Sitting in the doctor’s office and waiting for the results of a test is an anxious affair. The doctor is about to present a black and white scenario in which you either have a condition, or you do not. There exists, however, a more agonizing situation than this: the grayness that follows if you are told “yes.”
As Prof. Harry M. Collins, sociology, Cardiff University, and Prof. Trevor Pinch, science & technology studies and sociology, explain in their new book Dr. Golem: How to Think About Medicine, medicine is an imperfect art. The question that confronts both patients and doctors when they embark on the medical process is how to deal with the ambiguities and uncertainties that arise. The professors tackle this problem in their book, and they attempt to show not how to fix it, but how to best work with it.
“We were more interested in how science can contribute to making medicine better … than about the uncertainties attached its about more medical knowledge and practices of the uncertainty,” Pinch said.
The book is third in a series of books that two professors have co-authored. The first, The Golem: What You Should Know About Science, which deals with the uncertainties in science, and Golem at Large, which deals with the uncertainties in technology.
The golem metaphor, as Pinch explains, is an acknowledgment of the complex nature of all three disciplines. The golem, a creature from Jewish mythology, is a large and powerful giant who knows neither the extent of its greatness, nor the existence of its fallibility.
Thus, Collins and Pinch use the golem as a metaphor for fields of knowledge that have of the power to do great things, but also possess unseen – and dangerous – pockets of weakness. As Pinch explained, only in understanding both components can one best use the golem, metaphorical or actual.
“Science is kind of like a bumbling giant that doesn’t know its own strengths,” he said. “And if you know what the golem is he will help you and defend you.”
Due to the personal nature of the topic, the book was the hardest one so far for its co-authors to write. Impassioned arguments, which had been absent during the writing process of the previous two books, plagued the two authors to such a great extent that at one point, it was uncertain the book would be completed. Collins explained, “It was because medicine involves us personally and directly whereas in the two earlier books we were dealing with things that affect us only at one remove.” Thus, while in the previous two circumstances the authors could talk about the golem’s monstrosity in the abstract, in this case, both could see and experience his impact.
The two eventually resolved their differences, and their book was published. The two intend the book to be an accessible documentation of various case studies. Pinch explained that they hoped by making their writing “breezy and snappy” and characterizing “technical terms in way that people will understand” the book would be helpful to a general audience.
The book has three main themes that run throughout. The first is the imperfect nature of science, and of doctors being the experts of this field in the same way that mechanics are experts of their fields. Of course, as Pinch explains, encounters with one’s doctor will be the most important encounter with an expert one has.
The description of a doctor as an expert is one that is intended to contradict previous conceptions of doctors as having a complete and perfect knowledge. Pinch explains, “We see science and technology as lay people meeting experts. We think that’s the right model … rather than scientists being high priests … we see a middle road to think of them as people endowed with technical expertise.”
Thus, Collins and Pinch’s conception of doctors is directly related to their golem metaphor. Doctors have a great deal of knowledge, which entitles them to make certain decisions; however, these decisions are rarely clear-cut and never ordained. The second theme is the tension that exists between science for the collective good and science for the individual. Science for the collective good is a long-term investment in which one may not immediately see results. Science for the individual is an immediate remedy for a single person, but this remedy may not do society, as a whole, a great deal of good. As an example, when one gets a vaccination one helps society by contributing to a fight against a certain disease, but a vaccination also poses the risk of individual side effects.
As to where science’s responsibility lies – to the individual or to the society – neither Pinch nor Collins have a simple answer. As Collins states though, “We do not know how to resolve this tension but understanding it is a good start.”
The third theme Pinch and Collins deal with is how much expertise lay people can gain and the power people should have in using it. In today’s society, it is very easy for a patient to access information, most notably on the Internet. The question then arises whether doctors should have a monopoly on medical expertise or whether patients should be considered their equal.
Both Pinch and Collins believe that while patients can and should research their own disease, the power of declaring “expertise” is one of which both sides should be weary. Collins explains, “The big danger is when people believe they have expertise in areas that they do not have it in.”
So what do patients and doctors do with the information that the authors provide?
According to Rita Mizrahi ’07, who plans to eventually attend medical school, classes have taught her to put a positive spin on medicine’s imperfections.
“It’s always better than it was so that’s the important thing to remember,” she said.
Mizrahi understands medicine’s failings, but sees it as a field that constantly improves.
And what are lay men to do, as they anxiously wait for the doctor’s results only to then realize that the results are just the first step in an arduous, unclear process? Perhaps it is this very realization that is the key. Although he may be imperfect, it is always nice to have a giant like Dr. Golem on your side.
Archived article by Lauren Hirsch
Sun Staff Writer