharmacologically blocked with opioid antagonists like naloxone, confirming their biological basis. Bunge addresses this paradox from his systemic materialism: the therapeutic context, patient expectations, and physician-patient relationship trigger real neurochemical processes that modulate symptom experience and facilitate healing mechanisms.
| Medical Condition | Identified Neurobiological Mechanism | Magnitude of Placebo Effect | Clinical Implications |
|---|---|---|---|
| Pain (analgesia) | Release of endogenous endorphins; activation of prefrontal and rostral anterior cingulate regions | Equivalent to 8 mg of morphine in some studies | Potential to reduce dependence on opioid analgesics |
| Parkinson's Disease | Release of dopamine in the striatum | Improvement comparable to therapeutic doses of levodopa | Modulation of motor symptoms through endogenous mechanisms |
| Depression | Changes in brain activity in prefrontal cortex and limbic regions | Placebo response of 30-40% in antidepressant trials | Need for improved designs to evaluate real efficacy of drugs |
| Immune System | Conditioned modulation of immune responses | Suppression or enhancement of immunological parameters | Possible application in autoimmune diseases |
The placebo effect thus represents a threat to Cartesian dualism that underlies much of modern medicine 3 , according to which mind and body are separate entities, and matter (drugs, procedures) can affect the body, but mind (beliefs, expectations) should not directly affect bodily matter. Evidence shows this distinction is unsustainable: mental processes are material brain processes that can influence the course of a disease.
Medical research is sustained by a variety of reagents and tools that allow exploration of molecular mechanisms of health and disease.
The choice and proper use of these reagents exemplifies the concrete application of Bunge's philosophical principles: methodological rigor, materialism (working with concrete material entities), and systemism (understanding how parts relate in biological systems).
| Reagent/Tool | Main Function | Application in Research |
|---|---|---|
| Agosterol A | Inhibitor of multidrug resistance proteins (MRP1) | Reverse chemotherapy resistance in cancer; study resistance mechanisms 8 |
| Superoxide Dismutase (MnSOD) | Catalyzes dismutation of superoxide anions at cellular level | Investigate diseases associated with oxidative stress; study obesity as biomarker 8 |
| Anti-AGO2 human | Monoclonal antibody against Argonauta2 protein | Investigate microRNA molecules and regulation of gene expression 8 |
| TN-16 (3-(1-Anilinoethylidene)-5-benzylpyrrolidine-2,4-dione) | Cell synchronization agent | Study cell proliferation mechanisms, genetic transformation and virology 8 |
| Bialaphos | Inhibitor of glutamine synthetase | Research as antibiotic and herbicide; resistance studies 8 |
| NCDM-32b | Inhibitor of histone deacetylase JMJD2C | Investigate various carcinomas (esophagus, colon, breast) and leukemia 8 |
| Isoliquiritigenin (4,2',4'-trihydroxychalcone) | Natural chalcone with antitumor activity | Study apoptosis in cancer cells; antiallergic and anti-inflammatory effects 8 |
The responsible use of these reagents implies following strict safety and ethics protocols 5 , something Bunge would emphasize as part of scientific praxiology:
These practices reflect not only methodological precaution but also the ethical commitment to safety and environmental sustainability that should guide all scientific research.
Bunge criticizes the existence of 'two pharmacopeias: the effective one for the rich [scientific], and the illusory one for the poor [folk healing]' .
Mario Bunge's proposal in "Philosophy for Physicians" represents a call for reintegration of two knowledges that should never have separated.
Far from being abstract exercises or sterile speculations, the philosophical principles he defends - materialism, systemism, scientific realism, and humanist ethics - have profound practical consequences in the quality of medical care, the direction of research, and the effectiveness of treatments.
Medical philosophy is not an intellectual luxury but a practical tool to filter valid knowledge from pseudoscience, to remember that we treat whole people and not just isolated organs, and to maintain ethical direction in an increasingly technified and commercialized health system.
As Benjamin Herreros notes in "Philosophy and Medicine: A Love Story," medicine and philosophy "are in continuous dialectic, seeking their balance, and our happiness depends on this. That of each individual and, I would dare say, that of our society" 7 .
In a world of increasing medicalization where natural aspects of human life are converted into pathological conditions 1 , and where advanced technologies coexist with unsubstantiated pseudotherapies, the philosophical filter proposed by Bunge becomes more necessary than ever. Good medicine is already, inevitably, philosophy in action - recognizing this explicitly can lead us to a more conscious, more critical, and ultimately more human practice.