I am a skeptical apatheist, strict materialist, and avid follower of the likes of P. Z. Myers and James Randi. I also believe in the effectiveness of acupuncture and other traditional Chinese medicine.
I admitted it. Then, I thought ‘Now what?’.
It took me a while to reconcile these positions. The first thing I realized, immediately, is that excuses for how skeptical I can be in all other cases won’t do. To the skeptic who is convinced I am holding a belief irrationally, my willingness to follow the evidence in other cases doesn’t justify the case in which I don’t. I hold that antivaxxer nonsense is dangerous, faith healing illusory, and homeopathy a waste of time. I don’t believe in any New Age superstitions. I’m a strict materialist (everything is either physical or information on a physical medium), and I disagree with any explanations of TCM or concepts of chi that involve magical energies. While I agree that most explanations of the phenomena behind TCM are unscientific, I do believe that there is an actual phenomena there that can be exploited for medical purposes (and eventually explained scientifically). I even have a very limited amateur hypothesis attempting to explain how it can work, that is consistent as I can make it with my layman’s understanding of the science. I have standards and heuristics for evaluating TCM practitioners, and only visit those who are both well versed in Western medicine and referred by members of the martial arts community whom I trust. All of this is besides the point. Those who insist on the strictest consistent standards of proof must say I’m cheering on a placebo. That I degrade other placebos does not change that fact. Moreover, without objective and rigorous evidence, I cannot prove them wrong. There’s still a debate on the efficacy of TCM going on in the academic circles, but in this case “still in debate” means “not enough objective proof yet”.
So, then, why do I not change my opinion? I came to believe in the efficacy of TCM for a reason, after all. A personal history of effective TCM treatment, as well as similar histories with people I knew personally, was where I first became convinced. My practice with the internal (‘soft’) martial arts and studies in cognitive science eventually led me to form a hypothesis of my own on how the mind interacted with the body, and how TCM utilized this. I do have evidence - but it’s anecdotal. I do have an explanatory framework - but it’s personal. What I can use to make sense of the phenomena in a way that convinces myself is utterly inadequate for convincing others. Yet I have no reason so far to doubt my own judgment or senses. Is there a solution?
It is completely possible for an individual to come to a position by way of evidence that is anecdotal and context specific, such that there would be no reason for others with a different experience to come to that position themselves. The intellectually responsible thing to do in this case is admit to what I call empirical surrender - admitting that, while I do not believe that I am wrong, I can not deny having no objective way to prove that I am right. Thus, everyone else should not take my position seriously without further proof. After all, the problem here isn’t with what I believe, but with my lack of evidence for arguing my position to other people. I don’t have to change my beliefs. I just have to admit I don’t have what people should demand before changing theirs.
I find this arrangement entirely satisfactory. There are some other people who have come to similar conclusions as mine from their own personal experience, and we can discuss the details and debate the fine points on how we think TCM works. But I don’t need to be committed to the details of my position. Perhaps someday, overwhelming, crushing evidence against the efficacy of TCM will emerge alongside a strong neurological explanation of what exactly was happening when I went under the needle. Then I will have to throw up my hands and say “Okay, I give, these guys have it”. Or perhaps, TCM’s effectiveness will be vindicated in the future, and a theory similar to the hypothesis in my mind become mainstream. But I’m not a scientist, and I don’t do the work that would make me an authority on this issue. So I should leave to the people who are, and who do.
I offer the idea of empirical surrender to the world at large because it also has the nice potential to reconcile two seemingly opposing forces: the standards needed to maintain intellectual responsibility, and the viewpoints of people who feel threatened by such. Many perfectly responsible and civilized atheists, for example, make the point when arguing against creationism or various other religious falsehoods that people can believe whatever they like and hold whatever faith they choose. They simply can’t pretend that they have evidence when they don’t. Now, that’s a perfectly reasonable stance. Freethinkers, practically by definition, have an aversion to ‘thoughtcrime’ approaches and understand it’s pointless to try and police what people think. So granting all the freedom to believe, regardless of the irrationality of the belief, has to be a given. However, by insisting on evidence, we may indeed be demanding something of others’ belief systems that are threatening. The implication, to many religious who feel threatened by atheism, is that their belief systems are meaningless because they lack the evidence and sound reasoning that our belief systems value. This is especially difficult for anyone who has conflated believability with support from authority. There are a lot of people like that, and to fight pseudoscience like creationism, climate change denial, or antivax quackery, we need to be able to reach them.
