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Science-based medicine and Eurocentrism

A reader sent me an interesting post from her own blog. It’s well-written, compelling, and betrays an exceptional intelligence. It’s also completely wrong.

The piece is called, “Bias, Racism, and Alternative Medicine”, an intriguing title. The first part tries to establish that “Western medicine” in one of many ways of understanding health and disease. She starts with some personal anecdotes—always interesting, rarely generalizable:

While receiving Western biomedical treatment for ADD, the side effects of my therapy convinced me that western medication alone would not provide a solution to my problems.

One of the author’s fundamental misunderstandings is that the failure of a particular treatment to make her feel better does not invalidate all of medical science, and more important, it does not validate “other ways of thinking”. Still, I can understand how this happens. Personal experience is powerful; unfortunately, it is also misleading. I like this writer. She seems very kind. She goes on to describe her enlightenment further, but this is where a pleasant anecdote goes terribly wrong:

It was because eating the wrong kinds of foods, along with other stressors like studying all night, raises the inflammation of the body.

I worry for her medical soul.

Her statement about inflammation is just flat out wrong. If this is what she’s learned from medical school, she deserves a refund. “Raises inflammation in the body” is simply a meaningless statement. The author is trying to leverage her anecdotes about medical conditions that naturally wax an wane into a general statement about alternative medicine. This is a mistake.

This first part establishes her belief that so-called Western medicine is missing something, and that “other ways” of understanding disease have value. Having established that “Western” medicine doesn’t know everything, she tries to explain why this may be, not on the basis of scientific knowledge, but on the basis of cultural hegemony. Bad idea.

But neither am I in the group of Western medicine trained students or doctors who refuse to see other medical systems in their own rights, and therefore cannot make sense of why patients seek alternative treatments.

This statement rests on a faulty assumption, namely that we “Western” docs have failed to properly examine other medical systems, and have failed to understand why people believe in them.

I understand other systems—they are based on false, vitalistic, pre-scientific beliefs about nature. Understand, that’s not a moral judgment but a factual one. I also understand why people believe in things. We all have our own cultural context, our own baggage. We all wear blinders of one kind or another. I can’t tell you how many minority patients I’ve had who don’t trust doctors because of larger cultural experiences; it’s a lot though. But none of this changes what is biologically so. The fact that the Tuskegee Experiment allowed African American men to suffer and die from untreated syphilis does not change the biology of the spirochete; it changes the relationship of individuals and groups to the system as a whole. Failing to understand this can lead from one kind of neglect (e.g., Tuskegee) to another (e.g., Ayurveda).

An important thing to understand as a scientist (or as an “applied scientist” like a doctor) is that while what we do and how we do it is suffused with cultural biases and stereotypes, the physical reality is not. We may choose to ignore the genetic and cultural reasons that a minority group is more affected by a particular disease, but the genetics do not change. This is something the author has yet to learn:

Why do we lump all of these very different systems and practices of medicine into one category called CAM? What are these alternatives to? Missing from the picture is that CAM is only alternative to a Western biomedical system of medicine, and one form of CAM might be considered an alternative by a practitioner of a different CAM. This Eurocentric attitude, that the traditional Western biomedical system is the epitome of medicine itself, exists in even international organizations like WHO.

The answer to the question, “what are these alternatives to?” is “science-based medicine”, not “hegemonic, Eurocentric medical beliefs”. We consider science-based medicine to be the “default” because it is the one that reflects scientific reality. This doesn’t diminish the important role played by religio-medical beliefs in many people, but it does place them in the proper context: the are quasi-religious beliefs, not scientific ones, and people hold to them for various cultural and economic reasons—important reasons, but not science-based reasons.

Why are Africans and Asians said to use “traditional medicine” but not Europeans or Americans? In America, the Western biomedical system is our tradition.

Actually, our “tradition” has its roots in the vitalistic and humoral beliefs that we held to for most of our history. Our current understanding explicitly rejects these as pre-scientific and rather than forming a new “tradition” sets tradition aside for a reality-based system.

I understand where writing like this comes from. Many voices in this world are not heard, especially voices of women, non-whites, and the poor. These voices are particularly important in medicine, since we do not normally choose to serve only one population (although some do). The historic dearth of women and minorities in the sciences is an important fact, one that needs fixing for many reasons. One of these reasons is that we must serve everyone, and to serve everyone it helps to be everyone. Serving may mean understanding where someone’s beliefs come from, and even respecting these beliefs, but it does not mean endorsing these beliefs. They may be morally equal beliefs, but they are not scientifically equal.

She is right when she says we are biased, but not in what way we are biased:

Have we really recognized our own bias when evaluating a CAM therapy? We haven’t even removed the biggest bias of all, which is to see the Western biomedical system as the one and only valid form of science and medicine, instead of admitting that it is one system among many.

No. Our bias is not failing to recognize other ways of knowing, but in failing to treat other human beings with respect.

Our brave author closes with this:

I cannot comment on the efficacy of each non-Western medical system, because I’m not being trained in any of them, and I don’t have the understanding to praise or criticize those systems. Our version of medical reality has receptors, hormones and nerves, etc. Someone else’s medical reality includes energies, meridians, or doshas. We may be so ingrained in the traditional Western biomedical model that we’re unable to make sense of anything that doesn’t use the same concepts or language. However, many patients accurately see that there seems to be different ways of understanding a health condition, and they will choose the one that makes them feel the best at any given point in time. Even if we can’t accept their logic, we’ll have to accept that traditional medicine from other cultures will gain a stronghold in our population, just as we have imposed our traditional medicine on theirs.

In fact, as a trained physician and scientist, you can comment on “non-Western” systems quite effectively. You are in a special position to do so. This isn’t about “concepts and language” but truth and non-truth. To be better physicians and scientist we must understand why people believe what they do, and we must find ways to help our patients take advantage of real medicine in a way that does not violate their basic values. That is moral. What is not moral is placing other’s health at risk by declaring all knowledge equal but different, or in someone else’s words, “separate but equal”.

Posted in: Science and Medicine

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65 thoughts on “Science-based medicine and Eurocentrism

  1. Scott says:

    We’ll see how vigorously censored that blog is. Here’s what I attempted to post.

    You really ought to ask for a refund on your science classes.

    Someone else’s medical reality includes energies, meridians, or doshas.

    There’s simply no such thing as “someone else’s reality.” Facts are facts; just because some people choose to deny them based on effectively religious reasons doesn’t make them any less true.

