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Dec 28 2007

Untested by Definition: A Rant on Alternative Medicine

I blogged about this a little while back, but I made the mistake of burying it in a carnival announcement, and it kind of got lost in the shuffle. So I’m re-posting it as its very own post.

Skeptico’s piece on the lack of testing in alternative medicine really hit it out of the park, I thought. And it reminded me of something I’ve been wanting to say for a while about conventional versus alternative medicine.

MeditationIn her never-ending attempt to be fair, Ingrid has pointed out that alternative medicine is untested somewhat by definition. Once an alternative treatment gets some good, placebo-controlled, double-blind, peer-reviewed, replicable studies showing that it works, it’s no longer “alternative” — it’s conventional medicine by definition. (The use of meditation to reduce stress is a good example.)

ManusingmicroscopeBut in fact, I think that’s the whole point. The dividing line between conventional and alternative medicine isn’t any particular opinion or theory about treatment. The dividing line is whether or not it’s been carefully tested, using the scientific method, to minimize the effects of human error and bias as much as is humanly possible.

What I don’t understand is why practitioners and promoters of alternative medicine think that’s a bad thing.

SieveAlternative medicine boosters often accuse conventional Western doctors and medical researchers of being close-minded, biased against any theories and opinions other than their own. But the whole point of science (including medical science) and the scientific method is that it acts as a screen against bias and preconception: an imperfect screen, to be a sure, but a screen nonetheless. It’s an extremely humbling, often disappointing process.

LancetOf course doctors will sometimes have initial skepticism about new ideas. Medical providers are human, with the universal human attachment to being right. And initial skepticism about new ideas — not close-mindedness, but skepticism — is appropriate in medicine, and indeed in any scientific field. But medicine does change and move forward, quite rapidly these days… and it couldn’t do that if medical researchers and providers were consistently mulish and intractable about considering new theories and treatments. Medical journals are loaded with new ideas — some of them radically new.

HomeopathyAnd of course doctors can be biased and even arrogant. But how is that not true of alternative practitioners? They’re every bit as biased to believe in their theories as conventional practitioners, every bit as likely to succumb to confirmation bias and cherrypick positive results while ignoring negative ones. And they don’t have the advantage of having placebo-controlled, double-blind, peer-reviewed, replicable studies to back up their arrogance and show that their results aren’t just confirmation bias at work.

Galileo_2Which, again, is kind of the whole point. If the only difference between conventional and alternative medicine is that conventional medicine has, by definition, been carefully tested using the scientific method… then how is alternative medicine the better choice? How is it anything other than the Galileo fallacy in action?

HolywaterjugAnd as Ingrid has also pointed out: Doctors and medical researchers, probably even more than other scientists, could give a rat’s ass about being personally proven wrong if it means getting at the truth. Because the truth is what’s going to help them treat their sick, suffering, and dying patients. Ingrid is an HIV nurse, and if it could be conclusively shown that homeopathy, or Reiki, or acupuncture, or even for Pete’s sake prayer, could cure HIV or even alleviate it, she’d be all over it like white on rice. The reason she uses the treatments that she uses is that they’ve been through the trial by fire: they’ve been carefully tested and shown to be effective. If there were a set of placebo-controlled, double-blind, peer-reviewed, replicable studies showing that HIV could be cured or effectively treated by sprinkling holy water on goat entrails, she’d be right there on the Catholic goat farm with the sacrificial knife.

Domestic_goat_003But again, if there were a set of placebo-controlled, double-blind, peer-reviewed, replicable studies showing that HIV could be cured by sprinkling holy water on goat entrails, then it wouldn’t be alternative medicine. It’d be conventional medicine, by definition.

Because conventional medicine, by definition, is medicine that’s been shown to work.

31 comments

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  1. 1
    The Promiscuous Reader

    This all sounds very nice, Greta Christina, but it’s not quite true: “Doctors and medical researchers, probably even more than other scientists, could give a rat’s ass about being personally proven wrong if it means getting at the truth. Because the truth is what’s going to help them treat their sick, suffering, and dying patients.”
    For instance, when male doctors began horning in on childbirth, they accused midwives of being dirty, ignorant, superstitious, etc. The trouble was, women died in childbirth in embarrassingly larger numbers under ‘scientific medical’ care than under midwives’ dirty, superstitious, ignorant care. This didn’t cause doctors to say, Well, maybe we should just back off and let the midwives do it. Very much the opposite.
    More recently, we’ve had the forced sterilization of thousands (maybe hundreds of thousands) of poor, largely non-white women through the 1970s at least, the Tuskegee experiment, the use of harmful doses of hormones in the Pill, unnecessary Cesarian sections, and so on and on, all backed up by some version of other of “Trust me, I’m a doctor, this is for your own good, it’s scientific.”
    As I imagine you know, early AIDS treatment probably killed more patients than it helped. The doctors had no real idea what to do, so they just threw things at the disease, hoping something would stick. I recall, in Carl Sagan’s Demon-Haunted World, he dismissed the medical knowledge of pre-scientific peoples as having been acquired through trial and error at great human cost. Maybe so — he cited no evidence for that, and probably had none, which speaks badly for him — but the same is true of modern, scientific, mainstream medicine to the present day.
    I like your basic point, as I take it, that “alternative” practitioners are as dogmatic as “mainstream” ones; I agree with you there. But that doesn’t speak well for the mainstream: it means that it is, generally, as bad as the “alternative.” If only more mainstream doctors would say that a given “alternative” treatment hasn’t been properly evaluated, instead of simply denouncing it as superstition and the like. Setting a good example of readiness by admitting, even stressing, that one doesn’t know everything would be a good start, don’t you think?

