I have alluded to objectives in my discussion of applied, basic, and empirical science, which was a good place for their first mention but too narrow for a proper exposition. They are in the first case an expression of need, in the second case of desire, and in the third arise from perhaps an altogether different source. Here I am concerned with objectives of applied medical science. CLASSES OF NEEDS What can be the perceived needs of medicine but treatments, prevention, tests – to aid diagnosis or prognosis, methods, techniques and devices? EXAMPLES OF EACH CLASS Consider a patient with calcium oxalate stones not due to systemic disease, ‘idiopathic’ stones. Treatments This refers to stones present; they are there and surgeons need … Continued
This site is an unusual literary form. It is not a blog site, but a collection of essays which will eventually cover all or most of kidney stone disease. The essays are linked, and in perpetual evolution. Each one is longer and deeper than what I would have written on the specific topic in a standard book or review article. Being unusual it is an experiment, and like all experiments designed to produce an answer concerning its hypothesis.
The articles are meant to support the five steps to stone prevention which is the purpose of this site. They are supported by links to the peer reviewed primary research literature with some supplementary peer reviewed analytical reviews and tables and graphs I have made from primary data in published papers or our own research group. This link takes you to a drawing of the site which shows the articles arranged in their natural linkages with one another. The drawing cannot be edited but the links are live and will take you to the article mentioned.
Being so important, I have made links to this table from the main page and also here. All of the articles (posts) that concern kidney stone disease are listed. This page itself lists separately material that concerns how science and medical practice interact and relate to one another, using kidney stone disease as a model. The theory of stone disease provides a general structure of this specific field of practice and research. The subsequent posts concern the two sciences of medicine, and how these sciences relate to medical practice of kidney stone prevention and treatment.
In a graphical and prose format, I have presented a general overview of the whole field as best I can formulate it. By no means anything but an annotated graphical outline, it does give the site some sense of cohesion. Like all of this site, this page is likely to change over time.
The Table of Contents and the Theory are twin organizers of the site and reflect its logic. A third organizer is in the section that follows, which can seem more like philosophy than medicine or science but is in fact the foundation on which this site was founded. You need not read any of it in order to use the site or even enjoy it. But, if you do read it perhaps the materials of the site will do more for you by way of understanding. Perhaps not.
That there are two sciences is obvious to everyone who thinks about the matter. One concerns how nature does things. The other concerns how nature does things. Medicine uses both. Here, I present the two sciences in some detail, following Karl Popper as a guide through the strangeness of the radical unknown. They are so alike, these two sciences, yet so fundamentally different, confusion arises easily when we talk about ‘science’, especially ‘translational’ science and ‘evidence based medicine’. The third science is older than the other two. It concerns what nature has done, and is often called ’empirical’ science, or the science of measurement to define the real world in the best detail possible. Medicine is filled with examples, as it grew out of an empirical soil.
Basic science is my name for how nature does things. In our case it is about how nature has brought about kidney stones. Why we would want to know about this is obvious; to know how something has been brought about is to have insight into how we might reverse the process. But why physicians might want to know about this as they practice medicine, that why, is not so obvious. I propose here that such knowledge can lead to more passionate and subtle treatment, and of course to the proper education of patients, and that in so doing the knowledge improves matters. Within detailed examples I believe the case can be convincing. In general these propositions might be a basis for some new kinds of ‘clinical’ research.
All science begins with its objectives, what is being sought. In the ‘Three Sciences’ article I have made the point that applied science differs from basic science, and here expand the distinction into its first large division: The origins of objectives. These origins are practical as I have already mentioned, but desire to accomplish some practical aim is not enough to enable such accomplishment. Objectives need to be feasible, and therefore to arise out of what is true, or seems to be. In the case of stone disease, at least the one example I consider here of calcium oxalate stone treatment and prevention, objectives arise out of obvious practical needs and obtain their bodily shapes from what we can know about the world. Treatments to remove stones are brought into the body, and arise from the world which is available to the senses – technology so to speak. Drugs to speed passage of stones, and diet changes and drugs to prevent new stones are also brought into the body but act not through their own properties as modified by the body but through the mechanisms of the biology of the body. Those mechanisms, being the causes of what our senses show us, are discovered through basic science.
It is one thing to analyse how science or medicine works and quite another to analyse how these two large and disparate disciplines interact in order to progress their joint purposes. This article is my first attempt and uses the most simple example – that of the stone itself – as a test of the ideas. Like a marriage, medicine and science have intimacy between individuals. It may be that physicians can be scientists but I am after how the physician as physician and scientist as scientist work together – not in some general and gracious vision of cooperation but exactly in relation to progress of knowledge. This is an experimental article and probably a failed one, but so far it seems alright to me.
WHAT IS THE QUESTION? I understand that some physicians are skilled basic scientists, and that many physicians enjoy reading about basic science. But how does a knowledge of basic science benefit the patients of physicians who have such knowledge? There are two parts to this question. How can being a basic scientist benefit a physician in the practice of medicine, and how can a knowledge of the results of basic science benefit a physician in the practice of medicine. Of these two, I mean to consider only the second: How does a knowledge of basic science results benefit the practice of medicine. Of course, here, I mean practice of medicine concerned with kidney stones – the disease within the province of this site … Continued