Medicine: Art or science?BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7245.1322/a (Published 13 May 2000) Cite this as: BMJ 2000;320:1322
All rapid responses
Surely artistic and scientific qualities are essential in all walks
of life, not least medicine.
I worry about Dr. Rambihar's suggestion that 'chaos' reigns in
medicine - I realise that 'chaos' theory is one of the 'post-modern'
paradigms entertained by some scientists. It provides a convenient
scapegoat when things go wrong (a chaotic state exists) and is easily
dismissed when all's well (a non-chaotic period is enjoyed). I hear that
it is currently a favourite amongst weathermen when predictions fail.
"The art of medicine consists of amusing the patient while nature
cures the disease" Voltaire (1694-1778)
"Wherever the art of medicine is loved, there is also love of
"Art is I, science is we" Claude Bernard
"Science commits suicide when it adopts a creed" Thomas Henry
"But I have seen the science I worshipped and the aircraft I loved
destroying the civilisation I expected them to serve" Charles A.
Lindberg . Jr.
Science is "a branch of knowledge conducted on objective principles
involving the systematised observation of and experiment with phenomena"
(Concise Oxford Dictionary, COD)
Art is "human creative skill or its application" (COD)
Medicine is "the science or practice of the diagnosis, treatment and
prevention of disease" (COD)
Sounds like both science and art are essential elements in support of
the development, and application, of all good scientific conduct, whether
medicinal or not.
Competing interests: No competing interests
Sir- I wish to respond to the question posed in the BMJ, May 13, 2000
- Medicine: art or science? with a few quotes to add to Armand
Trousseau's of 1869 (1).
"Medicine and health are the most noble of the arts," Hippocrates 450
"In its highest form, medicine remains potentially the richest
expression of science because it is concerned with the various aspects of
man's humanness, ' René Dubos 1966.
"The new aesthetic created by chaos ensnares both artists and
scientists, both observer and observed, and the so called
objective/subjective wall that for centuries have divided scientist and
artist in their approach to nature is now being shattered from both
sides," Briggs J (2).
"Questing man and woman have traversed myth and magic, settling only
recently on science as a rational explanation of the mysteries in which
they find themselves ensnared.
Chaos - a consilience of art, science and philosophy can provide the
basis and a method for a new humanistic medicine for a new millennium. The
art and science of caring can be restored to medicine, unified by the new
science of chaos," Rambihar VS (3).
Chaos is a new basic and human science which emerged towards 2000,
bringing together diverse ideas once thought separate (4). The term
consilience, meaning jumping together, was introduced by EO Wilson, in
arguing for the fundamental unity of all knowledge (5). Chaos, a post
normal science for a new millennium (4), is thus introduced as a chaos
consilience for medicine, bringing together the art and the science of
I think Armand Trousseau, quoted by the BMJ to say in 1869, "every
science touches art at some points" and "every art has its scientific
side" (1) would surely approve.
1. Wyman AL. Medicine: Art or science? Endpiece Quote - Armand
Trousseau, Lectures on Clinical Medicine (vol 2), The New Sydenham
Society, 1869. BMJ 2000;320:1322.
2. Briggs J. Fractals: the patterns of chaos: discovering a new
aesthetic of art, science and nature. New York: Simon and Schuster, 1992.
3. Rambihar VS. A new chaos based medicine beyond 2000: the response
to evidence. Toronto: Vashna Publications 1999.
4. Rambihar VS. Science, evidence, and the use of the word
scientific. Lancet 2000; 355: 1730.
5. Wilson EO. Consilience: the unity of knowledge. New York: Alfred A
Vivian S Rambihar MD, Consultant cardiologist, The Scarborough
Hospital, 3050 Lawrence E, Toronto, Ontario, Canada. M1P 2V5.
Brian V Rambihar, General Practitioner, Preston, UK.
Contact: Vivian S Rambihar MD, Toronto. Email: firstname.lastname@example.org
Competing interests: No competing interests
Dr Wyman  raises a very important point about medicine as an art and a
science. Trousseau laments how far medicine has strayed from the spirit of
"Disease...is a dynamic process affecting the vital process of the whole
individual organism...a vital activity that...still remains far beyond
scientific comprehension...as a totality." 
'It is the natural forces in the diseased person that should be
strengthened, it is the natural means and life habits that should cure him.'
Of course, Trousseau is right, medicine is both an art and a science and in
my estimation it can never become totally one or the other. For at least the
last two centuries it has let itself get pulled along by an abiding
obsession with science and that is still the dominant impulse today. But
lest we forget, science is not the only way of looking at this world of
'Science is the attempt to describe nature...so that the description has the
same validity for every individual. It is an attempt essentially doomed to
failure...the two fields of enquiry [spirit and matter, or meaning and locus
of existence] cannot be separated...' 
'...nature appears different to every individual person, in a highly
personal and specific form. Every human being thus has his own image of the
world, his own definition of nature. A definition of nature that is
universally valid is therefore an absolute impossibility.' 
For convenience, I shall define an art as concerned chiefly with human
interactions, feelings, sensations, ideas, and making meaningful connections
laterally and holistically, to generate a particular body of knowledge. I
shall define science as essentially sceptical, materialistic and atomistic,
apprehending our world of experience through a cultural filter and impulse
first set rolling by Galileo [amongst others] and which, ever since, has
increasingly splintered our world into component parts, their interaction
being judged as like a huge machine. That is quite another sort of
'...a vision of the body as an hierarchical ensemble of discrete specialised
parts...formulated as the industrial age was beginning, corresponded to the
Hobbesian vision of society as an authoritarian machine, which still rules
our day.' 
