Realism at the Basement of Reality?

I’m definitely not a theoretical physicist. I’m also not a philosopher. I do have a doctorate in theology in addition to my medical degree. So, it makes sense for me to comment on something for which I have no real handle on…quantum mechanics. I do understand some of its concepts, and I know enough basic calculus to understand simple aspects of this important part of physics.

I have been fascinated for a long time regarding interpretations of quantum mechanics. I am not a determinist (although perhaps the atoms in my brain are spinning in a deterministic manner since the Big Bang to make me think I am not a determinist).

I find the Copenhagen Interpretation of quantum mechanics satisfying in a subjective sense when not just considering the mathematical aspects of it. I know Albert Einstein was not a fan of this interpretation. He was mechanical all the way down. He was clear that God “does not play dice“. However, if there is no way to separate a particle from a wave throughout the universe unless observed — whatever “observed” means — then I think reality, at its most fundamental level, has some degree of randomness.

If reality has some degree of randomness, I can make two theological claims:

  1. God is not deterministic. Thus, God does not force determinism on the universe.
  2. If God is love and God wants creativity / novelty which is the output of God’s love, then God can lure for the “the good” which I would define as more creativity. This lure is the still, small voice and not a demanding, authoritative command.

I want to make the statement that this randomness at the quantum level is actually realism and not idealism. This would work with a theological idea of God who wants all levels of creation to have some control over outcomes without God’s involvement (although God can “lure”). A great journal article on the concept of a divine lure is here.

Per Realism and Anti-Realism (Brock and Mares, Taylor and Francis Publishing):

“…scientific theories themselves sometimes explicitly use the concepts of and quantify over the objects of particular mathematical theories. For example, the following passage is taken from a popular textbook in quantum mechanics:

Postulate 4.1 For every dynamical system there exists a wave function that is a continuous, integratable, single-valued function of the parameters of the system and of time, and from which all possible predictions of the physical properties of the system can be obtained. This is the first postulate of quantum mechanics. It postulates the existence of a certain sort of function – a Schrödinger wave function – for each physical system (an electron, an atom, etc.). This function has certain features, such as being continuous and integratable, that are defined in a particular mathematical theory: calculus.“

Hence, wave-particle duality fits well into a continuous system in which outcomes can be statistically determined although it is helpful if the system being measured has boundedness. Infinities are impossible with integration. This mathematical stopping point regarding infinities suggests a limit to creativity. This limit (or limits) persists despite creativity (randomness potential) at the base of all reality.

The limit is lim Δ (a theological term which I invented) discussed in prior posts and in my recently published book. In lim Δ, all levels of nature can freely impose limits despite God wanting continuing creativity. Limits put in place by nature are part of God’s love which desires freedom of creativity in all of nature. If nature freely puts in place a natural limit, so be it.

An understanding of science can help change our theological models about God’s interactions in the world in helpful ways. Science advances; theology must adapt to advancements in science to help in our understanding of God, humanity, and humanity’s place in the universe.

By the way, Neils Bohr’s response to Einstein’s comment: “”Stop telling God what to do.” ; )

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The Light Cone and Process Philosophy / Process Theology

In my opinion, the light cone is one of the best ways to understand aspects of one of the 3 tenets of process philosophy and process theology — prehension. The other two aspects are panentheism and panexperientialism.

Simply put, prehension is the moment right before an event occurs. Process philosophy (and thus, process theology) is based on change. The basement of all reality is change, not matter. This change involved the eminence of time.

As a moment of time experience is just about to occur, many possibilities or actualities are available, but most will not occur as the next experience in time undergoes a concrescence into a real occasion. Time, if eternal, keeps the process of actualities / possibilities –> concretion –> actualities / possibilities eternal through time…quite beautiful to think about actually.

The light cone contains a point in space and time. Events in the past of the light cone contain all possibilities where the light may have come from. All events in the future contain all possibilities where light may be going. When one considers the immensity of photons in our universe, you can see how complex and beautiful events can become. Those areas outside of the light cone would not be associated with light as this area would require causation greater than the speed of light (unless quantum entanglement is real throughout the universe). Areas inside the light cone would have potential association as these events would be slower than the speed of light.

Here is a great diagram (below) associated with a great explanation here.