  2. BKsea says:

    One myth to dispense with is the idea that “Western Medicine” systematically ignores “traditional medicine.” Some part of western medicine has been built on the basis of traditional methods that actually work. Every time someone takes codeine, they can thank the traditional use of poppies dating back at least to Mesopotamia. I am sure there are better examples than this, too. The fact that claims of traditional medicine/CAM are commonly scientifically examined shows that science-based medicine is open to new methods. They just have to be shown to work.

  3. Kausik Datta says:

    Scott, I was going to comment, but then I saw your post here. It is now 4.39 pm EST, but your comment has not still appeared on her blog. I shall wait and see.

    Peter,

    I worry for her medical soul.

    You worry for her medical soul? I worry for the entire patient population that she is going to peddle worthless nostra to! By her own admission (see her own comment, at #2):

    i’d given ND school a thought but was still to embedded in the biomedical model to turn around. i hope i can at least do a good deed as an MD and refer patients to other healers.

    I am beginning to despair of these two terms, culture and tradition. They seem to be used indiscriminately to justify any amount of woo-woo in every sphere of life. In fact, this was used as a defense in the trial of the Australian homeopath who allowed his infant daughter to die of eczema and infection by treating her with homeopathy and not proper medical treatment. The defense lawyer made a big hooey about the fact that the person was of Indian origin, and therefore, was from a “culture” where homeopathy was an acceptable form of therapy. Thankfully, this did not wash in the court, but it left a very bad taste in my mouth. As an Indian, I am proud of my culture and heritage that has celebrated learning, knowledge and education since time immemorial, but I am also painfully aware of the culture of intellectual blindness, fatuousness and stupidity that pervades the climate of the country now.

  4. mckenzievmd says:

    Thanks for a cogent and clear response, with which I agree completely.

    Just to add a slightly different perspective on the argument to which you are responding, I would suggest that the cultural relativism underlying it is a two-edged sword. I tend to be a bit of an extremist myself in that I view many cultural values and institutions as arbitrary and having no universailty, no intrinsic meaning. And it is true that a certain degree of such relativism makes a nice antidote to the ethnic/religious/nationalistic myopia and bigotry that is all too common a human failing.

    However, while cultural reality may be a “construct,” as the post-modernists like to say, it’s not hard to demonstrate that physical reality is not. No cultural point of view prevents one from plummeting off a tall building. Antibiotics cure susceptible bacterial infections whether one believes in them or not. And homeopathy makes lousy birth control regardless of one’s perspective on the issue.

    I often find, however, that these post-modernist defenses of CAM are a bit inconsistent. While arguing that the realms of physics, chemistry, and biology are somehow relative to one’s point of view, despite the apparently obvious evidence to the contrary, the makers of such arguments often hold to universals in moral and cultural realms. They will proclaim that racism, homophobia, misogyny are always and universally wrong, yet illness and health are somehow a matter of perspective. Cancer, diabetes, swine flu are all just “Western” concepts, but human rights are universal and eternal. Prosyletizing for their morality, including the value of relativism itself, seems to be ok, but arguing for a universal reality behind human biology is an attempt to expand a patriarchal Western cultural hegemony.

    I happen to be a flaming liberal myself, so I tend to agree with the politics of the “pomos” while I find their perspective on matters of science shallow and naive. Yet I have yet to get a satisfactory response to why the relativism they promote is only supposed to apply to such matters and not to their own values.

    http://www.skeptvet.com
    http://skeptvet.com/Blog

  5. thatjoeguy says:

    Hey Scott. I’m sure you noticed by now, but your post went up at 7:30. Otherwise, great discussion you’re taking with this.

  6. nitpicking says:

    I wonder why more Indian-descended people don’t try to revive the ancient philosophy of Carvaka/Lokayata:
    http://en.wikipedia.org/wiki/C%C4%81rv%C4%81ka

    We don’t know as much we might about it because the theists exterminated it along with Buddhism, but it was a skeptical, rationalist, atheistic philosophy at one time very influential in proto-India.

  7. Prometheus says:

    I see that the Post-Modern movement has claimed another victim.

    While post-modernism may have a certain validity when discussing sociology, literature or art – fields where what is “good” and what is “bad” are largely influenced by culture – it completely fails when there is an objective reality.

    Some post-modernists – at least the more rabid variety – even argue that there is no objective reality and that everything is influenced by culture, but that doesn’t mean they won’t go “splat” if they step off the roof of a tall building, even if their “cultural norms” don’t include a belief in gravity.

    This poor, deluded person is in the grips of post-modern thought and deserves our pity. Few people ever recover from this disorder and those that do are often scarred for life.

    She clearly has also not done any reading in the history of medicine – or the history of the Western World – if she thinks that there is no “traditional Western medicine”. Like, “traditional Chinese medicine”, “traditional Native American medicine” and “traditional Indian medicine”, “traditional Western medicine” was/is based in sympathetic magical, vitalistic thought and sprituality.

    Some varieties of “traditional Western medicine” that are still extant are homeopathy, chiropractic, naturopathy, “faith healing”, exorcism and intercessory prayer. To these we should probably add practices such as “crystal healing”, “thought field therapy” and the many varieties of “energy medicine” (and others which I am – no doubt – forgetting) which, although they are not as old as the other “traditional Western medicine” practices, have many of the same features.

    What all of these “traditional” medical practices have in common is that they do not (or have not been shown to) work. If they had, they’d be part of “modern medicine” (i.e. real medicine). That’s the difference between real medicine and “traditional medicine”.

    Now, I expect that a number of people will write saying that they, their relatives or their friends have been “cured” by one or more of these “traditional” medical practices. However, when these practices are rigorously tested, they have regularly failed to show efficacy.

    The sad fact of the matter is that there is an objective reality and that our thoughts and culture cannot change it a bit. “Other ways of knowing” won’t change the reality of the universe.

    Another sad fact of life is that real medicine ruthlessly absorbs any and all effective practices from “alternative”, “traditional” or “complementary” medicine and makes them its own, leaving “alternative”, “traditional” and “complementary” medicine with only those practices that either don’t work or haven’t been shown to work.

    That’s reality.

    Prometheus

  8. antipodean says:

    Is it still Western Medicine when we practice it in the extreme East (i.e. Australia and New Zealand)?

  9. artemis says:

    you write “..In fact, as a trained physician and scientist, you can comment on “non-Western” systems quite effectively. You are in a special position to do so. This isn’t about “concepts and language” but truth and non-truth.”

