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  Sorting the Wheat from the Chaff
  

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By: Nicholas Lee, M.D.
Sorting the Wheat from the Chaff JAM Vol. 12, Nr. 4

We live, they say, in an era of information and communication. Never before has such a plethora of factual information been available to us, and it comes at us from all directions in all formats - the written word, the spoken word, radio, television, faxes. E-mail, floppies, stiffies, satellite transmissions, electronic data bases - never before has the world been a-buzz with so much data, and so many means of carrying it.

In the scientific and medical world, the traditional way of disseminating information has been through the professional journal. Papers are written and submitted to journals where they are perused by the editor and his or her advisors, and then sent out for peer review to experts in the field who comment on its originality and content, and express an opinion, when statistical analysis has been reported, the paper is also sent to a statistician to ensure that the figures are accurate and not a sophisticated form of science fiction. The paper and comments on it are then reviewed again by the editor and his or her advisors, who then make a decision about it. That decision will be whether to accept it for publication, whether to reject it, or whether to provisionally accept it subject to revision by the author in the light of expert comment by the peer reviewer.

There are of course two main aspects to any piece of written work which is reported in the scientific literature; the content itself, and the way in which it is presented. In general, scientific and medical journals are very suspicious of innovation when it comes to presentation. Rather as at formal social functions where the men are expected to wear tuxedos in order to render them practically visually indistinguishable, scientific journalism has developed a standard format for presentation which is known as the IMRAD format. IMRAD stands for Introduction, Methods, Results and Discussion. To be strictly accurate, it should now be called the AIMRAD format, because the Abstract is now one of its most important features (about which more anon.)

Papers dealing with original research start with an Introduction which tells the reader why this particular piece of research was conducted, and puts it into the context of work previously performed in the same field. The Methods section tells the reader how the work was carried out so that it can be replicated by others; the Results section speaks for itself, and the Discussion uts the work carried out into the context of the introduction and discusses what has emerged from the Results of the research carried out.

The Abstract is a relatively recent arrival on the journalistic scene, and started life as a short summary at the end of the paper for those who did not have the time or inclination to read the whole thing. It then migrated to the front of the paper as it gained in importance, and has now metamorphosed into the Structured Abstract which is in effect a mini-paper consisting of headings (with minor variations between journals) such as Aim, Study structure. Setting, Methods, Results and conclusion. The reason for the structured abstract is so that it can easily be retrieved from electronic data bases such as Medline which store only the abstract and not the whole paper. The only abstracts which are not generally structured are those for case reports and reviews.

Now what has all this to do with Anthroposophical Medicine and its written records? Such a materialistic description of what happens in scientific medical journals is surely enough to send a frisson of antipathy and rejection through any dedicated anthroposophist? Our way of doing things is not like this, I seem to hear them say. Anthroposophical Medicine is different, and must be written about differently in the light of its spiritual-scientific orientation. Is this a true perception in its entirety, or do we need to re-think it? Much of course depends on whether we wish merely to discuss Anthroposophical Medical matters among ourselves in a language which we have come to understand, or whether we really want to share our work with others outside the Anthroposophical movement? If we really want to do so, then I submit that we need to take some cognisance of how they go about things, and knowing about the method by which research is presented in the wider scientific world should surely be a part of that process. Not a few communications which I have read in the Journal of Anthroposophic Medicine would not have been out of place in a general medical journal if only more attention had been paid to the standard format of presentation as set out in the "Uniform requirements for manuscripts submitted to biomedical journals" issued by the Vancouver group of medical editors, a shortened version of which has been adopted by most medical journals in the world in the form of their"instructions to Authors." As sir Karl Popper has pointed out, there are two mindsets at work in scientific enquiry. One is the imaginative faculty which asks the question which inspires the research. The other is the scientific method which makes the research as objective as possible, and the one mindset should not stray into the sphere of the other - like using one's imagination when describing the methods or the results.

In his book The Life, Nature and Cultivation of Anthroposophy ,(1) Rudolf Steiner writes "Anthroposophy, to have existence in our time, must use the means which the civilization of today provides. In books and lectures it must find its way to men. But in its nature it is not of the library shelf. It must be born anew in the human heart whenever a human being turns to the written book to learn of it. This cannot be unless the author looked into the hearts of his fellow-men while he wrote, in order to discover what he must say to them. A man can only do this if he is touched by the living spirit as he writes."

To me, this is the essence of what needs to be done when we write about medicine and medical research which is inspired by Anthroposophical impulses. However, I do not regard it in any way as being incompatible with what have become standard ways of presenting scientific medical research, and believe that all those who aspire to writing about their work in the field of Anthroposophical Medicine should make a concerted effort to take a critical look at how they currently present their work to the world.

Nicholas Lee, M.D., Emeritus Editor, South African Medical Journal

Flora House

Queens Road

Simon's Town, South Africa

Reference:

1. Steiner R. The Life, Nature and Cultivation of Anthroposophy. 1976. London. Rudolf Steiner Press. p. 16.





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