In the world of process philosophy and its offspring, process theology, one can see how this reality works in metaphysical ideas of change. There is a potentiality of many, many events at every point in time. One event emerges. As that specific event heads to another event in time, a potentiality of possibility re-emerges. In some ways, it reminds me of a fractal although a fractal figure is deterministic, and ideas surrounding process philosophy / process theology are decidedly not so.

image from Wikipedia

If God consists of love, and God’s love consists of free will for possibility at all levels of reality, then there is the potential of creativity at all times and all places in our universe eternally. I like this idea although I think more work is needed in the realm of theodicy and death. I have some ideas here — working on them. Theology, done well, is very hard.

By the way:

  1. This is a GREAT blog on prehension, the light cone, and the ideas of Alfred North Whitehead who is the OG regarding this whole chain of ideas… Here.
  2. The Internet Encyclopedia of Philosophy has a great entry on the process philosophy, but it is fascinating how the post’s author describes Whitehead and his work on prehensions and concretions: “In Whitehead’s system, only actual entities can have causal efficacy. Thus, a divine actual entity was posited. Though Whitehead’s philosophy has inspired an entire tradition of process theology, the doctrine of God at this point (especially in Science and the Modern World) is very thin, theologically speaking. Whitehead was initially a reluctant theist. God appears as a metaphysical necessity—the evaluator and purveyor of universals—and little more.“
  3. To the point above: I’m gonna disagree. If one reads Whitehead’s magnum opus, Process and Reality, one sees that he may not have been such a reluctant theist. Consider these statements: “The primordial appetitions which jointly constitute God’s purpose are seeking intensity, and not preservation. Because they are primordial, there is nothing to preserve. He, in his primordial nature, is unmoved by love for this particular, or that particular; for in this foundational process of creativity, there are no preconstituted particulars. In the foundations of his being, God is indifferent alike to preservation and to novelty. He cares not whether an immediate occasion be old or new, so far as concerns derivation from its ancestry. His aim for it is depth of satisfaction as an intermediate step towards the fulfilment of his own being. His tenderness is directed towards each actual occasion, as it arises.” (p. 105) OR “Thus the actuality of God must also be understood as a multiplicity of actual components in process of creation. This is God in his function of the kingdom of heaven.” (p. 350)

Whitehead may have been some sort of theist. Probably not a Christian (although that really doesn’t matter) but probably, to some degree, a theist.

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Interesting Article on Interdisciplinary Study

So, I’m heading out at the end of the week. I don’t know how much computer access that I will have so I thought I would post something interesting early this week.

This article came out in the Journal of the Association for Information Science and Technology. The title of the article is “How do life sciences cite social sciences? Characterizing the volume and trajectory of citations”. Here is the article (abstract).

Here is one of the author’s summary of the article on the London School of Economics website. The summary is excellent. The study group looked at how often social sciences are cited in biology / life sciences journals. Two interesting things that I noticed:

  1. Most social science articles were cited in psychology journals. That makes sense. Social structures and brain activity go together.
  2. Most social science articles were cited only in the Introduction and Discussion sections of life sciences journal articles. Yuck. In other words, social science articles may simply be “filler” for expanding an Introduction or Discussion. You wanna get the right word count for a submitted manuscript!!!

I was somewhat depressed about these findings. I have been worried for some time the inter-disciplinary studies are not a priority in world universities and in current attempts at understanding new knowledge. I am probably yelling out into the void about my concerns.

“Calling Across the River” by Daniel Ridgway Knight

In my experience, theology could fill this hole if theology is done well. Unfortunately, it is most often not done well. Theology is not a science and is more of a liberal arts-type pathway of knowledge. Using theology to promote important science could be a tool to teach laypersons. Good theology can and must stress such ideas as the acceptance of evolution, acceptance of Big Bang cosmology (and the immense time scales involved), the importance of vaccination in the setting of pandemics, and the importance of preventing climate change. Obviously, theology should emphasize the love of others….and I mean ALL others.

Many religious people and denominations / religious groups do try to emphasize these issues, but they typically are drowned out in the sheer absurdity of news reporting and social media that pervade our brains.

Here’s to hoping.

Oh, I did write a God and Nature post about this issue once.