    Oh dear. Unfortunately for your endearing but apparently naive faith in (medical)science as the complete vehicle, expression and arbiter of truth, the whole truth and nothing but the truth, contemporary philosophy of science flatly disagrees with you. Now most med students don’t do too much history and philosophy of science but CHecking your own bio you mention how much like to read…. have you looked at Nancy Cartwright, Ian Hacking, John Dupre and others of the genre.. maybe check their “facts” against yours.

    Of course there are extremes of socio-historical relativism which are leftist misreadings of Kuhn, but lets not tilt at windmills ALL the time.. ? Modern authors ( as above) in the field admit the real complexities of trying to define scientific truth without lapsing into the dated and long discredited credo of scientism, = the one and only absolute truth, fact is fact etc. which in your parsing is factually precisely just another belief system.

    As a general comment , I wish you guys (the authors/contributors of this blog who are clearly articulate and have a lot to offer) would spend a little less time cheerleading for the football hooligan “biomedicine rules” crowd “CAM sucks” yeah, , CAMmers are stupid – right , GO SCIENCE because it demeans your credibility; tilting at windmills is not only proven in clinical studies to lack efficacy but is a distracted (arguably psychopathic) behavior that risks missing the real content of the debate by dumbing it down to a depressing degree that alienates the thinking folk you are trying to reach.

    Eg Shooting down “antivaccine wingnuts” is fine (windmill yawn) but when Cochrane is agnostic about the benefits of flu vaccines to date, how about helping out the questioning patients who read Medline Plus etc? Ranting against the vaccine loonies and claiming absolute authority is invested in medical practice because of its (religious) relationship to truth is likely offputting to a non-hooligan onlooker.

    But of course its your blog, so you are absolutely entitled to preach to the choir ….

    thanks for the opportunity to comment

  10. wertys says:

    I think the practitioners of SBM in Asia, including Korea, Japan, Taiwan and other countries who contribute so much to medical research and practice might have some feelings about this sort of patronizing attitude to ‘Western’ medicine. As might our colleagues in Russia, the Middle East, Africa and South America….

  11. weing says:

    “Unfortunately for your endearing but apparently naive faith in (medical)science as the complete vehicle, expression and arbiter of truth, the whole truth and nothing but the truth, contemporary philosophy of science flatly disagrees with you.”

    Sounds like a straw man to me.

  12. weing says:

    “Eg Shooting down “antivaccine wingnuts” is fine (windmill yawn) but when Cochrane is agnostic about the benefits of flu vaccines to date, how about helping out the questioning patients who read Medline Plus etc?”

    How true. Do you realize that there have been no randomized placebo controlled trials of parachute efficacy? There have been a few anecdotal reports . But what are they worth?

  13. Peter Lipson says:

    It fails the “leap test”. If you really think realit is so culturally determined (as opposed to scientific-sounding methods being interpreted and used in a particular context), then find someone who believes they can fly and watch them try.

    Bring a mop.

  14. wertys says:

    @Artemis

    That is a somewhat superficial response to the reasonable criticisms some of us have made of your blog post.

    I for one did a Pubmed search for the RCTs concerning windmill-tilting to which you were referring, but the 17 articles returned did not mention psychopathic behaviour and not one of them was a clinical trial as such.

    Actually would it be too arcane to enquire as to why windmills are such an important symbol to you ? They are mentioned three times in your post and they don’t come up much in most conversations on this site, except those about leftist misreadings of Kuhn and football hooligans who practice healthcare professions.

    Pleased to see you took the time to learn our cheerleading slogans, though !

  15. Dr Benway says:

    artemis:

    Oh dear. Unfortunately for your endearing but apparently naive faith in (medical)science as the complete vehicle, expression and arbiter of truth, the whole truth and nothing but the truth, contemporary philosophy of science flatly disagrees with you.

    People use the methods of science to test claims about the world. As with arithmetic, some people are good at the method and some are prone to make mistakes. That’s why we want to see studies replicated by independent parties.

    Is there some other method for figuring out what works and what doesn’t work? I’d really like to know.

    Here’s Mr. Smith, a 67 year-old with prostate cancer metastatic to his spine. He can’t roll over in bed due pain.

    He asks me to help him make it to his granddaughter’s third birthday. He can kinda sorta remember being three, so he’s hoping that if she’s three before he’s gone, he’ll be in her memories. And maybe if he’s there, she’ll remember how much her grandpa loves her. And maybe then nothing really bad will ever happen to her.

    So philosopher dude, whatcha got?

  16. artemis says:

    wertys

    Sorry about the apparent cultural obscurity of my references to de Cervantes, don Quixote and windmills. The original post did imply the author’s capacity to deconstruct Eurocentrism so I thought i was on safe ground….. mea culpa.

    Dr Benway

    “…So philosopher dude, whatcha got?”

    I am not sure what your example of bone met related pain in advanced PC is meant to imply. Mr Smith is apparently running out of medical options. Philosophy is not going to be curative either, but in some respects may be more helpful to him at this time might you imagine?

    But then Perhaps Mr Smith was misadvised at an earlier stage? Perhaps his PC was really aggressive when he was advised by his urologist that he might be eligible for watchful waiting with a typical T1c gleason 5 at age 65… so talking of PC did you catch the report this week UK report of the powerful prognostic value of heat shock protein 27 expression as a marker established in a study of 4000+ cases over 15 years that suggests that a significant majority of cases are over treated….whilst aggressive forms that will inevitably progress may be undertreated.

    One might think philosophy could perhaps be helpful in understanding this sort of problem. Is it ethically correct to overtreat the majority in order to cure the minority when you cannot tell them apart? When the “truth” is not known? Yes, no, sometimes, it all depends? On what? etc and so on.

    On the assumption your medicine is better informed than your philosophy..watcha got doc dude?

  17. Lawrence C. says:

    Artemis seems to be moving towards a point but also seems to have gotten it lost in a lack of brevity. This is, indeed, an excellent blog when it sticks to its domains but starts to go amiss when it tries to measure things for which it is unsuited.

    Knowing the limits of one’s instruments, including any one particular mind with particular training in particular ways of thinking, is one of the beginnings of real wisdom. Of course one “can” comment on anything but the effectiveness or irrelevancy of those comments are left to the reader’s judgment. Even a trained scientist with keen writing skills can produce something “well-written, compelling” and also get it “completely wrong.”

    So the point is this: the one thesis for which there can be in principle no scientific evidence is the thesis that only scientific evidence counts.

    What’s called science-based medicine around here will not be judged by those practicing it but by the people in their care. One can be a much more effective practitioner of “Western” medicine if one stops referring to it as “real medicine” and everything else as “non-truth.” This hyper-reductionist argument is bound to please no patient and can easily bee considered as grossly immoral and needlessly offensive.

