When Readers Comment (1/6/08) -- CAM edition

My rant last Friday about Complementary and Alternative Medicine (CAM) promoted a vigorous discussion, and I am happy about that. That ambivalence about CAM in even the scientific community is an interesting issue in and of itself.

Several commenters criticized my piece on the grounds that I was being inexact or extreme.

For example, jope had this to say:

While agree that in many cases individuals put far too much faith (and investment) in CAM, it is my opinion that you are going too far in making a blanket statement. While the majority of CAM probably does boil down to placebo effect (at best) or outright hokum (at worst), there is still value to be gained in objectively examining whether there a given approach does contain some useful kernels for science to expand upon. Your stance would seem to prohibit even that.

I'm also disappointed at your use of straw-man arguments, as well as convenient omission of any mention of harms that have been done under the auspices of science-based medicine. If you're going to attack the worst abuses in the system you oppose, you should at least recognize similar abuses in the system you support. Notwithstanding that portrayal of the opposing side, a surprising number of your assertions contain holes big enough to drive a truck through.

Presh Talwalkar added:

I agree CAM is not science in the Platonic world of science and no-science.

But I would definitely be open to it in times when medical science is impotent.

Imagine you have a rare disease where life expectancy is poor, like an aggressive cancer. You've heard a cocktail of multiple chemo agents is best--but no doctor is willing to prescribe the drugs (fear of litigation). In fact, no company will let you participate in clinical trials with combo drugs (creates confounding variables).

You're stuck with a probably ineffective drug.

Would you be willing to try homeopathy? Would you drink up some wheat grass? Or try acupuncture? They are readily available and might help. Acupuncture might even improve your quality of life--probably important for what little you expect.

Science is the best knowledge to apply to all people. But that might not be good enough.

Those should give you some flavor of the debate. Read the post to get the rest.

I want to add some additional comments to clarify my position.

1) I am not saying that CAM should not exist. That is a subject over which I have no control. What I am saying is that it is not science and should not be classified as such.

2) I think that CAM has pulled a much better PR job than science has in that it is convinced people that it somehow represents the scientific fringe -- new and as yet untested hypotheses that should be subject to further analysis. From this point of view, CAM has framed itself as the scientific outsider facing down an entrenched establishment.

Setting aside the observation that comparing yourself to Galileo and playing the Kuhnian-"science is socially constructed" card is usually the best way to know that you are dealing with a group of crooks, CAM is not part of a scientific fringe. The issue is not that CAMs assertions are untested. In the majority of cases, CAMs assertions have been tested and found wanting.

There is data about CAM, and in most cases it has found that the treatments it suggests are either demonstrably ineffective -- e.g. homeopathy -- or potentially dangerous -- e.g. mixing herbal remedies with prescription drugs. CAM is not a group of renegades challenging the reactionaries; rather, it is a group of cranks trying to ignore subjects about which a substantial amount of data already exists -- data that overwhelmingly demonstrates that CAM is not worth anyone's time.

3) What I object to most about CAM is that it attempts to substitute an alternative standard for truth in a scientific discussion.

Let me put it this way. I am prepared to accept alternative facts on scientific issues. (Let me know when CAM has some to offer.) I am prepared to accept alternative interpretations of existing facts. This is because science is a process, and we do not always get either the facts or the interpretations correct.

What I am not prepared to exist is an alternative standard for evidence. CAM posits an alternative standard for evidence other than the scientific method: a historical standard. CAM proponents argue that because a belief is widespread, it should by virtue of historical acceptance be deemed credible. Science, on the other hand, argues that the only acceptable standard for truth is inter-personal verification by experiment.

These two standards for evidence are mutually incompatible. Furthermore, it is corrosive to the scientific process to suggest that the two can exist side-by-side. How I can go to work and run experiments everyday with the knowledge that whatever I might find the truth will be determined by public intuition?

This is my response to those who argue that CAM and science can politely coexist. They can certainly exist in the same society, but they cannot exist in the same theoretical framework because they contradict one another. And they certainly cannot coexist in a scientific process that claims any credibility or coherence.

4) I want to address this issue of a straw man argument. Many people got the sense from my post that I was criticizing only those parts of CAM that were clearly hookum, ignoring those parts that have some scientific merit.

Many CAM proponents claim to accept the scientific method. Many people claim that a subset of CAM embraces experiment. I do not reject those elements of CAM that embrace the scientific method, but I do say that they are by definition not CAM.

For example, if a CAM researcher were to say that an element of grape juice has a certain pharmacological effect, and then they attempted to isolate and identify that element, I would have no problems with that process. However, I assert that in doing so, the CAM researcher has ceased to practice "alternative" medicine. The isolation of compounds and identification of their properties is a scientific process of analysis. What is alternative about that? The researcher clearly accepts the view that matter is composed of molecules with defined properties. What is complementary about that? I fail to see why researchers who are doing science insist on calling it CAM, like it is somehow super-special-ultra science.

You have to ask yourself: if an individual embraces all the assumptions of science, employs the same standards and practices, and desires the same goals; are they not a scientist? Is the title "alternative" appropriate in such cases?

Thus, if you are a CAM researcher and you think that truth should be determined by experiment, you are contradicting yourself. CAM has certain assumptions and science has certain assumptions, and the assumptions motivating your research are scientific not alternative.


More like this

It's always interesting to substitute "creationism" or "intelligent design" for CAM in a post like this and see how little changes. True, some "alternative" therapies have panned out, but the underlying principles are the same.

Thanks for this. Not enough Drs/scientists have the time or inclination to clear this crap up. What else do you think we plain old citizens do to help? Other than telling people they're nuts, of course.

How I can go to work and run experiments everyday with the knowledge that whatever I might find the truth will be determined by public intuition?