  2. 2
    Dylan Ferrier

    I just wanted to say hi and let you know that I have been reading your blog for a few weeks now ever since I came across it. I feel the same way that you do about alot of things I have a blog as well, feel free to read it sometime I left you the link on here…..Take care

  3. 3
    ssjessiechan

    I saw it the first time! It was good then too. And yes, Violet is a snuggle bumpkin. *goes to huggle own kitty*
    In response to Promiscuous, we can certainly all acknowledge that established medicine has done horrible things and acted in ignorance and hatred. Humans are unfortunately not immune to that sort of thing, much as we wish it weren’t so. ; ; No, we DON’T know everything, and I think science actually starts with that supposition. That there are things that need yet to be found out.
    But where I think Greta’s point shines through so well, is that at least science contains a method through which we can TRY to recognize our own errors. Sometimes it takes time. Trials can take stupid long, and the medical community is always wrestling with the moral conundrums of human experimentation. But unlike practitioners of many alternative techniques, practitioners of evidence-based medicine are interested in finding out if their techniques actually did work, and have spent much time and paper on developing techniques to discover if their solutions are viable.
    Homeopathy and other alternative therapies, while certainly practiced by at least a few sincere believers, are practiced on the base of that belief alone. The few studies that claim to validate them contain serious flaws, and studies that do not never get published. Adherents to some techniques claim that their cures ALWAYS work, and that failure to heal is the fault of the patient or a re-infection (those iTunes downloads for instance). While all humans are subject to bias, to wishful thinking, to the sincere want to alleviate suffering, science and evidence at least provide us a framework from which to hang our (collective) stethoscopes and seek an answer to the question, “am I helping, harming, or doing nothing at all?” Those that fear that question should be doing some serious thinking of their own.
    *snuggles kitty some more*

  4. 4
    Jon Berger

    An awful lot of people who eagerly embrace alternative medicine are suffering from the “the enemy of my enemy is my friend” syndrome — you know, the one that worked out so well for the U.S. in Afghanistan during the Soviet invasion. Mainstream medicine tends to be arrogant, impersonal, insanely expensive, and run by corporations; it’s easy to hate them. Alternative medicine says “those guys with ‘M.D.’ after their name are arrogant, impersonal, overpriced corporate bastards; come let us cure you instead,” and a lot of people respond positively to that.
    It’s understandable, because mainstream medicine is all of that stuff, and plenty more. But they’re also RIGHT, a very large part of the time. Not always. They’ve screwed up too. That Thalidomide thing? Not their finest moment. But jeez, there’s this little pill I take every day, and my blood pressure stays normal. That’s pretty cool. And I hate to bring this one up, but they’ve actually made an aphrodisiac that really works (well, for guys, anyway), which is something that our species has been trying to accomplish ever since we came down out of the trees. Impressive.
    And if you want to talk about greedy, how much does the alternative-medicine industry make from peddling cures for baldness, cures for fatness, and aphrodisiacs which in fact do NOT work? I don’t know the exact figure, but it’s huge.
    A friend of ours was diagnosed with breast cancer a few years back. They caught it early: she spotted the lump in a self-exam, just like you’re supposed to. They probably could have cured it; it might not even have taken a mastectomy, but that’s the worst it would have gotten. But she, having been told often enough that all those doctors, what do they know, they’re just evil greedy quacks, decided to treat it with vitamins instead. Lots of vitamins. Hundreds of pills a day. Vitamins measured in kilograms. When it became obvious, about a year later, that she was dying, she relented and went in for chemo or radiation or one of those mainstream techniques, but by then it was too late. I think alternative medicine has a lot to answer for.

  5. 5
    Ann

    I just ran into your blog. I don’t see a search box. I followed the links to this post. But, have you ever discussed research done by sociologists and anthropologists of science and their criticism of the idealist view of science? They’ve been publishing works for the last 30 years on science.

  6. 6
    jraoul

    Although everyone above (including Greta) has their points, I’d have to agree most enthusiastically with Promiscuous Reader. I have no gripe with The Scientific Method, but I think it’s a stretch to make the black and white associations: Mainstream Medicine=The Scientific Method; Alternative Medicine=A Bunch Of Booga-Wooga And Wishful Thinking. Many so-called alternative techniques have evolved from trial and error going back thousands of years; many so-called scientific methods are the result of marketing, politics, profiteering, and — yes — superstition, with scientifically proven contraindications ignored for many of those reasons. And the reverse is true on both sides. Show me a system that endorses the scientific method religiously (not a pun, but whatever it is, it’s intended) AND examines without prejudice methods from traditions other than white western patriarchal society, and I’m at the head of the line.