  18. pmoran says:

    “Oh dear. Unfortunately for your endearing but apparently naive faith in (medical)science as the complete vehicle, expression and arbiter of truth, the whole truth and nothing but the truth, contemporary philosophy of science flatly disagrees with you”

    No one ever said that scientific knowledge is complete or that present medical treatment has reached an optimum. We would merely claim to have a mind-set that produces desirable results over time.

    Can you provide a concrete example of where the “contemporary philosophy of science” “flatly disagrees” with us, and how it has, or could have, delivered superior outcomes in any respect?

  19. Charon says:

    Ooh, Penelope Maddy, Second Philosophy, contemporary philosophy of science… does not disagree with me.

    Using the term “scientism” is a great indication that you’re talking BS. Science is all about deduction and induction, coherent theories and rigorous empiricism. I would love it if you could explain how the hell else you can figure out anything. (Science is the same thing we do in our daily lives all the time, just much more careful and self-aware, to avoid known cognitive weaknesses.)

  20. wertys says:

    @Artemis
    it’s possible to ruin a perfect laugh by explaining too much but I feel you might like to wear your considerable learning more lightly and with more humility.

    That way you might be able to tell when someone is taking the piss out of you, instead of providing more evidence that you are a somewhat smug intellectual snob.

    I still do believe that your original post is patronizing towards scientific healthcare practitioners who come from outside of north America and Europe

  21. beatis says:

    @ Artemis:

    “… Oh dear. Unfortunately for your endearing but apparently naive faith in (medical)science as the complete vehicle, expression and arbiter of truth, the whole truth and nothing but the truth, contemporary philosophy of science flatly disagrees with you. Now most med students don’t do too much history and philosophy of science but CHecking your own bio you mention how much like to read…. have you looked at Nancy Cartwright, Ian Hacking, John Dupre and others of the genre.. maybe check their “facts” against yours…”

    Oh dear. Unfortunately, not only does your comment show that you do not fully understand the nature of scientific fact-finding, it also shows a limited knowledge of contemporary philosophy of science. You might want to look at Susan Haack’s work for example.

  22. lynninAustria says:

    Dear Mr. Lipson,
    I am replying to your post and ignoring those comments that appeal to emotion or contain personal slights. They do not interest me.

    your bias is that you are certain that science-based medicine is the only one having merit, and the only one that should consequently be practiced.

    Let me sum up the main s.based medicine vs. CAM arguments as I understand them.

    1- Science-based medicine is effective
    2- Science-based medicine is the best we have :
    . It shows reliable results for the greatest number of patients for the greatest number of diseases, doing the least harm (or side-effects or collateral damage – please excuse the medically inappropriate term)
    . It is based on facts and scientifically rigorous and proven methods.

    3- Science-based medicine is not perfect
    . because people make mistakes
    . because there is (still) a lot it does not know.

    4- This last argument does not invalidate the first two!

    5- CAM has not been shown to be reliably effective by scientific research, so far as it has been done.

    6- The evidence that CAM is effective is based on anecdotal evidence.

    7- CAM does not satisfy the standards of scientific methodology

    8- Some practises may be harmful or fraudulent

    9- Many people report having been helped by one form or another of CAM.

    10- arguments 5, 6, 7, and 8 do not invalidate argument 9, which is why I come out in favor of more tolerance. I welcome the practise of allowing some forms of CAM into official medicine.
    It is a good way of controlling abuses.
    As I see it, in the worst case, CAM is no better than a placebo, but if it helps many patients’ well-being, it has value, even if it is not scientifically demonstrated.
    Some argue it is a slippery slope, but with a good security rope and appropriate shoe soles, doctors may discover that they do not uncontrollably slip downwards, but are able to see unsuspected new horizons.
    Best regards,
    N. REY

  23. lynninAustria says:

    Let me try a different line of argument. Why should the testimony of many people be sufficient to validate some practices of CAM ?
    I am not talking about validating, just about being tolerant about some practices. I resort to alternative medicine when science-based medicine fails to help me, specifically, when I feel the first symptoms of a common cold coming on, I take a dose of a homeopathic remedy available at a pharmacy, and nine times out of ten, the cold fails to develop. As a skeptical individual, I accept that there may be many reasons for this other than the medicine. Maybe the symptoms would have disappeared anyway. However, when I try other methods such as lots of vitamin C and fluids and rest, it does not work. It is possibly a coincidence. Maybe the remedy works because I believe it will, and it is just a placebo effect. The fact is : I don’t care. I am happy I have found something harmless that works well enough.
    If you of the medical community tell me I should not take this remedy because it has not been proved to work reliably, and the basic science is at best shaky, I will tell you that you are obviously missing something, and let me take it, under my responsibility, until Science has found a reliably tested method against the common cold.
    This is not a scientific argument, I am merely arguing for freedom of choice and tolerance for alternative practices, because it is not only universal, proven scientific things that can do good and bring real improvements, at least for some people some of the time.
    I am shocked by the shrillness of the comments to this post. You all advocate scientific methods and rational thoughts, but repeatedly resort to personal attacks and emotional responses. You are only human…So do not restrict my choices of treatment, and trust me to turn to science-based medicine when I have a bacterial infection, broken bones or cancer, among others.
    Caveat emptor
    Regards,
    N.Rey

  24. weing says:

    OK. So you’ll seek out science-based medicine when you really are sick and quackery when you just want to be entertained or one of the worried well. How do you know when you really are sick and when you are just experiencing the symptoms of life?

  25. Mark_M says:

    lynninAustria, you are right that people should not be engaging in personal attacks. That’s just not appropriate. It is the ideas that should be addressed. And your ideas about CAM are misplaced.

    Your point that CAM’s can be harmless placebo effects is a good one. They can be harmless and in many cases they may bring someone peace of mind, like prayer does the religious. But there are some good reasons to resist this. Often, some of the most seemingly harmless CAM’s can actually be quite dangerous. Such as the administering of natural remedies instead of medication. These natural remedies ARE chemical-based and if they are not properly administered, they could lead to over/under dosing and dangerous results. Also, by acknowledging these kinds of remedies, society would be tacitly approving them. There are several cases of people who chose naturalistic remedies over medical treatment for very treatable conditions, and the results were disastrous, even death. So, we really don’t want to promote people to seek out cures that don’t help them and could possibly kill them. And we don’t want to promote the idea that if a doctor’s first attempt at treating something fails, then turn to your local witch doctor and get a snake oil treatment. That can be very dangerous and it’s irresponsible because when you resort to non-medical treatment, you have nothing to base your treatment on. You could justify any sort of treatment for any sort of ailment.

