In matters of health, do we place our trust in faith or science? A tussle between these two is as old as human history, best illustrated by the fight between Galileo and the Christian Church and many others since then. I use the traditional Indian concepts of pranam and pramana to elucidate this phenomenon in modern times.
Pranam is derived from Sanskrit with “pra” meaning “forward, outward, in front, before” while “ānama” means “bending or stretching”. Together, pranama means “bending, bowing in front” or “prostration”. Pranam is a common Hindu traditional custom of greeting a person where one often bows to a superior person. There is an implicit hierarchy based on social conventions in this process with the “lower” placed person initiating the greeting. Bowing to an eminent person and God is considered as a show of faith in them. I use pranam to denote faith, tradition, and dogma-based decisions.
Pramana, also a Sanskrit word, means “proof” and adds “mā” which means measurement to the “pra” and alludes to the concept of objectivity and science. It is the means that can lead to knowledge. Three of the pramanas or proofs, which are almost universally accepted (there are others) are pratyakṣa (eyewitness or personal experience), anumāna (logical inference), śabda (expert opinion). The onus of providing proof and convincing others is on the person professing it. I use pramana to indicate science and evidence-based decisions.
In a science-based society, unlike in a faith-based society, people have the freedom to question things, seek answers and then choose their way forward based on their own understanding or assessment. It is quite possible that two people ask the same question but end up with different “right” answers as their contexts may be different. They are free to exchange notes and learn from each other. The other important difference pertains to acceptance of change. Faith and dogma are constants and do not accept questioning and they promote the belief that everything on that topic has been already said and cannot be questioned. It also applies to many people of eminence who do not like to be questioned! Science, on the other hand, thrives on change. As new discoveries occur, our understanding is updated and our way of managing that issue has the potential to change. It is quite possible for what was scientifically appropriate at a given time and has become a tradition, to change at a later stage. This constant change in scientific thinking is often pointed out as its weakness, and constancy as a strength of tradition.
Let us now look as to how these apply in the health sector. Our attitudes towards and taboos related to menstruation is a case in point. Rather than treating it as a biological phenomenon, a lot of semi-religious customs have been built around it, all adversely affecting a girl’s health. Most parents and teachers are very uncomfortable discussing human biology with children. This is also reflected in health issues around childbirth, breastfeeding, and contraception. New mothers often find it difficult to navigate when caught between doctor’s scientific advice on breastfeeding (as early as possible, giving of colostrum, exclusivity, no prelacteal feed etc.) and traditional customs recommended by the elders in the family (waiting till a family member washes breast, use of ghutti, jaggery water, discarding of colostrum). One could also put the current controversy on the right and access to safe abortions in the United States as a fight between faith and science. This does not mean that there is no role of scientific thinking in health in the Indian population. The whole-hearted acceptance of vaccines, modern contraceptive methods are good examples of science triumphing faith. Though the battle is still far from over.
The approach to promote traditional medicine reflects this fault line. Should we promote traditional medicine just because it is our tradition, or should we insist that it be subjected to the rigours of modern science (measuring safety and efficacy)? To be called a science, not only should its treatment modalities be subjected to scientific scrutiny, but the knowledge base must also continually expand beyond those in ancient textbooks. One hopes that the promoters of traditional medicine will ponder on these issues and push for more science in it.
Today, in our society all three forms of pramana are under threat. The overload of information and our inability to process them appropriately has resulted in a peculiar situation where, unlike in the past, faith is being promoted in the presence of abundant information. Today, evidence is manufactured to suit one’s point of view, even making one question what one sees! While some criticism of scientific institutions and scientists should be tolerated and even encouraged, rejecting them wholly is unfair. As seeking truth through science becomes difficult, faith gains ground. The current Covid-19 pandemic saw a widespread use of science in our response, but it also provided a fertile ground for promoting faith and questioning science. Today, the teaching of science itself has become a ritual – that is more by rote than by understanding. We need to change this by changing the way we teach science to students.
So, does faith have any place in a reason-based society? Faith will always have a place in any society but should not be at the cost of science. Even the most devout follow science in some aspects of their life. It is also important for faith-based organisations to understand the limitations of faith and not undermine the importance of science in daily life. We need to learn to coexist, understanding the need for both for our societal wellbeing. Both need to be promoted but not at the expense of the other. We need to have more faith in science as a solver of our pressing health problems.
Scientific thinking needs people to think independently and critically. Pranam figures, like teachers or parents, should encourage children to ask questions, put them in touch with resources to enable them to decide for themselves rather than expect them to memorise theorems and formulae like mantras. Similarly, health professionals must also learn to not belittle faith. Platforms for constant dialogue and harmonious coexistence between these two critical pillars of a society are needed in the current times.
The writer is a professor at the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. Views are personal
