The Paradox of Progress: More Medical Data, Less Health Wisdom

We know more about the brain than at any time in human history, and yet we seem increasingly confused about what it means to be human. The first scientific revolution introduced a new concept of knowledge based on the experimental method.

“Science will deal with how things happen, not with why they happen”. Science will be concerned with how phenomena occurred, not with their final causes”. By transforming nature into a mechanistic system which can be described mathematically without assuming any theological scope or purpose, and by changing the human being’s position in the universe from being the scope to being the observer, this revolution unlocked enormous potentialities and hugely increased our capability to manipulate nature itself.

That was also the basis of the enormous successes seen in medicine and healthcare today. However, it seems to me that the increase in technological capabilities, which arise from scientific success, is not directly translating into people’s benefits.

On one hand, more tools and capabilities, on the other one more alienation and  less sense of agency. The speed of development and intrinsic power of new technologies escalate this divergence. In this podcast I will try to propose a new framework to catch up with this cultural lag and reconnect explanations with meaning across different sciences and dimensions of life.

The scope will be to regain some agency and the baricentre of our discourse will be health, because I’m a doctor, but also to keep us grounded to one of those key dimensions of life that can be acted upon singularly and societally and that is crucial to enable, for each of us, a flourishing life.

I hope everyone interested in health, but sometimes disappointed by traditional medicine and also skeptical by wellness culture will be interested. My guiding assumption would be that health is not just absence of disease, but a state of full well-being which cannot be disconnected from meaning and which emerges from interacting biological, psychological, relational and societal systems.

My strategic intent will be to move from being passive consumers of health information to become systemic thinkers. Yes, I think it’s the time for a new revolution, better, for a new renaissance.

One that can reconcile mechanism with meaning and restore the human whole to the centre of science and technology. Why  does it matter now? I think it matters because we all need to reacquire a sense of understanding, agency and prospect in this fast changing reality where we are all overwhelmed by information and technology, but in need of frameworks to make sense of what is relevant,

I will try to propose ways of thinking rather than just information with a goal to better understand and pursue health. We will address health-related topics in a non-reductionistic fashion, leveraging a multidisciplinary and inter systemic approach.

The issue is not that medicine has failed. On the contrary, modern medicine has extended life expectancy, transformed acute care and delivered some of the greatest achievements in human history. But current data also show a world increasingly shaped by chronic illness and mental disorders with a measurable gap between lifespan and healthy lifespan.

My name is Elisabetta Burchi. Resonating with the echoes of my Florentine homeland, I’ve always been fascinated by the complexity of things and convinced that understanding could only be captured through multidisciplinary lenses.

While I tried to nurture an all around education, I’ve never been satisfied by the perspective of understanding as an intellectual solipsistic exercise. I’ve always known that my fulfilment could not but be in a dimension of connection with or love for others.

That is why I decided to become a physician and realised the ideal of a job in which self fulfilment is intrinsically subordinated to a direct benefit to other human beings. The choice of psychiatry easily followed considering its object of study, the mind, the brain, the complex system par excellence and the core of being human.

From the time I decided to become a psychiatrist, I’ve sought to magnify the impact of my practice not only at the individual but also at the systemic level. In the attempt to find a key that could help me achieve this, I recuperated my original aspiration to embrace all fields and disciplines in neuroscience.

Neuroscience or neurosciences in fact is multidisciplinary by definition. More importantly though, being defined as the science that studies the brain as the active interface between our external and internal world, repositions the human being at the centre of inquiry and has the potential to enlighten the development and be the reference for the development of all other social and arts sciences.

This is my thesis: that we need a new human-centred neuroscience-based renaissance in science and medicine capable of giving an integrative understanding of things that unites mechanism and meaning.

This will be the gist of the podcast: neuroscience as a tool to analyse complex systems and overcome parcelization of knowledge and humanism as guiding principle, as the integral flourishing of the human person within its societal and ecological community.

Today I would like to cover three things. First, describe the paradox of progress in medicine. Second, explain why reductionism became both medicine’s strength and its limit. Third, sketch the outlines of a more systemic human-centred model of health.

Modern science has produced unprecedented explanatory power, but not necessarily an equally deep understanding of human well being. We live in an age of unprecedented knowledge accumulation. Look at medicine.

We can sequence the human genome in ours, image the living brain in real time and target molecules with precision that would have seemed miraculous a generation ago. And yet we seem increasingly confused about what it means to be healthy and even what it means to be human.

I see this as an instance of the paradox of progress: “the more, the less”. The more data we generate, the harder it becomes to synthesise it into wisdom. The more we know about parts, the less we seem to understand about the whole.

It might be also because of the so-called fallacy of misplaced concreteness, the error of treating abstractions like biomarkers in medicine as if they were the reality itself. Or the idea that things exist independently without reference to their relations and contexts.

For sure, it seems that we have lost focus on some of the relevant things or meaning, even in medicine. Let’s delve into some of the paradoxical aspects of progress in healthcare. In the last decades, for instance, life expectancy has increased dramatically to over 73 years globally in 2019.

This is genuine triumph. Yet the gap between lifespan and healthspan is widening. We are living longer, but spending more years in poor health. In high income countries, over 25% of additional years of life are spent in poor health.

Another relevant fact, the mental health crisis. Mental disorders are now the leading cause of years lived with disability worldwide. Depression and anxiety have risen, particularly among younger generations. Despite unprecedented material comfort.

Next to the great advancement achieved by medicine, these facts warrant an analysis. I would argue that those facts are also the result of losing focus on understanding what health is and what we should pursue as a society. In 1948, the WHO defined health as a state of complete physical, mental and societal well being.