    Finally, I question whether you really understand what you are talking about when you say you use medical treatment “first”. You mentioned the use of Vitamin C to treat the common cold. Well, this itself is nothing but a nonsense treatment; look up the research on it. There is no “cure” for the common cold, only treatments for it’s symptoms. Sure, you could easily experience varying degrees of sickness with a cold, but that doesn’t validate faith-based treatments as being effective. ANY kind of treatment has to undergo scientific testing to be truly evaluated. Personal experience is just too unreliable. So, even though your peace of mind may be better, it doesn’t mean you were affected on a biological level.

  26. Dr Benway says:

    Patients want treatments that work. They will buy alternative therapies because the marketing for them leads them to believe these therapies work. If that’s a lie, that’s not a good thing.

  27. lynninAustria says:

    You touch on the nature of illness, which I am not qualified to address. I know I am sick because I feel sick… I always make a judgement whether or not to consult a physician based on what has helped in similar cases in the past, on the severity of the symptoms, and on how well defined they are. The less well-defined and severe they are, the more I am inclined to think that they are just the “symptoms of life” and will take care of themselves. If they persist, I will look for a more specific explanation.
    I will also use my judgement as to what sort of quackery to resort to. I’ll hear what people whose opinion I value have to say, weigh arguments, etc. All very unscientific. I trust my intelligence, and try to err on the side of caution .

  28. lynninAustria says:

    Mark M,
    Doctors have a responsibility for their patients, and I agree that a doctor cannot advocate a treatment on anecdotal evidence. I would put no trust in such a physician.
    Let’s stick to the common cold, for which we agree there is no treatment. You may be right, I may not be affected on a biological level, but I am not developing the physical symptoms, which is all that matters to ME. you as a hypothetical physician cannot base any future practice on it, but I as a patient can.
    In order to scientifically understand what is really happening, it would have to be studied in order to prove:
    1- that the symptoms I had before taking the medicine were physiological
    2- To establish a correlation between taking the medicine and the symptoms disappearing.

    Then it would have to be repeated, and there would be attempts to explain the mechanism underlying it all. It would have to be done for every patient who claims he or she has been helped. obviously unworkable.
    And yet, there is no viable alternative, since the medical profession has to resort to labeling every patient who claims to have been helped as naive, or lying, or ignorant, or a fluke.

    What do you say to hunches? They are unscientific, but sometimes they occur and are proved right. It may also be a coincidence. Or it may not. My point is that there is still a great amount of research to be done on the way the brain works, psychosomatic deseases, the perception of pain and so on, and that many of the reported successes of alternative medicine may come to be explained in that way.

    Ignoring science-based medicine is foolish and dangerous, that some people are seriously hurt by following the pratices of CAM is a tragedy, and the job of a doctor is to avoid more casualties, but I claim the right as a patient to use benign practices as I see fit and I find it a good thing that they are available.
    Regards
    NR

  29. weing says:

    “And yet, there is no viable alternative, since the medical profession has to resort to labeling every patient who claims to have been helped as naive, or lying, or ignorant, or a fluke.”

    No, I call them anecdotes. A mechanism of action can wait as long as there is a proven effect. Hunches are an excellent source of hypotheses.

  30. daedalus2u says:

    Racism is applied to individuals, not to ideas or ways of thinking. CAM is not rejected by MDs because of the ethnicity of those promoting it. Some CAM is accepted simply because it does come from a certain ethnic group (i.e. Chinese Traditional Medicine).

    Most traditional practices are adopted because they are the traditional practices of the adoptees parents and ethnic group. SBM is not adopted as a traditional practice because it isn’t a traditional practice. It is a practice generated de novo by SBM practitioners.

    A modern interpretation of the tilting at windmills meme.

    http://xkcd.com/556/

  31. weing says:

    “I will also use my judgement as to what sort of quackery to resort to. I’ll hear what people whose opinion I value have to say, weigh arguments, etc. All very unscientific.”

    Maybe not scientific in the strict sense, but utilizing critical thinking.

  32. Dr Benway says:

    lynninAustria:

    I claim the right as a patient to use benign practices as I see fit and I find it a good thing that they are available.

    I was happy to say the same as you up until about a year ago when I found myself with children under my care being subjected to an ever-growing list of CAM therapies – e.g., gluten-free/casein free diet, mega-vitamins, probiotics.

    We shouldn’t be using unproven therapies on children who can’t consent. We should require proper studies demonstrating safety and efficacy first.

    The problem is, parents have been led to believe that studies have been done and that these therapies are justified by scientific evidence. There are MDs at leading medical schools telling them as much, thanks to the integrative medicine movement.

  33. Dr Benway says:

    Some CAM is accepted simply because it does come from a certain ethnic group (i.e. Chinese Traditional Medicine).

    Funny thing is, TCM was invented in the 1940s by Mao’s government when faced with the problem of too few physicians for the needs of 500,000,000 people. So one might say that “Western medicine” was invented at the same time.

  34. lynninAustria says:

    Weing,
    “No, I call them anecdotes. A mechanism of action can wait as long as there is a proven effect.”

    Would you elaborate on that? I don’t understand…

  35. beatis says:

    “…# Dr Benwayon 14 Oct 2009 at 10:55 am
    Some CAM is accepted simply because it does come from a certain ethnic group (i.e. Chinese Traditional Medicine).

    Funny thing is, TCM was invented in the 1940s by Mao’s government when faced with the problem of too few physicians for the needs of 500,000,000 people. So one might say that “Western medicine” was invented at the same time…”

    That’s correct. Sun Yat Sen, who was a physician, strived for a system of modern medicine in China. He hated the thought that people should be dependent on ineffective treatments such as acupuncture. Mao himself btw never made use of acupuncture.

  36. Dr Benway says:

    On the assumption your medicine is better informed than your philosophy..watcha got doc dude?

    Compassion for my patient who is in dire circumstances, a desire to help him live a little longer, and a rage at rich assholes using their political connections to corrupt evidential standards within academic medicine so that unproven therapies can be made to seem acceptable to the public.

  37. weing says:

    Aspirin was in use for headaches and joint pains for a long time before the mechanism of action was elucidated.