Is this a rhetorical question? Or soul-searching? Ack.

I think our underlying disagreement is well illustrated by your last point: You have adopted a mutually exclusive set of labels, with no allowance for the fact that virtually no one -- scientist, quack, or regular joe -- adheres absolutely to either set of standards. You then proceed to arbitrarily claim everyone in the middle-ground as being on the side of science. This of course leaves only the lunatic fringe to CAM, which was your goal. But by your own standards, doing so also waters down the alleged ranks of the science-minded and, as such, is a slippery slope into "some are more equal than others" elitism.

IOW, substantively we are in agreement, but you appear to have a framing problem. And there be dragons!

CAM isn't the only fringe "science" that is stealing money from taxpayers and from research. In that fine city of yours is the chairman of a department of "genetic" medicine. This chair is the recipient of numerous program grants, which as you are likely aware, more lucrative and substantial than a R01. What's he studying? Creating an anthrax vaccine, a program for which he has no expertise, limited knowledge, and a staff that simply cannot do it. Why is he given the money? Because he has connections within the NIH bureaucracy who steer these programs to him. Same thing is going on in DARPA where they have visions of developing methodology of "growing" limbs ala amphibians. These are but two examples of where emotions (fear & sadness) override intelligence and logic.

By Onkel Bob (not verified) on 06 Feb 2008 #permalink

Certainly we should never reject something as CAM before it's been scientifically examined, but my impression was that the label is only attached to things that have already been examined by science and found to be useless.

I don't think it's at all unreasonable of Jake Young to reject CAM when the defining feature of the category is the uselessness of its practices. If the shoe fits, wear it - if not, don't pretend it's serviceable.

If any defenders of alternative medicine can present an example of something that is unfairly rejected as mainstream medicine despite having a rigorously-demonstrated positive benefit, please, present it for us.

By Caledonian (not verified) on 06 Feb 2008 #permalink

Good points Jake. I do agree with jope that you put the middle ground into science.

One hopeful sign is that people have developed an automatic preference for science. That's a confirmation of science's great reputation.

This is why it's hilarious to hear people pretending to be science. Here's a good example. Yoga is probably good for the mind and body. You work on breathing. You excercise. You medidate.

But some yoga teachers aren't satisfied there. I've heard a teacher call it a "yoga science," and further claim that "it's the only science." She went on to explain that medical science only works on one body, when in fact, yoga tells us we have some thing like five or six bodies...

So here's my middle ground: her claims are not falsifiable, and I would not call it a science. But she is able to motivate people and get them to do exercise. Some thing that reports on health benefits don't seem to be as effective. So in the end, I would probaly still recommend people to try her techniques.

Interesting bit of waffling between your clear cut declaration of war: "CAM needs to end", to the updated back-handed concession "[CAM is unjustly positioned] as yet untested hypotheses that should be subject to further analysis" and back to "CAM and the scientific method are mutually exclusive".

I'm disappointed by your enthusiastic embracing of 'geezer medical politics': no doubt you are a welcomed member to the Old Guard, those who historically hold fast to the status quo until it becomes superstition, while common experience awaits technology-hampered metric-driven proofs.

Your own example of grape compounds is a case where common claims of health-giving properties were recognized as hypotheses and proven by newly available or applied tests. But according to your position, those who held the 'grapes have health-giving compounds' without the benefit of metrics, should have been summarily relieved of any respect, despite mass intuitive assessment of the human bodies' responses.

The history of science is replete with ebbs and tides of acceptance and rejection based on social constructs. As any cross-cultural inquiry will affirm, social constructs guide our codifications, in both positive and negative directions. Challenge from various 'lunatic fringes' are all that uproot the deadly stalls in rigidly incorrect models of thought. Certainly they must be verified, but to deny them out of hand is tantamount to the belief that our medical practices have reached the absolute zenith of human knowledge.

If a cure can be similarly effected by both a natural remedy and a synthetic analog of that naturally occurring substance, the artificial medicinal is clearly inferior if only for its larger negative bio-footprint. The truth is, good treatments are being suppressed by greedy people who would rather we buy into not-quite-right synthetics, rather than integrated natural approaches. Frankly, there are some diseases societies-in-flux simply forget how to treat. (I hope at some point you will study abroad in a society with a different set of foundational assumptions -- we would all benefit from such exchanges.)

Much of the disconnect between the intuitive and metric approaches resides in our model of how an organism functions, and the language we use to describe it. Presh Talwalkar's example in the comment above describes how yogi refer to an integrated model of the body. If the 'modern' scientist allows that the brain has overlapping control centers for multiple sensory inputs (5 or 6, perhaps?!), then she has just described what yogi have been saying for centuries, albeit with their 'unscientific' vocabulary.

Regarding toxins: take a look at synthetic estrogens, including those that are mimicked by plastic food containers, and how these substances can not currently be filtered from municipal water utilities. Compare with the rates of various cancers that proliferate in estrogen-rich environments, and then dare repeat your assertion that "they are all in peoples heads" (one of the most doomed phrases out of any prospective physician's mouth -- check the history of DDT and its delayed recognition as toxic to health for more in this regard, for pity's sake!)

And finally, a weighted counter-scenario:

If your spouse were addicted to a physician-prescribed re-uptake inhibitor (accidentally discovered to "make people feel better"), and his sexual performance is degraded, should you force him to confront stark reality, or shelter him in complacent delusion ("no worries darlin', sex was just a little recreation vital to our healthy marriage")?

I say no: Throw the flagging dog to the curb -- clearly he prefers sacrificing your relationship rather than empirically investigating natural depression remedies and their multi-dimensional healing abilities, probably in some misguided trust of so-called 'science' -- so cut your losses, babe, and dump the addict!