  7. 7
    Greta Christina

    PR and jraoul, you make some interesting points. So let me clarify. I’m not trying to argue that conventional medicine is perfect. I know it’s not. And I know it has some real horrors in its past, and probably in its present as well. I thought I’d made that clear in my post, but maybe I didn’t.
    But the thing about conventional medicine is that it has a built-in self-correcting mechanism. The horrors you cite, PR — they aren’t being done anymore. In fact, both the horrors themselves and the attitudes that led to them are now deplored.
    In fact, I would argue that, while medical practitioners and other scientists can certainly be arrogant (nobody in the field would deny that), the Victorian and 1950s attitude that science is perfect and infallible has largely been replaced with a humble awareness that our knowledge is limited and subject to change.
    Ingrid, for instance, has been to several conferences on HIV and AIDS where researchers reported, “When we did this research, we were really expecting to see A, but much to our surprise we saw B instead.” And nobody points at these people and goes, “Ha, ha, you were wrong, what a dummy.” The willingness to admit limitations and surprises is considered admirable.
    And I’d like to point out that, while medical science was responsible for these horrors, it was also largely responsible for correcting them. It was, for instance, a medical scientist who came up with germ theory… which is what alleviated the “women dying in childbirth under doctors’ care” problem.
    PR, your example of early AIDS treatment is a very interesting and very pertinent one — and I think it actually supports my point. Yes, in the early days of AIDS, doctors and researchers were pretty much throwing things against the wall to see what would stick. But the point is that *they had a method* for figuring out what was sticking and what wasn’t. They had double-blind, placebo-controlled, etc. testing to see which treatments were working and which ones weren’t. Plus they were doing research to find out, not only what might make patients feel better, but what the disease was and how it worked.
    And as a result of that process, over time we got HIV treatment that works. It ain’t perfect, goodness knows; but it’s a hell of a lot better than anything we had in the ’80s. And it’s getting better all the time.
    Compare that to altie medicine. Read the piece by Skeptico that I link to at the beginning of this post. Altie practitioners don’t do careful, double-blind, placebo-controlled, etc. testing of their treatments. And they don’t reject treatments once they’ve been shown not to work.
    In other words, they’re very bit as arrogant and stubborn as doctors. But they don’t have a mechanism for correcting their errors… and they don’t have a professional culture that admires and rewards rigor and accuracy and changing your mind when the data says you should.
    The self-correcting mechanism of science — including medical science — does take time. It takes time because sometimes doctors are stubborn, arrogant fucks; and it takes time because, even if it were done perfectly, the process just takes time. And that sucks royal donkey dicks when the correction process is happening on your back, or the backs of people you love.
    So I’m not saying conventional medicine is perfect. Far from it. I’m saying that it has a mechanism for correcting its errors over time… and a culture that encourages doing so. Which altie medicine doesn’t.

  8. 8
    jraoul

    I stand by my point, which you don’t address, which is that conventional medicine, good as it is, is sidelined by profit and politics. Not all the time, but enough of the time to give the alties the smug sense that maybe they’re onto something. I’m not saying that conventional is bad and altie is good, either, just that there’s something to be gained from both, and the perfect world (which we do not inhabit) would find a place for the good things from both, instead of the current finger-pointing and name-calling.
    Yeah, conventional medicine is beginning to grab a hold of some herbal remedies from indigenous traditions — those remedies that can be patented and profited by. Many of those that can’t are ignored or suppressed or ridiculed, instead of tested by the scientific method.

  9. 9
    Ann

    Indeed, jrauoul. Physicians are very much aware of industry’s influence on the results of research and the publication of those results (thus, the reason for indicating “conflicting interests” at the end of medical articles) in journals such as the prestigious New England Journal of Medicine. There’s a great of debate, if not uproar, about all this in the British Medical Journal and even Medical Journals in India – now that it’s “developing” country or wants to be in the tradition of the West – for the last 10 years or so. All this was presented by sociological and anthropological investigators for a long time: no matter how you want to describe it, science is nothing more than a human endeavor as such it is subject to all the frailties of what it means to be human. That includes, among countless other characteristics, undue criticism to “alternative” forms of investigation and bodies of knowledge.

  10. 10
    Greta Christina

    Okay, jraoul. Fair enough. I’ll answer your point.
    Is conventional medicine overly influenced by money and profit? Sure. (In America, anyway; my understanding is that that’s less true in Europe and other places with national health care.)
    And I think most medical practitioners and researchers would agree. Doctors and nurses hate the fact that they have to waste time fighting with insurance companies to get patient care approved; researchers hate the fact that that funding for their research often comes from people with a financial stake in how that research turns out.
    Yes. Conventional medicine is influenced by profit, to everyone’s detriment.
    But how is that different from alternative medicine?
    I look at the snake-oil aisle at Rainbow Grocery, at Whole Foods, at Trader Joe’s even — and I see shelves and shelves and shelves of tinctures and powders and ointments, products that are untested or poorly-tested or even flatly discredited, promising cures to desperate people that they can’t deliver. And I think: How is this not about profit? Conventional medicine is a multi-million dollar industry… but so is alternative medicine.
    Again, you have two systems that are both subject to human flaws, greed being among those flaws. But you have one system that has a built-in self-correction mechanism to fix those flaws over time… and another system that not only doesn’t, but that actively resists self-correction.
    Also, I think you’re mistaken when you say that conventional medicine adopts alternative medicine only when it can profit from it. Conventional medicine and pharma companies could profit just as easily from magnets or homeopathy or extract of mistletoe as it does from, say, meditation or aloe vera or other alternative treatments that have been adopted by conventional medicine because they’ve been shown to work. (Homeopathy especially. A form of medicine that’s stronger the more diluted it is? Big Pharma would be all over it. Their costs for raw materials would plummet.)
    But most importantly, the idea that conventional medicine doesn’t test alternative medicine is simply incorrect. Look again at the Skeptico article I linked to at the beginning of this post. It lists case after case after case of alternative treatments that *have* been tested using the scientific method, that have been found by the scientific method to be ineffective… and that are still being practiced by alternative practitioners, who reject the results of those tests. (What’s more, alt medicine is a multi-million dollar industry, and they could do their own damn double-blind placebo-controlled testing if they wanted.)
    If by “there’s something to be gained from both” and “the perfect world would find a place for the good things from both” you’re referring to specific treatments that exist in either conventional and alternative medicine, then sure. There probably are effective treatments in alternative medicine; there have been in the past, ones that have been shown by careful rigorous testing to be effective, and which have thereafter been adopted by conventional medicine.
    But I think you may be missing the larger point of my piece. The difference between conventional and traditional medicine isn’t any particular treatments or products they use. The difference is that conventional medicine, by definition, is part of a self-correcting system designed to carefully test whether any particular treatment is actually effective; a system designed to reward rigor and accuracy and attention to evidence above all else; a system designed to limit error and bias and wishful thinking as much as is humanly possible. Alternative medicine, by definition, is medicine practiced outside that system. I don’t see why that’s a good thing.