  38. jmm says:

    “I understand other systems—they are based on false, vitalistic, pre-scientific beliefs about nature. ”

    This is a deep misunderstanding seen routinely in science vs. religion discussions. When science first came along and was so incredibly powerful, religion (plus associated belief systems) was threatened. One reaction was to claim, for the first time, a similar power of access to literal truths about the material world of a kind that had no other historical precedent. This is the fundamentalist position. The modern atheist position, which you are paralleling in this debate, is to ACCEPT the fundamentalist terms of the debate, but to reject their position. This is ultimately the rejection of a straw man, albeit a straw man that a distressingly high number of people accept.

    In fact, these previous belief systems are built on metaphor and subtleties of subjective experience, and can excel when considered strictly on those terms. The modern concept of “nature” does not apply, and statements should not be interpreted literally in the Western sense. These systems are of course of no use for treating cancer. They are perhaps helpful, however, in coming to terms eg with the ultimate inevitability of mortality, something that the culture of modern medicine has profoundly screwed up.

    A traditional system like, eg, ayurveda, is built around the SUBJECTIVE feeling of wellness and balance. One observes that eating a fatty meal makes one lethargic afterwards. If one is already that way inclined, this is bad thing: if one is inclined to the opposite sort of flightiness, it is good. It is, in fact, an observation-based system, only the observations are all subjective. To understand it on its own terms, you must see, eg, that it does not share the same concept of “disease”. It can make you feel subjectively better, however, irrespective of what Western medicine would consider your disease state.

    The success of SBM has led to the perversion of many traditional systems, as they seek to emulate that success. They will never be able to compete head-to-head, but they can offer something distinct when understand on their own traditional terms.

  39. zen_arcade says:

    Fantastic post as usual, Dr. Lipson! Very much appreciated.

    Also great comment from mckenzievmd regarding cultural relativism, postmodernism, etc. Couldn’t agree more. I’m at university now as a slightly older non-traditional undergraduate student and it never ceases to confound me how reflexively these feeble positions are trotted out at the slightest mention of empirical science (or “Western Science” as I’ve heard and seen it condemned — note the capitals).

  40. daedalus2u says:

    Some CAM is accepted simply because it does come from a certain ethnic group (i.e. Chinese Traditional Medicine).

    I would go so far as to say that all CAM is accepted this way, accepted from the “top-down” due to the charisma and “truthyness” of the CAM proponent, which often correlate with ethnicity either because “the other” is always right, or always wrong.

    There is no other reason that people accept CAM other than the CAM proponent says it works. There is no data, no physiology, no generally accepted theoretical reason the CAM treatment should be anything other than a placebo.

  41. Dr Benway says:

    A traditional system like, eg, ayurveda, is built around the SUBJECTIVE feeling of wellness and balance.

    If the shaman-types told patients clearly, “the theater experience I can give you will make you feel better for a time,” I’d have no problem with that.

    But the alties say stuff like, “take saw palmetto for your prostate,” and patients believe that means the herb will shrink their prostates. In real life, not just pretend.

    That’s f*cked up.

  42. Dr Benway says:

    Oh and jmm, the alties recommend their unproven treatments for babies and pets. Where’s the “subjectivity” in that?

  43. Chris says:

    I got to the party late, and tried to read her blog posting linked in the first paragraph, plus the new one that is in a link about titled “On being Completely Wrong”… but they are gone!

    All I get is “Page not found.” So all I can go by is what you have written here. Sigh.

    Should I accuse you all of being big meanies?

    (I should note that the Western versus elsewhere medicine stuff always bothers me. For one thing a “traditional Western” treatment include various herbal tinctures, mustard plasters and homeopathy. When fan of homeopathy told that “Western” medicine was not perfect, I asked her where she thought Germany, where homeopathy originated, was located. Also I wonder if DTaP and varicella vaccines are “Eastern” because they were both developed in Japan. … end of side rant)

  44. KT says:

    I think the key to this conversation is this:

    “One of these reasons is that we must serve everyone, and to serve everyone it helps to be everyone. Serving may mean understanding where someone’s beliefs come from, and even respecting these beliefs, but it does not mean endorsing these beliefs.”

    And this:

    “To be better physicians and scientist we must understand why people believe what they do, and we must find ways to help our patients take advantage of real medicine in a way that does not violate their basic values.”

    Where both sides are correct and overlap is that different cultures create different understandings of reality. But what is most true is that the underlying reality doesn’t change from one culture to the next.

    It is absolutely right to say that it is important to understand the perspective of other cultures and their beliefs and their systems of approaching problems, medical and otherwise, so that you can better understand how to approach the person.

    But nothing, especially not the country you were born in, will make an ineffective form of treatment effective or render an effective form of treatment ineffective. Science provides the best tools we have for testing all forms of treatment whether they derive from a pill or from a plant or don’t involve taking any substance at all. If a treatment is effective, then there is no reason for science-based medicine NOT to want to find that out or to incorporate it into normal treatment regimens, especially if it were something as simple as diet or behavioral change or something similar.

    You could just as easily make the argument that “Eastern” medical traditions have an anti-Western bias because they fail to acknowledge scientific studies that show no basis for the efficacy of a treatment commonly used in that traditional medicine practice.

  45. jmm says:

    Dr Benway, I’m not talking about the “alties” as a monolithic current group. I’m talking only about genuinely longstanding traditions in their full cultural context. Ayurveda was never traditionally about treating pets or about shrinking prostates. The first is just silly, the latter is clearly a more recent form of science-envy. I’m asking the question of what these traditions were about in pre-science days, which of course was not science-envy.

  46. Dr Benway says:

    Well jmm, back when there were no effective treatments for most diseases, shamanism was probably pretty comforting.

    But patients today expect more than relaxation and tripping while they die from their appendicitis. When the shaman shows up with some herbs, they expect more than a flavorful tea shared in the context of a caring relationship. They expect that the special herbs actually do something.

    I think if you told most patients in US hospitals that Ayurveda was theater, they wouldn’t bother. And NCCAM wouldn’t be funding studies of Ayurveda. And Ayurveda wouldn’t be offered by MDs as a treatment option at our leading medical schools.

  47. pmoran says:

    JMM: “A traditional system like, eg, ayurveda, is built around the SUBJECTIVE feeling of wellness and balance”

    I am a little surprised to hear that. I thought “wellness”, and even the unqualified use of the word “balance” (of what?) were rather fatuous buzzwords in CAM marketing.

    Nevertheless, I agree that CAM thrives at the level of human subjectivity.

    I have been trying to get a similar idea looked at using different terms. A weakness of the standard skeptic position is that the placebo-controlled trial explicitly excludes subjective responses to medical attentions, yet such studies have been allowed to become the de facto standard via which ALL matters to do with medical care tend to be judged. There is nothing wrong with placebo-controlled RCTs –it is just that they are designed to give answers to a very precise question and NOTHING ELSE.

