Nous sommes famille (What you brought with you)……. demarcation 

“I take after my mother…..” she said whilst we discussed her family medical history. “We both have sciatica” she continued. Does she have any other medical history? Oh yeah just cancer, diabetes, BP, MI, varicose vein surgery. 😳😳😳😳. Family ties often have a real divergence of both strong resemblance or distinction.

So what is it to be the ‘same’? Is 100g of caster sugar the same as 100g icing sugar? It is the same weight but not exactly the same substance. Is 1g of caster sugar the same as 100g of the same thing? It is the same substance but not the same quantity. Would we notice if we switched these in a cake mix?

What about snowflakes or fingerprints? They are the same but not identical. Each unique. They share commonalities. In the last few posts I have been exploring the commonalities and the uniqueness of people. Their objects. Their subjects. And everything between. The allure of pure objectivity to science is obvious. There is more concrete-ness. Measuring is easier. Predicting is easier. But does pure objectivity exist?

Objects contain the capacity to change if certain conditions are met. This doesn’t involve cognition or subjectivity. Sugar dissolves in water. Water changes substance at high and low temperatures. Metal changes property under particular loads and heat. But how objective are objects? A ridiculous question?! Another even more ludicrous “where is the object found?” It’s smallest component part? It’s properties? It’s mass? Well there are types of icing sugar that do not dissolve readily. Whilst metal is also a judgement or continuum about how metallic an object’s dispositions are. There are also elements that are possibly metal (meitnerium, darmstadtium, roengenium etc). We also have halfway groups of chemicals referred to as Mettaloids. Whilst metals can appear in both metallic and non-metallic forms. Astrophysicists even use ‘metal’ to classify all elements other than helium and hydrogen.

It seems object is more difficult than we imagine! The more complex the group of objects the more difficult to demarcate. This difficulty in demarcation can be summarised with what’s known as the Sorites paradox. How many minuscule changes are needed to change the object? One? A few? Many? Metal is defined by a number of different characteristics or properties. How much of these do we need of each to consider it a metal? Are some more important than others? If we slowly subtracted minuscule amounts of properties away where would be the cut off? It seems even objects may not be as objective as we imagine! The more complex the group of objects the more difficult to demarcate. Indeed demarcation is an active noun. “Actively fixing boundaries or limits”. If this is accurate who does the activity? Does the boundary or limit change between different individuals and communities? Or is it universal?

We tend to group things around certain dispositions, properties, familiality (a concept borrowed from Wittgenstein). It helps communication to have labels and concepts. Then we don’t always need to name every possible different hue of colour, type of animal, variation of protein. This semantic revolution is what makes language meaningful and accessible. In a world of uniqueness objects come to represent groups, forms, families of things. Sure semantics has the possibility of misunderstanding but without it we would need infinite language beyond what is reasonable for humans. With the most educated having a vocabulary of approximately 80,000 words. Of course combined this brings significant descriptive power although no guarantee on clarity (as I demonstrate unintentionally).

The history of Science tells a story of reworking the boundaries of Science. With each generation involved in this process. A dynamic process. It may be risky to assume or view Science as a static entity. There are forces at work within and from outside Science that help shape it. Not in a spooky way. Just in a real life influence way. There are forces in my life that shape me. Those forces are different now to 20yrs ago. It is clear that from an Evidence Based Medicine approach there is favour on systematic review and meta-analysis. This creates a culture or desire for uniformity of outcomes so data can be pooled. Does this pressure lead to choosing more desirable or comparable outcomes rather than chosen fit for purpose? (If you have read my previous blogs about pain scales I would argue yes). Randomised controlled trials record Humean contingency……….. In English this means they tell us the degree to which humans are creatures ruled by a singular stimulus followed by response (behaviourism or determinism). This may work well with objects. But in humans it turns out not so much. We seem not to be passive responders to stimuli. But interactors with willful agency. This means some things are good at measuring some stuff. Some at other stuff. Rarely is one thing good at everything.

Subjects have dispositions too. However dispositions in subject-objects (humans) are not as static as less complex objects (sugar, metal, robots). Subjects have more dynamic histories that unfold, more dynamic environments that shape them, and dynamic matter that allows new capacity. Even simple objects such as a roughened stone with a disposition to create friction along its surface may have some dynamic properties e.g. if it is thrown into a stream where it’s edges are smoothed. The more dynamic a subject-object the less stimulus-response like it is likely to act. We each bring with us dispositions into each clinical encounter. Just as each patient brings their own dispositions too. Whilst Science also brings with it its history, context and tendencies.

Science takes on its dispositions. It is not conscious that it may create its own. It is not an object we can touch but a subject we try to grasp. It vicariously acquires dispositions and tendencies from those engaging with or in it. Symbolic interactionism acknowledges that both object and subject (or “social/abstract objects”) are given meaning by individuals with help from their communities and interaction. They become symbolic. Each person interacts with these objects or symbols depending on meaning ascribed by themselves and their community. Hence symbolic interactionism.

So what of Science. Politics. Pain. Disability. Health. They hold meaning symbolic to the individual and community in question. Notoriously tricky to demarcate. There are no easy binary definition. Instead meaning is imbued from socio-economico-political spheres. For example Science relies on many activities: thinking, doing, perceiving. These are very human endeavours and depends on who is doing the thinking, doing and perceiving. The fewer people allowed to define Science narrows the concept and protects from liberal use by exploiters and fraudsters. The more stakeholders involved the broader the vision that emerges allowing more diversity in interpretation and protects from paternalism and megalomania.

In the case above it transpired the sciatica was actually vascular claudication which settled quickly with simple exercise. I have seen cases go the other way where people are wrongly convinced or worried they have a family resemblance. Healthcare professionals can build patterns of resemblance through experiencing case studies or anecdotes. This should involve an active demarcation of diagnosis through resemblance. Asking what does fit? What doesn’t? Would anything else fit better? What am I uncertain about? How can I explore this uncertainty?

Be more human. Be less robot.

Thanks for reading this far.

Neil

This was exploration deeper into my CauseHealth talk in May 2016. You can find the slides for the whole talk here:

https://twitter.com/neil_maltby/status/730741254250725380

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