Are you a philosopher? If you said no, I invite you to think again. We associate philosophy with ancient Greeks like Plato, medieval thinkers like Thomas Aquinas, or Age of Enlightenment intellectuals like John Locke. However, if people ponder, even if only briefly, “fundamental truths about themselves, the world in which they live, and their relationships to the world and to each other,” they are philosophizing! That is how one university’s Department of Philosophy describes what you’re doing when you find yourself wondering, “What’s it all about?”

Philosophy is not just the province of long-dead thinkers. Every person has a philosophy of life. It’s based in their worldview, which colors their preferences and choices, what they look for in a mate, how they raise children, the work they do to earn a living, acts of service they perform, even the fun and pleasure they seek. As we grow, our worldview or philosophy of life develops according to the unique experience of each of us. There is no owner’s manual or rule book that tells us how to create our worldview—it seems to just happen.

On the other hand, science develops according to conservative rules that govern how experiments are conducted, the protocol for analysis, which statistical formulas are used to demonstrate results, etc. It must have rules because it is a collective and cautious endeavor based on testing and re-testing, striving for agreement regarding the nature of the world and what we can do to it. This is as true for medical science as for any other. And yet, all sciences are practiced by human beings who bring their intangible, unformulaic worldviews to the task. For some, their worldview includes strict adherence to the rules; for others, their philosophy allows for thinking outside the box that permits questioning the rules and conjuring new ideas.

One outside-the-box thinker is Uwe Haberkorn, MD, PhD, professor of nuclear medicine at the University Hospital/University of Heidelberg. Years before he came to medicine, he was headed toward a degree in philosophy. During that youthful period, he quickly progressed from reading classic German philosophers to studying contemporary, often edgy thinkers, mostly American. It must have been the practical side of his worldview that informed a decision to pursue a career in medicine. After all, reliable income is not guaranteed for many whose heads are in the philosophical clouds. His unique philosophy of medical science helps explain why innovation in treating prostate cancer moves more slowly than many of us would like.

Haberkorn’s ideas

One of the philosophers who influenced Haberkorn was the Harvard-affiliated philosopher Willard Van Orman Quine. Quine postulated that “philosophy is continuous with natural science,” an idea appealing to Haberkorn’s organic integration of philosophy and medical science. In addressing Quine’s view that science has a strong conservative streak, Haberkorn says that scientists,

“usually want to keep what we have, because it is established and proven by many experiments before and that we agree to changes only when inconsistencies appear. He went on to say that inconsistencies usually appear at the edge of the web [of belief], where science meets reality, and not at the center, where logic and mathematics are located. You could change some of these inconsistencies at the edge to obtain a better correspondence to the world.”^[i]

But, says Haberkorn, waiting for inconsistencies to appear and then making changes to make them more harmonious with the whole is a passive, negative approach to change. This also accounts for why changes in medical practice, such as prostate cancer treatment, take so long to come about.

A good example is breast lumpectomy. Breast removal (mastectomy) was the standard of care. It left women’s bodies disfigured and their self-image crushed. Patients increasingly sought breast surgeons who would remove just the tumor, usually followed by a course of radiation and/or chemotherapy. These pioneering surgeons were scorned by the establishment, who waited for lumpectomy patients to die in large numbers. The inconsistency between traditional belief vs. reality appeared with rising lumpectomy survival rates. The way it was always done slowly shifted. Today, thanks to early detection, breast lumpectomy is a standard of care.

This happened in urology, too. The entrenched position was a belief that all prostate cancer (PCa) is multifocal and must be treated aggressively by radical (whole gland) surgery or destruction. Inconsistencies began to appear as a few brave innovators began offering focal cryotherapy (freezing) to patients who did not want radical treatment to put their urinary and sexual function on the line. Like their BCa counterparts, they were willing to gamble that their cancer would be controlled while their quality of life would be preserved. The conservatives began to surrender as success data grew, but it took long years before the “male lumpectomy” was accepted not just by doctors, but also by Medicare and the insurance industry.

It doesn’t have to be this way, says Haberkorn. He asks,

Why are we not a little bit more positive by including fantasy in the game? Fantasy doesn’t mean uncontrolled fantasy––that would be fiction. But I think we should take a look outside our field and add some features to science that take us into more risky projects, even if this means neglecting existing dogmas.^[ii]

He’s talking about creative imagination, or thinking outside the box. He suggests that rather than let fear of failure stop medical creativity, “innovative scientists should love failures… [W]e may need to look not at a change in the lack of inconsistencies but at a change in the presence of opportunities.”

To welcome — or at least accept — failure is an invitation to broaden one’s philosophy of science. Haberkorn is not advocating an irresponsible, reckless manipulation of human lives. That would constitute an abuse of imagination, and historically we have witnessed appalling horrors when innocent people were unethically and immorally victimized in the name of “scientific experiments.”

Instead, as doctors compassionately listen to patients’ concerns about things like over-diagnosis and over-treatment, it’s a chance to step back, gain perspective on current practice, and ask critically imaginative questions. Why wait till more problems appear that science doesn’t address? Can we do it differently? What will happen if we do?

Haberkorn and his research team’s work in nuclear medicine is a good example of welcoming failure. They are working on a radiopharmaceutical solution that would be universally effective at the molecular level against all tumor cancers. His is an incredible journey of failures embraced, learned from, and surmounted. Throughout, he has had courage and good cheer, bolstered by a forward-looking philosophy of medical science.

I hope I speak for all clinicians in saying we need encouraging role models like Dr. Haberkorn to make leaps of informed faith on behalf of our patients. Thanks to him and many others, I see our own practice at Sperling Prostate Center as serving patients whose needs might not have been served at the conservative center of the web of scientific belief. I see our integration of mpMRI, Focal Laser Ablation, TULSA-PRO, Exablate/MRI-guided Focused Ultrasound, and Artificial Intelligence as positioning us much closer to the edge of the web, and bringing the future closer. It is an exciting place to be.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Haberkorn U, Czernin J. A conversation between Uwe Haberkorn and Johannes Czernin. J Nucl Med. 2019 (Nov); 60(11): 1495-93.
[ii] Ibid.