Offering people the option of empirical surrender sidesteps all that. It just means that there are two kinds of reason to believe a proposition: personal reasons, which only apply to you, and solid evidence, which is good enough for everybody [1]. Thus, if you lack solid evidence, but there is no solid evidence specifically disproving your position, then you are not stupid or crazy for holding your belief [2]. However, it would be dishonest of you to try and convince other people that your beliefs are true without solid evidence, you know, the reason to believe something that applies to everyone.
This cuts out and denies positions like creationism and antivax quackery, while still leaving a safe space for fuzzier positions like belief in some sort of God (or in the general efficacy of TCM). It does not require the hardened skeptics to ’soften’ their approach (such as by attempting a “science and religion are compatible” position) since those declaring empirical surrender will cease acting like they have evidence when they don’t, which is all a skeptic could ask for. The best thing about this proposal is that it is palatable to anybody on the losing side of a skeptical debate as long as your ego can accept people disagreeing with you - unless, of course, you have a vested interest in getting people to believe something in opposition to evidence and rational inquiry. In which case, you’re probably some sort of con artist. The interests behind denial of anthropogenic climate change, for example, have too much money riding on the outcome to admit that no one should take them at their word. Likewise, homeopaths will have trouble marketing their product if required to give a disclaimer stating “we have no evidence and you shouldn’t support us at the expense of the medical practices that do”. But that’s tough beans for them. Everybody should enjoy the right to believe whatever they wish; but the ‘right’ to deceive others, nobody should enjoy.
And while I do believe in the effectiveness of acupuncture, I can admit I may be wrong. Rather than risk deceiving others, then, I will keep my belief to myself.
Though if you’re looking for an acupuncturist or reiki practitioner in Toronto, I can recommend a few names.
[1] Assuming of course a sound explanatory framework, in light of which the evidence makes sense. Remember that the sun’s rising and setting through the sky was once construed as evidence for a geocentric universe until we changed our framework and saw that the phenomena, while still existent, did not prove what we thought it did. But that tangent is the subject for another essay. You could teach a phil of sci course on it, and brighter minds than mine have.
[2] You may be guilty of some cognitive dissonance, but there’s little shame in that. I personally think the ability to compartmentalize is a useful and essential cognitive trait in humans, usable for good as well as ill.
Evil font, should not be allowed on my server!
Comment by Devin Baillie — June 24, 2010 @ 8:05 am
Your “evidence” and “explanatory framework” sound remarkably like the “evidence” put forth by creationists (”I have a personal relationship with god, you can’t understand it unless you’ve experienced it”).
You are, of course, correct, in that you are free to believe whatever nonsense you want. Legally, you’re even free to claim whatever non-evidence you want (within advertising laws if you’re selling a product). Just as with creationists, skeptics will point at your irrational beliefs and laugh.
Further you say you believe in “traditional Chinese medicine” in general. Why only Chinese medicine? Why not traditional Japanese medicine, traditional Native American medicine, or traditional African medicines? What is it about the Chinese medicines that make you believe they work, rather than any other ethnic group in history? Did they have some hidden source of knowledge, so that despite the fact that the entire reasoning and motivation for their medicines is wrong (by your own admission), the medicines somehow work?
For the two particular modalities you mention by name:
Acupuncture: In every (sufficiently large, properly controlled) scientific study, it has been shown to be no better than placebo. In one case, it was shown to be less effective than placebo. The conclusions of the authors: The placebo must have had an effect too.
Reiki: If you ignore “chi”, and all that garbage, this is just faith healing without any god to do the healing. I never thought I’d say it, but that means there is actually a form of alt-med that is actually less plausible than faith healing.
In conclusion: You’re not a skeptic, a skeptic is willing to subject their own beliefs to rational analysis. You’re probably correct that we all have cognitive dissonances, but a skeptic abandons them if they don’t hold up to rational analysis. You just plug your ears and say “I don’t have any evidence, you can’t hurt me”. You believe in an implausible form(s) of alternative medicine based on faulty reasoning, with no evidence to support it.
