Shaving with William

Just outside the M25, the motorway circling London and sometimes called the world's largest parking lot, where England is at its greenest, lies the small hamlet of Ockham, Surrey. It is just around a pastoral corner from the Royal Horticultural Society's garden at Wisley, which garden enthusiasts may have visited or at least know about. Ockham consists of only a few houses, most of them country style red brick, some half-timbered, and you would expect DCI Barnaby to saunter through All Saint's churchyard any moment. In 1285, when the place was still spelled Occam, a boy was born there who later became a Franciscan friar, calling himself William of Occam/Ockham.

William must have been pretty smart because he made it into Oxford University, where he studied theology, graduating to become a philosophy teacher thereafter. He was interested in heuristics, the art (or scientific principle) to approach a problem in a practical manner, aiming to get to a solution with limited knowledge. Trial and error, for instance, is a heuristic technique. Our man from Ockham designed the lex parsimoniae, the “law of briefness,” meaning that the way to cognition needing the least steps or assumptions is most likely to be the correct one. In his honor William Hamilton and John Stuart Mill, philosophers of the 19th century, coined the term “Occam's/Ockham's razor” for this theory, because it radically shaves off complex contemplations. Not surprisingly, the Church disapproved of these simplifying thoughts and charged William of Occam with heresy. He thought it wise to leave the university and later even the country, dying in Munich in 1347.

It is easy to understand why many surgeons are eager followers of William. In his brilliant Editorial “A Blood Test to Predict the Future,” however, our editorial board member Thomas V. Bilfinger raises a word of caution.[1] Having reviewed numerous manuscripts describing the use of a more or less specific “biomarker” for risk stratification after cardiac surgery, he has come to the conclusion that this endeavor is a bit like the eternal quest for the philosopher's stone. And it may need a sorcerer to find it. Research like this will continue because it is fairly easy to do and can even come up with catchy results such as “High serum asphalt levels are good for you.” The underlying problem is that the approach as such presumably is wrong. In medicine, and especially in surgery, a chaotic system (patient) is disturbed by a chaotic confounder (disease). Supposed help is brought by another chaotic entity (read: therapy or surgeon) leading to a modified and hopefully, but not necessarily, more stable chaotic system (recuperation or healing). It always remains to be seen how much chaos can be tolerated by the individual.

I think surgeons can all still stay with William when contemplating the potential cause of a painful resistance in the right lower abdomen. It is much more likely to be a good old appendicitis than a troubled diverticulum of Meckel. Luckily, for this example the consequence is the same and surgical: if in doubt, get it out. If neither is found and the bowels look more generally inflamed, it may still be that rare case of amoebiasis which had been mentally shaved off before by the razor made in Surrey. That is why the medical profession keeps being exciting and full of suspense.

Speaking of shaving aficionados: yet another traditional English perfumer has stopped producing shaving soap in a bowl. Maybe William of Ockham is really going out of style.

• Reference

• 1 Bilfinger TV. A blood test to predict the future. Thorac Cardiovasc Surg 2019; 67 (06): 426-427