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HOW TO CURE KNOWLEDGE DICHOTOMY AND SUPPRESS THE BIAS OF THE CURRENT "TRAINING" IN PUBLIC HEALTH

" One must make the regents[1] raise their eyebrows" (translated from Robert Walser's original statement: "Mann muss die Regenten stutzig machen.")

Aim. I suggest here that the physical and, primarily, human conditions individuals enjoy before, around and after their birth determine not only their health as adults (as already substantiated by fundamental life-sciences and clinical data) but also their personal culture (Weltanschauung) and contributions to society's choices. As a consequence, primal prevention[2] can be propounded as a coherent answer to the challenge raised by the current ill success and excessive cost of our public-health system.

Knowledge. Because of its integrative nature, knowledge is a hardly exchangeable value between adults whose realities differ. Human knowledge, like that of any living creature, progressively builds itself within every individual from the very beginning of his life as a function of the quasi continuous inflow and integration of his sensorial - or sensory-motorial - experiences. In this sense, there is no qualitative difference between, for example, human and other primates’ knowledges. In humans [at least], language immensely contributes to the potential richness of transmitted sensorial experiences, as well as to the grand illusion of any "reality" (or universe, for that matter) outside of the individual[3].

Knowledge dichotomy. Unaware of it, and most probably as a function of their very first human interactions and other experiences in life, individuals started to build reality from two different sources of sensorial experiences. Those lucky ones who developed a secure attachment to others - and therefore self-confidence - enjoyed their natural propensity to communicate with – and receive their knowledge and beliefs from – other subjects. For the sake of simplicity, I shall refer to these lucky ones as the "lucky ones". Those, less lucky ones, who developed attachment and self-confidence to a lesser degree, were more inclined to take a cautious observer’s distance to their environment (which includes other subjects) and to treat it as an object of study. For the sake of simplicity, I shall refer to these less lucky ones as the "observers". I suggest here that the difference between lucky ones and observers might be the root of the inflamed and still not extinguished controversy raised in 1959 by C. P. Snow’s pointing out the persisting cultural split between two poles[4]. Indeed such an emotional split, similar to religious/ideological ones, can only reflect deeply rooted beliefs/convictions resulting from primal, personal orientations. The trouble with the view that primal experiences may determine a whole life’s orientation is that it is highly unpopular[5]. Very few authors, until now, are convinced that human behavior may largely be determined by cultural evolution of primal care. Among them, the American psycho-historian Lloyd deMause recently showed that, by and large, from primitive to present western societies, the way humans have felt about – and behaved with – their offspring was towards more respect, better care, and love. This might result from the epigenetic reinforcement of primary acquisitions along generations[6]. In this connection, it is perhaps no coincidence that a majority of new students in Switzerland belong to the "lucky ones", who feel at home in the world as it is, favor knowledge and artistic sensitivity transmitted by others and register in social and applied sciences (and related domains like law, economy, medicine), or art studies. Meanwhile, some of the "observers" manage to publish papers dealing with fundamental sciences - fundamental life-sciences, for one - in journals and reviews characterized by unforgiving editorial policies. And in fact these scientists do provide us with material pointing to a very early development of personality, long-lasting effects of primal experiences (as demonstrated a long time ago by Marcel Proust) and the absence of a clear-cut distinction between nature and nurture (i.e., between what depends on our DNA heritage only, and what depends only on how it is used by its environment, from our conception on).

Current trends and "training" in public health vs. primal child care. Present as a pure-bred "observer" at the 14th European Conference in 2006, I sure felt different from the thousand or so lucky participants "trained in public health" (sic), none of whom appeared to be much interested in child care, let alone primal child care. In his outstanding lecture, epidemiologist Leonard Syme reviewed several of the large experimental public-health projects he conducted in the USA during his career. From every one of these well conceived studies, he drew the astonishing conclusion that the results of any effort to induce a more healthy living in adults equaled zero. Interestingly, every time he acknowledged this, there was a good-hearted laugh in the audience, and nobody ventured to ask: "So, what can be done?". At a workshop following his lecture, Dr Syme assured us that he was very proud after all, because he had at least contributed to demonstrate the failure of the traditional way of dealing with public health. He said this would force us to have a different approach if we wanted to cure our present public-health ill success, a non negligible consequence of which is the economical burden it inflicts upon individuals and society.

The obstacle. Unfortunately, under the current cultural and political climate, the efficient cure will remain out of reach, and will remain so as long as a tiny but powerful[7] fraction of the same society will continue to thrive under a fiercely guarded status quo. In addition, any implementation of primal prevention will scarcely be considered an immediate-return public investment. Indeed, it would entail a substantial reorientation of public contributions to provide young people meant to become parents with the best possible conditions, material as well as educational, for their loving potential to freely develop and be susained throughout their offspring's primal period[8]. Only at the subsequent generation would we observe some decrease of human sufferings (and concomitant social ills) and a reversal of the cost increase of public-health. Meanwhile, this cost increase could only continue in a world still ignorant of the fact that primal health is the premise of adult health, and that primal prevention is the only way to act on the fundamental determinants of health at the population level.