Comment by Devin Baillie — June 24, 2010 @ 8:27 am
PS. You may agree with skeptics on many issues, but that doesn’t mean you are a skeptic.
Comment by Devin Baillie — June 24, 2010 @ 8:28 am
PPS. Reiki is (according to wiki), of Japanese origins, not Chinese.
Comment by Devin Baillie — June 24, 2010 @ 8:33 am
Really, the only thing I can add that to Devin’s remarks that I haven’t already said through Wave was that the uniqueness of empirical surrender only applies when there is no objective, contradictory evidence to your position. If Alice has subjective experience X on a position and Bob does not, then Alice is only justified in offering an empirical surrender if there is no objective evidence Y that both Alice and Bob have access to that contradicts the position.
I would part with Devin slightly and argue that in this scenario, an empirically-surrendered Alice can still be a skeptic so long as she is willing to look for potential contradictory evidence instead of just saying “I have no way of knowing” (itself an argument from ignorance similar to the God of the Gaps argument), and - critically - she must be willing to change her mind and abandon those beliefs in spite of the surrender if the evidence points that way. A classical skeptic would have withheld judgement on the position until verifiable evidence either way is presented, of course, which sidesteps the whole need for surrender.
Incidentally, “there is still debate” doesn’t always mean “insufficient proof”. It occasionally means “very vocal minority clinging to belief”. This is especially evident in creationism, where a small list of specialty (vanity?) journals publish dissenting opinion and call for more research into a given claim which has long since been resolved by the more mainstream journals. Exactly the same thing happens with alternative medicine, except there’s a facade of experimentation and more money for publishing non-vanity journals that still specialize in that particular viewpoint. As soon as you slay the sacred cow of “it’s traditional to the Chinese” (or similar), your specific examples don’t hold up to experimental inquiry.
And at that point, those flying the white flag of surrender would appear to be just using it as a security blanket: Sooner giving up their honor than their cherished (but demonstrably false) beliefs. This is what concerns me about advocating for such a position. To the extent that it’s useful, it’s irrelevant (since it amounts to accepting that a belief held without any objective evidence either way is irrational), and to the extent that it’s novel, it’s dangerous (in that it amounts to a sort of reverse God of the Gaps: a strategy for preserving an existing belief from encroaching scrutiny, here by simply deflecting attention).
Comment by Brian D — June 24, 2010 @ 11:53 am
Traditional Chinese medicine (and most other sorts of alt-med) is not a case where there is “no objective evidence Y that both Alice and Bob have access to that contradicts the position”. As I mentioned in my earlier comment, there is objective evidence, and it indicates to no benefit over placebo (sometimes even not as good as placebo, which might be expected when you are stabbing a patient, possibly introducing pathogens).
Further, even if we neglect, for a moment, the clinical studies, and assume there is no evidence either way to support or contradict the hypothesis that TCM works, the skeptical/rational approach is still to conditionally reject the hypothesis based on its inherent implausibility. The proposed mechanism of action is ridiculous (the concept of “Chi” or similar) according to all scientific knowledge, and there is no rational proposition for a “new” mechanism.
To use a slightly modified version of Russel’s Teapot:
If I tell you that there’s a teapot in orbit around the sun between Earth and Mars, too small to be seen with any modern telescope (though not, fundamentally, invisible to potential future telescopes), is the skeptical position:
a) There is no teapot, the suggestion that there is is, frankly, ridiculous.
or
b) We do not have sufficient evidence to reach a conclusion on the existence of a teapot until a more powerful telescope is built. Ergo, a skeptic can champion either side of this discussion, via “Empirical Surrender”, and still consider themselves to be rational.
Part of being a skeptic is the application of Occam’s Razor.
Comment by Devin Baillie — June 24, 2010 @ 2:23 pm
Even if we be more generous, and consider a situation in which both alternatives in a situation are equally (un)reasonable, and no evidence yet exists to support/disprove either hypotheses, the skeptical approach is to accept neither until the evidence becomes available.
Comment by Devin Baillie — June 24, 2010 @ 2:28 pm
Sorry for posting so many separate comments, but I keep thinking of things to add:
We can be even more generous in this discussion, and still TCM practioners/believers lose:
Assume that there is no evidence in favour or opposed to the effectiveness of TCM. Assume further the (ridiculous) idea that “TCM is effective” is more plausible than its opposite.
