Cavichi’s book deals with the “crisis of the medical mind.”

by Gian Franco Gensini

The relationship between “thought and medicine” has always been difficult. Evan gives us the opportunity to reflect on the “interrupts” for some of our national debates. The pledge to rethink our scientific medicine is an arduous and always very difficult path. But in all fairness I don’t think there are alternatives.

June 16

Latest book written by Ivan Kavici “Unparalleled Science” In my opinion, it is a real “work” of great importance and convenience. A work that, more than all that has preceded it, explains with rigor and precision the precarious situation of our scientific medicine, and shows us above all the way to go.

The relationship between “thought and medicine” has always been difficult. Evan gives us the opportunity to reflect on the “interrupts” for some of our national debates.

A work that is published and known to all
In my opinion, Cavicchi’s work should be known and widely disseminated because, in relation to the problems of scientific medicine and the problems of the medical profession, such clear, relevant and profound analyzes are not found in the wonderful circulating literature, but above all there is no such medical idea and project as The one that Evan has been practically proposing to us for years.

Thinking about medicine in our country makes me as a doctor and as a proud citizen, and also because so far many of the prescriptions that have come to us from abroad and from the channel (think medical humanities, EBM, choose wisely, etc.) to which we have adhered, have not always kept their promises, and often What they prove to be culturally weak is rare and incomplete. Above all, it is not about the challenges of rapidly increasing complexity of medicine.

With Ivan, of course, one can agree or disagree, but what he proposes to us, this time as always, is a real and deep idea, that is, carefully studied and ready for use and application in the field.

Evidence example A few days ago I read in this newspaper an article about the “alleged” crisis in EBM which reminded me that it was only two years ago that I had the honor again in this newspaper to open the Forum “Scientific Evidence in Medicine”. The opportunity was provided by a prophetic book of Kavici that I selected, with two interventions on QS, a turning point book or, as the English say, a real “breakthrough”.

“Salute Internazionale”, our qualified online magazine run by the esteemed Gavino Macciocco, ignored the book and the forum, but two years later translated Article from BMJThe illusion of evidence-based medicinewhich bounced off our computers as if it was a cool and astounding find, and some commentators have laudably decried it.

Cavici’s musings on the problem of evidence were already foreseen 20 years ago in another book that I will define as a great area for confrontation and challenge, a true icebreaker, and the first timely response to the risks, which Cavici was already in a bind. Mawlid was defined as a “given medicine” that was launched by Law 229 which imposed on physicians an obligation of propriety, an obligation that would contribute significantly to the creation of the famous “medical question.”

Medical Mind Crisis
With “incomparable science” we certainly go beyond thinking about scientific evidence, and finally sail out to sea and come to an agreement with what any philosopher would define “crisis of the medical mind.”

After this latest book by Cavicchi I challenge anyone, even the most hard-line and backward:

  • To deny that there is and always will be a crisis in scientific medicine,
  • To explain the medical question without clarifying its relationship to the medical crisis,
  • To explain this paradox of our time which is the distrust of an entire society towards our most powerful science,
  • To make it clear that medicine is just a science,
  • To show that the crisis of medicine can be overcome without a second thought.

This latest work by Evan appears as the result of at least 30 years of serious and continuous exploration and reflection.

Through this work he clearly explained to us:

  • What are our problems,
  • Where we must put our hands if we want to solve it.

He stated that…
My other esteemed colleagues wrote in Cavicchi’s book that there is not a single chapter of it that you do not impress and do not draw your attention and that does not convince you, but to me for my mental structure, and especially it hit that part more. My work where Cavici with his polished pragmatism pretends that he has to write a resolution and describe the necessary changes to medicine, that is, those that would serve us in a positive way out of the crisis.

Cavicchi uses the ritual formula for the decision “We arrange it…” He has a responsibility to tell us what needs to be changed in the model, in doctrine, in discipline and practices.

No one has done similar work internationally.

No one has proposed to infer from unparalleled science the unparalleled legal status of the physician.

Anti-boycott Reflection
In order to write this article, I admit that in addition to Cavicchi’s book, I also read all the authoritative comments on “Peerless Science” published in this journal.

Without hurting anyone, in fact by making my previous reviews my own, I must say that the reflection that struck me the most is the most anti-interrupting one. That is, Giovanni Brandi, famous oncologist and director of the School of Specialization in Oncology in Bologna.

Against the current, Brandi proposes to us an explanatory thesis of great importance:

“If we owe Claude Bernard the invention of experimental medicine as a mechanistic and analytical paradigm, and thus the basis of our present scientific medicine, we undoubtedly owe it to Cavicci for the theoretical framework of medicine as an unparalleled science.”

Both Bernard and Cavecchi, Brandi are right, ultimately go through the same basic process of deducing medicine from non-random, scientific sociocultural assumptions, and interpreting their own historical time and place.

Bernard two centuries ago deduced experimental medicine using the culture of his time and thus positivism. Cavici in the third millennium works essentially on the same thing, i.e. he defines science as incomparable but in a post-positivist sense. Whereas the first deduces medicine in the reductive sense (the number of facts), the second infers medicine in an anti-reductive sense (beyond the facts there are events and relationships).

But neither had an urgent practical necessity: to invent a drug appropriate to their historical era. So we both grapple with a crisis, not to solve it, but to make it happen. Cavici writes that crises, with logical and linear precision, in order to solve them must be realized, that is, they must respond to the previous changes they created with other changes.

Therefore “unparalleled science” is the “non-regional” answer that Bernard would have given today to the crisis of medicine had he lived in the third millennium.

Conclusions
what I say? In the meantime, congratulations, or better yet, the “opener” to Kavici. But above all thanks. The pledge to rethink our scientific medicine is an arduous and always very difficult path. But in all fairness I don’t think there are alternatives.

Three things are safe for me:

  • Medicine could not afford the luxury of staying on Bernard,
  • To rethink medicine, we need intelligent thinking in the etymological sense, i.e. capable of choice, between legeramong many options such as Cavicchi Option,
  • We have a great and urgent need for this thought, but to use it and make it grow and develop, we must all be able not only to welcome but also react to what is moving the world in this inevitable direction now, but we must understand the whole and map, a freer head, free of regional inclinations degraded.

    Gian Franco Gencini

June 16, 2022
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