  11. 11
    Greta Christina

    A quick response to Ann:
    Yes, science is a human activity, subject to human frailties. Nobody’s claiming otherwise. Nobody’s claiming that science is perfect.
    What those of us who support medicine backed by science are claiming is that the scientific method is *the best we have.* No, it’s not a perfect way of gaining knowledge. It’s just the best way of gaining knowledge that we’ve found so far.
    Especially when it comes to questions of cause and effect in the physical world. Maybe the scientific method isn’t the best way to answer questions like, “Do I love this person I’m dating?”, or, “Should I stay in this career?” But when it comes to questions like, “Why do plants grow towards the sun?”, or, “Does taking an aspirin every day reduce the chances of heart attack in high-risk patients?”, it’s a very effective method indeed.
    And in particular, it’s a method that’s very effective over time. It makes a lot of mistakes in the short run; but the method has self-correction built into it, and those mistakes tend to get filtered out over the long run.
    I encourage you to read this piece by Skeptico on the “alternative forms of investigation” question:
    http://skeptico.blogs.com/skeptico/2005/10/the_appeal_to_o.html
    Quick summary: The scientific method has been shown to be astonishingly effective, with predictive powers far outstripping chance, guesswork, and intuition. If you think you have a better method for investigating and evaluating claims about the world, it’s not enough to just say, “science isn’t perfect.” You have to show why your alternative method is better.

  12. 12
    Ann

    Fair enough. But, don’t assume all alternative forms of knowledge and science are necessarily not self-correcting. Consider for example the information from peer reviewed journals in India on, for example, yoga, and the new journals in the US as from the Noetic (?)Institute that discuss such things as healing, parapsychology and the like. They have a “self-correcting” facet to their information, if you want to call it science or not.
    Please read about what sociologists who study science say about the “scientific method.” Basically, there is no such thing. Science is a matter of getting funding and playing politics. It’s a matter of culture and semantics as well as status and prestige. And, how do you figure Thomas Kuhn’s “Structure of the Scientific Revolution” in into your ideas of science? How about the cultural and social influences of what we assume to be “objective”?
    Thanks for the reply.

  13. 13
    jraoul

    Greta writes:
    But how is that different from alternative medicine?
    I write:
    It appeared that your point was that there was a significant difference, and my point was that those differences tend to diminish when looked at closely. Yes, the scientific method is invaluable on paper, but as applied in the real world it is riddled with and undermined by prejudice and profit. I’m with Ann on this.
    Not used to feeling like I’m winning an argument with the usually inarguable Greta Christina, Queen Of Norway,
    jrb

  14. 14
    Greta Christina

    You miss my point, jraoul. There is a significant difference between the two.
    Yes, both conventional and alternative medicine are flawed, and one of those flaws is that they’re overly influenced by profit.
    But conventional medicine has *something* to back up its claims — namely, careful, rigorous, double-blind, placebo-controlled, peer-reviewed testing. Yes, that testing process is imperfect, and the profit motive adds seriously to its imperfection. (Again, in the US — my understanding is that it’s better in Europe and elsewhere.) But it is still significantly and demonstrably better than nothing at all. And over time, the errors in the system tend to get screened out.
    And it has something else to back up its claims — namely, results. It has a history of being extremely effective at preventing and treating a whole host of conditions, from polio to HIV, from high blood pressure to diabetes. The method works: slowly and imperfectly, but a damn sight better than inspired guesswork or trial and error. If you have friends with HIV who are alive today, they’re alive because of conventional medicine.
    Alternative medicine has nothing to back up its claims. It gets either no testing, or unbelievably sloppy testing. It is subject to all the flaws of bias and profit that conventional medicine has… with no system in place to screen out those flaws.
    And most importantly, when careful testing shows that it doesn’t work, its practitioners don’t give up on it — even for a particular treatment for a particular condition, much less on the practice in general.
    This is the point made in the Skeptico article I linked to. And unless I missed it, neither you nor Ann has addressed it. When faced with a whole host of tests showing that their treatments aren’t effective for some particular condition, alternative medicine practitioners don’t say, “Okay, let’s stop doing that.” They come up with rationalizations for why the test doesn’t count, and keep on going.
    My point is not that conventional medicine is perfect. My point is that conventional and alternative medicine share many of the same flaws — but conventional medicine has a significant advantage that alternative medicine doesn’t have. It has a process for testing what treatments do and don’t work; a process that is flawed, but that, even with its flaws, is significantly better than no process at all.
    Again, conventional medicine, by definition, is medicine that has been carefully tested. Alternative medicine, by definition, is medicine outside that careful testing system. And again I ask: What is the advantage of that? What makes that a good thing?

