From: lady@uhunix.uhcc.Hawaii.Edu (Lee Lady)
Newsgroups: sci.med
Subject: Re: On pre-scientific traditions of medicine (was: Use of term
Summary: Justifying continuing ignorance doesn't benefit anyone.
Date: 17 Aug 92 22:08:59 GMT
Followup-To: sci.med
Distribution: sci
Organization: University of Hawaii (Mathematics Dept)

In article <1992Aug15.053327.11521@spdcc.com> dyer@spdcc.com (Steve Dyer) writes:
>In article <1992Aug15.025116.15939@news.Hawaii.Edu> lady@uhunix.uhcc.Hawaii.Edu (Lee Lady) writes:
>
>>I think the point that many people in this discussion don't realize is
>>that this big bucks system of testing serves the alternative
>>practitioners as well as it does the establishment.  If accupuncture, for
>>instance, were tested using the approved methodology and found worthy,
>>then it would be absorbed into the mainstream.  It would be taught in
>>medical schools and people like the present practitioners couldn't offer
>>it anymore because that would amount to practicing medicine without a
>>license.
>>(And furthermore, let's face it, a lot of the alternative
>>approaches would fail such tests and then there would be definitive
>>proof that they're no good, instead of just a lot of hot air being
>>exchanged on usenet without any factual basis.)
>>Everyone involve has disincentives for actually putting alternative
>>therapies to the test using the approved procedures.  The only group
>>the present system doesn't serve is the general public.

>     ... 
>Your point is well taken that the majority of these schools
>of "alternative medicine" would prefer to operate under a
>shadowy situation of vague claims and diffuse promises
>rather than being subjected to rigorous scrutiny.

I may respond to some of the rest of your reply after you've had time to
calm down and think rationally about what I wrote and what you wrote.
But I want to address this point immediately.  

Your paraphrase is attributing to me something which I didn't say and
tried to be extremely careful not to say.  I didn't say that alternative
practitioners prefer not to have scientific respectability.  Clearly many
of them very much want recognition from the scientific and medical
establishment for what they do.  You can see this quite clearly from
their postings on usenet.  (These are the idealistic ones.  It's
plausible to believe that the minority who are making bundles of money 
might be quite happy with their status, as you claim.)  

From a practical point of view, though, once the believer in massage, or
accupuncture, or hypnotic imagery, or Chinese medicine starts to think
about the enormous investment of time and money involved in doing a study
that would actually be accepted by the medical establishment, they can't
help but wonder (in my opinion -- I'm mind reading) "What would I get out
of it?"  There are no incentives for them to do careful research (except
for their own idealistic enthusiasm) and if they really think the matter
through (as I don't think many of them have) they would realize that
there are actually disincentives.  

>>(And furthermore, let's face it, a lot of the alternative
>>approaches would fail such tests and then there would be definitive
>>proof that they're no good, instead of just a lot of hot air being
>>exchanged on usenet without any factual basis.)
>
>And what's the matter with that?  I don't know what's so great about
>people taking money from consumers when they're offering a service
>which has been shown to be ineffective.

What's the matter with that?   It's not being done, that's what.  We
can argue about whether or not alternative practitioners prefer to
operate in a shadowy situation of vague claims and diffuse promises
(which certainly doesn't apply to all such practitioners).  But
people's motives are really irrelevant.  It's  not in the interest of
the general public for these claims to remain uninvestigated, and
realistically, the only way to have them investigated satisfactorily is
to have it done by the existing scientific community.

There have been cases where alternative practitioners have put their
whole soul out, at considerable personal sacrifice, in an attempt to do
a study that will be accepted by the scientific community.  But there
always (as far as I know) turns out to be something wrong with such a
study.  And the establishment doesn't respond by saying "Your study,
although not definitive, certainly shows that your approach has promise
and is worthy of further investigation."  Instead, the attitude is
"Aha!  We found a flaw in your study!  We're throwing it out.  Your
approach is still unproven and we're justified in ignoring it."

I do not think this is a straw man argument.  I can't cite particular
instances for you -- I leave it to the proponents of alternative
approaches in sci.med to do that.  But I read the popular press and I
notice this sort of thing happening.  

And in In article <16084@pitt.UUCP> geb@dsl.pitt.edu 
      (gordon e. banks) writes (in response to my statement, quoted at
      the beginning of this article):
>
>Yes, that is true.  Evaluation is a no-win situation for the quack 
>practitioner.  If his secret bug juice really works, why it will be 
>adopted by the "establishment" and he won't be allowed to sell it anymore.
>And if it doesn't work after testing, the FDA will have him arrested
>as a fraud.  So, since he's found enough suckers (or believers, as
>you will have it), why bother testing?  Just keep raking in the cash!

Gordon, you're just illustrating the overall point I was making in my
posting.  The use of pejorative terms like "secret bug juice," "quack,"
and "suckers" is not rational argument, but merely a cover-up for a lack
of any rational or factual basis for one's argument.  And whether someone
is raking in cash or not is not a scientifically relevant consideration
to the effectiveness of a treatment -- fortunately, or most physicians
would be discredited!  

Furthermore, you don't see the implications of what you're saying.
Casting aspersions on practitioners and their motives is good for
vaccuous arguments on usenet but it does nothing to solve the problem.  

If there is any real benefit to be found in any of the alternative
approaches, then serious research can reveal this and make this benefit
available to a larger part of the public.  Where there is no benefit,
then serious research can show this and save the public from investing
large amounts of time and money in things that don't work.  

For instance, look in the yellow pages for any reasonably large city
under the heading chiropractors.  There are an incredible number of
chiropractors around.  And to me it's absolutely scandalous that after
all the time chiropracty has been around and all the money people spend
on it, there's still no serious research (except for the recent studies
showing that it does have real benefit for some orthopedic problems) and
that people are still reduced to arguing about it on usenet on a
non-factual basis.  

The attitude expressed by so many on sci.med is "We're justified in just
ignoring these approaches since the type of research we believe in hasn't
been done."  This attitude doesn't benefit anyone.  
--

Imagination is more important than knowledge.  -- Einstein 

lady@uhunix.uhcc.hawaii.edu         lady@uhunix.bitnet
Newsgroups: sci.med