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A key note address at the KFMC Annual Research Conference held on 12-13 December 2010 by Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Bioethics Faculty of Medicine KFMC omarkasule@yahoo.com, <okasule@kfmc.med.sa>
ABSTRACT
Islam encourages active intellectual effort in looking for knowledge. Modern scientific research is part of ijtihad (defined as exertion of maximum intellectual effort to discover the truth or understand the relation between truths). Research starts in a simple way by critical observation and consideration of information, al nadhar bi al tadabbur, to derive empirical knowledge from the earth, the human organism, and the cosmos. Accurate quantitative descriptions of the observations lays the ground for analytic research that elucidates causal relations. Technology and other practical benefits from research result from manipulation of these causal relations. Observational research allows nature to take its course, records the occurrences of disease and answers questions on the what, where, when, and why of a disease. Its advantage is low cost and minimal ethical issues. It suffers from 3 disadvantages: disease aetiology is not studied directly because the investigator does not manipulate the exposures, unavailability of information, and confounding. The paper concludes that there is high motivation for research in the Islamic heritage and that innovative research can be undertaken by careful observation of our own environment that will suggest testable hypotheses. This will be more useful than repeating studies elsewhere, looking for uncovered gaps in others’ research, or being mere followers and imitators.
1.0 THE MOTIVATION FOR RESEARCH
1.1 Emphasis on the search for knowledge, talab al ‘ilm: 1slam puts emphasis on seeking knowledge[1]. The search for knowledge is a difficult but necessary process as we learn from the story of the difficulties that Musa went through to get some knowledge and the righteous man[2]. Knowledge sought must be of practical use[3] [4]. Research should be seeking practical solutions to problems for example the prophet’s teaching that there is a cure for every disease[5] in a challenge to modern medical researchers not to rest until they find a cure for all human ailments.
1.2 Empirical research is a mode of ijtihad: Empirical medical research is a form of ijtihad and should earn the same recognition as ijtihad in fiqh or other branches of knowledge. Ijtihad is exertion of maximum intellectual effort to discover the truth, understand the relation between truths, or identify falsehoods. This is equally applicable in empirical research as it is in juridical sciences, ‘uluum al fiqh. There are parallels between the processes of inductive logic used in empirical research and some of the tools of usul al fiqh for example analogy,qiyaas, and consensus, ijma,
2.0 DESCRIPTIVE KNOWLEDGE
2.1 Empirical knowledge from observation: Empirical knowledge is from observation of the environment[6] and the human organism[7]. This is not passive or chance observation; it is deliberate and purposive, al nadhar bi al tadabbur. Correct thinking is then based on the results of empirical observations[8].
2.2 Description of objects in the environment: The Qur’an teaches the culture of observation of the environment by describing objects and phenomena in the environment. It described mountains as elevated[9], firm[10], stable[11], colored[12], mobile[13], and erect[14]. It describes the partition between oceans[15]. It describes the benefits[16], manufacture[17], and softening[18] of iron. The wind is described raising clouds[19], changing the direction of blowing[20], seeding clouds to cause rain[21], and pushing boats in the water[22]. The sky is described as layers[23], held in place[24], raised without pillars[25], of wide expanse[26], and issuing smoke[27].
2.3 Description of processes of change and motion: The Qur’an describes the motion of boats[28], the sun[29], the moon[30], the water[31], and the wind[32] as well as changes of atmospheric pressure[33]. It describes the manufacture of iron[34] and armor[35], the construction of dams[36] and boats[37], and the creation of the human from dust[38] and water[39].
3.0 ANALYTIC KNOWLEDGE
3.1 The constant laws of nature, sunan al laah fi al kawn: As we said above, knowledge should be acquired for practical applications that essentially involve manipulations of the human organism or its external environment for beneficial purposes. Under the doctrine of taskhir[40], Allah gave humans the authority and capacity to change the environment around them in a systematic, deliberate, and purposive way unlike any other creation. Objects and phenomena undergo changes according to fixed laws, sunan al allah fi al kawn. The laws are fixed and stable[41]. An orderly universe and predictable universe is due to the existence of these laws.