  15. 15
    Greta Christina

    Ann (and to some extent jraoul): It seems to me that you’re making a serious logical error, which cuts to the heart of your argument. It seems to me that this is what you’re arguing:
    a) The scientific method is imperfect. It is a human activity, subject to human flaws both small and large. Even in theory it’s imperfect, and in practice it’s very imperfect indeed.
    b) Therefore, the scientific method is no better than any other system for acquiring and testing knowledge. All such systems are flawed — and therefore no system has any advantage over any other. All are equally valuable.
    Here are the problems with this reasoning.
    a) Agreed. Nobody’s arguing with this.
    b) But b does not proceed from a. The effectiveness of science versus other methods is not a black- and- white, all- or- nothing question. I can agree that the scientific method is flawed and imperfect… and still argue that it’s demonstrably better than any other method we’ve found for acquiring and testing knowledge about cause and effect in the physical world.
    Or to put it more succinctly: Saying that science is an imperfect system is not an argument against the proposition that science is the best system we have.
    If you have a system for acquiring and testing knowledge about the physical world that you think is better than the scientific method… well, what is it? And why is it better? And what evidence do you have that it’s better?
    Your argument is very all- or- nothing, Ann. You seem to be arguing that, because money and politics, culture and semantics, status and prestige, all play a significant role in science, therefore that’s all there is to it.
    And that is demonstrably not true. If it were true, science would not get the dramatic results that it gets. As Richard Dawkins famously said: There are no cultural relativists at 30,000 feet. If you get in an airplane and it stays in the air, it’s because thousands of scientists got their sums right.
    The scientific method has proven to have *astonishing* predictive and creative powers. It’s taken us from believing that the Earth was the center of the universe and illness was caused by demonic possession and bodily humours… and has given us the ability to send telescopes into space. It’s shown us black holes and quasars and millions of galaxies outside our own. It’s how we eradicated smallpox. It’s why we have lightning rods. It’s why we understand that humans are primates. It’s why we understand why brown-eyed parents can have blue-eyed children, but not the other way around. It’s why we know how to prevent infection in a wound. It’s why we know what electricity is. It’s why we’re having this conversation on the Internet. I could go on for pages.
    The scientific method has utterly astonishing powers to help us explain, predict, and create new things in the physical world. If you’re going to argue that other methods are equally good or better, you need to do more than just say, “It’s a flawed human activity.” You have to propose an alternative — and you have to explain why your alternative is better.
    And it’s interesting that you mention Kuhn, Ann. Many scientists first responded to Kuhn with extreme hostility. The scientific community has now not only accepted his ideas, but has embraced them and adopted them into their method. The idea that science works within accepted assumptions and paradigms until a preponderance of data contradicts them… this is now a standard model of how scientists understand and practice science. It’s well-understood that all scientific theories are provisional, only as good as the last experiments supporting them.
    And as the article I linked to by Skeptico shows, that it demonstrably *not* the case with alternative medicine. Alt medicine actively resists changing or relinquishing its theories even when a preponderance of data flatly contradicts them. I’m sorry, but their journals and research and other supposed self-correction methods are a joke. When they bother to do testing at all, they don’t use placebo controls and double blinding and other methods of screening out confirmation bias, etc. And when their experiments are repeated by researchers who do use those methods, the results vanish like mist.
    There’s a famous quote from a chiropractor when a test of a specific technique failed to show its effectiveness: “You see, that is why we never do double-blind testing anymore. It never works!” Citation here:
    http://skepdic.com/akinesiology.html
    That sums up alt medicine in a nutshell — and why I have such enormous problems with it.

  16. 16
    datan0de

    JRaoul, I frequently hear vague claims by “alties” that efficacious treatments and remedies are being “suppressed by the medical establishment”, but have never seen a specific claim that held up under scrutiny. If you can cite a specific treatment that works definitively (beyond placebo effect and cherry picking data points) then I vigorously encourage you to do so. I’d be quite interested see your claim backed up! A single verifiable example could turn “the establishment” on its ear, and allow the very self-correcting mechanisms that Greta describes to work to everyone’s benefit.

  17. 17
    Nurse Ingrid

    I would like to hear jraoul or Ann respond to Jon Berger’s excellent post above. His friend DIED because she chose not to trust so-called “Western medicine.” Does that trouble you at all? You say that you don’t like medicine that relies on the profit motive. Well, someone made an awful lot of money selling this woman — and many others like her — those megadoses of vitamins.
    If her doctor had ordered such a treatment, which did nothing to treat her disease and quite possibly hastened her death — that doctor would be held responsible, probably sued, maybe even lose their license. But somehow the woo practitioners never face such consequences. How about it — if these “treatments” really do work, then those who provide them should be subject to malpractice suits and other punishments if there is a bad outcome…right?