What is the rational and (perhaps more importantly) ethical course of action:
a) Use it on patients while we wait for evidence.
b) Conduct clinical trials to test its effectiveness and side effects, beginning with proposed mechanism of action, followed by animal studies, small human studies, and finally large scale clinical studies. If, after all of this it has been shown to be effective compared to placebo, and have no/acceptable side-effects, then, and only then, make it available to the general population.
(Here’s a hint, if you choose option ‘a’, you’ve just ignored the last couple thousand years of medical ethics, but are in agreement with virtually every alternative medicine practitioner in the world)
Comment by Devin Baillie — June 24, 2010 @ 2:37 pm
Here’s one study of the type I mentioned:
http://www.ncbi.nlm.nih.gov/pubmed/19433697?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
To summarise it:
They compared “individualized acupuncture”, “standardized acupuncture”, “simulated accupuncture”, and “usual care”. They conclude that the placement of the needles, or even whether or not you stick them in is irrelevant (that is, both “real” acupunctures failed in comparison to their placebo control of “simulated acupuncture”, of course, that’s not how they spin it).
They conclude that all three forms of acupuncture are more effective than “usual care”, but neglect to mention in their conclusions that they define “usual care” as “no study-related care”; that is, all of the acupuncture patients were getting “usual care” in addition to their acupuncture treatments. This comparison is therefore uncontrolled and poorly designed.
This paper is therefore consistent with most other accupuncture studies (both positive and negative): In properly controlled and well designed studies, no effect above placebo is observed, and proponents of acupuncture spin it as “the placebo must be effective too”. In uncontrolled and poorly designed studies, proponents of acupuncture find an effect. Confirmation bias and/or dishonesty much?
Comment by Devin Baillie — June 24, 2010 @ 3:24 pm
Hi guys! Good to have you following. Sorry about the Times New Roman; this was a copy/paste from Google Docs. Y’all prefer Helvetica?
Now, onto the responses.
First things first: I can not defend the efficacy of acupuncture. This essay is not in the defence of the efficacy of acupuncture. The very point of this essay was that regardless of my personal position on acupuncture, you should treat my position as wrong if it doesn’t agree with the science, and I should be honest enough to tell you to do so (which I hope I have done clearly).
Second things: I want to give every comment the attention it deserves, but right now I’ll try to give a response that helps for them all and return later to deal with individual points one on one. The main thrust of the idea of empirical surrender is that there is a separation between propositions we privately hold as beliefs and the propositions we can responsibly share in the public square. That first group of propositions cannot be policed. Period. It’s not ecologically valid, and the religious and ideological movements that have tried to police them we hold in disgust, and with good reason (”You can sin in thought, word, deed, or omission”). The second we can, to some degree, although not easily. This is what empirical surrender is trying to address. By trying to give those with irrational or untrue beliefs a comfortable way for them to reconcile their beliefs so that they do not continue to present them as factual, we can prevent these beliefs from perpetuating themselves. Creationism needs creationists to indoctrinate the next generation of creationists, and that’s a reproductive system I’d like to neuter.
A skeptic can’t “champion” both sides of the issue with empirical surrender. Representing a view that flies in the face of objective evidence and reason, such as my view on TCM, is a violation of the surrender (call it empirical perfidy; you’re not allowed to fly the white flag and then start shooting as soon as the other side accepts). If it makes things clearer, what I’m proposing can be viewed as a kind of intellectual quarantine. We don’t expose the faulty positions to others, trying to argue for them, in the same way that you don’t expose yourself to healthy people when you’re sick with a nasty contagion. I chose TCM as my example not because I think I can argue for it well (if I could, it would make a poor example) but to show that I was willing to walk the walk as well as talk the talk. Choosing a hypothetical example not related to my personal experience would not have had the same weight as choosing something I believe and agreeing to shut up and not defend it in public. It’s like showing that I support a quarantine solution by voluntarily quarantining myself upon discovery of an illness.