3.2 Scientific research and the sunan: purposeful scientific research aims at discovering the causal laws that relate objects and phenomena. Once the laws are known then their manipulation results in changes of the environment and the human organism. These manipulations can be positive and beneficial in introducing new technologies or new drugs or can be destructive of the environment.
3.3 Evidence-based knowledge and action: The Qur’an calls for an evidential basis for human actions, al burhan[42] [43]. It condemned non evidence-based knowledge such as sorcery[44], fortune telling[45], and speculation or conjecture, al dhann[46]. Speculative unrelated to evidence thinking was condemned as dhann. Human thought is a tool and not an end in itself; it operates on the basis of empirical observations and revelation, both objective sources of information. Thought, ra ay, that is not based on an empirical basis or revelation is speculative and leads to wrong conclusions, was discouraged[47] especially if it contradicts Qur’an and sunnat[48]. It is tolerated in situations in which there is not authoritative text[49] but should be practiced with a lot of prudence[50].
3.4 Objectivity, istiqamat: The Qur’an calls for objectivity in measurement[51]. It calls for revealing the truth[52] and condemns following subjective feelings, hiwa al nafs[53].
3.5 Drawing conclusions from empirical observation: The Qur’an teaches deriving lessons, al ‘ibrat[54], from observed phenomena. Ibrahim by his empirical observation of the sun and the moon was able to reach true knowledge of Allah[55]. His heart was calmed in his belief in resurrection when Allah showed him the revival of birds that he had killed[56]. Human knowledge from empirical observations has limitations because the senses on which it relies have limitations for example human vision is limited confusing a mirage for water[57].
3.6 Rational thinking and logical operations: The Qur’an teaches logical thinking. It provides reasons for prohibited actions for example with regard to alcohol both the benefits and the harms were mentioned and the reason for prohibition was given[58]. The Qur’an uses similitude, tashbiih, of two things and phenomena to show logical connections for example: movements of the earth with movements of clouds[59], truth and light[60], resurrection of the dead with revival of barren earth[61], pulverized mountains on the Last Day and wool[62], the rebellious heart and the rock[63], unity and a strong building[64], and many examples, amthaal, to illustrate concepts[65].
5.0 MEASUREMENT OF OBSERVATIONS
5.1 Variables and constants as measures of what is observed: Scientific research requires that observations be quantified accurately as variables. A variable is a characteristic of a sample or a population that can take on various values. It results when numerical values are assigned to results of observations that involve either measurement or counting. Variables can be discrete or continuous. Discrete random variables arise from counting objects or events. Continuous random variables arise from measuring objects. A constant is the opposite of variable. It has only one unvarying value under all circumstances. Constants are few for example the speed of light.
5.2 Properties of random variable: In order to use variables properly to describe our observations we need to know their six properties: expectation, variance, covariance, correlation, skewness, and kurtosis. The first property is the expectation (or average) which is based on the Qur’anic concept of the middle (wastiyyat). Even if the variable changes a lot, there is some central or middle value around which in hovers most of the time. This value can be treated as the representative value of that variable. The second property of a variable is its variation (called variance) that reflects the Qur’anic concepts of constancy vs change, thabaat vs taghayyur. The third property is the comparison of its variation to the variation of other variables technically called co-variance. If 2 variables change in the same way, we must suspect some causal relation between them. The forth property is comparison of the magnitudes of two random variables, technically called correlation. A causal relation is suspected if the magnitudes of 2 variables change in tandem. The fifth and sixth properties of a variable are related to a common law of normal distribution which is that when a phenomenon is measured repeatedly, its values will hover around the average and few will be in the extremes. When plotted on a graph paper normal distributions of most natural measurements have a bell-shaped curve. In a few cases observations deviate from this pattern giving rise to 2 additional properties of a variable: skewness and kurtosis. Skewness is a measure of how biased the distribution of the variable is away from the center. Kurtosis is a measure of how peaked the random variable is at the point of its expectation. High kurtosis means that many random variables crowd around the average.