    How to even test the potential of subjective influences? We would expect some factors to suppress them, others to enhance. The whole therapeutic environment comes into play. Practitioners will have their good days and their bad days.

    We know there are serious limitations to their therapeutic potential. The course of most serious illnesses will not be affected.

    We cannot, however, on the available science, exclude powerful subjective responses of the kind that some testimonials describe. The euphoria expressed in some testimonials could not possibly be faked. It is risky, unscientific, and potentially damaging to the skeptical cause to assume that such experiences have no therapeutic consequences at all.

  48. jmm says:

    Dr Benway, are you denying the truth of the specific example of a subjective experience that I gave, namely that eating a heavy meal makes one feel lethargic afterwards? Or is this impression a consequence of “theater”?

    You, _together_ with nutcase-CAM-proponents, insist on viewing such systems in Western medical terms. You are making the same mistake as those you oppose most. I am saying something else, to look at the systems truly on their own terms in their historical context rather than as hyped by nutcases.

  49. daedalus2u says:

    jmm, I don’t doubt that “theater” can make people feel full and bloated. I know that people with anorexia report feeling full and bloated even when emaciated. I don’t doubt their subjective feelings; I do know they are not based on a correct interpretation of reality.

    Theater may be able to reproduce some of the subjective effects of being full and bloated. It does not reproduce the physiological effects of the nutritive value of a digested meal.

    CAM theatrics may reproduce some of the subjective effects of “wellness”. It does not reproduce the physiological effects of pharmacologically effective treatments.

  50. Dr Benway says:

    Dr Benway, are you denying the truth of the specific example of a subjective experience that I gave, namely that eating a heavy meal makes one feel lethargic afterwards? Or is this impression a consequence of “theater”?

    I think we might be talking past one another, perhaps because we think of science differently.

    All experience has a subjective and an objective component. It’s not the subjectivity of an experience that determines whether it’s fit for scientific study. It’s the degree of inter-rater reliability that matters.

    If I present a card to several individuals and ask them to name its color and 19 say “red” and one says “green”, that’s pretty good inter-rater reliability. I can study “redness.”

    If I present patients with a fatty meal and ask them to describe how they feel afterward and 19/20 say, “lethargic,” I likewise can study that experience.

    When you say, “Western medical terms,” I’m not sure what you mean. Is there “Western” arithmetic?

    Controlled studies are observations combined with a bit of math.

  51. Dr Benway says:

    blockquote fail above.

  52. Dr Benway says:

    You, _together_ with nutcase-CAM-proponents, insist on viewing such systems in Western medical terms.

    Perhaps by “Western medical terms,” you mean a concern for what is literally true. Guilty as charged, I reckon.

    If the Ayurvedic doctors aren’t prescribing treatments that literally help patients, shouldn’t they say so up front?

  53. jmm says:

    Dr Benway, I understand science exactly the same way you do. I completely understand the distinction between subjective and objective, and that objective is the domain of science.

    My point is that science is not the only way to see the world, which is the whole point of the cultural sensitivity issue. Subjective experience IS an important part of the human condition IN ADDITION to the objective.

    An Ayurvedic practitioner can honestly state that their techniques are likely to make a patient feel better. This is no mean thing.

    It is possible that in some cases (a priori for diseases with the strongest mind-body connection) the patient will also objectively improve. This is the reason one might try to scientific studies of the practices.

    Due to science-envy, CAM proponents have been making ridiculous, unsubstantiated claims, to compete with the sort of claims that science is honestly able to make. This is a grave mistake on their part.

    In some cases, CAM draws on longstanding refined traditions that predate science. “Literal truth” is a concept that did not exist in the same way in prescientific human society. To understand these traditions, one must see past absurd recent perversions of them, and look at the tradition in context. Doing so requires genuine cultural sensitivity, and the recognition that some things that are important in life are subjective, and hence not readily amenable to scientific study. Otherwise one has a “have hammer, see nail” syndrome, and misses much of what life is about. This is a serious danger posed by the success of science to “Western” culture. I have no doubt the benefits of science outweigh this danger, but the danger is still there.

  54. Peter Lipson says:

    Is there any disease without a strong mind-body connection? I don’t recall dissecting a mind in anatomy.

  55. Dr Benway says:

    “Literal truth” is a concept that did not exist in the same way in prescientific human society.

    I have a hard time believing this. Some of our oldest written records are 100% boring, literal facts about numbers of goats, acres of land, dates of marriage, etc.

    One reaction was to claim, for the first time, a similar power of access to literal truths about the material world of a kind that had no other historical precedent. This is the fundamentalist position.

    I’ve heard educated people make this argument (Karen Armstrong). But I don’t think it works. Modern Christian fundamentalists are overly literal about some bits of the Bible, I grant you. But when they say that the Lord “maketh me to lie down in green pastures,” I note that none of them have any grass stains on their clothes.

    The sin of the fundamentalist isn’t literalism exactly. I think it’s more accurate to say that they suffer from motivated reasoning.

    Cults of true believers generally share some vision of a better world that they want the rest of us to buy into. Selling that vision becomes more important to the believer than figuring out what’s true. Of course they still care about the truth in most other areas of their lives. It’s just the inconvenient truths that muck up their utopian fantasy that they’d rather avoid.

    The Christian fundamentalist relies upon an argument that claims a real Garden of Eden, a real fall of Man, and a real Jesus sent to save us. That’s why they have some trouble with evolution. They make no claims about shape-shifting into sheep now or in the distant past, so they have no problem reading Psalm 23 as metaphor.

    Like all people who reason in service to some persuasive goal rather than in service to the truth, they cherry-pick to suit. They cherry-pick from the Bible, from science, from philosophy, from the newspaper, from personal experience –anything that might make their message more convincing.

    So it’s not literalism per se that makes them seem so crazy. Rather, it’s the motivated reasoning.

  56. Dr Benway says:

    I don’t think I used bad wurds. No linkies neither. Wonder why I’m getting flagged for moderation.

  57. jmm says:

    Dr Benway, good point about the motivated reasoning vs literalism, and yes I am basically arguing for Karen Armstrong’s perspective here, but concede that both are strong factors. But either way, systems like ayurveda had a history that was very different to the literalistic and cherry-picking context of cultish CAM proponents, and debunking the latter does not translate automatically into debunking the former. And the only way to assess the former is on its own terms, with cultural sensitivity.

