Musings of a Cancer Doctor
Wide-ranging views and perspective from George W. Sledge, Jr., MD

Wednesday, February 8, 2012

On Changing Your Mind

We tend to be of two minds about changing our minds. The first is embodied by the words of the English philosopher-mathematician-logician Bertrand Russell: "Of course I change my mind when new facts emerge. What do you do?" This could pretty much represent the scientist’s ethos. In this world-view, close-minded and unchanging are not terms of endearment.


The other worldview sees a willingness to change one's mind as a form of weakness, even immorality. For several centuries European monarchs delighted in the title of "Defender of the Faith" and viewed open-mindedness with suspicion. This worldview persists to this day, and is understandable.


When change is the only constant, when technology and economics constantly seem to erode yesterday's certainties and values, being open to changing one's mind may often be necessary but it is unlikely ever to be appreciated. Modern science (and its change agent, technology) have brought us many unpleasant gifts, and their social consequences have not always been benign.


While I believe most scientists view a willingness to change one's mind as a positive, and view themselves as open-minded, not everyone shares this view of scientists. Some view the entire process of science with suspicion, and indeed some have come to view science as just a different, and dangerous, sort of religious belief. Or irreligious belief.


In part this distrust of scientific open-mindedness emerges from a dislike for the stories of science (Copernican astronomy in the 16th century, and evolution, the big bang theory, and climate change today). But at a deeper level it is the process of science, not its stories, that engenders distrust. If a scientist believes that nothing is sacred, then those who believe in the sacred (and they have always outnumbered scientists) will find the process of science uncomfortable and threatening.


At the same time, open-mindedness is now widely considered a public virtue, and even those who secretly detest it profess to believe in it. It has even become a weapon used against scientists in our current culture wars: if you are unwilling to give equal time to unscientific nonsense in the public schools you must be close-minded.


The philosopher of science Thomas Kuhn denied that most scientists were open-minded. Kuhn, you may recall, inflicted the word "paradigm" on modern intellectual discourse. Most scientists, he declared, practiced "normal science," fill-in-the-blank, incremental, not very imaginative work that fit into neat predetermined boxes. It was only the Copernicuses and Newtons and Einsteins of the world who created new paradigms, great mental leaps forward that shattered the old and started a new era of "normal science.”


Kuhn was dismissive of the idea that scientists were particularly open-minded to new paradigms. He was fond of quoting Max Planck to the effect that "a new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it."


Kuhn's view of the progress of science rapidly became established dogma among philosophers of science, and then migrated to the scientific (and particularly medical) literature.


I have always had trouble with Kuhn’s basic thesis. Where does one draw the line between “normal” and “new paradigm” science? I view the history of science and find it hard to imagine Newton without Kepler or Galileo, or Watson and Crick without Oswald Avery. I see more recombination of old ideas than “out of the blue” masterstrokes even in the best and most important science.


And Kuhn’s thesis does not jive with my experience. Scientists are an ambitious bunch, and many love slaying the dragons of dogma. Scientists hate being called close-minded, and want to be remembered as bold, creative, old-paradigm-destroying, new-paradigm-creating guys. The end result, over the past few decades, has been an onslaught of papers by scientists identifying their particular hypothesis as a "new paradigm."


A recent PubMed search reveals some 8720 articles with the word “paradigm” in their title. Good Lord! Very few use the word in its original Kuhnian sense, and over time “paradigm” has morphed into a synonym for “hypothesis” or “theory” or even “approach.” Even allowing for this, that is a boatload of paradigms. My head aches even to contemplate them all.


When we say, "I've changed my mind," what do we actually mean? We understand it in a figurative sense, of course. But have we literally changed our minds? It is an interesting question, and it goes to the heart of much recent research in the neurosciences.


Francis Crick, who took on neurobiology as a second career following his co-discovery of the structure of DNA, wrote a book towards the end of his life called The Astonishing Hypothesis. The astonishing hypothesis, which I must admit has always seemed pretty obvious to me, is that everything "we" are from the standpoint of our beliefs and intellect and thoughts "are entirely due to the behavior of nerve cells, glial cells, and the atoms, ions, and molecules that make them up and influence them." A natural, rather than a supernatural, process.


If this is true, then when we change our minds we must literally change the physical structure of our brains. The mental is physical. There is now a growing literature devoted to neuroplasticity, the ability of the brain to change its structure in response to external stimuli or injury. For a brief introduction to the concept of neuroplasticity, you can see an interview with the University of Washington’s Dr. Ione Fine at


In contrast to what was once believed, the adult brain is quite capable (though not as capable as a child’s) of changing, of rewiring itself. Fine discusses the case of a patient who regained sight after 40 years of blindness, which required fairly major reprogramming of the brain, but we all must do some of our own reprogramming on a regular basis, if to a lesser degree.


I came across a recent article discussing the effects of psilocybin, the active ingredient in the “magic mushrooms” so popular in the 1960s. Katherine MacLean and colleagues, writing in a recent issue of the Journal of Psychopharmacology, showed that after a single high dose of psilocybin, “we found significant increases in Openness….In participants who had mystical experiences during their psilocybin session, Openness [“which encompasses aesthetic appreciation and sensitivity, imagination and fantasy, and broad-minded tolerance of others’ viewpoints and values”] remained significantly higher than baseline more than one year after the session.”


This is fascinating: not only can the adult brain change; we can pharmaceutically re-program the brain to be more open to change for prolonged periods. The scientific and law-abiding parts of me are not all that enamored with mystical experiences, and I of course already score well on aesthetic appreciation, sensitivity, and imagination, as all would agree. And I am quite tolerant, except of the people I disagree with. So I will pass on the magic mushrooms, thank you very much. But I suspect we all know someone who might benefit from a dose of openness.


Is oncology an area that might benefit from therapeutic neuroplasticity?  We certainly see many patients who have suffered neurologic catastrophes: chunks of brain tissue damaged by tumor, cut out, fried, or poisoned.


And indeed, is neuroplasticity already occurring yet unrecognized? I think of all my patients suffering from that somewhat vague but certainly real complaint of “chemobrain.” The neuroimaging literature offers increasing testimony that my drugs acutely affect the brain, yet the long-term effects of these agents have been hard to quantify. Is this because the brain is constantly changing, being reprogrammed by the new experience of being a cancer survivor?


We’ll no doubt learn more as our tools get more sophisticated. In the meantime, I’ll try to keep an open mind on the subject.