It’s time to revisit the scientific method to deal with the complexities of alternative treatments.
The U.S. government has belatedly confirmed a fact that millions of Americans have known personally for decades – acupuncture works. A 12-member panel of “experts” informed the National Institutes of Health (NIH), its sponsor, that acupuncture is “clearly effective” for treating certain conditions, such as fibromyalgia, tennis elbow, pain following dental surgery, nausea during pregnancy, and nausea and vomiting associated with chemotherapy.
The panel was less persuaded that acupuncture is appropriate as the sole treatment for headaches, asthma, addiction, menstrual cramps, and others.
The NIH panel said that, “there are a number of cases” where acupuncture works. Since the treatment has fewer side effects and is less invasive than conventional treatments, “it is time to take it seriously” and “expand its use into conventional medicine.”
These developments are naturally welcome, and the field of alternative medicine should, be pleased with this progressive step.
But underlying the NIH’s endorsement and qualified “legitimization” of acupuncture is a deeper issue that must come to light- the presupposition so ingrained in our society as to be almost invisible to all but the most discerning eyes.
The presupposition is that these “experts” of medicine are entitled and qualified to pass judgment on the scientific and therapeutic merits of alternative medicine modalities.
They are not.
The matter hinges on the definition and scope of the term “scientific.” The news is full of complaints by supposed medical experts that alternative medicine is not “scientific” and not “proven.” Yet we never hear these experts take a moment out from their vituperations to examine the tenets and assumptions of their cherished scientific method to see if they are valid.
Again, they are not.
Medical historian Harris L. Coulter, Ph.D., author of the landmark four-volume history of Western medicine called Divided Legacy, first alerted me to a crucial, though unrecognized, distinction. The question we should ask is whether conventional medicine is scientific. Dr. Coulter argues convincingly that it is not.
Over the last 2,500 years, Western medicine has been divided by a powerful schism between two opposed ways of looking at physiology, health, and healing, says Dr. Coulter. What we now call conventional medicine (or allopathy) was once known as Rationalist medicine; alternative medicine, in Dr. Coulter’s history, was called Empirical medicine. Rationalist medicine is based on reason and prevailing theory, while Empirical medicine is based on observed facts and real life experience – on what works.
Dr. Coulter makes some startling observations based on this distinction. Conventional medicine is alien, both in spirit and structure, to the scientific method of investigation, he says. Its concepts continually change with the latest breakthrough. Yesterday, it was germ theory; today, it’s genetics; tomorrow, who knows?
With each changing fashion in medical thought, conventional medicine has to toss away its now outmoded orthodoxy and impose the new one, until it gets changed again. This is medicine based on abstract theory; the facts of the body must be contorted to conform to these theories or dismissed as irrelevant.
Doctors of this persuasion accept a dogma on faith and impose it on their patients, until it’s proved wrong or dangerous by the next generation. They get carried away by abstract ideas and forget the living patients. As a result, the diagnosis is not directly connected to the remedy; the link is more a matter of guesswork than science. This approach, says Dr. Coulter, is “inherently imprecise, approximate, and unstable-it’s a dogma of authority, not science.” Even if an approach hardly works at all, it’s kept on the books because the theory says it’s good “science.”
On the other hand, practitioners of Empirical, or alternative medicine, do their homework: they study the individual patients; determine all the contributing causes; note all the symptoms; and observe the results of treatment.
Homeopathy and Chinese medicine are prime examples of this approach. Both modalities may be added to because physicians in these fields and other alternative practices constantly seek new information based on their clinical experience.
This is the meaning of empirical: it’s based on experience, then continually tested and refined – but not reinvented or discarded – through the doctor’s daily practice with actual patients. For this reason, homeopathic remedies don’t become outmoded; acupuncture treatment strategies don’t become irrelevant.
Alternative medicine is proven every day in the clinical experience of physicians and patients. It was proven ten years ago and will remain proven ten years from now. According to Dr. Coulter, alternative medicine is more scientific in the truest sense than Western, so-called scientific medicine.
Sadly, what we see far too often in conventional medicine is a drug or procedure “proven” as effective and accepted by the FDA and other authoritative bodies only to be revoked a few years later when it’s been proven to be toxic, malfunctioning, or deadly.
The conceit of conventional medicine and its “science” is that substances and procedures must pass the double-blind study to be proven effective. But is the double-blind method the most appropriate way to be scientific about alternative medicine? It is not.
The guidelines and boundaries of science must be revised to encompass the clinical subtlety and complexity revealed by alternative medicine. As a testing method, the double-blind study examines a single substance or procedure in isolated, controlled conditions and measures results against an inactive or empty procedure or substance (called a placebo) to be sure that no subjective factors get in the way. The approach is based on the assumption that single factors cause and reverse illness, and that these can be studied alone, out of context and in isolation.
The double-blind study, although taken without critical examination to be the gold standard of modern science, is actually misleading, even useless, when it is used to study alternative medicine. We know that no single factor causes anything nor is there a “magic bullet” capable of single-handedly reversing conditions. Multiple factors contribute to the emergence of an illness and multiple modalities must work together to produce healing.
Equally important is the understanding that this multiplicity of causes and cures takes place in individual patients, no two of whom are alike in psychology, family medical history, and biochemistry. Two men, both of whom are 35 and have similar flu symptoms, do not necessarily and automatically have the same health condition, nor should they receive the same treatment. They might, but you can’t count on it.
The double-blind method is incapable of accommodating this degree of medical complexity and variation, yet these are physiological facts of life. Any approach claiming to be scientific which has to exclude this much empirical, real-life data from its study is clearly not true science.
In a profound sense, the double-blind method cannot prove alternative medicine is effective because it is not scientific enough. It is not broad and subtle and complex enough to encompass the clinical realities of alternative medicine.
If you depend on the double-blind study to validate alternative medicine, you will end up double blind about the reality of medicine.
Listen carefully the next time you hear medical “experts” whining that a substance or method has not been “scientifically” evaluated in a double-blind study and is therefore not yet “proven” effective. They’re just trying to mislead and intimidate you. Ask them how much “scientific” proof underlies using chemotherapy and radiation for cancer or angioplasty for heart disease. The fact is, it’s very little.
Try turning the situation around. Demand of the experts that they scientifically prove the efficacy of some of their cash cows, such as chemotherapy and radiation for cancer, angioplasty and bypass for heart disease, or hysterectomies for uterine problems. The efficacy hasn’t been proven because it can’t be proven.
There is no need whatsoever for practitioners and consumers of alternative medicine to wait like supplicants with hat in hand for the scientific “experts” of conventional medicine to dole out a few condescending scraps of official approval for alternative approaches.
Rather, discerning citizens should be demanding of these experts that they prove the science behind their medicine by demonstrating successful, nontoxic, and affordable patient outcomes. If they can’t, these approaches should be rejected for being unscientific. After all, the proof is in the cure.