Articles of interest
22nd May 2023
Book in Focus
Controversies in Medicine and Neuroscience
Through the Prism of History, Neurobiology and Bioethics
By Miguel A. Faria, Jr.
My objectives in writing Controversies in Medicine and Neuroscience: Through the Prism of History, Neurobiology, and Bioethics (2023) were to enlighten medical science researchers, edify life science scholars, and entertain science enthusiasts by relating selective and controversial issues in medicine and medical history as well as fascinating topics in neuroscience and neuropsychiatry, and to educate novitiates in the resolution of ethical and moral issues from the contrasting perspectives of medical ethics versus bioethics. The book was needed because some of the controversies in medicine and neuroscience have reached a fevered pitch, and in few cases, even a boiling point.
Since the book bridges varied but related areas of specialized knowledge, I envisioned an audience of readers including neuroscientists, medical practitioners, public health workers, bioethicists, and medical historians; both for students as well as post-graduate scholars and experienced researchers and other life science academicians. Additionally, several sections of the book will be of particular interest to health care policymakers. Nevertheless, the conclusions drawn were formulated from an empirical perspective and the personal research and experience of an academic neurosurgeon and medical historian.
Without hesitation the book plunges directly into fascinating and at the same time controversial issues in medicine and neuroscience. To be more specific, the issue of violence, mental illness and the brain discussed in Part 1 will instruct the reader in the historic advances made in psychosurgery up to the present time.
In Part 2, the discussion branches out into the fields of neurobiology and the advances in learning and memory; neuropharmacology and how hallucinogenic drugs or the “Plants of the Gods” affect the human brain; and neuropsychiatry with intriguing frontal and temporal lobe syndromes.
Neuroscientists throughout the world are still formulating theories about learning and memory. I try to bring the reader up-to-date without overwhelming him with minutiae, while at the same time explaining the meaning and ramification of the most important points. For example, in Chapter 4, I wrote:
One point that Kandel repeatedly makes is that because of evolutionary development, animals, including invertebrates, such as the sea snail (Aplysia), and the fruit fly (Drosophila), maintain the biological systems needed for survival, and this includes simple neuronal circuits involved in flight or fight reactions. Moreover, the inference is that complex (conscious) explicit memory in humans is only more complex and only quantitatively different from simple reflexive implicit memory in the sea snail. The intimation is that the puzzle of learning and memory is largely solved; all we have to do now is to work out the mechanism for human consciousness, and then once and for all, we can end the concept of the duality of mind and body and delegate Plato and Descartes to the dustbin of metaphysics! As I will discuss later, with due respect to Kandel, this is far from being the case.
Another dilemma that is purportedly solved by evolutionary theory is the associated phenomenon of the random process of natural selection and adaptability accounting for similar neurobiology in all animals. This implies that, for example, by studying the neural circuitry of the sea snail (Aplysia) or the earthworm (annelid) that we can learn the intricacies of the human brain. But here again, Charles Darwin (1809–1882), who once suggested that his greatest teacher was not Lamarck, Linnaeus, or Cuvier—but “old Aristotle,” may not have all the answers as far as the evolution of the human mind. Although Aristotle and Darwin both believed in a hierarchical systemization of animals, Darwin, of course, believed in natural selection as a random event in evolutionary theory. Aristotle believed in intelligent design, a teleological theory of final cause—i.e., an efficient universe in which all actions have been designed by the prime mover (God) toward an end. Plant and animal life preserve systems because in following utilitarian principles, nature does not waste its resources uselessly. In this regard, Kandel’s proposition is consistent with current thinking: “In the course of evolution, humans have retained some of the cellular mechanisms of learning and memory storage found in simpler animals,” not according to him by intelligent design but by random natural selection (p. 144). It may turn out in the end that Kandel is correct, but the scientific proof is not yet in evidence.
