While I am on vacation, I’m reprinting a number of “Classic Insolence” posts to keep the blog active while I’m gone. (It also has the salutory effect of allowing me to move some of my favorite posts from the old blog over to the new blog, and I’m guessing that quite a few of my readers have probably never seen many of these old posts, most of which are more than a year old.) These posts will be interspersed with occasional fresh material. This post originally appeared on January 21, 2006.
I know I’m a bit of a stickler, a curmudgeon, if you will, when it comes to medicine. Call me crazy, but I have this rather annoying tendency to want to see evidence-based research based on sound physiologic principles backed up by basic science and well-designed and well-executed clinical studies that show a treatment, drug, or remedy to be effective. When someone makes a claim for a drug, herb, therapy, etc., my first reaction is to ask for the evidence behind those claims. Also, contrary to some straw men arguments that are sometimes made in response to my writings, this evidence does not necessarily have to be in the form of a randomized, double-blinded, placebo-controlled trial. True, they represent the gold standard, but all doctors, including me, know that some therapies are just not easily amenable to such trials. For example, it can be impossible to double-blind participants and doctors during clinical trials of surgical therapies, particularly trials involving surgery versus no surgery or trials involving two different operations (in which the surgeon, at least, knows what operation was done). There are also diseases which are not sufficiently common to produce enough patients to do a randomized trial with adequate statistical power to detect differences in outcome. In these cases, the goal is evidence as close as possible to randomized, double-blinded trials, and, the closer to that goal the evidence is, the more credible it usually is. I’m also aware that for many treatments the literature is sometimes contradictory, meaning that a synthesis of the best scientific and clinical evidence is what is needed to come up with treatment recommendations. Even so, to me scientific evidence-based medicine represents the best method by which to determine if treatments do what is claimed.
Not surprisingly, this has gotten me some rather negative reactions from alties. And, contrary to some accusations, I do try to apply these criteria to both “alternative” and “conventional” medical treatments that I come across. I also get a bit annoyed when I see, as is all too frequently the case, fawning credulous articles written about unproven, ineffective, or pseudoscientific treatments:
When Ismael Calderon was growing up in Puerto Rico, his mother was the nurse of the neighborhood. There were no doctors.
“People would come to her and she would cure them by using plants,” said Calderon, now science director of The Newark Museum. “She did not have a license to practice, but she learned ethnobotany from her predecessors. Different plants have chemicals that assist us in having better health.”
Was his mother a scientist? No. But what she practiced was ethnoscience, which refers to time-tested traditions passed down by various ethnic groups through the ages.
Ethnoscience is not pseudoscience, Calderon emphasized. Neither is it fad science. It is good ancestral science.
My first thought was: “What the hell is ‘ethnoscience’?”
“Ethnoscience is not pseudoscience?”?
You just know that a statement like that is going to get my attention, because I really hate it when alties misappropriate the term “science” in order to claim the mantle of authority that science brings. Science involves the empiric observation of measurable quantities and the testing of hypotheses to falsify or support them. Mr. Calderon’s mother may have had a lot of practical experience, but she was not doing science. Consider: What diseases did she “cure” using plants? How do we know she “cured” them, rather than the disease being self-limited? How do we know her apparent “cures” weren’t due to the placebo effect? Did she make hypotheses, test new treatments based on those hypotheses, and cease using treatments that didn’t work and, most importantly, record her observations carefully and as empirically as possible, so that others could build on them?
The answer is almost certainly no. For one thing, traditional “healers” almost never stop using any treatment that has been passed down to them, even ones that clearly don’t do what is claimed, such as homeopathy or using echicinea. The same “healing” just gets passed on from generation to generation with little or no change. For another thing, such healers almost never do anything resembling a clinical trial to see if their treatments truly work. They instead rely on memory and experience with their treatments. Sometimes their experience may be correct in concluding that a certain treatment or herb is effective against a certain disease, but confirmation bias and regression to the mean (a problem that is difficult to control for even in well-designed clinical trials), among other problems and biases, will guarantee that at least as frequently their “experience” will lead to a conclusion that appears correct to them but in reality is not. In either case, they’re not really doing science.
Finally, look at some of these statements and see if you think that any of these should be able to claim the mantle of “science.” I pick the one that’s closest to something that is empirically testable and might have elements that stand up to scientific scrutiny first:
Colbin’s specialty — how food changes the way the body works — was sparked long ago when she discovered that modifying her diet cleared her complexion and gave her a deep supply of energy. The truth was never more apparent to her, she said, than the day she cured a migraine with applesauce.
Using food therapeutically is inexpensive, easy and available to anyone with enough will to learn, she said.
There’s no doubt that food may influence health. The problem is determining what foods and how. In any case Colbin’s statements are so vague as to be meaningless. “Deep supply of energy”? What the heck does that mean? How do you measure this “energy”? “Cure a migraine with applesauce”? If that‘s truly effective in treating migraines, it shouldn’t be too hard to demonstrate empirically, should it? If it’s that effective, it would take just a small clinical trial that wouldn’t take very long to perform. Believe me, having known some people with horrible migraine problems that were poorly responsive to standard treatments, I know that their doctors would have been more than happy to recommend applesauce to them if it actually helped them get rid of migraines. In any case, there’s little doubt that improving one’s diet can result in better health, but what, specifically, constitutes “improvement” in the diet? What specific food items can prevent disease? Science represents the best way to find out.