'...disease may be interpreted as the result of an imbalance between
vitalising and destructive forces. Strategy one is: destroy, or at least
suppress, the demolishing or sickening forces. Strategy two: strengthen the
vitalising forces.' 
Moreover, modern scientific medicine seems to operate on an entrenched and
unquestioned assumption that the body truly is a machine and can be treated
and repaired like one. And - taking its cue from science - it pompously
regards this as the only valid perception of the organism.
'Reductionism in medicine has undoubtedly achieved some great successes, but
it is now outliving its usefulness...workers blunder blindly down the
reductionist path...' 
'...the fear that scientific medicine implies a mechanistic monster
displacing the 'art of medicine', on which homeopaths rightly lay great
'This modern tendency to regard medicine as a science, tends, in my opinion,
to create a mental attitude to the patient which is apt to ignore the
essential individuality and personal characteristics of each one...[and]
leads to the search for disease specifics, to mass treatment on standard
lines, to the conviction that medicine should be standardised
experimentally...that treatment can be administered according to the
formulae of the pundits...' 
As long as medicine uses solely chemical drugs, hews exclusively to the line
of materialism, denies vitalism, panders to reductionism and atomism;
dissects, analyses events into pathways and mechanisms, then it will retain
a patina of a scientific element, but it will necessarily be an incomplete
view of disease and the organism and, like chemical agriculture, will
comprise a very lop-sided form of 'healing'.
'The 'New Medicine's' rejection of the mind-body duality and its
reintroduction of spirituality, form a strong counter to the crude
materialism of scientific medicine - and its narrow emphasis on what it
construes as mainly physical and biological sources of disease...' 
'...cure is always individual, in the concrete case or patient, never in the
generalised disease.a specific cure for a disease does not, and.cannot
exist, since no two cases of the same disease, are ever the same.' 
'...from a natural healing perspective, illness does not exist - at least
not in a practical sense, and certainly not as disease entities.' 
And more and more it will strive to see each individual as only a blurred
example of some abstract conception, a universal type, which is just as
heartless and anonymous as it is 'scientific': a mere part in a big machine.
Who in truth wants that? It absolutely demeans human beings to just so many
chemical reactions. Such a nihilistic path is utterly and completely
unworthy of a system of healing in the laudable sense Trousseau had in mind.
'...scientific medical therapies can be standardised...to some extent; by
their very nature and self-definition, holistic-styled modalities cannot.'
"[Homeopathy views]...the sick as a whole individual with his mind, body and
soul...manifestations and results of the one disease, the entire removal of
which means total annihilation of the disease...removal or suppression of
any or one or a part of these isolated manifestations, however compelling,
has nothing to do with...annihilation of the disease." 
In truth, has not medicine been deluding itself through this obsession with
science? It can never entirely embrace that path, as it will always be
firmly rooted in the realm of human affairs, with all the nebulous,
subjective and irrational aspects of art and culture which that inevitably
entails. As Trousseau implies, medicine seems forever doomed to stand
between science and humanity.
'The basic strength of the holistic health movement is in the concept of the
human body and mind as a fully unified biological system...according to this
philosophy, the primary function of the physician is to engage to the
fullest the ability of the body to right itself.' 
'...every part...recognised as essential and autonomous and having its needs
met gladly in the whole; it involves balance and intricate
interdependence...the whole beyond the parts...in medical terms...an
ecological approach to health maintenance...' 
If, however, medicine were to embrace another form of science, just as
deserving of that name - holistic, phenomenological, observational and
descriptive, but which eschews the fragmentary illusions of mechanism,
atomism and reductionism - yet, one which cherishes each individual as a
truly unique whole being, then it can become once more a true healing art, a
synthesis, that combines the best elements of science and humanity.
"[In] modern scientific therapeutics...the patient with his life has gone
out of the picture...any acquaintance with the patient himself has become of
secondary or no importance." 
'Doctors do not treat us, they treat the disease, nor do they concern
themselves with the general state of adaptive powers.' 
'Medical science [allopathy] seeks to fight diseases, and to neutralise
whatever it perceives to be disease cause.' 
'...most modern drugs are entirely foreign to the biological systems of the
human body and comprise a form of 'blood pollution', so to speak, which
tends to deplete the body of its vitality and stamina, often with adverse
effects mentally and spiritually as well as physically.' 
For it is that which more profoundly deserves the emblem of Caduceus, a
sword of truth entwined by two serpents - one of art and one of science that
only when combined together comprise a truly healing whole.
'...natural healing therapies have nothing to do with curing disease. They
seek only to strengthen, not oppose.' 
'...while medicine condemns germs as an enemy to be destroyed, the natural
healing principle considers them simply living creatures we share this
planet with, sometimes peacefully, sometimes not. When our adaptive powers
are strong, we live with germs in peace.' 
Thus, in many respects, Trousseau is still right today: medicine has veered
a long way from that ancient path and needs to return to deeper roots to
become re-balanced and re-integrated as an art and as a science.
As has been stated in BMJ repeatedly, physicians seem to be overtrained in
science, in passing examinations and are under-trained in social skills and
relating to their patients as human beings. How can the 8 minute
consultation enable them to be truly holistic? To pretend to that looks like
mere tokenism. As Trousseau says: "the worst man of science is he who is
never an artist." He is speaking directly to the modern physician who is
dripping in science and knows nothing of the art in medicine. This quote is
therefore highly relevant to modern times.
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Competing interests: No competing interests