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Thinking About Mathematics

In light of my recent book being published, I have once again thought about mathematics. Honestly, I started thinking about it again on Friday afternoon at the end of the work week. I discuss the human endeavor of mathematics quite a bit in the book. Please note that I am not a mathematician. I just did a semester of calculus in college. I am fairly good at understanding statistical science as a part of my job. Although I am not a mathematician, I have deep respect for those who pursue the field as their career.

Recently, I came across two interesting comments about mathematics.

The blog (“Not Even Wrong” — good blog BTW) pointed to an arXiv article which reproduced a letter written by Richard Feynman in which his work on the path integral was discussed. The letter is complex. I understood some of it at times; I understood none of it most of the time. But the ending of the letter was interesting. Per Feynman: “I will work on your 2nd quantization, when I get time. I really believe it is correct – but is another example of the terrifying power of math. to make us say things which we don’t understand but are true.”

I also came across this lecture from Eugene Wigner as part of a lecture on math and science at NYU published in 1960. The 1959 lecture is titled, “The Unreasonable Effectiveness of Mathematics in the Natural Sciences.” Towards the end of his lecture, he has this beautiful quote: “The miracle of the appropriateness of the language of mathematics for the formulation of the laws of physics is a wonderful gift which we neither understand nor deserve.”

So here we come to a conundrum as has been discussed by people more educated in the metaphysics of mathematics than I will ever be. See here and here.

Is mathematics the basis of all reality similar to the philosophy of Platonic forms? Such an idea has become a type of religion in the past as seen in the setting of Pythagoreanism. The metaphysical beauty of mathematics in and of itself has been described as mathology.

On the other hand, is mathematics just a human central nervous system construct? This concept would describe mathematics as intuitive theory or a psychological construct.

As a religious person who finds both process theology and open & relational theology helpful, I wonder if a way to consider mathematics is to combine both concepts: mathology + intuitive theory. Mathology could be construed as objective metaphysical reality. Intuition has subjective components such as considering beauty.

Mathology strikes me as Platonism; intuitive theory strikes me as accidental evolutionary formation. When combined, I see:

Aspects of process theology in which God desires novelty or creativity and…

Aspects of open & relational theology in which God desires such creatvity through divine love of all entities. This love is expressed as freedom of nature to create without intervention.

If I accept the ideas contained in Naturalismppp (see previous posts), then I can consider that:

a. The existence of present events is based on the pulse of creative energy from past events providing potentially infinite possibilities for all future events.

b. All of nature is in God. God is in time. God experiences all events in nature / the universe in real time.

c. Every entity has experience. Perhaps this experience is consciousness…perhaps not.

Naturalismppp is not woo. There is a long tradition of such theological writings.

So, perhaps the world has limitations in creation set forth by the rules of mathematics, and the world is based on such mathematics (mathology). There may be an infinity of such mathematical possiblities in such a propsal unless there are limits. I have previously written that such limits can be theologically defined as “lim Δ” or limits (lim) in place for any change (Δ). At the same time, we are all part of this mathematics since mathematics is simply a part of the nature of all entities — how ants walk, how bees make hives; how animals migrate; how stars form; how I am writing this essay right now. It is part of our substance or of our bodies

In other words, if one is to assume that God is all in all and in real time experiencing the entirety of gluons to galaxies, then mathematics is both subjective and objective as the essence of reality. It is equation based but also beautiful. It is proof solving but also mysterious. It is a metaphor for how God and every entity experience the world — the subjective and objective combined in an eternal dance.

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Science is “Stupid”? It is not what you think.

The editorial below has been making the rounds on the grand, ol’ internet. It was published in the Journal of Cell Science, and since everyone seems to be reposting it, I am imagine it must be open acess. The editorial is below:

Dr. Schwartz makes several good points.