Comment by Michel F — June 25, 2010 @ 1:54 am
Finally: the minutiae and nitpicking: yes, I’m aware that Reiki is Japanese, I choose not to extend my position on TCM to other traditional medicines because I have not had personal experiences that lead me to think they work, and for people who have, if their position is as tenuous as mine on TCM then I would encourage them to admit empirical surrender too.
Regarding post 8: the problem is that you have patients voluntarily signing up to the treatments. Just like everybody has a right to believe what they wish, everybody also has the right to screw up their own health and take stupid risks, sadly. I would select option b) in every case, BUT, that of my own health. If other adults (very important distinction here!) wish to, that’s their right. In the case of my children, if I had any? Not sure. I think I’d like to teach them to trust the science over their Dad, and I would certainly not take them to TCM practitioners in the case of anything remotely dangerous or life-threatening. (That rule of thumb I mentioned, only visiting TCM doctors who practice Western medicine as well, is specifically so I can be sure they’ll tell me to go to the hospital and get away from the herbs when it’s important. If that isn’t an admission of surrender, I don’t know what is.)
Finally, on post 9, I’m aware of that study and trend, though I thank you for bringing it up. That study was actually the finding that convinced me to admit complete empirical surrender on this issue rather than keep recommending TCM to others who didn’t already believe in its efficacy.
If you guys want to know why I would still subject myself to TCM, we can discuss that on a conversation regarding the efficacy of TCM, which I’m not sure this comment thread should become (to Wave!). However, as per the terms of the surrender, I do want you to hold that I am wrong, and the discussion would be merely an exploration of why and how and to what degree I am wrong. K?
Comment by Michel F — June 25, 2010 @ 2:10 am
Regarding post 8: the problem is that you have patients voluntarily signing up to the treatments. Just like everybody has a right to believe what they wish, everybody also has the right to screw up their own health and take stupid risks, sadly. I would select option b) in every case, BUT, that of my own health. If other adults (very important distinction here!) wish to, that’s their right. In the case of my children, if I had any? Not sure.
Doesn’t matter if patients are voluntarily signing up for the treatments. The people administering the treatments are misrepresenting the evidence about the treatments. While you may acknowledge that there is no (objective) evidence in favour of the effectiveness of the treatments, others do not. People have the right to take stupid risks, but the practitioners should not have the right to sell placebo as medicine. If they were all open and honest about the evidence against TCM, and people were therefore able to make an informed choice to take the stupid risk.
It’s even worse if we assume that there is an physiological effect, but that we have no understanding. Assume, for a second, that acupuncture actually does help with pain relative to placebo. We have no idea of the mechanism of action, therefore no idea what potential side effects are. I could envision it somehow causing nerve damage, which would help with the pain alright. In that case, we can say that making the patient a paraplegic also helps with the pain. TCM practitioners are selling (and claiming the efficacy of) “treatments” which are, at best, completely ineffective; or, at worst, causing unknown physiological effects in their patients. Many of them go further and downplay or even deny the effectiveness of science-based medicine.
In the case of children: Do you support the right of others (perhaps less well-informed than yourself about the lack of evidence) to take their children to a TCM practitioner instead of a proper doctor? How would you draw the line about what severity of medical conditions parents (or yourself) are allowed to take their children to alt-med practitioners instead of real doctors? There are TCM practitioners who claim that acupuncture can cure everything from back pain to cancer. If a parent believes this, should they be allowed to take their child with cancer to an acupuncturist instead of an oncologist? I don’t think so.
Support of any form of alt-med is a form of science denialism, which is why I say it is incompatible with being a skeptic. Alt-med practitioners are selling “treatments” for potentially life threatening conditions (Do you know if your chronic back pain, for example, may be caused by bone cancer? I bet 99.9% of acupuncturists don’t either.), and so should be held to the same laws and standards as pharmaceutical companies/hospitals/doctors. If a pharmaceutical company sells a treatment which they don’t know the effect of, they will be (rightly) sued. This is true even if they admit they don’t know. As soon as you label it alt-med or TCM, it gets a free pass. Why is that?
Also, just to clarify your position for me:
Are you saying that:
a) The evidence for acupuncture (and TCM in general) is inconclusive and/or unavailable, so you believe in it’s effectiveness based on personal experience.
or
b) The evidence is clearly against the effectiveness of acupuncture, and you believe in it’s effectiveness based on personal experience despite this fact.
