Is medical academia just following academia?

Is Medical Academia repeating Academia’s history? In a recent essay in a small-circulation, specialized periodical, Academic Questions, Prof. John M. Ellis, emeritus Professor of Literature at the University of California, Santa Cruz, recounts the past 4-5 decades of changes in liberal arts departments in US colleges. (How Preferences Have Corrupted Higher Education, Acad Quest, 2008; 21(2):265-274)  One modern academic controversy not needing recounting is the takeover of liberal arts departments by post-modernist theology and the partial takeover of universities themselves by radical politics dating from the 1960s.  But as recounted by Prof. Ellis, the fifty-year metamorphosis has not only changed universities, but has produced a branching network of intended and unintended consequences.

We have noted before that medicine is both a science and a practice that reflects current social attitudes and mores. (I minimize the aliquot of art, persisting from prior centuries; cultural influences being a more accurate term.) But the changes in universities now reflect in the normative thinking and mores of the modern medical school – at least a nucleus of them.  Thus Dr. Ellis’s observations may be a metaphor or template for a medicine of the next several decades.

Medicine’s cultural roots anchor in recent as well as distant history. In the distant past, pre-scientific medicine was based in Greek philosophies and proto-religions with concepts such as miasms, humours, opposites, balances, and ideas of reference and similars. Recent influences include the Soviet –Marxist based Lysenkoist theories that set back Russian genetics for decades, the People’s Republic of China’s politicization of traditional Chinese medicine, and of course the racial theories of the 1930s that justified brutal practices in Axis-occupied Europe. Today’s American pluralistic system of private, group, and public care systems reflects the heterogeneity and conflicts of American political thought. Prof. Ellis now documents a trail of developments in universities, set in motion by a beneficent but planned social movement – racial and ethnic preferential admissions policies to aid social and economic mobility – in the cause of a better society, free and egalitarian.

Yet the trail has left a network of forks and alleyways of consequences. In this segment I want to outline the academic community’s trail as recorded by Dr. Ellis. Readers can use their imaginations in drawing correlations to today’s climates in many medical schools.  The two sets are not identical. Different mechanisms and motivations drive the two sets of changes. Overlapping areas are only partial and others may seem unrelated. But there is enough similarity to take away some lessons and to stimulate thought.  The main lesson is not to oppose movement toward equality and fairness, but to try to predict consequences and dangers of manipulating normalized social structures.

Dr. Ellis outlines the following steps.  Numbering is mine but the sequence is Dr. Ellis’s. Direct quotes are in italics.

1. This story of the series of changes initiated by [admission and hiring by minority] preferences begins in the 1970s, as pressure slowly grew for colleges and universities to admit more minority and women students, and to hire more minority and women faculty. 

   2.  Soon this pressure became intense, and every new faculty appointment was expected to help increase the numbers of minority and women faculty. Many departments began to do what was expected of them, and in the humanities and social sciences almost all did.

  3. Implementing the concept of diversity led to use of diversity as the primary selection indicator for applicants.

4.  Once a significant or “critical” level of like-thinking faculty was reached, political belief replaced academic curiosity, imagination, and excellence as primary qualification.  And so we now have the first major unintended consequence of preferences in faculty hiring: as the number of these new appointees mounted, the entire political complexion of the faculty was slowly tilted, not to the left, but to the radical left.

5.When the nucleus of new faculty feel constrained by policies of their departments, accordingly they soon press for new departments of their own where they will make their own rules—not academic ones. New departments of women’s studies, black studies, ethnic studies, and others like them soon arise.

6. New departments needed additional faculty to staff them, which meant still more   political radicals added to the faculty, and ever greater campus influence for radicalism.

7. Even so, they were still very far from a majority, and so one might have expected their influence to be limited, especially since they were out of step with the values of the rest of the academy. But in point of fact that was precisely why they were so effective. Their behavior was so unlike that of academics that administrations and faculty alike were completely unprepared for dealing with them.

 8. The unintended consequences of preferences had now developed through the initial stage of simply more radicalism on campus, on to separate radical departments and finally to major radical influence on campus—which meant that something that was completely out of step with the core values of academic life had now gained considerable influence over it.

9. Another major unintended consequence of preferences is a transformation of college administration. If you were to examine any speech made by a university president forty years ago, you would find that the word “Excellence” occurs with great frequency. That concept was the guiding light of the academy. If you made the same examination now, you’d find that the word “Diversity” has taken its place. That change has altered both the relationship between administration and faculty, and the pecking order within the faculty.

10.  The obstacle to real educational progress for minorities that now surfaced had its roots in the fact that political radicals don’t look at the past and see accumulated knowledge and wisdom, nor do they look at their society with respect for its institutions and achievements. Their natural instinct is to denigrate society as it is and has been, in order to make the case for the sweeping social change that they think is necessary.

 Substitute medical school models for the academic ones and one can see the similarities. Dr. Ellis was not writing about radical politics replacing a dominant political belief system, but of replacing an academic tradition that led to the Enlightenment, political advancement, the rise of reason and science, and evolution of functioning democracy with individual freedom. Now, if a reader were to substitute for “radicals,” terms like “CAM advocates” or “Integrative medicine,” and substitute an intention to change medicine to “more holistic,” to “humanize,” to “become more humanitarian and subjective,” and to “be less removed, cold, unreachable,” it’s like using an overlay map. Perhaps there is less to expand on than I thought might be necessary, because most people will have gotten it. We are in the early to middle phases of a “quiet revolution” leading to a wholesale change of what it means to be a physician, what the practice of medicine is, what evidence and proof are (see Steve Novella’s post of yesterday) and what the roles of rationality and science are.

One can anticipate a clanging of politically-inspired expletives and ad hominem accusations by some who might want to accuse such thinking as right-wingism. Yet the issue is real – is how direct political action in the name of ideological principles have the potential for repelling intellectual and rational advances. Recounting the rise of “CAM” observed through this historical lens will be not only obvious, but I hope enlightening, and a warning.

Posted in: Medical Academia

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22 thoughts on “Is medical academia just following academia?

  1. Fifi says:

    “post modern theology”…. “right-wingism”…. Um, the surge in popularity of CAM has little to do with “post modernism” (which seems to be the label some kind of boogeyman for some people in American academia), though clearly there are some very real power and ideological struggles going on in some American Universities. Medicine has, historically, indulged all kinds of very weird (and not evidence based) prejudices over the course of its academic and practical history – and presented them as fact based in presumed authority – and some of them not in the distant past. I’m not sure why doctors and medical academics are surprised some of their colleagues still entertain non-evidence based philosophies and theories when that’s always been that way (I’m not sure what ideal time the nostalgic are actually pining for since it doesn’t seem to have existed to me, for the most part, since American universities have always been influenced by wealthy contributors and outside political forces, particularly the elite universities created to educate the children of the wealthy and politically powerful so they’d be ready to assume that power and exert their privilege).

