From: dyer@spdcc.com (Steve Dyer)
Newsgroups: sci.med
Subject: Re: On pre-scientific traditions of medicine (was: Use of term allopath)
Date: 15 Aug 92 05:33:27 GMT
Article-I.D.: spdcc.1992Aug15.053327.11521
Distribution: sci
Organization: S.P. Dyer Computer Consulting, Cambridge MA

In article <1992Aug15.025116.15939@news.Hawaii.Edu> lady@uhunix.uhcc.Hawaii.Edu (Lee Lady) writes:
>I don't think any reasonable person could deny that western medicine is a
>science, or call it a religion.  However, I do think that the attitudes
>of many of its supporters, especially here in sci.med, have a cultist
>flavor to them.  

>By cultist I mean:  the dogmatic assertion of certain beliefs without any
>supporting justification or with minimal justification, especially in a
>loud slow tone of voice, and the conviction that anyone who would
>disagree with any of these beliefs would have to be simply stupid.
>("Haven't you been LISTENING to what I've been saying?")  

Sounds like Greenstein to me.

Listen, if you're going to assert the world is flat, don't expect to
be treated with kid gloves, and when I say you're all wet, don't ask
me for my references.

>And by cultist I mean:  The automatic rejection of all alternatives.  And
>the tendancy of the believer to quickly slip over into dishonest
>arguments:  ad hominem attacks, begging the question, use of slanted
>language, use of ridicule or abuse as a substitute for evidence and
>reason.  Even though the believer is well enough educated to know
>better.  

"But the earth really IS flat!!"

>Opponents of alternative medicine here start out with the claim that the
>use of double-blind controlled trials is better than any other
>methodology.  They don't say "Double blind controlled trials are more
>effective in excluding the placebo effect and cases of spontaneous
>remission than any other methodology," which is something many people
>could agree with.  But they say BETTER, as if such trials were superior
>in respect to every possible criterion, which is certainly not the case.

Oh, please.  This is
	1.) a red herring
	2.) a strawman
	3.) a distortion

>(For instance, they are certainly not "better" in the sense of being
>quicker or cheaper.)  

It's perfectly possible to design a bad study (i.e., one that is
methodologically flawed such that the study tells you NOTHING about
the efficacy of a treatment) which uses more money than a well designed
study.  A poorly designed study, no matter what it costs, is a waste of
time and money, because it doesn't advance its objective.

>But okay.  Agreed, double-blind controlled trials are a very good
>methodology.  But now comes the logical flim-flam.  From saying that
>the establishment methodology is "better" opponents of alternative
>therapies jump to the implication -- the non-sequitur -- that other
>methods of testing are NO GOOD AT ALL!  

Horsefeathers.  This is another strawman argument based on an imaginary
"establishment".  I suspect you don't have the first idea what constitutes
research or what criteria are used to judge a study's design.

There are many studies which can't be performed in a double-blind fashion,
either because of ethical considerations or because the drug can't be
blinded because of its physical properties or pharmacological actions.
That doesn't mean that there aren't methodologies which can't be used to
help eliminate bias and placebo effects.

However, we do have a pretty good idea of what is BAD research.
Relying solely on an appeal to "thousands of years of experience can't
be wrong" is one of them.  Depending solely on anecdotal reports from
patients and practitioners is another.  Doctors and patients are very
good at fooling each other and coming to improper conclusions about the
efficacy of a treatment or intervention, if the variables aren't
well-controlled.  This happens all the time.

You still see a bit of this in conventional medicine as well,
because of its intrinsic conservatism, especially when the
issue is moot and not primarily relevant to a patient's outcome.
But these get winnowed out with time.

>And then comes the dishonest use of slanted words:  Approaches which
>haven't been tested in the approved manner are labelled "unproven" or
>"untested."  Giving the connotation that these approaches have just
>been dreamed up by some people who have never even tried them out.  My
>God, who would want to use something that hasn't even been tested?

Yeah, precise jargon confuses me.  I think everyone should write
to a 3rd grade reading comprehension level.

>These arguments support a cultist attitude toward establishment medicine,
>making it impossible for outsiders to break in, because the approved
>methodology is a big bucks methodology and the only approaches that can
>raise the ante are those with some sort of academic/institutional funding
>or remedies that some corporation has some hope of making a bundle on.
>(It's like saying:  "Our school doesn't discriminate.  Anyone can get
>in who passes our admissions test.  We charge $10,000 for the test.)

This description of "alternative medicine" as a kind of quaint cottage
industry is quite amusing, but it has little relevance to reality.
There are billions of dollars just begging to be spent in this
arena.  If scientific validation were a concern to them, perhaps
these companies could form a foundation to support research grants.

>And then from the opponents of alternative approaches comes the sleaziest
>argument of all, often not quite overtly stated, but definitely implied:

Hmmmm, an implied sleazy argument?

>The implication that because the supporters of an alternative approach
>have, for whatever reason, not run tests using the approved methodology,
>that therefore their approach is not capable of passing such tests.
>("Obviously you're not good enough for our school because you never took
>the admissions test.")  

I think it depends a lot on the therapy.  Something which is ultimately
grounded in unscientific nonsense (e.g., homeopathy) is going to be
treated with a lot more skepticism than, say, acupuncture, which at
least has a recognized track record in certain restricted applications.

>>...actually does work.  If a therapy (whether alternative or not) cannot
>>produce an effect in a double-blind trial then it does not work.
>>Period.
>
>(As if all the alternative therapies that are discussed here had failed
>to produce effects in double-blind trials.  Whereas in fact I believe
>that none of them have undergone such trials.  Which may justify
>skepticism, but certainly not the assertion that such a therapy "does not
>work.  Period.") 

How about: "There is no convincing evidence that the world is flat."

>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.

I don't know, in most states practitioners such as acupuncturists
have to be licensed, and their practices seem to be flourishing
nonetheless.  This is not a process which is divorced from the
medical profession.  Though it is primarily a governmental/political
body which sets the standards, these are formulated with their
input from medical and acupuncture professionals.  I should note
that this process says nothing one way or another about the scientific
legitimacy of acupuncture therapy.

>(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.

>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.

Conventional medicine has no disincentives for integrating
therapies which are efficacious into its armamentarium.
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 promised
rather than being subjected to rigorous scrutiny.

-- 
Steve Dyer
dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer