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EDITORIALS: Roy Porter Millennial musings BMJ 2000; 321: 1092-1093 [Full text]

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Transdisciplinary musings

John M Last   (4 November 2000)

Genes, Dreams, and Realities.

B M Hegde   (5 November 2000)

Missing Millennium musing: Almost certainly not bound to be wrong.

Vivian S Rambihar   (6 November 2000)

Greater holism

Peter Morrell   (4 December 2000)

genome expansion

Mary Raidy   (6 December 2000)

Transdisciplinary musings 4 November 2000
John M Last, Emeritus professor of epidemiology University of Ottawa, Canada Send response to journal: Re: Transdisciplinary musings	Roy Porter's thoughtful millennial musings gently debunk the sensational nonsense about the human genome project as a panacea for human ills. However and wherever in the world we view the pattern of illness, disability and premature death, the contribution of genetic determinants is trivial compared to the myriad environmental and behavioural factors. Porter's musings illustrate the importance of thinking about health beyond the boundaries of the biomedical sciences. Reflecting on the present human condition and the ways it might change in the next few decades, I am struck by the complex array of unprecedented changes of the century just ended. Our numbers quadrupled, we have "conquered" many deadly disease scourges, we have mastered techniques of electronic communication that have created a truly global village - but we are quarrelsome, vicious, predatory, often mindlessly destructive of our own kind as well as other living things with which we are interdependent. We have badly damaged many of our life-supporting ecosystems. But we are inventive, creative, at our best when confronted by grave challenges, of which plenty lie ahead. The present challenges to the public's health require a transdisciplinary approach that is the exact opposite of the reductionist method of problem-solving. Violence, whether domestic or genocidal, HIV disease, uprooting of populations by natural (or manmade) disasters such as crop failures due to climate change, won't be alleviated by applying the results of the human genome project. But public health specialists working with agricultural, political, behavioural and social scientists, marine biologists, urban planners, the informed media, and with historians, philosophers, poets and performing artists too, can make a difference. I am encouraged by talking to some of the next generation of entrants to the medical profession who are thinking creatively about the problems they will have to tackle - and want to tackle them, rather than join the battalions working on the human genome project.
Genes, Dreams, and Realities. 5 November 2000
B M Hegde, Vice Chancellor Manipal-576 119. India. Send response to journal: Re: Genes, Dreams, and Realities.	Dear Sir, In an article under the above title that I wrote some years ago (title borrowed!) I had predicted exactly what Roy Porter had done! Like his beautiful book Medical History of Humanity, he debunks the predictability of anything in this dynamic Universe. We have been predicting the Unpredicatble all the time, anyway. Reductionism, that started with Rene DesCartes in the seventeenth century, still dominates our thoughts in the twenty-first century. While it has stunted the real growth of medicine for so long, time has now come for us to think of the real problem in the field of health care delivery. 80% of the world population still does not have access to hi-tech stuff that bothers most of us. If only we could think of three things we could make a bigger difference than all that the genome pundits claim to do for the future, viz. *clean drinking water for the poor masses *Food, enough in quantity, not contaminated by human and animal excreta *Smoke not only from the poisonous tobacco, but even that generated by wrong cooking methods used in the poorer segments, to be avoided in houses where children live. Finally trying to understand the role of human mind in human disease would go a long way. bmhegde.
Missing Millennium musing: Almost certainly not bound to be wrong. 6 November 2000
