The idea that science, including medical science, is an unnatural practice, comes as a rude shock to me, as I always used to tell my students, during the last three decades, that the greatest asset of a good doctor is robust common sense. May I humbly offer a few comments which might stimulate a healthy debate?

Dynamic human body does not obey the rules of linear Euclidean mathematics. Stability in biology is only a myth. It occurs only after death. We have been predicting the unpredictable in medicine all along. What happens to the human organism as time evolves depends on the total knowledge of the initial state of the organism. Since we can not know this, with the help of the reductionist science, we are unable to predict the future. We can only assess the human phenotype, which forms about 30% of the organism and the rest is made up of our genotype and consciousness. We need non-linear mathematics of " Chaos " to predict man’s future.

Attempts at predicting the future events with the help of the exercise ECG test (Bruce) fail to follow the positive-negative paradigm. Diamond and Forrester have gone back to the Pascalanian law of probabilities. Most of our linear screening tests applied to the "healthy" populations, are bound to end up with many false positives, making life miserable for those unfortunate victims. Similar is the experience with predicting death based on the left ventricular ejection fractions, in the immediate post myocardial infarction phase. If one goes deep into all this one wonders how any of our mathematical formulae could be applied to any human organ. Let us take the heart for example. Is it a triangle, square or an oblong? It has no integer measure at all; and how do we apply the integer measure formulae to calculate the various facets of cardiac function? For want of a better measure of the non-integer human heart, we still hang on to our old formulae.

We see daily the " Butterfly Effect" of Lorenz in human affairs. The new science of Chaos is our only future hope. When the conventional science has been heading for a crisis with increased specialisation, it is the new science of non-linear mathematics that has come to our help.

To say that science is based on uncommon sense does not appeal to me. Why should one feel that common sense should tell us that the sun goes round the earth? It could be the other way as well. It was common sense that led William Harvey to look for blood circulation after he saw the London fire hydrant in action on one of his evening walks. It was again common sense that made Jenner believe the old lady about the cow pox protection. That was the singular discovery which has been able to eradicate a disease from this planet, smallpox. All other reductionist scientific methods have not been able to eradicate any disease so far! Was it not commonsense that got us quinine from Cinchona bark, and the all powerful aspirin from the Willow bark?

Serendipity is the key word in science. It was serendipity that gave Fleming the petri dishes from Florey’s laboratory with the fungal growth inside. Florey did not plan the experiment to grow the fungi in the first place. It is serendipity that gave us the benzene ring and many other examples could be given.

If one is committed to patient care one quickly realises how deep is the mind -body connection in human affairs. This was known even to William Harvey who wrote in 1649........." And what indeed is more deserving of attention than the fact that in almost every affection, appetite,hope or fear, our body suffers, the countenance changes, the blood appears to course hither and thither. In anger the eyes are fiery and pupils contracted; in modesty the cheeks are suffused with blushes; in fear, and under a sense of infamy and of shame, the face is pale, but the ears burn as if for the evil they heard or were to hear; in lust how quickly is the member distended and erected!..." It will be naive to believe that the human mind follows the linear mathematical rules.

In the field of clinical medicine " clinicians can not avoid uncertainty or pass it off as inherent aspect of the art of medicine. Certainty is a delusion-only uncertainty is certain.... this must be acknowledged and addressed explicitly, especially in clinical training, if reason is to be used most effectively to improve quality and cost effectiveness of clinical practice." say Drs. Logan and Scott from Auckland in a recent article in The Lancet.

The best definition of science was given by Federal Judge, William R. Overton, in the Arkansas case in 1982, Creationists Vs Evolutionists. " Scientific theory must be tentative.... and always subject to change". How true! Newton’s Laws of deterministic predictability were proved wrong by the Einstein’s theory of relativity, which, in turn, was found wanting in space. Quantum physics finds it difficult to define an electron correctly. If one knows its position , one does not know its velocity and vice versa. When it is not moving it is everywhere. Here we need the help of the observer’s consciousness; the latter defies mathematical measurements.

" Technology should be used to unravel the mysteries of diseases only" said Sir Thomas Lewis. I wonder how he could foresee the present day market forces goading technology to run the show for doctors; the latter only acting as gatekeepers of technology. A study in Nottingham showed that about half the coronary interventions were inappropriate. A study from Boston showed still greater percentage.

I could not understand how the evolution of an elephant could be attributed to technological marvel. Feynman, a Nobel Laureate physicist, noted how Nature keeps its secrets close to its bosom, only revealing bits and pieces to us. We claim great credit for our scientific prowess.

Surprisingly, a retrospective study published in the BMJ, showed that Friday the 13th was, in fact, inauspicious for at least 50% of the population. We can not laugh at even the old superstitions! Another study in the same journal showed that Arum Triphyllum, a homeopathic drug, was very effective in the management of hay fever. This study was triple blind and very well controlled. How can we have a holier than thou attitude towards any system about which we do not have enough data in the scientific literature. It is estimated that about 85% of medical interventions are based on flimsy scientific data and only 15% of our interventions are based on hard data. This is revealed in an editorial in the BMJ entitled " Where is the wisdom? "

Bernard Shaw was right when he said " do not try to live for ever, you will not succeed." I also agree with Karl Popper’s saying that "knowledge advances by the refutation of false dogmas and not by repetition of the true ones." D.H. Lawrence is still not proved wrong by our scientific and mathematical rules, when he said " Our egress from this world will be nobody knows where.": may I add, when and how also?!

The Nobel Laureate economist was right when he said that " common sense used to come in the way of his learning economics all his life ". A couple of examples will suffice. It is good economic sense to dump the extra wheat grown in the New world in the Atlantic ocean, while common sense would urge us to donate that wheat to the starving children in Somalia. Adam Smith’s " laws of stock market " predicted that one man can never upset the stock market, because of the inbuilt safety measures. The 1984 NewYork crash and the recent Indian stock scam are good examples of how the economic theories are not as good as common sense.

In my opinion science is "logical skepticism" and research is " organised curiosity". Both of them need robust common sense. " Uncertainty Principle " of Werner Heisenberg will govern medical science always. Like him, we will have to do a lot of Gedanken experiments.