Medical history is replete with enthralling mysteries and alluring secrets. In Part 3, I relate a surprising new hypothesis that I believe has solved the mystery of Neolithic and Bronze Age trephinations as investigated by the late Dr. Plinio Prioreschi. I wrote:
Observing that small injuries to the head, more frequently than other injuries, resulted in “dying” (i.e., LOC with a concussion or a contusion resulting in coma) and “undying” (i.e., spontaneous recovery), they must, according to Prioreschi, come to believe that “something in the head had to do with undying.”[5,6] More blows would not accomplish the ritual, but an opening in the head, trephination, could be “the activating element,” the act that could allow the demon to leave the body or the good spirit to enter it, for the necessary “undying” process to take place. If deities had to enter or leave the head, the opening had to be sufficiently large. Prioreschi writes: “It would appear that he was trying to recall to life people who had died (or were dying) without wounds (or with minor ones), in other words, people affected with diseases and people whose small wounds (e.g., undisplaced fractures of the skull with small lacerations of the scalp) were not so serious as to prevent ‘‘undying’.” Incomplete trepanations, as mentioned previously, are explained, not because the patients died during the procedure, but because of patients waking up and interrupting the procedure by suddenly becoming “undead.”[5,6]
The head was chosen for the procedure, not because of any particular intrinsic importance or because of magic or religious reasons, but because of the unique and universally accumulated experience observed by primitive man in the Stone Age with ubiquitous head injuries during altercations and hunting. Otherwise, the pelvic bone or femur could have served the same purpose. We must recall that even the much more advanced ancient Egyptian, Mesopotamian, Hindu, and even Hellenic civilizations believed the heart to be the center of thought and emotions, not the brain. In fact, the association of the heart with emotions lingered to the present age.
The reader’s journey then continues through aspects of primitive and ancient medicine as well as Greek and Roman medicine. I culminate the part with recently released details from the Soviet archives about the controversial death of Joseph Stalin, and question the conventional theory that Stalin died of a stroke.
The exploration of controversial issues, such as end-of-life care, assisted suicide, euthanasia, and infanticide, continues in Part 4 with the contrast between medical ethics, practiced according to the precepts of Hippocrates, and bioethics, based on utilitarianism; and I probe whether in that context bioethics and longevity are two incompatible concepts in modern medicine in Part 5.
In distinguishing traditional medical ethics from the utilitarian motives of bioethics, I wrote:
Bioethics (and potentially neuroethics) is based on utilitarianism and collectivist, population-based ethics that are susceptible to manipulation by social engineers and the influence of government monetary and funding considerations.[1,5,7,10] Bioethics and the veterinary ethic are applicable to humane animal research and when treating sick and injured animals—in which the veterinarian does not act necessarily in the best interest of the injured animal, but according to the wishes of the animal’s owner, the person responsible for paying the bill—but not to sick human patients.[5,7,10]
Bioethics is not concerned with individual autonomy, natural law, moral principles, or the dignity of human life, as it claims. Instead, its tenets are based on situational ethics, moral relativism, utilitarianism, and what is in the best interest of society or more apropos, the state. Attorney and moral philosopher Wesley Smith has called the bioethics movement “a culture of death” because it supports euthanasia of the elderly and infirm; abortion on demand; physician-assisted suicide; and the withholding of food and water for terminally or chronically ill patients. Pope Benedict XVI decried the movement and reaffirmed the tenets of beneficence, nonmaleficence, natural law, and the sanctity of human life.
In Part 6, I explore specific problems in the American health care system and look at whether socialized medicine is the proper solution. In the final section, Part 7, I return to medical history to discuss past plagues and epidemics in public health and conclude with a brief review of a book dealing with the source, events, and politics revolving around the recent COVID pandemic.
I hope the book closes several gaps of knowledge in the various fields of medical history, medical ethics, and neuroscience—and I would be very satisfied if at least some of my learned readers agreed.
Miguel A. Faria, Jr. attended the Medical University of South Carolina, receiving the Merck’s Manual Award for scholastic achievement and earning his MD degree in 1977. He conducted his neurosurgical residency at Emory University, USA, completing his training in 1983. He practiced neurosurgery in Macon, Georgia, USA, and he is Associate Editor-in-Chief of Surgical Neurology International. He has written over 200 articles and published several books.
Controversies in Medicine and Neuroscience: Through the Prism of History, Neurobiology and Bioethics is available now in hardback at a 25% discount. Enter code PROMO25 to redeem.