Vivian S Rambihar, Cardiologist. The Scarborough Hospital, Toronto, Canada. Send response to journal: Re: Missing Millennium musing: Almost certainly not bound to be wrong.	In his "Millennium musings," with the sub-title caution "Are almost certainly bound to be wrong" (1), Roy Porter reminds us that "in the scientific revolution, physics and mathematics were touted as the keys to the medicine of the future," and of the consequent failings of the view that "diseases were all manner of body hydraulics and hydrostatics." He highlights the fallacy of similar claims in decrying the reductionist view that health and disease were unitary. There is a missing musing however. When I completed medical school in 1975 with some earlier training in physics and mathematics and having done courses in physics and mathematics as applied to medicine, I was similarly disappointed that this mechanistic approach to applications did not solve medicine's problems. However in 1975 was born an entirely new mathematics called chaos (2) (and later complexity theory) which has changed everything and could be unitary, at least for now, of a non-reductionist art, science and philosophy of medicine and health, which encourages multiple perspectives and narrative, and other forms of inquiry. It may not be the key to medicine of the future, but it is currently the best interdisciplinary effort to incorporate the complex dynamic biological, social, cultural, personal, spiritual, economic, political and other interactions that determine health or disease (2). This is a new thinking embraced widely across disciplines, only now reaching medicine and health. It introduces a new perspective and vocabulary, transferrable across disciplines, and requires no skill in mathematics or physics, enhancing its broad appeal. It is the subject of many international conferences and seminars in medicine, has been discussed with regards to the practice and organization of medicine (3,4) and is even included as one of the innovative ideas being explored at a "Re-thinking cancer" think tank at the Newton Institute for Mathematical Sciences at Cambridge University in December 2000. It has been used widely outside medicine, with recent intriguing applications to world social and economic problems that would thus have impact on humanity and world health (2,5). It is thus worth exploring this missing Millennium Medicine mathematical musing, which I would think, in the spirit of the uncertainty fundamental to chaos, is almost certainly not bound to be wrong. References: 1. Porter R. Millennium musings are almost certainly bound to be wrong. BMJ 2000; 321: 1092-3. 2. Rambihar VS. CHAOS 2000: Making a new medicine for a new millennium. Toronto, Vashna Publications, 2000. 3. Griffiths F, Byrne D. General practice and the new science emerging from the theories of "chaos" and complexity. Discussion paper. British Journal of General Practice 1998; 48:1697-9. 4. Greenhalgh T. Change and complexity - the rich picture. Br J Gen Pract 2000; 50:514-15. 5. Homer-Dixon T. The Ingenuity Gap: How can we solve the problems of the future? Toronto, Alfred Knopf, 2000. Vivian S Rambihar MD Toronto.
Greater holism 4 December 2000
Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University Send response to journal: Re: Greater holism	Sir, One might predict as a ‘millennial musing’ [1] that the real shift in the next 50 years will be towards greater holism. Clear evidence for this exists already. Medicine will certainly move to a greater reliance upon holism, quite simply because it is conceptually superior, being closer to how the complex system of an organism actually functions in reality. Patients crave to be treated holistically and to have multi-tasking drugs and therapies and non-invasive treatments free of side-effects. They want all their health problems tackled at the same time where possible and their general level of health elevated. Surgery and chemical drugs have signally failed to deliver these commodities. They no longer want palliation and dependency, which currently seems to be 'the main show in town'; they want fundamental cure and full restoration of good health. Thus, it seems clear that medicine will have to respond and adapt to these demands, and deliver them. Not only will the holistic therapies become increasingly integrated into healthcare across the board, but they will rise to the challenge and come to dominate the medicine of the future purely because they are conceptually and therapeutically superior, that is, they are in line with the real functioning of the complex systems that are living organisms. What has already happened in agriculture and food production - the shift towards holistic and organic methods that cause no harm, that are in tune with natural systems - will occur next in the entire field of medicine. Of course, that is not to say that all the best aspects of modern surgery and life-saving methods will be ditched; far from it. But it does mean much greater medical pluralism and every technique that works to restore and improve health will be clearly visible 'in the same shop window'. [1] BMJ EDITORIALS, Millennial musings, Roy Porter, BMJ 2000; 321: 1092-1093 http://www.bmj.com/cgi/content/full/321/7269/1092
genome expansion 6 December 2000
Mary Raidy, independent blood group dna research BCI Institute Send response to journal: Re: genome expansion	I think the human genome project will give more information that we can currently imagine. The increasse in information will parallel the unexpected findings of introns. Introns were never imagined, though exons had been defined in the genomes of both bacteria and humans.