  18. 18
    jraoul

    Greta writes:
    It seems to me that this is what you’re arguing:
    a) The scientific method is imperfect. It is a human activity, subject to human flaws both small and large. Even in theory it’s imperfect, and in practice it’s very imperfect indeed.
    b) Therefore, the scientific method is no better than any other system for acquiring and testing knowledge. All such systems are flawed — and therefore no system has any advantage over any other. All are equally valuable.
    I reply:
    No. My point is: The scientific method rocks, but neither conventional medicine nor alternative medicine rely whole-heartedly on it. Both types of medicine have shown demonstrable results, and both types of medicine have suffered from not relying more heavily on the scientific method. My argument is not with the scientific method; it is with the props given to conventional medicine. I object to foolhardy sticking to treatments that don’t work in both camps, whether such sticking is due to superstition or greed.
    Here’s an almost perfect analogy for what I’m saying: I believe democracy rocks. I believe that America has at times been a pretty good exemplar of democracy. I believe that the current American government pays lip service to the notion of democracy but engages in a whole mess o’ undemocratic practices. I believe there are societies that do not exhibit democratic behavior that have still done some good. I believe the best of all possible worlds would be a society that is both democratic and shows the benefits that have emerged in non-democracies.
    It’s not that I’m a big fan of alternative medicine — I’m not. I just don’t prostrate myself before Big Med either, because it, too, has its problems. I don’t consider the usage of the scientific method to be one of its problems; I consider its *selective* use (and the reasons behind not using it) to be one.

  19. 19
    Greta Christina

    “My point is: The scientific method rocks, but neither conventional medicine nor alternative medicine rely whole-heartedly on it. Both types of medicine have shown demonstrable results, and both types of medicine have suffered from not relying more heavily on the scientific method.”
    Okay. So the problem with conventional medicine is that it doesn’t adhere well enough to its own ideals; i.e., those of the scientific method.
    Granted. I’ve been granting that point since the beginning of this debate.
    But alternative medicine doesn’t adhere to those ideals AT ALL.
    Testing in alternative medicine is generally non-existent. And when alt medicine does test its practices, it does so in this cargo- cult- science way, going through the motions of the scientific process without seemingly understanding the concept behind it, or knowing how to do it right. I’ve read about the tests that alt medicine runs on itself, and they’re a joke. Their methodology has holes in it that a high school science student could drive a truck through. Read Skeptico’s blog, or the Skeptical Inquirer, or any number of other skeptical resources, for details.
    In fact, for the most part alt medicine practitioners don’t even consider the scientific method to be a worthwhile goal that they should be striving for. Some examples: See the quote I offered above, “You see, that is why we never do double-blind testing anymore. It never works!” And in a more serious case, the Society of Homeopaths recently responded to criticism from a skeptical blogger by pressuring the blogger’s ISP to remove the page in question. That is not just falling short of the ideal of the scientific method… it is absolutely antithetical to it.
    And once again, I’ll point to the piece in the Skeptico blog I linked to at the top of this post, the piece that no alt medicine defender in this discussion has so far addressed: the long list of instances where a specific alt medicine practice has been shown to be ineffective… and where alt medicine has ignored those studies and carried on as if they didn’t exist.
    These are not the actions of a medical community devoted, even in theory, to using the scientific method to carefully and rigorously reach the closest understanding we can have of reality. Alt medicine is a multi-billion dollar industry, and it could set up its own systems for doing double-blind, placebo-controlled, peer-reviewed, etc. testing of its treatments if it wanted. It doesn’t want to. It doesn’t care about that.
    You say that alternative medicine has shown demonstrable results. My point is that, on the few occasions where that has happened, the results have been demonstrated *by conventional medicine.* The reason we know they work is because of conventional medicine.
    And Ingrid makes an excellent point, pointing out another enormous advantage conventional medicine has over alt medicine:
    Accountability.
    Like Ingrid, I ask you to re-read Jon Berger’s excellent comment on his friend who died of cancer because she pursued untested and ineffective vitamin therapy instead of conventional cancer treatment. And like Ingrid, I will point out: If a conventional oncologist ignored the standard of care for a cancer patient and instead pursued their own form of untested treatment, and the patient died, there’d be accountability. They could be sued, they could have their privileges and even their license revoked. In extreme cases of repeated reckless negligence, they might even be put in jail. There is no such accountability for practitioners of alt medicine. Why? What possible defense could there be for that?
    I don’t “prostrate myself before Big Med,” either. In every single comment I’ve written in this thread — and in the original post itself — I’ve acknowledged that conventional medicine is flawed and imperfect… sometimes with serious flaws.
    But you keep saying, “Let’s take what alternative medicine has to offer as well.” And I keep asking, “What does alternative medicine have to offer that is not offered by conventional medicine?” And that question keeps not being answered. Yes, alt medicine has occasionally come up with a useful treatment… but the reason we know it’s useful is that it’s been carefully and rigorously tested by the conventional medical system.
    I think you’re making the “golden mean” mistake: the error of thinking that, in a conflict between two opposing sides, the truth must lie somewhere in the middle, with some truth on both sides. That is sometimes true, but it isn’t always true.
    And I really don’t think it’s true here. If the problem with both conventional and alt medicine is that they don’t adhere closely enough to the scientific method, then once again, conventional medicine, while far from perfect, is still vastly superior to alt medicine. It adheres to the scientific method to a fair degree much of the time… and for all its flaws, it has done so with some extremely impressive results.
    Alt medicine doesn’t adhere to the scientific method at all. And their results show it.

