EBM CQI Article of the Week 11.28.2021

Continuing the thread of Nietzsche’s “anti-foundationalism” let’s consider “foundationalism”.

Plato is the model of foundationalism, his impact upon Western thought incalculable.  Plato exposited ideals of reason and pure knowledge as Forms.  These are ultimate conceptions of Wisdom, Courage, Temperance, Justice (his 4 primary virtues) as well as essences of matter and objects.  These Forms exist apart from our earth-bound material world,……and understanding these ideals is the ultimate meaning of Mankind’s existence. 

He wrote beautifully, mathematics clearly influenced his thought,……his attractive appeal to pure contemplation, and the seductiveness of an irreproachable world apart from our minds but available to imperfect humans played a large role in the subsequent growth of Christianity and other religions,……something not widely appreciated today.

Plato was never able to explain, much less prove, that these Forms actually existed,,……and materialists and empiricists of various persuasion over the last two millennia have quite disagreed with foundationalism’s assumptions and metaphysics.  Thoughtful writers such as Baruch Spinoza, David Hume, Ralph Waldo Emerson, Friedrich Nietzsche, William James, and Bertrand Russell to name just a smattering, have argued that Plato’s Forms in regard to morality are wholly speculative and context-dependent.  In reality, “What is ethical is what the majority decide”,……Morality is what works for the powerful”,……”Virtue is entirely culture-specific”,……”The truth of any proposition is borne out by subsequent events, not theory.”

This makes for superlative reading and dialogue, if we wish.  Foundationalism vs. Anti-foundationalism is 100% relevant to modern healthcare and our 4-dimensional complexities,………we get distracted by high technology, marketing, bias, short-term targets, and arbitrary hierarchies.  The primary question might be – “Do we collectively, justly, reasonably improve healthcare and well-being based upon principles of foundationalism or anti-foundationalism?”  Fundamentally, we can’t use both paradigms, despite wanting to appeal to both,……it’s ir-rational to try, unreasonable to defend.

The attached article is worth reading,.…..from an influential American physician who has contributed much good to healthcare, we respect that.  But, reading it carefully reveals that he inadvertently mixes foundationalism and anti-foundationalism,………ironically, he being the progenitor of the vaunted Triple Aim, a benchmark no large organization has demonstrated successfully,..….because it’s a Platonic Form?

I added a few comment boxes to the article, feel free to correct me, point out what I missed,…….dialogics indeed.

Joe Kaempf, MD

Portland, OR

Volume 13, Number 36

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