    You know, the way the term “post-modernism” has been hijacked by new agers AND the reactionary elements of academia in the US is pretty much the same way CAM and new agers have hijacked the term “medicine”. By continually framing the quest for EBM as a political reaction to/war on the bogeyman of “post-modernism” (which you don’t seem to actually understand outside of its hijacked context) you’re actually weakening the basic argument which is this isn’t about politics and ideology but about what works and what doesn’t and a process that allows us to understand what does and doesn’t work in healing and treating sick people. The call here actually seems to be for a pre-modernist academia not an academic one but most of us who are plugged in, international citizens live in a post-modern world in practical terms. Sure you can deny there are layers of meaning beyond the surface or deny that one’s upbringing and beliefs systems create a lens through which one interprets the world but that doesn’t make it so and, to me, starts to sound like CAMmers who only see and hear what supports their pet theory.

    Really, it seems to me that EBM loses the moment it’s made into an ideological academic battle between opposing cultural theories as it’s framed in this blog and continually framed in the US by BOTH sides of the war.

  2. Fifi says:

    That should read…
    “The call here actually seems to be for a pre-modernist academia not a Modern one…”

  3. Fifi says:

    “3. Implementing the concept of diversity led to use of diversity as the primary selection indicator for applicants.”

    Unlike previously when wealth and social privilege/connections was amongst the primary selection indicator for applicants to elite universities (with a small bone thrown to very high academic achievers to fluff up the ranks of the elite with some academics and thinkers).

  4. Harriet Hall says:

    Fifi said,

    “it seems to me that EBM loses the moment it’s made into an ideological academic battle”

    Science-based medicine has been accused of being an ideology. It isn’t. That’s what we need to fight.

  5. tarran says:

    Well, there is a simple solution to this problem:

    Start a new medical school free of the holistic guys, hire away the best teachers you can attract from the top of the line medical schools, and start churning out doctors. Do it right, and you will have the best candidates fighting to be trained by the top men in the field, and the top men, of course, will probably be happy to have to stop wasting time on folderoll.

    There are two obstacles:
    1) You would need financing. This is difficult but not impossible, a new topline school should be able to pay for itself especially with the government subsidization for student loans which permits the market clearing price of education to remain quite high.

    2) The state medical boards’ loyalty to their primary mission of ensuring that doctors are scarcer than they would be in a free market by tightly controlling the number of graduates medical schools are permitted to produce. This will be the deal-killing obstacle: it will take a lot of political pressure ot overcome the lobbying of established medical schools to have the government prohibit a new, better school from being started up that would attract away their customers. Again, hiring top name teachers from other facilities should help overcome their efforts to paint your new university as “unproven” and a “danger to the public”.

  6. overshoot says:

    IMHO neither you nor Dr. Ellis trace this change to its proximate common root, which is the “great divorce” commented upon by C. P. Snow in The Two Cultures. If, as Snow observes, you divorce the physical sciences from the social sciences and humanities, if you cut the lines of communication between them, the latter are freed of the stick-in-the-mud types who are less concerned with how the Universe should be and insist on asking what it actually is.

    However, that is precisely the divorce that you observe happening a half-century after Snow’s book in academic medicine, isn’t it?

    Having graduated two children from the home of Andrew Weil, one from the college of Social and Behavioral Sciences and one from Physical Sciences and Engineering, the total disconnect is perhaps more apparent to me than to some. The physical sciences are and probably always will be in the minority, regarded as a necessary evil for the funding they bring in. The medical school, while somewhat separate, is not immune to the same influences.

  7. Fifi says:

    “Science-based medicine has been accused of being an ideology. It isn’t. That’s what we need to fight.”

    Dr. Hall, I agree with you wholeheartedly, which is why I pointed out that presented as it was in this blog post – as what reads to me as an ideological battle against “post-modernism”, essentially a culture war, and equating EBM with the “establishment/history/whatever – is counterproductive and smacks of promoting an ideology not EBM.

    It may well be worth talking about EBM within the context of the American culture war but equating it with one ideological stance or the other seems counter productive to me since EBM exists outside of the context of elite American academic institutions and their internal power struggles and squabbles.

  8. wertys says:

    I think the role of ‘post-modernism’ in promoting CAM has really essentially been to provide sCAMmmers with a societal environment, particularly among tertiary-educated people, where intelligent sounding and complicated rationalizations for dismissing science can find a credulous hearing. I gather that some postmodernists have made specific attacks upon the medical profession from time to time, but the most damaging aspect of it is that it allows the ‘tu quoque’ fallacy to be trotted out time and again…

  9. Wallace Sampson says:

    I’m not sure I understand all of Fifi’s points after two readings. I promise to read again tomorrow. So I cannot answer all Fifi’s comments, but she may have misinterpreted. My own post may not have been clear enough as to its purpose. So I will leave a few comments I hope can reorient readers.