AND here are my thoughts (combined with the editorial):

  1. The best research is done when looking for things that we (i.e., all of humanity) are very stupid about. By “stupid”, I mean things that we still have minimal to no understanding about. Such unknowns things can be found both in the sciences and liberal arts.
  2. Schwartz makes the point that we need to make students “productively stupid.” In other words, we need to make students know that they (and we as their teachers or professors) have many blind spots in reality. It is modern U.S. higher education practice for PhDs to be required to a research project which turns into a dissertation and possibly publication. Are we moving these students into and through programs for which there is generally no public interest or funding capability? Are we just pushing them through just for them to get the degree so they get “done.” Such a process floods the job market with a bunch of other folks who had to get “something out there” for their research? Is their research, in the end, frivolous? This assembly line is a most tragic turn which can lead to mental health issues. Even in my little world of academic pediatric gastroenterology, the ABP requirement for a research requirement to finish training combined with long-term lower salary compared to peers in other specialists has lead to dire consequences. This research requirement leads to often poorly done research that is minimally understood by the training fellow. Additionally, despite promises of training institutions to help trainees have a successful post-training career, the ability of these trainees to obtain NIH, NSF, or NEA funding after their training basically…well…sucks.
  3. We need to teach statistics. We need to teach HOW to read a journal article. These skills among scientists, physicians, and in many aspects of the liberal arts are just absolutely horrible. I added this aspect. This is my soap box in many faculty meetings.
  4. In the end, we need to search for “truth” (objective and subjective) in the realm of our collective stupidity about what our species knows while having existed for only a short time on a tiny, insignficant planet in an immense galaxy surrounded by billions of other galaxies in a perhaps infinite universe. Scientists (including academic physicians) should be trained to discover new truth and not regurgitant. The system is not working.

I recently obtained my DThM degree. It was quite a bit of hard work but worth it as it made me consider my science training. Honestly, I think finding new truth in our world of stupidity (i.e., the unknown) is more difficult in the liberal arts as data sets in science can be looked at many ways to publish many articles that don’t necessarily promote knowledge while simultaneously helping obtain new grants and tenure. It is very sad.

Wolfgang Pannenberg (one of my favorite writers as well as theologians) has written that “Theologians may envisage such a general concept of science in a different way from other philosophers of science, but these very differences must rest on an assumption of the unity of truth…” He wrote this passage as well as other wonderful words in Theology and the Philosophy of Science which I highly recommend.

So, my point is that our knowledge will increase if we collectively must work on the hard projects — whether in science, medicine, statistics, history, literature, or theology. Otherwise, we are wasting paper that will end up in city dump and quickly forgotton.

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A Review of My New Book is Out!

A friend of mine sent me a short article regarding how scientific research is having problems in the United States (if not worldwide). I need to write my opinions on that well-written article soon. As an academic physician, I see such problems frequently. This article will probably be discussed in my next post.

However, a new book review just came out (!!!) on my new book (A Theology of the Microbiome: An Intersection of Divinity and the Microbial Life Within Us) available on Amazon as well as through the book’s publisher (SacraSage).

Dr. Jay McDaniel who runs a great website / resource for process philosophy and process theology (Open Horizons) wrote this excellent review here.

Dr. McDaniel’s review of my book was very positive which was encouraging. Also, like every good reviewer, he pointed out some areas that could have been improved or expanded. A good book review should always acknowledge the positives and negatives of any book, if possible.

Regardless, his review of my book was kind, enthusiastic, and generally helpful for anyone who might have interest in my new book.

Please keep in mind that I am donating all proceeds from this book to the Center for Open & Relational Theology, so your purchase of the book makes this wonderful theological center accesible for more people.

My New Book Is Out!

After a few years of being an adult learner and while working full time, I was able to recently complete a DThM (Doctor of Theology and Ministry) degree at Northwind Theological Seminary. It was super exciting to get this degree which has been a long-standing goal of ine.

However, even more exciting was my ability to take my dissertation and convert it into a book. My book (“A Theology of the Microbiome: An Intersection of Divinity and the Microbial Life Within Us“) has just been released and it available on Amazon as well as through my publisher, SacraSage.

It has been an amazing ride! I have written small academic articles and book chapters through the years that mainly have been in the realm of medical science, but the process of writing a book on theology takes 1) time, 2) patience, and 3) patience. You noticed I put down “patience” twice…needed.

My disseration advisor, Thomas J. Oord, was super helpful in helping me turn this extensive project into a book. Also, my editor, Jonathan Foster, made the book a much better read.

Both of these individuals do wonderful work:

Tom’s work is here.

Jonathan’s work is here.