I’m not on wave yet, you could post a new post here if you want to debate the effectiveness.
Comment by Devin Baillie — June 25, 2010 @ 1:05 pm
Actually, one of the things I think I saw on the Google dev threads (and in the LONG video when Wave was revealed) is a plugin for Wordpress that lets blog posts or comment threads act as waves (actually, it embeds a wave in a webpage that can be edited in the page or through the Wave interface as normal). I don’t know if it’s finished yet, but that’d be a much more interesting way of handling comment threads. Certainly would allow for better threading.
Stepping back a bit from the TCM basis of this conversation, I’m wondering if this is also an attempt at justifying the split between opinion or values-based statements and statements of fact (the is-should distinction), or an attempt at reinforcing that distinction in a way that might reach people who have no idea that they’re confusing the two. The latter seems dangerously accomodationist to me.
Comment by Brian D — June 25, 2010 @ 3:49 pm
Sorry about the delay, fellas.
@ Devin: My exact position is probably closer to b). However, they haven’t just started studying acupuncture yesterday; as far as I know, most national health organizations have acupuncture and most of TCM under the “ineffective but harmless” heading.
But back on topic. I think you’re still mistaking the position of empirical surrender for something weaker than it is. “Doesn’t matter if patients are voluntarily signing up for the treatments. The people administering the treatments are misrepresenting the evidence about the treatments.” And that’s not empirical surrender. Empirical surrender means not representing anything about the treatments to anyone except those who are well-informed and have made a conscious decision. It forces them to either work an inevitably shrinking market with a career doomed to fail, or go into the science and look for the objective evidence that will save the practice (I suppose that even if they don’t find that evidence, and they very well may not, they’ve got a career in medical research to fall back on).
“Many of them go further and downplay or even deny the effectiveness of science-based medicine.” “There are TCM practitioners who claim that acupuncture can cure everything from back pain to cancer.” And they’re wrong, and they’re not exhibiting empirical surrender. Have I ever implied they are right or endorsed that kind of behaviour? Here or anywhere else? Ask Brian.
“Do you support the right of others (perhaps less well-informed than yourself about the lack of evidence) to take their children to a TCM practitioner instead of a proper doctor?” I don’t support the right of anyone to do anything ill-informed about their health except going to the scientifically supported doctors. I have no idea how to enforce it, though, so it would be better if the ill-informed were not advertised at by the maliciously deceptive. Which is part of what I’m trying to address with empirical surrender.
@ Brian: I don’t recall or quite see how the ought-is distinction is coming in, and I’m not sure I understand how the latter option is “dangerously accomodationist”. That’s probably just me, though - please explain further.
Comment by Michel F — June 30, 2010 @ 6:41 pm
“I don’t support the right of anyone to do anything ill-informed about their health except going to the scientifically supported doctors. I have no idea how to enforce it, though, so it would be better if the ill-informed were not advertised at by the maliciously deceptive. Which is part of what I’m trying to address with empirical surrender.”
How to enforce it is simple. The same way you do with new/untested drugs: You don’t let “health-care” providers (using the term loosely to include all alt-med practitioners) provide untested/unproven therapies. I’m not aware of any TCM practitioner (including the ones who also practise “Western” medicine) who actually inform their potential patients that all the evidence points to no effect beyond placebo. If you know of any such practitioner, let me know, and I’ll this claim:
All TCM practitioners are (intentionally or otherwise) misrepresenting the effectiveness of TCM. I’m not arguing that you shouldn’t have the right to take whatever risks you want, but that they shouldn’t have the right to market it as “health-care”, “medicine”, or as having any effect above placebo. As far as I’m concerned, providing TCM and advertising any effect beyond placebo is fundamentally dishonest and a violation of medical ethics. If anything, it’s even worse coming from a doctor who otherwise practices real medicine. I’ve seen some alt-med practitioners who recommend (their particular modality) of alt-med in conjunction with “Western” medicine, but never any who openly admit that the evidence is against their particular modality having any effect.