    First, Wertys got it right, and if Fifi understands wertys, I don’t have to answer.
    Nevertheless, here is an expansion: What happened in Academia was a political shift within faculties and administrations placing social goods ahead of intellectual/academic qualities for both admissions and faculty selection. This extended into journals and meeting papers, in which classical scholars could not gain access (publication or presentation) without including radical socio-politico-economic interpretation, usually from a decidedly radical/leftist orientation.
    The 1996 NY meeting and book, “Flight from Science and Reason” has opinion papers on the situation from historians, philosophers, mathematicians, biologists, all of whom had been experiencing a discriminatory change in their respective academic worlds – from classical intellectual pursuit to pursuits with socio-political effects. Much has been written since then. Dr. Ellis, an authority on the situation, merely described the natural history of the phenomenon in colleges.
    I have personal experience in this, having read widely of postmodern authors, and having taken university courses in literature (from Rorty) and medical anthropology (from arrivals from the Harvard department.) . Some courses are filled with sociological and political dogma which describes medicine in political and social hegemonic terms.
    In Academia the “normative” standard and “narrative” is determined by leftist/radicalleftist, anti-US, anti-Israel, pro-radical Muslim politics combined with postmoderrnist analyses (of usually political “subtexts” to readings) and a fluid set of definitions of truth, reality, mostly equivalent views, and perceptions of science and of medicine as “social constructs.”
    This last directly contradicts the Enlightenment discovery of reality perception through mathematics, rationality, and objective measurement. Although as I described, social and political lenses and meanings have ever been part of medicine and science, the modernist view is to minimize those influences through reason and experiment, etc.
    The postmodernist demeans the thrust toward objectivity in favor of “the narrative”, personal views, the segmentation of reality into classes (feminist, Afrocentric, etc.) personal and socio-economic interpretations; and the thought that language determines reality (Derrida) not vice versa.
    This is heady stuff. But as wertys said, postmodernist mindset lays the fertile groundwork for anti-intellectualism, and lack of standards – thus the “moved goalposts and widened sidelines” for establishment of truth and the openings for believing in the implausible (CAM.)
    But that reveals what I was going to present next…that med school higherarchies have tasted this KoolAid (and pocketed the money) that has corrupted the medical academic commons.
    How else to explain the most prestigious internal medicine journal (Annals…) throwing open its pages for three years to pseudo-scientific papers and dissertations on highly implausible claims written by people who decades before would be considered cranks?
    So far, none of ths concerns EBM specifically, and may concern it only as it is one representation of getting to objective reality.
    This series is on the changes in medical academia that are allowing institutional insanity to run with little check or resistance.
    Sort of like the Fannie Mae/Freddie Mac thingy? You bet. Knock-knock…Anyone home?

  10. Fifi says:

    wertys – There are even doctors and medical researchers who give CAM a credulous hearing, as this blog so often points out. I’d suggest this is the same kind of new age distortion that occurs when people claim that all scientific activity is subjective. Post-modernism doesn’t posit that “it’s all subjective” or that reality or the material world don’t exist, the theory proposed that the stories we tell ourselves about reality are subjective and shaped by culture, and that our language shapes our understanding of the world and our beliefs. Certainly there have been post-modernist critiques of various systems, do you feel that medicine should somehow be outside of critique or examination as a cultural system or looked at within the context of the larger culture in which it exists? That would seem silly since there’s very specific research going on about medicine and culture, health and culture and so on. SCammers existed long before Modernism or Post-Modernism, it ain’t something new (only “new age”, which, ironically, grasps at old ideas as novel).

    My main point isn’t to defend Post-Modernism – and I do understand there’s a very, very bitter battle going on between academics at certain elite US institutions – it’s to point out that the good Dr is dragging EBM into his particular cesspool of academic politics and making EBM about an ideology he holds and what seem to be personal grudges, unrealistic nostalgia and American academic politics at elite institutions. To me it’s like those atheists who’ve converted from a religion and approach being an atheist religiously, it’s an ideology not just being godless. By mixing in his ideology with EBM and trying to make them synonymous, he’s in fact making it about ideology not what works and what doesn’t. Supporting science and EBM isn’t a religious or ideological battle for me – though I understand it is for many on both sides in the US which is fighting ideological and culture wars on many fronts – it’s simply about keeping science useful (especially now that we’re finally moving beyond the cultural – religious in their root – prejudices that blinded science for so long).

    I do understand that “enlightenment ideals” is a buzzword at the moment in political and academic circles engaged in a war of ideologies. Nice to float around but like quoting the ancient Greeks as a pinnacle of democracy it ignores some reality – the ancient Greeks kept slaves and the Enlightenment period wasn’t some mystical era of perfection either.

  11. Fifi says:

    Dr Sampson – Like I said, this seems very personal to you, which it clearly is. I’m not sure if you’re recognizing your own bias in this situation and taking it into consideration because of just how personal (and seemingly emotional) this topic is for you. If it’s meant to merely be an opinion piece, then I can easily take it as that and accept that you’re expressing a personal belief and opinion about what you think is a superior ideology. Personally I think it’s damaging to EBM in general to associate it with what is very clearly (to an outsider) a political/social ideology that’s part of the us vs them American culture wars.

    Dr Sampson, don’t you recognize your own narrative and how it informs your bias? (And your seemingly rather personal and emotional dislike of PoMo.) Seriously, that’s not a question posed from a PoMo perspective or a new age “everything’s subjective” perspective but a question that emerges from science regarding the kind of self awareness that’s crucial to being able to perceive one’s own bias and be intellectually and emotionally honest.

    Once again, PoMo doesn’t posit that the material world is subjective or unreal but that our narratives about the world are subjective and shape our experience of the world, as do the structures of our institutions. While certain narratives are dominant (the victors write history is an old fashioned way of expressing this), there are a multiplicity of narratives, experiences and perspectives of one event. The facts don’t change per se but their meaning changes with who’s telling the story – science isn’t about meaning per se, cultural theory is very much about meaning. Once again, it seems to me that it’s like waging a religion vs science battle, or science vs art or any other two things that are like comparing sheep and oranges.

    What’s your objective with this blog? To support EBM or to fight an ideological battle? Do you really think making it all about ideology and academic politics serves to support EBM? It seems to me, as an observer, that you’re actually in some ways disempowering the other bloggers here by making it about ideology when some of them have clearly stated it’s not an ideological battle. (Not that I think you intend to do this, and maybe the other bloggers don’t see it that way, I’m just telling you what I see in the hopes it may be useful in gathering rather than alienating support for EBM in the future.)

    It’s human nature and how cognition works that lays the ground for belief in CAM and the misunderstandings that lead people to believe that their subjective experiences are objective facts – not PoMo. People believed in and taught quackery long before PoMo was a giggle between Foulcault and Derrida. Since you consider yourself informed about PoMo, I’m sure you know just how many PoMo academics worked at universities in Canada. We’re not having the same culture wars or drama in Canada in academia so this seems to be something that has more to do with American politics (academic, social and general) than EBM (not that I’m sure one couldn’t find a few cranky professors in Canada but there’s a cranky professor or two out there for every cause under the sun). Of course, a study on yoga or meditation in Canada isn’t an ideological battleground either – it’s just seeing if stuff works or not, and how it works if it does. That, to me, is EBM – not some ideological polemic which blames, amongst other things, promoting equal opportunity for women and minorities (while not recognize that many students in elite universities are there because they’ve inherited an unequal access to elite education due to wealth and connections, not for their very poor academic skills, though I’ve yet to hear anyone in academia speak up about that!).

    I do find it very ironic and entertaining that you think PoMo promotes anti-intellectualism!