6.0 NON-EXPERIMENTAL OR OBSERVATIONAL STUDIES
6.1 Definition and classification: Observational studies allow nature to take its course and just record the occurrences of disease and describe the what, where, when, and why of a disease. They may be descriptive (incidence or prevalence of disease or risk factors) or analytic (etiology or causal relations). Etiological studies employ 2 types of comparison: disease in exposed vs. disease in non-exposed & exposure in diseased vs. exposure in non-diseased.
6.2 Importance of observational studies
Observational studies have been crucial in leading to causal discoveries as shown in the following 6 examples. The increasing deaths from lung cancer in the past 50 years and cigarette smoking[66]; oral contraceptives and venous thrombosis[67]; congenital cataract and intra-uterine rubella infection[68]; low rates of dental decay in populations with mottled teeth living in municipalities with a high fluoride water content[69]; Burkitt’s Lymphoma in low altitude and high rainfall areas that have high malarial infection[70]; and increasing demand for pentamidine to treat P. carinii pneumonia and the HIV/AIDS epidemic[71].
6.3 Basic designs of observational studies are cross-sectional, case control, and follow-up. Cross-sectional studies collect data on disease and exposure at a point in time. Case-control studies compare distribution of risk factors in diseased individuals (cases) and disease-free individuals (controls). Follow-up studies study temporal relations prospectively, retrospectively,or ambi-spectively. Two other designs can be described as quasi-experimental and correlational. Quasi-experimental observational studies compare 2 groups that were not assigned randomly. Correlational observational studies measure two attributes of the same subject to see how they relate to one another.
6.4 Strengths & weaknesses: Non-experimental or observational studies are easy, convenient, cheap, and have fewer ethical problems. They however are liable to confounding effects. Several unplanned co-factors (giving rise to confounding, interaction or effect modification) are not controllable in observational studies making interpretation of results difficult. Observational studies study etiology indirectly because direct study would require manipulation of exposures by the investigator which is possible only in experimental studies.
7.0 GENERAL CONCLUSIONS
Research output in the Muslim world is relatively low compared to western countries. If Muslims would excel in scientific research if they connected to and were inspired by their religious and intellectual heritage. The Qur’an is a great motivation of research because it devotes attention to empirical observation of the universe. Medical research is a mode of ijtihad and should have the same high consideration as ijtihad in other disciplines like fiqh. Undertaking innovative research requires starting from the basics: earnest search for knowledge, talab al ‘ilm; careful and purposive observation of local conditions and experiences to identify testable hypotheses; experimental research to establish causal relations, and translating research into products and services.
REFERENCES (full hadith citations available from the author)
[1] al wusaat bi talab al ‘ilm (KS390 Ibn Majah Intr B2, Darimi Intr B31, Darimi Intr B45)
[2] Qur’an 18 : 60-82
[3] , al intifa’u bi al ‘ilm wa al ‘amal bihi (KS390 Ibn Majah Intr B23, Darimi Intr B26, Darimi Intr B33, Darimi Intr B45, Darimi Intr B55, Ahmad 2:499)
[4] , la ‘ilm bighayr ‘amal (KS390 Darimi Intr B23, Darimi Intr B55)