  20. 20
    jraoul

    Greta writes:
    Yes, alt medicine has occasionally come up with a useful treatment… but the reason we know it’s useful is that it’s been carefully and rigorously tested by the conventional medical system.
    I write:
    And that’s what I’ve been saying. Let’s take what alt medicine has to offer, combine it with the scientific method (which rocks). Not just rely on strategies that have emerged solely from conventional medicine, which tend to skew towards those that are going to preserve profits and power bases.
    We’re both repeating ourselves so much, I’m guessing we’re simply losing sight of what the other is saying.

  21. 21
    Nurse Ingrid

    “Let’s take what alt medicine has to offer, combine it with the scientific method (which rocks).”
    I couldn’t agree more. Of course, once these treatments have been subjected to the scientific method and have been found to be both safe and effective, it would be a stretch to continue labeling them “alternative”…
    In fact, these sorts of studies are already going on. Just in my immediate professional circle, I am acquainted with “Western” medical doctors, highly respected in their fields, who are studying the following:
    1. whether oyster mushrooms will lower blood cholesterol
    2. whether medical marijuana helps certain types of chronic pain (I’m curious what they use as the “placebo” in that trial. Oregano? I’d think people could tell the difference.)
    3. Whether meditation and other stress-reducing techniques are beneficial to the immune sytems of people with HIV
    There are also, of course, treatments that were once considered “alternative” that have stood up to rigorous testing and are now used routinely in conventional medical settings. Like glucosamine for joint problems, fish oil to lower cholesterol, even zinc has been shown to shorten a cold. And some treatments that did not stand up to testing are no longer recommended, like echinacea which has been shown to be no better than placebo for a cold.
    Could there be more studies like these, more funding for a wider range of alternatives? Sure. But it’s simply not the case that we are “just relying on strategies that have emerged solely from conventional medicine.”
    And again I would ask, are you seriously trying to argue that woo practitioners are NOT motivated by profit? The crystal catalogs? The vitamin stores that seem to be in every mall now? “Faith healers” clamoring for donations on TV? $1,995 for an electronic “detox box” that claims to be a cure for cancer? It sure seems to me like there is no shortage of people getting filthy rich selling stuff that has no actual evidence of either safety or efficacy, and you bet that concerns me, especially when my patients decide to forgo lifesaving medications and buy the snake oil instead.

  22. 22
    Neur0mancer

    As a practitioner of “mainstream medicine” and as someone whose current career is to try to advance it (MD, PhD, doing a research fellowship at a major academic medical center regarding the best way to diagnose and treat ischemic stroke), I’d like to add my voice to this discussion, though I don’t know if there is much that has not been covered by you guys – this is a truly excellent blog and the debate carried on in the comments is outstanding!
    Human beings are lousy at identifying true patterns in complex sets of data where multiple factors influence an outcome. We are so good at grasping simple patterns that we constantly overinterpret results and impose our preconceptions on reality.
    It used to be the case that “mainsteam” (or Western, or whatever) medicine was developed based on the experience of experts. This was not much better than voodoo, because “experts” are just as susceptible to cognitive illusions as anyone else. Now, medicine in the US has migrated to an “evidence-based” standard. Physicians now (at least in theory… we’re all human and fallible) base their practice on what can be PROVEN to be effective. There are defined standards for proof of effectiveness (check out the wiki page on this: http://en.wikipedia.org/wiki/Evidence-based_medicine)
    It’s hard, and goes against our human ego-driven instincts, but it does make us a little LESS human in a good sense.
    I’d strongly recommend a book called “How We Know What Isn’t So”, by Thomas Gilovich, to anyone who is interested in cognitive illusions and an understanding of the fallacies that plague our thinking machines. Much of the work of physicians doing research is trying to avoid errors and biases (including self-serving bias… for some reason, alt medicine people don’t recognize that).
    The comment on “male doctors horning in on childbirth” are valid, but they relate to 19th century medicine, which was not evidence-based. In fact, many of the critiques of modern medicine seem to be focused on the medicine of a hundred years ago. You can point to all the embarassing mistakes that doctors have made and call them charlatans, but damn it, at least we’re trying, in the best ways we know how. I don’t think that can be said for the alt medicine movement. There is a lot of heart there, but critical analysis (which means recognition of our cognitive limitations) seems to be absent.