  12. Fifi,

    I disagree with you. First, rebutting an ideological attack on science does not perforce make the author of the rebuttal an ideologue or his arguments ideological. Does arguing against “intelligent design” or against including it in science curricula transform Darwin’s theory into ideology?

    Second, your description of PoMo is watered down to the point of being almost unassailable:

    PoMo doesn’t posit that the material world is subjective or unreal but that our narratives about the world are subjective and shape our experience of the world, as do the structures of our institutions.

    Who would argue with that? Yet for that very reason, if that’s all there is to PoMo it has made no contribution to intellectual thought. The assertions are trivially obvious.

    Third, that isn’t really all there is to PoMo, and PoMo really is a problem in the academy. Have you read Sokal and Bricmont? (referenced below). It’s also a problem in medicine. Here’s a summary written by Roy Poses a few years ago as part of his paper “A cautionary tale: the dysfunction of American health care” (European Journal of Internal Medicine 14 (2003) 123–130), complete with references:

    Postmodernism, which has ‘‘increasing reach and power within the [American] university’’ [85], has provided the erstwhile intellectual rationale for suppressing academic freedom. Postmodernism is ‘‘an attempt to question the fundamental philosophical and political premises of the West. It argues that many of the concepts we take for granted—including truth, morality, and objectivity—are culturally ‘constructed’’’ [86]. To postmodernists, truth is just what the powerful say is true [87]. This facilitates a slippery slope argument for the suppression of free speech and academic freedom. For example, in his aptly named book, There’s No Such Thing as Free Speech, and It’s a Good Thing, Too, the well-known postmodernist Stanley Fish, Dean of the College of Liberal Arts and Sciences at the University of Illinois, argued ‘‘some form of speech is always being restricted, . . . someone is always going to be restricted next, and it is your job to make sure that the by someone is not you.’’ Finally ‘‘the only question is the political one of which speech is going to be chilled’’ [88].

    Postmodernism is also a direct threat to the integrity of medical research. Medical postmodernists, believing that truth is politically defined, deride widely accepted standards for research methodology as political constructs. For example, Berkwits charged ‘‘the preeminence of clinical epidemiologic research in medicine derives not from its ability to reveal the truth about clinical phenomena, but from an agreement within the medical community for a variety of reasons that it will grant greater authority to statistical expressions of evidence over others’’ [89]. Postmodernists argued that clinical trials became pre-eminent not because they are less susceptible to selection bias than are observational studies, but because they somehow gained more political support than did other methods, e.g., ‘‘in a self-authenticating manner, the double-blind RCT became the instrument to prove its own self-created value system’’ [90].

    Although basic scientists have fiercely repelled post-modernist attacks in the ‘‘science wars’’ [91], the postmodern viewpoint has received a warmer reception from medical researchers. There is a vocal postmodernist faction in medical qualitative research [92–94]. Postmodern arguments also underlie some of the current enthusiasm for alternative medicine. For example, Kaptchuk and Eisenberg, the editors of a prominent published series on alternative medicine, asserted the ‘‘old cultural war of a dominant culture versus heretical rebellion in politics and religion as well as medicine has begun to transform into a recognition of postmodern multiple narratives’’ [95].

    [85] Epstein B. Postmodernism and the left. New Politics 1997;:6.
    [86] Rothstein E. Attacks on the U.S. challenge the perspectives of postmodern true believers. New York Times, September 22, 2001.
    [87] Sarchett BW. What’s all this fuss about this postmodernist stuff. In: Arthur J, Shapiro A, editors, Campus wars: multiculturalism and the politics of difference, Boulder, CO: Westview Press, 1995, pp. 19-28
    [88] Fish S. In: There’s no such thing as free speech, and it’s a good thing, too, New York: Oxford University Press, 1994, p. 102.
    [89] Berkwits M. From practice to research: the case for criticism in an age of evidence. Soc Sci Med 1998;47:1539–45.
    [90] Kaptchuk TJ. Powerful placebo: the dark side of the randomised controlled trial. Lancet 1998;351:1722–5.
    [91] Sokal A, Bricmont J. Fashionable nonsense: postmodern intellectuals’ abuse of science. New York: Picador USA, 1998
    [92] Poses RM, Isen AM. Qualitative research in medicine and health care. J Gen Intern Med 1998;13:32–8.
    [93] Poses RM, Isen AM. In defense of qualitative research: in reply. J Gen Intern Med 1998;13:69–72.
    [94] Mays N, Pope C. Qualitative research in health care: assessing quality in qualitative research. Brit Med J 2000;320:50–2.
    [95] Kaptchuk TJ, Eisenberg DM. Varieties of healing—1: medical pluralism in the United States. Ann Intern Med 2001;135:189–95.

    Finally, PoMo is also a problem in Canada. Remember the paper that David Gorski “deconstructed” a few weeks ago? (

    Look at its source:

  13. daedalus2u says:

    I put a less well thought out version of this as 2 comments over at Orac’s blog.

    One of the commenters there brought up the EBM approach to parachute use, that without a randomized clinical trial of their effectiveness, the EBM clinician doesn’t know what to do (not strictly true because there is an excellent theoretical analysis that shows parachutes to be beneficial and no clinical trial showing they are not beneficial).

    I think the problem with EBM and SBM is that it doesn’t go quite far enough. We all know that in Medicine, the objective of every treatment for every condition is to balance beneficial therapeutic effects with adverse side effects and that it is then the patient who chooses exactly where that balance becomes worth doing. If there is zero expected benefit, the level of harm doesn’t need to be looked at.

    The EBM heuristic only looks at benefits; it does not explicitly look at adverse effects. Adverse effects are only considered in the context of a lack of benefit. I think this is the wrong approach. Adverse effects should be explicitly accounted for and tracked separately from therapeutic benefits so they can be weighed against each other explicitly and ideally using the same criteria so they truly are comparable. I think clinicians do this implicitly, in discussing side-effect profiles of various treatments, but having it explicit closes up some loose ends.

    I suggested adding additional evidence levels that are related to lack of effect or to expected harm.

    6a. No expected benefit based on known physiology (e.g. prayer, homeopathy, Riki, acupuncture) equivalent to zero a priori probability of a positive effect. Administration is probably useless.

    6b. No expected harm based on known physiology (e.g. prayer, homeopathy (provided produced under GMP with sterile and pure water), Riki, most foods, some supplements, inert placebos. Administration is probably not harmful.