Now, let’s go to one therapy that’s even less scientific:
Kejian Xiao, originally from Changsha, China, and currently practicing traditional Chinese medicine in New Jersey, will diagnose the public’s chi and then prescribe individual teas to balance their ying and yang energies.
One recent day in her K.J. Clinic in Skillman, Xiao made teas and spoke about the Taoist ying/yang philosophy that underlies traditional Chinese medicine. Ying, she said, comprises the substances of the body — blood, fluids, structures. Yang is the movement of the ying. The two are always in flux, establishing and re-establishing balance in the body.
Health problems happen when there is sluggish or no movement, resulting in stagnation, stiffness and pain.
“Most of the diseases start with the yang and the body not moving correctly,” Xiao said. “Over a long time, eventually you develop a disease.”
Various teas, blended for individuals’ unique ying/yang mix, are created using some 400 herbs, including leaves, twigs, roots, flowers, mineral products, animal products and oyster shells, depending on the practitioner’s style. Xiao uses six to 12 herbs in her formulas.
What is “chi”? How is it measured empirically and objectively? The definition of Ying is so vague as to be meaningless, as is the definition of Yang. Be that as it may, let’s ask this: How does she know that the “Yang” and the body “not moving correctly” cause disease? What diseases? All diseases? It’s certainly possible that some of the herbs or teas that Xiao likes to use may have therapeutic benefit, but on what scientific basis does she know that they “work” or which one “works” for which disease? How does she determine each individual’s “unique ying/yang mix” using teas?
Not surprisingly, regardless of the disease, in most cases the treatment is more or less the same:
The concept of ying and yang extends even to a person’s mental life, according to Xiao. An overactive mind, considered too yang, is manifested by excessive talking, frustration and the overstimulation of stress. A mind that is too still, however, can manifest in depression.
Both are considered out of balance. Both are treated with teas.
Or how about this, the least scientific therapy of all in the exhibit:
Dr. Kamau Kokayi, who earned his medical degree at Yale University School of Medicine and is medical director of the Olive Leaf Wholeness Center in Manhattan, will cap off the day’s events with a 4 p.m. talk and demonstration of African medicine.
“I’ll introduce the attendees to traditional African medicine as another cultural expression of the healing power that’s inherent in human beings,” Kokayi said. “Most people in the Western world now have heard about Chinese medicine and Ayurvedic medicine, but when they think about Africa they don’t associate it with healing potential.
“Africa usually is seen as an area in constant need of aid from the West. I want to dispel that notion.”
Central to African medicine is the belief that people are spirits encased in physical bodies. Given that assumption, divination is key, according to Kokayi, who was born in the United States but has traveled extensively in seven African countries to create a documentary on traditional healers there. He will bring traditional African diviners to the museum to demonstrate what they do.
“Spirits encased in physical bodies”? This may or may not be true, but it is definitely not science, “ethnoscience” or otherwise. “Divination is the key”? What the heck is “divination”? On what basis do they divinate? What empiric observations lead to their divinations for specific patients and diseases? Has the accuracy of their divination ever been empirically tested? How? What were the results? Finally, if it isn’t empiric observations that lead to divination and treatment, then why on earth should I take the claims of these African healers any more seriously than I take those of John Edwards or other psychics or spiritualists? Without empiric evidence and a basis in observable, reproducible natural phenomena, all that’s left is superstition and pseudoscience.
The bottom line is, whatever the basis of these “healing systems” are, whatever value some components of them may have in complementing “conventional” medical treatments, the vast majority of these systems aren’t scientific in any way, shape, or form. Much of what is contained in them isn’t even empirical. Indeed, in large part, these “ethnoscience” healing arts are based on untested and untestable religious beliefs (Chi, Ying/Yang, “spirits encased in physical bodies,” etc.) that remain outside the purview of science because they cannot be empirically measured or tested. It is quite possible that some of the herbal remedies used by these healers have value, given that many drugs are derived from plants and natural products, or that some treatments like acupuncture may help pain, and it is worth testing empirically the ones that give an indication that they might have some efficacy. Nonetheless, for these “healers” to try to claim the mantle of science by labeling their belief systems “ethnoscience” sounds to me like a case of special pleading, where they try to argue that they are entitled to claim the mantle of science even though their evidence and methods do not meet or conform to the standards demanded by science because of their special situation or history;. Also, at least in part, this appropriation and modification of the word “science” can be seen as a case of pseudoscience and religious beliefs trying to redefine what science is to include the supernatural, as “intelligent design” creationism advocates on the State Board of Education have voted to do in Kansas. Fortunately, science doesn’t (or at least shouldn’t) work that way. If advocates of these “healing systems” want to claim the mantle of science for their specialties (be it “ethnoscience” or any other hyphenated science), they should be held to the same standards of hypothesis generation, experimentation, and evidence as scientists are.
Until advocates of these different “healing arts” can conform to and meet the standards of science to demonstrate that their herbs, treatments, and “rebalancing of energy” can do what they claim they can do for patients and provide a scientifically plausible mechanism by which they accomplish this, it’s way too premature to grant the label of science to these “healing arts.”