Why did I write the book? Well, a small seed for this book was planted in 2018 when I wrote a short essay for God and Nature Magazine. Also, I strongly believe that as we get older, every person should try to expand their learning into other fields. This type of learning / education is good for the brain.

The experience and learning associated with life’s circumstances can be helpful when getting new knowledge out to the population at large, especially for young people. I have worked in medical science for over 30 years, but I have had a side interest in theology for about the same period of time. I felt like it was time to lear more and to get information out to the community at large.

Both science and theology are unending fields of study. Science is considered objective; theology is considered subjective. However, there is often an overlap between the objective and subjective.

From a philosopical and theological standpoint, I discuss the idea of the “SO-Monad” in the book in which reality has both subjective and objective components — one greater than the other at times; both equal at times; both always there; both eternally present in time. If such an idea sounds interesting, perhaps you should buy a copy!

I am donating all of the proceeds from this book to the Center for Open and Relational Theology in order to advance a new way to study theology (although ideas such as open and relational theology have circulated for centuries), a new way to consider religion, and a new way to understand God.

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Minor Meditating in Nature

My spouse and I spent this Labor Day weekend hiking around Great Basin National Park. This national park is huge and is often overlooked by tourists due to its lack of accesibility.

I am a terrible at meditating. I have been told that such an intervention is helpful. My wife is great at it. I, however, become super distracted and my mind wanders. Honestly, I think that a certain percentage of the population is not great at meditating. I further think that meditation does not help a subset of our species. Mediation as a “cure all” is kind of a dumb idea as has been documented here and here.

The exception for me is in the setting of nature. For some reason, a quiet day in the wild puts me immediately in the “meditation phase” and bypasses the “concentration phase” — again, I’m not really sure how scientifically rigorous such terms can be. I live in the Intermountain West of the U.S., so there is still the ability to get away from civilization relatively quickly.

Such an experience occurred at the Great Basin on Saturday. We were in a meadow where several small streams were leaving the mountain ranges and heading to terminal lakes. There was a bit of cloud cover. We are at an altitude of 9000 feet. The temperature was cool. Three hours into our hike, we came to a clearing. I stared at a small field there with the wind moving the leaves of the Aspen right behind me. Boom. Immediately I lost myself in this little bit of quiet nature.

As always, the picture does not do the actual area justice.

This event caused me to think about God. I believe God is around us / nature, in us / nature, in time with us / nature (panentheism). Consider 1 Kings 19 in the setitng of Elijah’s interaction with the divine. The story is mythic but also perceptive. The wind, the earthquake, the fire and then the still, small voice… Perhaps there is a corrolary to my experience in that field. It was a pleasant wind in the Great Basin that was formed by volcanic activity, earthquakes, and fire. The majesty of natural creation 25 million years ago lead to the quiet field that I was standing in on Saturday.

In such experiences in the wild, I always am struck by the of immensity of deep time, the imperceptable changes in geology over millions of years, and the flicker of the human life span. I wonder if God, although everywhere, retreats to such little fields to enjoy the creation of events. I imagine such peaceful areas exist throughout our cosmos.

I feel that God was with me at that moment in time and at that location in Nevada although God is always around all entities at all times. The experience of sight / hearing / smell in that little field combined with my neurotransmitter reacting to my senses appeared to make my awareness of God much more focused yet confused. God was there but what was God? It will never be known.

Loren Eiseley once wrote: “Down how many roads among the stars must man propel himself in search of the final secret? The journey is difficult, immense, at times impossible, yet that will not deter some of us from attempting it… We have joined the caravan, you might say, at a certain point; we will travel as far as we can, but we cannot in one lifetime see all that we would like to see or learn all that we hunger to know.“

My time is limited on this little rock. I won’t see all of the possibilities of nature in my lifetime. I see the blackness of night and consider the infinity of space that I will never understand.

I can only experience what happens in my little bit of time and location in the universe’s reality. I do have the ability to let others in this bit of spacetime — and by others, I mean all entities — be themselves in their fullest form. This fullest form is equatable as creativity and love. Love neighbor. Love God. Ergo, love nature and appreciate all that I can see in such quiet, time-limited experiences.

I left the field and walked back down the mountain.