I think we’re arguing two different issues here. You’re arguing for your right to make an informed decision to take a placebo for whatever ails you. I agree with that you have this right. It’s your body, and I fully support your right to do whatever you’d like with it. If you want to visit a dominatrix and have her pierce your skin for sexual fun, I would agree that you have the right to do so (I don’t need to know about it, but you have the right to do it). I can’t (self-consistently) argue at the same time that you shouldn’t be able to go to someone and have them poke needles into you for non-sexual reasons. I’m arguing that “they” should not have the right to market TCM as “medicine” in any way shape or form.
So I guess if you can show me a TCM practitioner (whether or not they also practice “Western” medicine), who freely admits that the evidence is against TCM, then we are in complete agreement on all issues.
PS. No worries about the delays, don’t be surprised if I don’t have time to post for the next few days.
Comment by Devin Baillie — June 30, 2010 @ 10:46 pm
“So I guess if you can show me a TCM practitioner (whether or not they also practice “Western” medicine), who freely admits that the evidence is against TCM, then we are in complete agreement on all issues.”
I honestly have no idea. I’ve never pressed any on the issue. Moreover, we’re unlikely to reach complete agreement, and it’s besides the point, which is that we can disagree and I’m willing to acknowledge in public that the evidence is on your side and people should agree with you over me.
(On a side note: I don’t know if TCM in particular qualifies as “untested”; Western medical science has been probing it for a while now and I’ve never heard anything more negative than “ineffective but harmless”.)
Comment by Michel F — July 7, 2010 @ 6:30 am
“Ineffective but harmless” isn’t harmless if uneducated people are convinced that “it”’s effective, and choose “it” over truly effective medicine.
What are your thoughts on the more general issue of the ethics of offering untested (or tested and found to be ineffective) treatment modalities and claiming that they are effective? Should a doctor/practitioner be allowed to prescribe placebo and tell the patient that it’s effective medicine?
Comment by Devin Baillie — July 7, 2010 @ 8:02 am
Untested stuff is bad and off limits. Tested stuff that’s found ineffective is going to depend on a case-to-case basis, and here I’m going to have to admit I have no damn clue. I understand (to my limited layman’s degree) that we’re still trying to iron out the degrees of placebo so that we can define at something other than “makes pain go away for no reason”. If not all placebos are created equal, then I can only leave the judgment to the experts on a case-by-case basis.
And frankly, the thought of noninvasive painkillers that don’t have any significant side effects is mighty tempting.
Comment by Michel F — July 7, 2010 @ 5:43 pm
Pain goes away “for no reason” (actually, because the human body is remarkably good at both repairing damage, and ignoring persistant pain) all by itself. That’s what placebo controlled trials are designed to account for: Any effect other than the proposed effect (for example, some people might start to think they feel better just because they are in a hospital and someone is paying attention to them).
Perhaps you should read up on what it actually means when a treatment has no effect compared with placebo, if you don’t actually know what it means, you can’t really say you’re making an informed decision about TCM, now can you?
Comment by Devin Baillie — July 8, 2010 @ 8:19 am
If the pain goes away who cares if it is all in the mind?
Comment by Tony — July 17, 2010 @ 1:37 am
We care for the same reasons we have false advertising laws, and testing requirements for new medical treatments.
Alt-med practitioners are essentially lying to their customers about treatments which have either not been proved to work, or been proved not to work.
Comment by Devin Baillie — July 20, 2010 @ 7:59 am
Tony, if the goal is mere removal of *this particular* pain, then I suppose you can make an argument that the difference doesn’t matter, right now. However, if the goal is understanding the pain so that it can be treated in the future, or in others, then a causal understanding is required. Every attempt at understanding the causes of pain and treating them points in the same direction as medicine, not (say) homeopathy or TCM. Sure, the patient may subjectively be assured for a little while, but it doesn’t treat the problem - and that misdirection leads other patients to ignore conventional treatment in favor of platitudes. That is why I care.
Or, to put it more succinctly, we can rephrase your comment as a simple “What’s the Harm?”. There are costs to wooly thinking - and not just to yourself, but to others as well.
Comment by Brian D — July 21, 2010 @ 10:36 am
Which is why I’m saying this to Tony: go with what Devin and Brian say. They’ve got the better argument.
I haven’t had much chance to read up on placebo research, guys. Sorry for abandoning ship without a word; I’ve been busy.
Comment by Michel F — July 29, 2010 @ 1:11 pm