Oncology and a time of crisis. Science, complexity, ethic values, and incertitude. An argumentative essay

Who faces a neoplastic disease is more bewildered than in the past, in spite of the improvement of the possibility of cure and priority attributed to this subject by the health institutions and medicine, compared to few decades ago. Nevertheless, disorientation is increasing due to many factors, also beyond those of the scientific and welfare context of cancer and is related to the general background of crisis. The landscape of crisis involves the changes occurring in both epistemic and contextual values, and methodology of science at large, as well as those particular of the medical field, including oncology. The perceived ltoss of reliability of universal laws and the limits of general theories, in favor of the conception that elementary events concurr to outcomes, makes the scientific appraisal more probabilistic than deterministic. This framework of “complexity” is characterized by non-linearity in the causal links, opacity of the investigated subject, and emergence of the phenomena we observe and analyze. In oncological medicine, the present deterministic “gold standard” of the random comparative trials, grounding the so-called evidence-based medicine (EBM), and the guidelines for clinical management - although being the most reliable resource - are critically considered. In fact, new “systems biology” approaches, based on big data analysis and advanced statistical methods, may bridge the gaps between the biological/pre-clinical and clinical investi-gations, hopefully allowing “precision” or “personalized medicine”. Artificial Intelligence is consi-dered an indispensable tool to this regard. However, also this approach couldn’t effectively work without a sound, general theory on cancer, presently not at hand. Moreover, all of the above contexts suffer of the pressure of industry, interested in the economic impacts. On the other hand, the costs of cancer management, increasing at a higher rate compared to care results, motivate the health authorities to take physicians out of the personal professional and trust relationship with the patients. In this situation, oncologists have mainly to cooperate – often in a subordinate position - with bureaucratic professionals for the implement-tation of pre-established guidelines. As a consequence, patients are institutionalized and deprived of the reassuring presence of an entrusted doctor, thus experiencing enhancement of distress and solitude feelings. This connects with crisis in the social domain, defined as a strength that conquers autonomy without a manifest theory of itself, thus without a project, but with an impact capacity producing high perceivable effects. This existential landscape characterizes the present time as “the age of incertitude”. Complexity and uncertainty thus exist also in society. The social pact between individual and state (relinquishing of a part of freedoms by the former in exchange for security by the latter) is compromised, and the indeterminate nature of the crisis obscures any solution. The statements on the right to health are perceived as abstract formulations, generating mistrust in institutions and further distress. From the physicians’ point of view, this must not imply loss of responsibility, but even more so imposes a great ethic commitment. They must operate as best as they can, despite being aware that the desired effects could be vanished by context. This is a further subject to consider in the relationship between medicine and health institutions: the former must preserve its own statutory purposes of prevention and care of diseases in the best possible way, even if the inherent epistemic complexity and the contextual background makes this task more problematic than in the past. Indeed, medicine should cooperate with health institutions, developing the necessary attitudes given the present social background, but not in a subordinate role, as far as its intellectual and operative domains are concerned. Another factor of crisis must be considered, that is, communication. A diagnosis of cancer, an ominous event, induce to look for any glimmer of hope and entrusts false believes or pseudo-scientific results, because these appear easier to comprehend and promise clear-cut good results, compared to the scientific argumentations, hard to understand and expressed in terms of probability. The present cultural background of society is affected by the lack of humanistic education, that is, what grounds critical thinking. Biomedical researchers and physicians, sometimes suffering of the same deficiency, regrettably have also other faults, that is, defects in intellectual honesty such as egocentrism and self-reference that can generate mistrust in science on the long run. After examining these items in the light of the available data and authoritative sources of the related literature, we reached the conclusion that a “new alliance” can be promoted between oncological science and society, based on “the humanism of science”. Improving intellectual honesty by the biomedical community, as well as critical thinking also in society is mandatory. This can be obtained with suitable educational programs in high school and university. Cultural empowerment, and a realistic approach to the epistemic and ethics issues on cancer may mitigate the related individual and social discomfort and - hypothetically - improve clinical outcomes through the increased patients’ compliance to therapy and prevention programs.