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Statistics (Can We Add It to that Old-Time Religion?)

The Economist posted an article this week titled “The trial of Lucy Letby has shocked British statisticians“. Great read. My take on the article is not that statistics may have been poorly performed in the setting of a murder trial while also stating that statistics are poorly understood in general.

In the United States, science in general and statistics in specific are poorly understood — including by scientists and physicians! Yet, understanding of BASIC statistics would help everyone in their daily lives. Think about how understanding basic statistical significance would affect how Americans understand basic economic principles, gambling, health outcomes, banking and investment, and parsing out unbelievable political statement by both of our main political parties.

C.P. Snow (1905-1980) had the wonderful “The Two Cultures and the Scientific Revolution” (A Rede Lecture) published in 1959. What a read and I highly recommend it! At that time, he believed those in the liberal arts were going to be consumed by those in the sciences. I think his prediction came true as those in the liberal arts and fine arts now basically can only advance academically with peer-reviewed papers, grants, etc. That complaint is for another essay… Regardless, he states clearly:

“But I believe the pole of total incomprehension of science radiates its influence on all the rest. That total incompre- hension gives, much more pervasively than we realise, living in it, an unscientific flavour to the whole traditional’ culture, and that unscientific flavour is often, much more than we admit, on the point of turning anti-scientific. The feelings of one pole become the anti-feelings of the other. If the scientists have the future in their bones, then the traditional culture responds by wishing the future did not exist. It is the traditional culture, to an extent remarkably little diminished by the emergence of the scientific one, which manages the western world.“

I don’t like the term “western world” as I think the fight between how we think concretely and how we feel emotionally / how we do math and how we read literature / how we think objectively and how we think subjectively leads to anti-intellectualism and leads to further problems such as racism, denial of climate change, the anti-vax movement, etc.

How do such concepts fit into religion? At least in my strain of faith (Christianity), the understanding of basic science principles among many church members and leaders is bereft of simple, basic knowledge. There is so much to write about this issue, but I would recommend this wonderful essay by Andy Crouch in BioLogos and a small essay I wrote about this issue in God and Nature Magazine.

One theological point to move to here…. My book, “A Theology of the Microbiome” (SacraSage Press) is in full publication mode. I am hoping it is out soon, soon, soon. Endorsements are done. Final editing is done. The cover looks great. I do spend some time in the book talking about God being basically a statistical being since statistics appears to be a significant part of reality. Mind you, my writing is theological here as the concept of God is unprovable and the concept of no God is unprovable.

Thus, a statistical God (the “Uber-statistician”) could predict accurately but not exactly or deterministically all future events. This concept makes sense in the setting of Naturalismppp, including ideas contained in panentheism and prehension (see prior posts). In my upcoming book, I state:

“God does not ‘know’ or ‘choose to know’ the location of every
quark, atom, molecule, and creature. Instead, God has just enough knowledge
through God’s self, which one would identify as ultimate statistical
knowledge (thus, the ‘Uber-Statistician’)…Since God has predictive power but no foreknowledge, determinism goes away…God’s lack of foreknowledge, as described by open and relational theology, would allow each individual entity to have freedom of outcomes. God may come close to all knowing, but God will never completely know outcomes. The Uber-Statistician is compatible with non-deterministic
creativity in nature even in its simplest elements as can be seen with statistics
being used to predict the distribution probability of a particle in the setting of wave-particle duality.”

Indeed, lots of ideas here regarding free will, determinancy, limited free will, theodicy, etc. Want to learn more? Put an order in for my book. ; )

If I go back to The Economist article, how much more helpful would it be for clergy to get some training (and I mean even the absolute minimal training) about statistics in high school, college or seminary? I think it would change the ways many “doctrinal” ideas in Christian denominations would be considered. Am I flaunting controversy? No. I am being a realist, especially when dealing with the triumphs and tragedies of every human on our planet (not counting the triumphs and tragedies of every creature on Earth — and including our home, tiny planet).

BTW: Great resource on world statistics here from the University of Arizona.

Johnny Cash (one of my favorites) singing “Give me that old time religion” here (no mention of statistics, sadly).