    Ayurveda, on its own terms, does profess to be based on inter-rater reliability, but only of subjectively assessed states.

  58. Peter Lipson says:

    I’m not sure what that means.

  59. Dr Benway says:

    Dr. Lipson,

    The interpretation of a post-modern linguistic production does not typically enjoy a high level of inter-rater reliability, in my experience. However, I have been told that inter-subjective agreement is possible within academic circles concerned with textual deconstruction vis a vis actual or potential political contexts. I’m hesitant to take this claim at face value, however, without documentation of the BAL of those participating in the discussion.

    Using language to deconstruct linguistic products carries certain risks Self-referentialism is nothing to sneeze at. This sentence no verb.

  60. Dr Benway says:

    jmm

    And the only way to assess the former is on its own terms, with cultural sensitivity.

    In other words: dont’ be a dick. Hey, I’m cool with that. But I’d also add: don’t be a patronizing dick.

    “Cultural sensitivity” shouldn’t mean sugar-coating the truth or challenging factual errors simply because they represent some widely held belief within a particular community.

  61. jofspammo says:

    Hi,
    I enjoy reading these science-based articles, even though I often disagree and see holes the size of Greenland in them, yet thank you! for helping me challenge my own viewpoints. Here goes mine:

    “I understand other systems—they are based on false, vitalistic, pre-scientific beliefs about nature. Understand, that’s not a moral judgment but a factual one. ”

    >>> These other medical systems are EXPERIENTIAL in nature and based on the science of this works in real life situations. Would you say that a drug studied in a closed scientific lab for say 5 years is better than a treatment that has been used and recognized as effective for several hundreds of years by a traditional medical system of a given culture. How many drugs have been recalled because they were tested insufficiently and have side effect that end up hospitalizing or even killing their users? How many herbs would do that? At least let’s explore these natural treatments with scientific method, recognize they work and integrate them within standard treatments.

    “I also understand why people believe in things. We all have our own cultural context, our own baggage. We all wear blinders of one kind or another.”

    >>> admitting it is the first step to recovery ;)

    “this doesn’t diminish the important role played by religio-medical beliefs in many people, but it does place them in the proper context: they are quasi-religious beliefs, not scientific ones, and people hold to them for various cultural and economic reasons—important reasons, but not science-based reasons.”

    >>> circumcision is not a quasi-religious belief? That’s exactly where it came from. Yet now we have justified it with science and have spent lot of money “proving” its worth. Should we not explore other important cultural practices with such ardour? I’m sure if we really explored our own “science-based truths”, we would be surprised to find how many have quasi-religious origins.

    “I understand where writing like this comes from. Many voices in this world are not heard, especially voices of women, non-whites, and the poor. These voices are particularly important in medicine, since we do not normally choose to serve only one population (although some do).
    One of these reasons is that we must serve everyone, and to serve everyone it helps to BE everyone.”

    >>>it’s not a race issue (a blinder of western medicine and all cultural medicines), it is a cultural one. We need to integrate other cutural viewpoints into western medical science. This is why alternative medicines have come into being in the first place (Duh!) The next step is to have pharmaceutical companies (and the FDA) test, standardize and admit herbal medicines and so called unprocessed “natural” treatments into the regular pharmacopeia; to teach regular doctors their use instead of having them dispense expensive prescription medicines for which there are proven natural counterparts for pennies or less per treatment. It is amazing the lengths at which the current medical establishment will go to justify it’s medicines (and the high cost, which in many serious cases is very appropiate and necessary) by claiming that herbs (or natural treatments) are not science-based, as if man made medicines were better for the human body than mother nature itself – quicker perhaps, but at what cost both figuratively and literally?

    The main reason standardized plants based “natural” treatments are still not a staple of western treatments is because of proprietary knowledge attitude of western culture and medicine. The pharmaceutical industry do not want doctors (nor pharmacists) to know how to make a medicine. It’s easier to derive, patent and dispense at great profit. It is not possible to patent a raw plant, herb or spice, and you can thus not have a monopoly (at least for 5 years) on the revenues this medicine generates. I am not for the abolishment of modern pharmaceuticals, but for a change leading to a reduction of their excessive use when not strictly needed. While you’re at it, why not make all doctors nutritional experts (since food is the best medicine), so they can teach ALL patients proper nutrition. (How many doctors eat garbage while on shift? Amazing!) A bulk of people visiting doctors in the USA are sick due to improper nutrition in the first place. Maybe some are slightly allergic to foods, many eat a highly processed diet exclusively. Give people the tools to figure out their own wellness instead of making them dependent upon a medical system and strong drugs that often only add a burden to their already struggling organism. This is what CAMs want. Prevention, prevention.

    “This isn’t about “concepts and language” but truth and non-truth….
    That is moral. What is not moral is placing other’s health at risk by declaring all knowledge equal but different, or in someone else’s words, “separate but equal”.

    >>> Truths change, my friend. They are changing every day, and yes, I understand this is scary for a doctor. It’s like being told that what you believe true may be false tomorrow.
    In terms of morality, tread carefully. An “our medicine is more equal than others’ ” attitude – kind of like a priest or pasteur telling you Jesus is the only path to salvation – is typical to western culture and not very science-based. There really are many truths.
    Again, Thank you!

  62. Dr Benway says:

    An “our medicine is more equal than others’ ” attitude – kind of like a priest or pasteur telling you Jesus is the only path to salvation – is typical to western culture and not very science-based.

    There is no “our medicine.” There are treatments with degrees of evidence in their favor. That’s all there is, east or west.

  63. pmoran says:

    “Would you say that a drug studied in a closed scientific lab for say 5 years is better than a treatment that has been used and recognized as effective for several hundreds of years by a traditional medical system of a given culture. ”

    I don’t know what is meant by a “closed scientific lab”. If you mean “studied via controlled clinical trials” then the answer to your question is a resounding YES!!!.

    If there is one single message to the history of medicine it is that ANYTHING at all can become credited with healing powers, whether it does anything or not. Controlled trials are the result of doctors’ humble admission that they can be hopeless at assessing the true worth of treatments, something that is still being demonstrated almost daily.

    “Alternative” medicine can be looked upon as our modern Western culture’s manifestation of that abiding principle.

    Look at the myriads of claims it has accepted over the last few decades, or better still since the birth of homeopathy 200 years ago, all sustained by the staunch belief of practitioners and patients, even Professors and Nobel Prize winners. Yet how many have been shown to be valid when required to perform as claimed? Name one.

    I allow that many may “work” as placebo, within the limits that that imposes.

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