I can hardly remember when I first studied Philosophy with a capital P, by which I mean the theories of Socrates and Plato, Descartes and Spinoza, Locke and Hume. Maybe it was during my high school years. I dropped it, not long after, concluding that my feeble mind is not well suited to ponder upon those. I went on to study Veterinary Medicine, forgetting everything I learned from Philosophy, if I ever learned anything. There is no question that between those years and now, I philosophized, with a small p, a lot. I threw a lot of whys and hows to all kind of things around. But, philosophizing is different from studying Philosophy, and while both are important, this piece intends to discuss why Philosophy, the robust field of study, should be integrated to veterinary education, with special focus on Philosophy of Science and Ethics/Moral Philosophy.
In attempt to decipher the universe’s secret, men has travelled far, from debating the nature of knowledge as justified true belief to developing sophisticated methods in doing science. Philosophy’s questioning nature has urged us to constantly refine scientific method. That scientific method will always be refined forces us to accept that the way we do science today is not perfect, nor will ever be, even though we can confidently proclaim to approximate truth more and more. Wherein lies the responsibility to refine and perfect scientific method? In the hands of scientists who philosophize, and philosophers who do science.
Not every veterinary graduate goes on to become a full-time scientist, but basic scientific methodology is in the curricula of every veterinary school. Most other majors also teach it, but Veterinary Science, along with a few other disciplines, is unique, in that it is a specialized training, and its graduates proceed to become part of a profession. Many jobs do not restrict itself to graduates of certain major, especially when the candidate shows extensive competence and experience related to the role. In constrast, only holders of veterinary degree can practice veterinary medicine, and even a degree is not enough. Veterinary practitioners must hold a practice licence, which has to be renewed every certain year. And what does it take to renew licence? Continuing education hours. Veterinarians must remain on the cutting edge of their discipline or stop practicing.
Here is the thing: in the race to cutting edge, pseudoscience and less-than-scientific ideas abound in medicine and veterinary medicine. For some, following a maverick is an exclusive membership pass to the enlightened few, amidst the flocks of sheep who blindly submit to Big Pharma’s gambit. These mavericks sometimes do have legit credentials and experience, even more robust than their mainstream oppositions (Nobel disease?). So, what prevents us from trusting them? How do we know which novel ideas in our profession are worth entertaining, and which are pseudoscientific rubbish? Enter Sackett’s evidence based medicine (EBM). In a world dominated by anecdotal experience to guide clinical practice, came a call to evaluate the scientific basis of it all.
How does Philosophy of science fit into this? EBM is a beaming example of Thomas Kuhn’s paradigm shift. It has helped us separate truly effective treatments from the bogus ones through controlled trials (and other means, when an RCT is not fitting). But, EBM is just another fleeting framework. It is better than the last that we had, but it is definitely not perfect. Even today, there is already an urge to revise EBM with science-based medicine (SBM); that is, not to take every RCT or systematic review with equal weight, but to first evaluate whether the underlying phenomenon is founded on sound scientific reasoning. So, it is up to the scientists to look for answers through given research designs, but science is a constantly refining process, and the task of questioning and refining the way we do science belongs to Philosophy. Even though this notion comes from human medicine, I do not see why it should be applied any differently in animals.
While we do not expect to burden veterinarians with that task, this much we do expect: that vets, who are to some extent scientists, are aware of the current scientific paradigm in veterinary medicine, and that it will be refined in the future. However, my observation towards this nation’s veterinary community — which I hope is wrong — shows that we are yet far from attaining it. A few months ago, I inquired several friends from different schools if they had heard of EBVM. The response was almost unequivocally negative, except for one — but she was an outlier. In their defense, though, EBVM is just a label. We might be already practicing it all along, and not knowing its label does not invalidate our legitimate practice. But, do we? This is not me feeding my superiority complex. Granted, I too thought I had been putting scientific evidence in my study and content synthesis, but was I? I can only answer with a partial affirmative, at best. The devils are, of course, in the details. It was when I started learning EBM and EBVM, step by step, did I learn that I know very little.
We are lagging behind. It is such a sad state that while our partners in human medicine have started pointing out the flaws in EBM and ringing a call for SBM — a very normal process in the course of Science — we are barely familiar with EBVM. Of course, EBM does not have to be separated from SBM. We might never have to see a similar phenomenon (i.e. a call to revise EBVM with SBVM). SBM only became necessary because some people found loopholes with EBM, and with it EBM was turned on its head.
Again, what does Philosophy has to do with all these? Philosophy is the enabler, the driving force of the iterative questioning that led us from experience based medicine to evidence based medicine; from evidence based medicine to science based medicine. It is a bit funny that this realization hit me while reading a Physics article with nothing to do with Medicine. Briefly, Physics is suffering from the same plague that befell EBM. And although there is no such thing as evidence-based physics or EBP, the author of that article was well aware that Physics needs a science-based medicine, or more precisely science-based physics, of their own (paraphrase mine). The ultimate purpose of that article was to defend Philosophy as an ever-living, ever-needed branch of study, even in Physics. If it is so in Physics, maybe, more than EBM, Philosophy is what we need in Veterinary Medicine. In this regard, I view Philosophy in the context of lesson in thinking. We were all endowed with an optimally functioning brain; too bad, it did not come with an instruction of use. Maybe, Philosophy is the instruction leaflet, which somehow failed to be included in the original package and therefore, needs to be acquired separately.