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Academics: The Issues (Well, at Least in Medicine) *and Maybe Theology

A little about me (see my blog home page)… As soon as I entered medical school, I learned that medicine could have an academic track. I was a first-generation physician so the field was very opaque to me. In fact, I had NO IDEA what a fellow was. For the audience, a fellow is a subspecialist trainee position after residency. I loved the idea of combining teaching, clinical care, and research. I was and am still idealistic about the concepts of professors of medicine having the same impact of knowledge as professors of physics or literature or biology or theology.

Thus, let us assume that academic medicine is a “three legged stool” of 1) medical education, 2) clinical care, and 3) research.

Here is the tragedy of medical education over the years in my opinion. Two of the legs have been broken, and I fear the legs will never be repaired. Thus, academic medicine is very broken.

Medical Education: Due to the expense and time of medical training and especially considering that academic physicians could be spending that time seeing patients (i.e., billing), less and less valuable time is spent teaching medical students. I see this effect mostly at the level of medical student education, but it is beginning to affect post-graduate education at the resident and fellow level. I base this finding on my experience in 23 years of teaching. However, the rising cost of medical education, the loss of protected time to teach (this will destroy the medical education track of scholarly academic advancement), wellness issues, and the emphasis on clinical care over teaching stressed by academic medical systems are reducing the quality of medical education in the United States.

Medical Research: There is so much to say here. However and briefly, there is no doubt that individuals with terminal MD degrees are not pursuing research careers compared to those with terminal PhD degrees in the biological sciences. This graph says it all:

image from the NIH

Now, one may say that you would prefer your physician to just take care of your clinical issues. Fine. However, how would you feel knowing that most graduating medical students and residents have minimal training on statistics, on how to read a journal article correctly, on how consider a clinical research project to improve patient care long term? How would you feel knowing that your physician really has no clue how to do quality improvement which our medical societies like to emphasize but do not follow through with? This is a very real aspect at every medical school and academic health system. I would recommend the #openaccess section titled “Notes from the Association of Medical School Pediatric Department Chairs, Inc.” in every monthly issues of The Journal of Pediatrics to get a sense of this problem. There are lots and lots of good ideas mentioned in the journal, but funding mechanisms are typically unclear.

Clinical Care: Ah, yes, the golden goose. Funding to teach is typically zero. Getting a grant is hard, and indirect grant costs by institutions are high. Seeing patients will generate revenue — always. So, if one is an MD faculty at an academic medical center, it is common for such faculty to see patients at the expense of medical education or research. I get it. It is expensive to run a clinic or a hospital or a medical system. Many academic medical systems are branching out to higher income areas in cities to get more private insurance payers. The pipeline from seeing a patient to generating revenue for the academic health system is relatively easy and based soley on volume. Great articles about this issue are here and here.

By the way, the importance of tenure is big issue currently in the United States. In academic clinical medicine, tenure is simply disappearing and probably will never return. Academic clinicians are considered “career line” academics, and our employment is typically based on revenue production.

The 3-legged stool is broken.

A Solution? To help others (our patients) and to help other ideas (our community):

Academics in general have a long history of “siloing”. I think this issue is becoming extremely common in academic medicine. If we, as academic physicians, are not able to do research or to teach to any effective degree, I suggest we break down our clinical silo to reach another community.

Are you a good writer? Compose a poem or write an essay for a literature journal. Your aspects of medical science and humanism will be needed in the literature community.

Do you enjoy history? Write an essay about the history of medical device or medical test or disease diagnosis or well-known physician. Submit it to a history journal or historical society. You will have ideas that probably have not been considered which will make a difference.

The possibilities are pretty much endless.

In my particular situation, I have had a long interest in science-religion overlap (probably deserves a long post in itself). I decided to pursue a DThM degree at a seminary which took about 3 years. Thus, although I was pretty busy as a clinician at work, I could write or produce some theology that I thought would help religious people understand the importance of science. For example, I wanted such people to understand the importance of vaccinations, especially in the setting of COVID-19.

The seminary that I received my degree from is big about “church futuring” which is a term that basically means more and more lay people probably need theology education as (guess what) full time academic theology is running into some of the similar aspect of higher education as medicine. These parallels are not complete of course.

OK…that is my rant for today. I hope the links provided are helpful. Thank you for reading my blog.

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