    7. Intervention expected to be harmful based on known physiology (coffee enemas, liver flushes, HBOT for seizure associated disorders, chelation, acupuncture (it does break the skin causing potential for infection)). Administration is probably harmful. A clinical trial on these interventions should not be done unless and until there is increased understanding of the physiology involved such that the assessment that the intervention is probably harmful in the intervention population changes. If there happens to be clinical data (as in acupuncture) showing that it isn’t very harmful, that could trump theoretical arguments that it is harmful, but potential harm mechanism have to be taken into account. A lack of infections doesn’t relieve the practitioner from practicing infection control. There haven’t been RCTs of sterile technique in surgery either.

    8a. Interventions known to be harmful in an individual, idiosyncratic drug reactions, drug allergies, known drug interactions (MAO inhibitors plus amine drugs e.g.), teratogens in pregnant women,

    8b. Interventions known to be harmful in all humans (silver supplements, radioactive water). Known to be harmful people administering it should be prosecuted for criminal assault, poisoning and/or battery.

    For example, some types of chemotherapy are quite toxic and could cause harm. They can only be tested in a clinical trial because there are good physiological reasons to expect they would be beneficial to some people with some types of cancer. The testing in a clinical trial allows the benefit/harm ratio to be measured with sufficient precision to determine the benefit/harm ratio. If it is good, the treatment can be used, if not, then it can’t. Similarly, some antibiotics are teratogens, some antipsychotics are teratogens, but sometimes the ratio of benefit to harm is such that giving them is not a bad idea.

    Many of the HIV deniers dismiss the effectiveness of HAART because the comparison group isn’t a co-current placebo group, but a historic untreated or a historic placebo group from the first trial. If the “benefit” of HAART were compared against the “harm” of untreated HIV, the fact that they are in separate trials only adds modest uncertainty, much smaller than the benefit.

    A treatment with no physiological basis for a therapeutic benefit and no clinical trials showing a therapeutic benefit has no place in medicine. People can do it as entertainment if it isn’t harmful, but some chiropractic manipulations are potentially harmful and should not be done even for entertainment without full warning and disclosure.

    I think that EBM has to include explicitly include anecdotes and other lesser sources of information in its treatment basis hierarchy. It is included, the paper that Dr Crislip linked to in the earlier post explicitly allowed for use of anecdotes in determining idiosyncratic adverse drug reactions where the increase in harm and potential for harm is severe, but anecdotes of benefit in the absence of physiology or clinical trials doesn’t increase the likelihood for benefit very much. EBM should say that “we do include anecdotes of harm” (which are all that idiosyncratic drug responses are) because they do.

    I agree that EBM isn’t an ideology either, it is a heuristic to weigh different types of evidence to present as treatment options to the patient. It is simply a tool to make explicit and formalize what most clinicians do implicitly.

    The problem with CAM is that they are trying to “game” what ever system there is to get their woo accepted as legitimate. The heuristic used by EBM isn’t designed to be resistant to gaming or to outright fraud. Designing systems to be resistant to this type of failure is quite difficult and is known as the Byzantine Generals problem (where there may be erratic or traitorous elements in the network doing distributed decision making).

    http ://

    The article points out that many Byzantine fault tolerance methodologies fail when the number of traitors exceeds n/3.

  14. scotsilv says:


    Studying under cardiovascular surgeon Victor P. Satinsky, I learned that the response to nonsense and hysterical people who live nonsense should be simple and quite direct.

    Let’s be plain.

    Postmodernism is bullshit.

    It is in reality pre-modernism, a return to child like superstition and foolishness that characterized the pre-monotheistic human race, when morals were relative and he who had the largest sword and most brutal, bloodthirsty demeanor defined those morals.

    As Victor Satinsky might say, Postmodernists spew their drivel right up unitl the time that they get crushing chest pains radiating downt hat left arm, diaphoresis, pallor and a feeling of impending doom.

    Then, most seek out the security of that Western science-based institution, the ED, what with its access to physicians, EKG machines, cardiac enzymes tests, defibrillators, vasodilators, pressors, and ticket to cath lab and/or CCU when necessary – all of those having been developed and perfected thanks to Western science.

    And those postmodernists stupid enough not to seek medical refuge under such circumstances face their last battle with Western science: natural selection.

    — SS

  15. Fifi says:

    Dr.s Sampson and Atwood – Of course I offered a simplistic version of PoMo, so did you when you presented it as the root of all evil. The fundamental point I wanted to address was your assertion that PoMo declares there that the physical world is subjective, a new age idea and not what PoMo asserts. You also made PoMo (and giving women and minorities access to universities) responsible for everything from 60s radicalism to the decline in critical thinking. That’s just silly and ignores the much more influential social factors that created a culture of idiots in the US. It’s amazing how affluence allows idiots to float to the top. (Bush would be a perfect example of how privilege allows one unearned access to – and graduation from! – an elite university based on wealth and connections, but I see no complaints about his ilk bringing down the level of intellectual discourse, while you blame affirmative action!)

    As I said and you keep seeming to ignore, PoMo states that narratives are subjective and shaped by their context. Yes, that’s PoMo expressed in its most simple form. Would you prefer I dress it up in excess verbiage to make it appear more complex so we could hurl big words at each other like monkey’s throwing poo? Academic poo is still poo. PoMo is really not as complex as people think, though like many ideas in academia it’s dressed up like a cheap whore to make it look like a more expensive idea (add in the general tendency of academics to try to baffle with bullshit and intellectual hubris which means a lot of gibberish goes unchallenged , with the translations of some texts wich make them a bit confusing in English, and there’s a lot of people out there who don’t actually understand what PoMo means…but then a lot of people don’t understand cultural theory very well either, particularly if they’ve never spent real time outside of their own culture).

    Post-Modernism has nothing to do with a “return to childlike superstition” – I’m starting to feel like I’m talking to a bunch of new agers about science when talking to you guys about cultural theory!

    Yes, morality is a construct – generally constructed upon the tenets of religion. Do you seriously believe morality isn’t a construct?!? (Sure we have a basic ethical nature that emerges from being social animals, which is facilitated by empathy, but morals certainly sometimes go very obviously against nature or label them as “sin”.) For a long time the medical community and science (academic and practicing doctors) treated homosexuality as disease and unnatural. Why? Certainly not because people didn’t see animals having homosexual sex or the evidence that it was natural didn’t exist, but because there was a societal “moral” and religious bias against homosexuality and the observers couldn’t move beyond their own bias to see reality. This bias was so strong that instead of being able to see the evidence in front of their eyes, alternate theories were constructed to explain the behavior in a way that supported the religious moral bias present in society. Not surprisingly, once societal prejudice started to abate scientists who didn’t hold those prejudices were able to see homosexuality for what it is (rather than through the lens of the dominant social religious morality).