[5] li kulli daai dawaa (KS338: Bukhari K76 B1; Muslim K39 H69; Abudaud K27 B1, 10; Tirmidhi K26 B2, Ibn Majah K31 B1, Zayd H987, Ahmad 1:377, 413, 423, 443, 446, 453; Ahmad 3:156, 335; Ahmad 4:278, 315; Ahmad 5:371; Tayalisi H368, Tayalisi H1232)
[6] al tafkkur bi al nadhar fi al aafaaq Qur’an 3:191, 7:185, 10:101, 29:20, 30:50, 50:6-7, 80:24-32, 88:17-20
[7] , al tafakkur bi al nadhar fi al anfus Qur’an 30:8
[8] al tafakkur bi al nadhar Qur’an 22:15, 27:33
[9] Qur’an 77:27
[11] Qur’an 7:143
[12] Qur’an 35:27
[13] Qur’an 27:88
[14] Qur’an 88:19
[15] Qur’an 25:53, 27:61, 55:19-20
[16] Qur’an 57:25
[17] Qur’an 18:96-97
[18] Qur’an 34:10
[19] Qur’an 30:48
[28] Qur’an 2:164, 10:22, 11:41-42, 22:65, 31:31, 42:32-33, 45:12, 54:13-14, 55:24, 69:11
[29] Qur’an 6:78, 13:2, 31:29, 35:13, 36:38-40, 39:5
[30] Qur’an 6:77, 13:2, 21:33, 31:29, 35:13, 39:5
[31] Qur’an 2:266, 4:57, 6:6, 11:42, 43:51, 47:12
[32] Qur’an 3:117, 10:22, 14:18, 15:22, 30:46, 30:48, 42:33
[36] Qur’an 18:95-97
[37] Qur’an 11:37-38, 23:27
[40] Qur’an 22:36, 22:37, 7:54, 16:12, 16:79
[42] Qur’an 2:111
[44] Huruat al sihr (KS275)
[47] Karahiyat al ray bila daliil (KS244)
[48] Ray yunaafi al nass (KS244)
[49] Ray fi ghiyaab al nass (KS244)
[50] Al hadhar fi al futiya (KS286)
[51] Qur’an 17:35, 26:182
[54] Qur’an 12:111, 16:66, 59:2, 79:26
[55] Qur’an 6:75-79
[56] Qur’an 2:260
[57] Qur’an 24:39
[58] Qur’an 2:219, 16:67
[59] Qur’an 27:88
[60] Qur’an 5:15-16, 6:122, 13:16-17, 14:1, 14:5, 33:43, 35:20, 57:9, 65:11
[61] Qur’an 7:57, 22:5-6, 30:19, 30:50, 35:9, 43:11, 50:9-11
[62] Qur’an 101:5
[63] Qur’an 2:74
[65] Qur’an 2:26, 36:13
[66] Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004 Jun 26;328(7455):1519. Epub 2004 Jun 22. Abstract OBJECTIVE: To compare the hazards of cigarette smoking in men who formed their habits at different periods, and the extent of the reduction in risk when cigarette smoking is stopped at different ages. DESIGN: Prospective study that has continued from 1951 to 2001. SETTING: United Kingdom
[68] Several early articles on cataracts were (1) Arch Ophthal. 1947 Nov;38(5):706-11. Relationship of rubella in the mother to congenital cataract in the child. COAR EL, POTTS CR. (2) PERERA CA. Sightsav Rev. 1946 Fall;16(3):135-7. Congenital cataract following German measles in pregnancy. (3) GOAR EL, POTTS CR. Am J Ophthalmol. 1946 May;29:566-9. The relationship of rubella in the mother to congenital cataracts in the child. (4) MILLER HC. Sightsav Rev. 1946 Winter;16(4):191-5. Congenital cataract associated with German measles. (5) KRAUSE AC. Ann Surg. 1945;122:1049-55. Congenital cataracts following rubella in pregnancy.
. [69] Early articles on Burkitt's Lymphoma and malaria were (1) Etiology of Burkitt's lymphoma--an alternative hypothesis to a vectored virus. Burkitt DP. J Natl Cancer Inst. 1969 Jan;42(1):19-28. (2) Association of Burkitt's tumour and holoendemic malaria in West Nile District, Uganda: malaria as a possible aetiologic factor. Kafuko GW, Baingana N, Knight EM, Tibemanya J. East Afr Med J. 1969 Jul;46(7):414-36. (4) Lancet. 1970 Oct 10;2(7676):771. Burkitt lymphoma and malaria. Stewart AM. (5) Lancet. 1970 Aug 22;2(7669):418. Burkitt lymphoma and malaria. Greenwood BM, Playfair JH, Torrigiani G. (6) Int J Cancer. 1970 Jul 15;6(1):1-9. Burkitt's lymphoma and malaria. Kafuko GW, Burkitt DP. (6) East Afr Med J. 1969 Jul;46(7):414-36. Association of Burkitt's tumour and holoendemic malaria in West Nile District, Uganda: malaria as a possible aetiologic factor. Kafuko GW, Baingana N, Knight EM, Tibemanya J. (6) J Natl Cancer Inst. 1969 Jan;42(1):19-28.Etiology of Burkitt's lymphoma--an alternative hypothesis to a vectored virus. Burkitt DP.