A false hope. At the time of the Conference, I could but warmly hope that the outcome of a brand new Swiss national research program, NCCR SESAM (Swiss Etiological Study of Adjustment and Mental Health), would contribute to such a reorientation. Alas, this was a false hope. Because of a profound reticence in having one's primal life - or that of one's children - under close scrutiny, and because of a continued criticism of the SESAM project by "interest groups" (sic), the Swiss National Science Foundation had to request that the Swiss Federal Department of Home Affairs would terminate the project - which it did decide on January 19, 2009.

Towards a natural resolution of the most debilitating effects of knowledge dichotomy. According to the above hypothesis as to the origin of this dichotomy, the efficient cure should grow a society of lucky ones, which of course is an unduly schematic view (as well as a fearful one!). Although some knowledge dichotomy would undoubtedly continue to cause misunderstandings between individuals whose primal orientations differ, it is not unreasonable to speculate that "observers" would progressively become more self-confident - thereby spontaneously more 'public' - and therefore "lucky ones", being more exposed to knowledge from fundamental sciences, would themselves become more inclined to make radically new political choices. Meanwhile, in the absence of such an evolution, no attenuation of the perverse effect of knowledge dichotomy will occur in a society domineered by lucky ones where, in contrast, observers not only seem to keep themselves withdrawn but are sometimes actively marginalized to the detriment of all. As long as pharmaceutics will be the "regent" of the sick 'sovereign' in our democracies, marginalization of observers will remain evident in the closed world of public health, of its economy and politics.

Auguste Edouard Chinet, MD, MER, retired from the [former] Physiology Department of the University of Geneva, Faculty of Medicine, CMU, rue Michel-Servet. Present address: Grand-Rue 79, CH – 1180 Rolle.

  1. In democracies - where by definition people are the sovereign - as well as in other political systems, a regent governs during the minority, absence or illness of the sovereign.
  2. English version of www.preventionprimale.org: http://primalprevention.org
  3. Think, for example, of a scientist who may've heard or read about the results of a three-years experimental project conducted by others. Strictly speaking, he would've acquired a sensorial experience of the subject (auditory or visual, respectively). And true, the effect of this perhaps one-hour acquisition of sensorial experience on his integrated knowledge, that is, on his "Weltanschauung" (or reality, for that matter) would've been enormous compared to the effect that could've resulted from his having actually contributed - for one hour only - to the same, three-years experimental project. It remains that, in both cases, his sensorial experience would've been the one and only canal through which, for him, reality would've developed (note that if, for him, the content of articles he hasn't read contributes nothing to reality, in contrast, his being aware that there are articles he has'nt read does contribute something to reality).
  4. Snow was speaking of the "literary intellectuals at one pole, at the other scientists, and as the most representative, the physical scientists". Because some poets, however - as well as some other writers - clearly belong to observers, I prefer to speak here of the lucky ones at one pole, at the other observers.
  5. There are reasons to foresee an imminent change of attitude, however, as the implications from new developments in epigenetics start being published in the media (e.g. "How the first nine months shape the rest of your life: the new science of fetal origins", Time magazine, october 4, 2010, by Annie Murphy Paul).
  6. The second major work of Darwin, the importance of which has only recently been discovered by evolutionary psychologists, already suggested that "selection in relation to sex" (i.e., in relation to partner choices) is much faster, as a process, than that uniquely related to the greater number of offspring produced by survivors to maturity. Indeed, recent findings show that measurable genetic activation changes can take place in a few generations (e.g., Nature Vol 456/6 November 2008)
  7. Powerful through its being the relentless stimulus of a large-scale, positive feed-back phenomenon of which, unfortunately, the medical establishment itself is not conscious: the stronger the belief that our health is maintained through medicine and medicines, the broader the popular and political investments in public-health "training" and pharmaceutics.
  8. This pertains particularly to affluent societies where income inequalities are large (Wilkinson & Pickett, The Spirit Level, 2009). By tolerating such large inequalities, these societies are likely to impose on all future parents an insidious societal stress.


Further references: Wikipedia: Public health; Wikipedia: Social epidemiology; Wikipedia: Prevention; Wikipedia: C. P. Snow; Wikipedia: Lloyd deMause; about primal health: http://www.primalhealthresearch.com; http://www.wombecology.com; about epigenetics: http://www.slate.com/articles/arts/books/2011/06/goodbye_genetic_blueprint.html; http://www.primalprevention.org.

N.B.: To facilitate reading of the above article, and of THIRD-TYPE KIN CAREGIVERS as well, by French speaking people, a French translation by Arkenholz will soon be available under: SANTE PUBLIQUE: NOUVEAUX PARADIGMES, and PROCHES AIDANTS DU TROISIEME TYPE ?, respectively --Arkenholz 09:43, December 27, 2011 (UTC)

Latest activity

Some review aimed at more clarity of text; one reference added.--Arkenholz 11:14, January 27, 2017 (UTC)

--Arkenholz 12:44, April 5, 2017 (UTC)

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