    Similarly, it was a common and long held notion amongst scientists that animals don’t feel love or have similar feelings to humans. Why? Once again, this was based in the Christian idea that humans are special because they have souls and are apart from and “above” other animals – that love is “divine” and human not animal. Now it’s accepted that mammals experience love and that it’s an evolutionary feature that ensures mammalian offspring survival due to the unique features of mammalian young. Of course, it was also a very convenient belief for researchers who worked with mammals. As someone who grew up godless around science, it was interesting to observe socio-religious bias at work in science and how science usually drops a bias AFTER a social movement has had significant social impact (this was very much the case with bias against homosexuality).

    These are just two examples of how Western academic science has been influenced by the political, social and religious context in which it exists. It does not, of course, reflect badly on the scientific process or method but it does on the people who distort science and refuse to recognize their own biases. The process of science isn’t about any one culture – it’s a methodology not a belief system – and it is influenced by whatever context it’s practice in, whether that’s China and the political and cultural pressures that create an atmosphere where there is a bias towards positive results or the US where apparently it’s being used (like the kid of divorcing parents who is used as a pawn) and abused by academics, religious types and politicians fighting over power and turf. It seems pretty weak to me to claim that the history of academic medicine and the practice and teaching of science isn’t influenced by the context it’s practiced in when you’re complaining about the current context and conflicting ideologies.

    Perhaps you could start speaking about “Medical PoMo” because whatever strange variation of PoMo you guys all have a hate on for doesn’t actually bear a great deal of resemblance to the cultural or literary theory. I’m not even a huge supporter of PoMo as a theory – though some of it has been quite prescient and applies quite well to our post-analogue and post-industrial world.

    Reality is what it is and it’s not the same as truth or morality, both of which are also claimed by religion as its domain. Claiming them for the socio/political perspective you hold seems to once again make your post even more ideologically motivated. EBM, or at least what I support as EBM, is about discerning reality as best we can to provide effective treatment not “morality” or “truth”. I don’t hold any illusions that individual humans are objective, which is why it’s been exciting seeing science finally overcome some of the social biases it was influenced by (based in religious social morality and personal prejudice) as both society changes and better tools have been developed. Labeling “60s radicals” and policies created to give minorities and women access to institutions which previously excluded them as PoMo makes your post sound even more politically and ideologically motived. Maybe you can’t see this or don’t understand how your post may read to others – or how linking EBM and the scientific method to your position and academic infighting in the US – does both the scientific method and EBM a disservice. You can tell me I’m “wrong” as much as you like – we clearly hold quite different positions on a number of social and political issues, which you touched upon in your blog post that you claim isn’t about ideology when it clearly contains some very cliché ideological elements to do with academic in-fighting at elite US universities. I didn’t post to be “right” or argue the finer points of PoMo (or defend PoMo), I did so in exactly the same spirit as I do when I see people promoting pseudoscience as science and because, quite frankly, I’m turned off by the ideological bent of the blog post, which very unfortunately lends validity to accusations by some proponents of CAM.

  16. Wallace Sampson says:

    Aw, Gee. Here I thought I was on to something. Not that it’s original and fresh – people critiqued PoMO before I knew it existed. I went to a PoMo conference in SF at the request of some skeptics in 1989 or so, who got me to start a brief stint in a weekly FM radio talk show. (Now that’s something original you didn’t know.) But I did not know postmodernism until the md-90s.

    The major sectarian sCAM problems have in just 9 months been examined and turned inside out here. So I’m looking to other background ideas, hoping to uncover influences on current thinking. (Sound familiar?) A kind of blogging PoMo jiu-jitsu?

    Fifi, many here have already demonstrated familiarity with PoMo. And PoMo is largely irrelevant in the hard and biological sciences. On the other hand, SCAM literature is scattered with PoMo language, references, and “narrative.” It is now an embedded meme – a convenient heuristic. Thinking generated through relativism and PoMo affect areas not noted before. The postmodern meme is being used to justify a pluralistic medical system – or, a plurality of systems. The meme enables tolerance of unresolved conflicts and concurrent unrelated explanatory concepts. It minimizes the cogency of EBM, which is one contributing method to resolution of those conflicts. Living color paradigm change.

    Fifi, note also that I have not involved EBM. But I want to explore changes in the Academy that affect classical medical science and classical thinking, and the possible current and future alterations in medical school teaching. Postmodern approaches, especially political-economic concerns dominate thinking and teaching in medical anthropology and sociology courses. I will present examples. I hope you continue reading and see the connections.

    Regarding the analysis of my emotional states, I thought blog communities encourage colorful expression, free of the formalities of scientific journals. Are the rules changing?

    Daedalus, Good points. Some have thought of these other indicators, yours are welcome additions. We are working on this.

  17. Regarding the analysis of my emotional states, I thought blog communities encourage colorful expression, free of the formalities of scientific journals. Are the rules changing?


    Trust me on this one. If anything, however, we at SBM tend to be less colorful and serious, but that’s just because we have a serious purpose. However, anyone who’s read some of my earlier posts would realize that I sometimes lapse into some fairly, well, colorful language.

  18. Fifi,

    Speaking only for myself:

    I didn’t present PoMo as “the root of all evil.”

    I certainly didn’t make “PoMo (and giving women and minorities access to universities) responsible for everything from 60s radicalism to the decline in critical thinking.” Nor, for that matter, did Wally. My own view, and he might agree, is that extreme cultural relativism, also called the “strong programme,” gained traction in universities partly as an unintended consequence of some of the good ideas of the ’60s, including, for example, increasing access to minorities.

    Such access was a GOOD idea. What was not a good idea was “solving” the problem of many (NOT ALL) newly admitted minority students having been poorly prepared for higher education by inflating all grades or by redefining all academic standards. That happened; at least part of its rationalization was self-righteously provided by advocates of what is now called PoMo: that the old standards (“excellence,” for example) were nothing special, just a way to “privilege” the “dominant culture.” I was there; I heard it frequently; plenty has been written about it, both for and against.

    Irony: the privileged honkies who pushed this crap, with their residual ’60s guilty consciences, were doing no favors to those that they imagined they were championing.