But the traditional healthcare system seems sometimes to have forgotten the fundamentals. “The operation was a success, but  the patient died.” There is an interesting parallel to be made here with economics.

Economics once treated GDP as the privileged summary of collective success. But more recently it’s becoming increasingly recognised that raw economic growth as measured by GDP,  misses central dimensions of a society’s well being. Traditional economics often equated prosperity with economic output. Contemporary approaches instead increasingly focus on human flourishing, influenced mainly by the capability approach developed by Amartya Sen and expanded later by Martha Nussbaum.

In this framework, the goal of development is not merely producing wealth, but expanding people’s capabilities to live meaningful lives. I think that medicine should face a similar transition towards an expansion of what counts as medically relevant.

From asking whether pathology is present to asking whether a person can function, adapt, relate and flourish. 

We became better at measuring the pieces of life than at understanding the conditions of a life well lived.

To see why, we need to look at the model of knowledge that made modern medicine so successful in the first place. 

Reductionism is an approach that aims to explain phenomena in terms of lower level paths and mechanisms. In medicine this approach enabled specialisation and huge breakthroughs up to precision medicine.

But where reductionism fails in medicine is when we talk about emergent properties because it lays on linearity, context independence, decomposition of the whole into parts. While reductionism led to hyperspecialisation and to hyperfocus and capabilities in medicine it also led to fragmentation of care.

Think about the fact that the average Medicare patient sees two primary care physicians and five specialists in four different practices each year. This also led to an efficiency pressure in the development of healthcare.

This pitfall, this failure is even more clear in psychiatry where there is no linearity between cause and effect because there we have key emergent properties. So, evidence-based medicine has made important contributions but embodies reductionism’s limits as well, such as focus on average rather than individuals. The technocratic risk follows from here. AI and data driven medicine are powerful, but current literature warns about depersonalization, opacity and bias when care is organised around algorithmic authority without preserving trust, judgement and relational care.

Some philosophers of medicine argue that health and disease cannot be exhausted by a purely statistical or purely mechanistic account. Canguilhem,  in particular, opposed equating health with normality. The organism is not healthy because it matches a number, but because it can actively negotiate and remake its relation to the world.

The limits of reductionism in evidence-based medicine matter because much contemporary disease burden is multisystemic. Think about metabolic diseases, psychiatric disorders, inflammatory syndromes. 

So, reductionism gave us extraordinary power, but not enough understanding.

The challenge is then to transcend it. 

A better model of health would integrate mechanism with meaning, physiology with lived experience and biological precision with systemic understanding.

System medicine defines the body as a set of dynamically interacting  units, whose collective behaviour matters as much as any component. But we need time to implement it in  clinical practice. The World Health Organisation definition of health was historically important because it made health explicitly broader than disease absence.

It puts physical, mental and social well being in the same frame. There were some models that revitalised this vision. The so-called biopsychosocial model looks at the biopsychosocial factors as regulatory systems maintaining homeostasis and looking at causal interactions across domains.

The underpinning principle of that model was that flexibility versus rigidity defined health. That was the heuristic that travelled across levels of understanding. Health is not complete equilibrium, but the power to establish new norms in changing conditions.

We might say now that health is a complex, dynamic, multi level systemic concept that goes beyond the boundaries of different medical disciplines and is dependent on biological, psychological, environmental, relational and existential factors.

And we might say that it’s connected to flexibility, characterised mainly by flexibility. Health then is the capacity of a person to adapt, integrate and generate meaning and value in a changing environment. Similarly, disease or lack of health can be reinterpreted in the same manner in an intersystemic fashion, being characterised by loss of adaptability and increased rigidity within interactive systems.

If this is true, health promotion requires interventions spanning multiple levels, from the biological to the psychological, the relational, environmental, societal and even existential levels.

Integrating biological and existential dimensions of health, requires interdisciplinary collaboration that medicine is only beginning to develop. But the whole point of it is that the human being  – embodied, relational, meaning-seeking  – must remain the reference point of all health discourse.

Today, I think we need to reunite fragmented disciplines and restore the human whole as the reference point, uniting explanations with meanings. 

I think in medicine, a human centred neuroscience approach could be the tool for guiding this new synthesis across different disciplines.

Neuroscience is intended not as a tool to reduce the human being to mechanisms, but as a science of complexity that helps overcome fragmentation. 

Keeping a humanistic approach doesn’t mean to be anti-scientific.

It means to reacquire the reasons we do science at all. 

Neuroscience now reveals systems, emergence, relationality. And medicine is sitting at the junction of empirical science and human meaning.

Looking for a new renaissance, not as a rejection of modern science, rather as a reintegration of sciences with the object of their studies. Scholars during the Renaissance oriented knowledge around the human person, affirming the scientific and intellectual pursuits ultimately serve the understanding and flourishing of human life.

Science. The scientific revolution itself grew out of this new confidence in human inquiry. After centuries of extraordinary scientific progress, we may need a new synthesis, one that preserves the analytical power of modern science while reconnecting it to the deeper question that Renaissance humanism asked: what does it mean for human beings to flourish?

Five hundred years ago, the Renaissance transformed the way we understand the world. By rediscovering classical thought, scholars placed the human being back at the centre of knowledge. And from that shift, modern science was born.

Today, we live in an unprecedented moment of scientific and technological power. We can map the brain, sequence the genome, design molecular therapies and monitor physiology continuously through digital devices. Yet this immense analytical power has generated fragmentation of knowledge and loss of a coherent understanding of what it means to live well as human beings.

Perhaps the challenge of our time is not to produce more information, but to reconnect knowledge with meaning, to integrate mechanisms with experience, data with wisdom, science with the human person it ultimately serves.