  23. 23
    Neur0mancer

    The interaction between this site and Wikipedia is less than perfect. The “)” at the end of the link I included actually makes the site screw up.
    Here is the real link for evidence-based medicine:
    http://en.wikipedia.org/wiki/Evidence-based_medicine

  24. 24
    debbyo

    I ask you, should people that have been proven pairs, like many altie charlatans, be beyond questioning simply because they aren’t “mainstream”? The extent of that logic is that if I make up a story about the goblins causing cancer, everyone should forget about what we know about cell changes, spend millions on goblin research, ignore it if it fails to find goblins and balance cancer research between cell changes and goblins. This is madness.
    As a blogger who divides her time between skeptical blogs and political blogs, I go along with the political angle. I think many alties see themselves as anti-establishment – and targeting multinational corporations is part of that – especially pharmaceutical companies. But that does not make the scientific method the enemy any more than disapproving of the way education is funded makes education the enemy. The results of science can be used for good or evil. They can be used for both simply because the method works. I think the altie intuition that something is wrong with the world (especially with authority) is right. We see war, injustice, inequality, racism alongside enormous privilege. But exactly, why is science the enemy? And pharmaceutical companies are the only capitalists on the hit list?

  25. 25
    debbyo

    Whoops, That should have been “Proven liars (not pairs) – sorry about that.

  26. 26
    Joreth

    I think the problem here is that the altie-proponents are suggesting that we shouldn’t dismiss alt. medicine out of hand just because it’s alt. medicine.
    But what they’re missing is that when it *is* subjected to rigorous testing to determine the validity of its claims (and found valid), it *becomes* “conventional medicine” by the process of testing.
    While it is labeled “alt. medicine”, it is either not yet tested or it denies the test results that prove its claims false.
    What Greta Christina is saying here is *not* about dismissing all potentially untested treatments without testing them. What she’s saying is that untested and proved-false solutions are inherently less valuable than the tested-and-proved-true solutions and that once an “alternative” solution has been tested, it becomes, by definition, “conventional” because “conventional medicine” means “we tested this a lot and found it true”.
    If someone makes a suggestion, like, vitamins cure cancer, the conventional method is to test it to see if it’s true or not before offering it to the public. The alternative method is to offer it to the public first and then refuse to do testing at all while simultaneously denying the results of someone else’s tests.
    In the cases where alt. medicine has been accepted by the conventional medical community, it’s because the conventional medical community tested the claims and found them true. It doesn’t mean the conventional medical community is flawless, it means they made the effort to learn the truth with the tools they had available at the time. Then, by definition, those claims are no longer “alternative” because they have been tested.
    Anyone can make a correct guess about something purely by chance. The alt. medicines can sometimes be real and valid medicines and can be “discovered” by a non-scientist purely by chance. But when they are tested to be proven true, they become “conventional medicine” based on the testing process. It was only “alternative medicine” when it hadn’t been tested or when those making a profit on its sales deny test results that prove it false.
    What’s that saying about enough time and enough monkeys with typewriters can produce the works of Shakespeare?
    Ya’ll aren’t really arguing about the same things.
    One guy says “but alt. medicine sometimes is true!” and someone else says “yes, but we only discover it’s true by testing, and that’s what “conventional medicine” means – it was tested first”. So the first guy says again “but conventional medicine is flawed too!” and the second person says “yeah, I already agreed with that.” So the first person says “but sometimes alt. medicine is true!” and the second person says “I already acknowledged that sometimes alt. medicine is true, but it’s the scientific method that tells us if it’s true or not, and subjecting a claim to the scientific method is what makes the medicine no longer “alternative medicine”.”
    Alternative medicine has 2 definitions: 1) we have not subjected this to rigorous testing, so basically, we’re pulling this out of our ass and hope you won’t notice. And 2) someone else subjected this to rigorous testing and proved it false, but we don’t like that idea so we’re gonna ignore those results and hope you never hear about it because we like the profit and we don’t like to admit when we’re wrong.
    Conventional Medicine has one definition: We tested this thoroughly and so far it seems to work. When someone offers a better solution with sufficient evidence to back it up, we’ll stop offering this option.
    If an “alternative” option undergoes testing and proves valid, it is no longer “alternative”. It is, by definition, “conventional”. This doesn’t mean that alternative medicines are *never* valid, it means it has not yet been proven valid or it has been proven invalid. Nor does it mean that conventional medicine doesn’t screw up sometimes.
    Alt. medicine and conventional medicine have exactly the same flaws, but conventional medicine has one thing going for it that alt. medicine doesn’t – it *tries* to overcome those flaws most of the time and often succeeds. Alt. medicine does not try to overcome those flaws and, in fact, holds onto those flaws the way that religions hold onto faith in the face of evidence as a more noble state.

  27. 27
    WF

    i would love to hear your thoughts on this article http://www.huffingtonpost.com/dana-ullman/medical-research-lies-dam_b_555525.html maybe an update to this post is in order?

  28. 28
    Rob

    Do you think studies done involving “alternative medicine” in other countries holds up or do just want to see studies from the US?

  29. 29
    Doug from Dougland

    Rob,
    Scientific studies are international. If it is shown to work it is shown to work. The problem is a lot of alternative therapy studies are not scientific (most specifically in the fact thet the results are not replicable, but also in the methodology like controlling for variables or double blinding it) and therefore not conclusive.

  30. 30
    Cleo Pascal

    I think that proving alternative medicine and healing methods work doesn’t make them conventional. They will only be such if they were accepted and used by the majority. Also, I don’t think that we should make the scientific method the basis for considering something as better. For me, what matters is that the product is proven to be effective by the people who have used them. There are many natural and alternative health treatments out there that are like that, and they also deserve some attention.

  31. 31
    Sensemaker

    Strictly speaking, much alternative medicine, certainly homeopathy us not really untested. It is tested and has failed the test -often repeatedly.
    Sensemaker

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