    Such “deconstructing” of previous standards hurt all students: it’s the reason, for example, that most members of my generation (college in early ’70s) are barely literate and are easily duped by misleading language. Dubya and his pals musta thought they’d died and gone to heaven when they realized that not only had they been spirited through the back door at Yale, but that so little would be expected of them that their cover wouldn’t be blown.

    Entry to an elite college based on wealth and connections, of course, has been around for centuries and can therefore hardly be blamed for the recent “dumbing down” of society. It’s also a different topic. Do you need to be reminded that it’s an example of the tu quoque fallacy?

    I agree with some of your points about the social bases of morality, but I would argue (as have many others) that at least in the secular world, there has been a trend toward greater freedom, human rights, justice, and compassion over hundreds of years (since the Enlightenment, mainly). PoMo, ShmoMo.

    I strongly disagree that social movements have typically preceded scientists changing their minds. One of the great ironies of the PoMo view of the world is that it is oblivious to the important role of cumulative knowledge, especially in the last 150 years, in leading important social changes. As a child in the ’50s I first learned the term “pseudoscience” from scientists who used it to describe craniology and Hitler’s racial “theories.” Sure, some scientists (and more MDs, who have historically been stupider and more conservative than basic scientists) clung to old prejudices, but you can be damn certain that science itself, and therefore many scientists, were in the vanguard of change.

    Darwinism itself (not “social Darwinism”) was, and still is, a tremendous source of what might be called secular liberation thought, as you’ve suggested above (ironically, it seems to me), precisely because it overthrew previous, arbitrary, religion-based dogma.

    My own teenage “consciousness raising” experience regarding the prevalent social bias against homosexuality went something like this: since it seems to exist in every human culture at about the same frequency, since homosexuals describe their early feelings of libido in much the same way that heterosexuals do (ie, it simply, but powerfully, happens to them), and since it also appears ubiquitous in other mammals, it’s almost certainly a fact of biology, if not necessarily “genetic” per se. In general, it’s obviously not a “choice.”

    Since religious explanations of human origins have been shown to be myths (Darwin again), and therefore religion-based moral codes can reasonably be questioned, any argument that homosexuality is immoral, or that homosexuals ought to be limited by social pressures in some way, had damn well better be strong ones, based on reality rather than myth. Well, duh: there are no such arguments. No PoMo needed there.

    The same point is even more easily made about animals, and once again you have made it yourself. It was Christianity that declared that animals have no “souls,” but it was science that blew that ridiculous notion out of the water. It is an objective, scientific outlook that allows us to see what our ancestors could not, having been fooled by the superstitions of their time: that we ourselves are animals (Darwin again), and that it’s quite obvious that we share many traits, including pain and other forms of suffering, with our close mammalian relatives.

    No PoMo there. PoMo, in fact, distracts from that obvious truth by insisting, as it does, that no truths are obvious. To PoMo, our recently acknowledged kinship with animals is just a superstition of our own (postmodern?) times. So is our new-found “tolerance” for homosexuals, which is far from complete but if PoMo had its way would be even more vulnerable to recidivism than it is. After all, it would be just another superstition, based on nothing more than a shift in “power,” without any firm ethical basis.

    Well, no. It really is better, in an absolute sense, to base social mores on reality rather than on myth. Science doesn’t tell us how to treat homosexuals, but it certainly informs us that traditional, malicious treatments of them have been based on myths. We really are kin to animals, in the most fundamental sense of the term. We always have been and we always will be, whether we knew it or not or whether we continue to know it or not. It is not a social construction. Much of what we do is “socially constructed,” but this is trivially obvious and needs no frowning, sanctimonious PoMo spewers to explain it.

    Again, the way you describe PoMo makes it sound unremarkable: social things affect science and everything else, to varying extents. Everyone knows that and knew it before anyone had heard of the term “PoMo.” PoMo has added nothing of importance to science or medicine, but it has distracted from those, as in the examples that Roy Poses offered or the paper that David Gorski criticized, linked above. That paper is PoMo drivel at its finest.

    Here are other examples relevant to SBM material: from one of the book reviews in the NEJM, “Bivins questions why researchers continue to assess treatments from other cultures in a Western framework.” ( );

    There are quotations from David Katz that I didn’t bother to include here:

    Here they are:

    “Do we not routinely ignore evidence that diverges from our native preferences(?)”

    “Dr. Atwood might revisit Hamlet’s precautions to Horatio if inclined to think all truth, and only truth, resides within the realm of our allopathic philosophy.”

    If you go to the source ( ) you’ll see how handily Dr. Katz combines such nonsense with a generous helping of tu quoque. Dishonesty in language and logical fallacies are frequent bedfellows. Yet that doesn’t mean, PoMo style, that the first begets the second. I know you know this, Fifi, because you’ve been commenting for a long time and what you’ve written above is a surprising departure from the rest.

    Is it not clear that PoMo is one of the arrows in the sheaths of some sCAMmers? Of course it’s not the only one, but we never said it was.

    Finally, there’s a suggestion in your writing that its merely the misuse of the term “PoMo” that you object to. Perhaps I’m wrong, but it seems that you don’t believe in the “strong programme” of cultural relativism any more than I do; rather you object to its being called “postmodernism.” Perhaps you are right about that in some sense. I’m not a linguist or a PoMo historian. There is, however, an ample literature of both PoMo proponents and PoMo critics who use the term in the way that you find objectionable. See, for example:

    Such use is the norm; you’ll have to excuse us if we’ve been misled. Nor can it be compared, for example, to the common misuse of “allopathic,” which has both an etymology and a history that demonstrate it to be misused. “Postmodern” has no such etymology (from that point of view it is an absurdity), and whatever history it has is likely to be ambiguous–just as our differing understanding of it appears to be.

    What is not at issue is the reality of the phenomenon that many have called “PoMo” but that also goes by other terms, eg, “cultural relativism,” “social constructivism,” “critical studies,” etc. It is real and it is injurious to rational, skeptical inquiry. It is also a rip-off, in that it’s fed to unwary college students. If you still protest, consider physicist Alan Sokal’s discussion of Bruno Latour’s “semiotic analysis of the theory of relativity” beginning on page 13 of the book linked above (the first 14 pages are available for free at the link). According to Sokal, it seems that for Latour, “Einstein’s text is read as a contribution to the sociology of delegation.”

    Sokal continues: “Why is that? Because Latour finds Einstein’s popular book on relativity full of situations in which the author delegates one observer to stand on the platform and make certain measurements and another observer to stand on the train and make certain measurements; and of course the results won’t obey Lorentz transformations unless the two observers do what they’re told! You think I exaggerate?…”

    Please click on the link to read a follow-up quotation from Latour himself, if you still doubt the reality of this crap.

    Sokal concludes:

    “The upshot is that Latour has provided 40 pages of comical misunderstandings of a theory that is nowadays routinely taught to intelligent college freshmen, and ‘Social Studies of Science’ found it a worthy scholarly contribution.”

    And it ain’t just in the US.

  19. pmoran says:

    Fifi: ” As someone who grew up godless around science, it was interesting to observe socio-religious bias at work in science and how science usually drops a bias AFTER a social movement has had significant social impact (this was very much the case with bias against homosexuality).”

    But would the social movement have been effective or even gotten off the ground without parallel improvements in the scientific understanding of homosexuality including the shaking off of some of the influence of Freud? Who has sufficently in-depth acquaintance of such complex events as to be able to pronounce judgment? Probably not any post-modernist theorist.

    I certainly have no expertise at all in these fields. All I know is how easily it is to look at complex matters and see only what prior biases and pet theories demand. We all do it.

    I agree with Kimball that it is trivial to state that we make mistakes (or mostly possess only first approximations to the truth) and are influenced by prior biases. It can lead us into further error if we focus only on selected sources of mistaken belief and fail to recognise the innate self-correcting nature of science and the many other factors that influence its progress (such as technology and improving methodology).

    I do share your discomfort at some of the attitudes expressed l on this blog but we don’t own it.

  20. daedalus2u says:

    fifi, excellent comment. You have put it all into very nice perspective which I actually think I now understand what postmodernism is. Not that understanding it in any way makes it useful to me, other than as a bad example of how to think.

    This does relate to some things I am working on (in a somewhat tangential way) trying to relate individual attainment of the ability to communicate during neurodevelopment (i.e. language acquisition) as acquisition of a “theory of mind” (which is used to map language symbols (acoustic, gestural, visual, symbolic, etc) onto neural networks so as to invoke a certain mental state (the thinking of the idea being communicated)). To a very large extent, the mapping of communication symbols to neurological states is completely arbitrary. A particular language symbol only has a specific “meaning” because all communicating individuals have agreed (often implicitly) that the symbol has that meaning. The “theory of mind” (the mapping of symbols into thoughts) works best at communication if all individuals in a society share exactly the same mapping, and if that mapping is invariant over time (i.e. completely rigid).

    I think this relates to the great trade-off during neurodevelopment, the trade-off of “theory of mind” for “theory of reality”. A “theory of mind” is arbitrary so long as it matches the “theory of mind” of everyone else, a “theory of reality” must actually correspond to reality as it actually is. A “theory of reality” must be changeable and must change as new information and new relationships between information becomes apparent.

    A “theory of mind” is the only way that people can understand other people. The only way that one can communicate is by translating a thought generated in one’s own “theory of mind” into language, communicating that language to another where the other then translates that language into a thought via their own “theory of mind”. Communication is only the transfer of mental states by the exchange of communication symbols. If the neural networks that comprise the two individuals’ brains are unable to support equivalent mappings of the same mental states, the two individuals cannot communicate that idea in any way.

    The social and moral ideas that prior societies held as invariant truths, were simply components of the shared “theory of mind” that the society had, and they were unable to conceive of not having them. These are analogous to the paradigms that Thomas Kuhn talked about in the structure of scientific revolutions.

    For those with a strong “theory of mind”, these paradigms are difficult if not impossible to change. I think that to a large extent the combined set of those paradigms is a reflection of when one’s “theory of mind” became fixed. I think that relates to when one loses the ability to form a Creole language as part of a group.

    When children acquire language, they adopt the language used by the adults around them, provided that language is “well formed”, that is provided it has the appropriate grammar and syntax. If the adults are speaking pigeon versions of languages, languages without a well formed grammar and syntax, the children will synthesize a new language, a Creole out of those components, but one that does have a well-formed grammar and syntax. The various sign languages didn’t become “well-formed” complete languages until children learned them as their first language. They then modified them such that they then did have proper grammar and syntax.

    How this fits into PoMo and CAM is that one “theory of mind” is just as good as any other “theory of mind”. It is largely arbitrary. However if one has a strong “theory of mind”, and a weak “theory of reality”, one may use one’s “theory of mind” instead of one’s “theory of reality”. A “theory of mind” is good for communication, both projecting and receiving. A “theory of mind” is not good for thinking about reality. An individual with a strong “theory of mind” can project that “theory of mind” onto others. I think this is what happens when people say they are “making their own reality”. They are not, they are simply forcing others to “drink the Kool-Ade”. This is how many “beliefs” with no basis in reality are transmitted and also academic bullshit.

    When one uses a “theory of mind” to try and think about reality, one can only think in anthropomorphic terms. Objects are treated as entities with anthropomorphic properties, not as objects with non-human properties.

    This is what Uta Frith showed in her work on individuals imputing emotional motivation to moving triangles. Triangles don’t have mental states and emotional motivations. Any imputation of such is on some level a type 1 error, a false positive. Dr. Novella has a good post at his blog on Hyperactive Pattern Recognition. Good communication requires good pattern recognition and good matching of a signal to a pattern. There is an immutable trade-off of type 1 errors (false positive) for type 2 errors (false negative).

    I think that fundamentally “theory of mind” is done non-algorithmically via neural networks that are (mostly) hard-wired. The process is transparent to the user, and the details are not available for analysis and testing.

    “Theory of reality” is done via algorithms that emulate the interactions under consideration. The primitive details are available for analysis and modification the way that a “theory of mind” is not.

    A “theory of mind” is fundamentally not equivalent to a “theory of reality”. A “theory of mind” doesn’t allow access to the primitive mental operations necessary to modify a “theory of reality” for it to actually correspond to reality. A “theory of reality” can be used to emulate a “theory of mind”, but it is a slow and cumbersome and error prone process. Someone with only a “theory of mind” may not have the ability to appreciate that they don’t have a viable “theory of reality”. They want to apply their arbitrary “theory of mind” and use it as equivalent to a “theory of reality” which it isn’t and never can be.

    In the ideal limit, science (and ideally physical medicine) is done with a “theory of reality” and doesn’t require a “theory of mind”. Mental health (non-pharmacological aspects) is done with a “theory of mind” that is interfaced with a “theory of reality”. The placebo effect is mediated through communication, so it requires a “theory of mind”.

    CAM is done with a “theory of mind” with no connection to a “theory of reality”.

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