Thursday, January 22, 2009

Some clarity on alternative therapies and medical science

Mindblog reader Ian has pointed me to this essay on alternative medicine and new age spirituality by Bruce Charlton, at the University of Newcastle upon Tyne. His website contains other interesting bits of writing. He paints what I think should be a useful and clear distinction:
I would define alternative therapies in terms of them having non-scientific explanations. In so far as a therapy does have a biological explanation, I would regard that therapy as simply part of orthodox medicine. The crucial difference between orthodox and alternative therapies is therefore that alternative medical systems have non-scientific explanations based on spiritual, mystical, legendary or otherwise intuitively-appealing insights...I am broadly supportive of alternative and complementary therapies because I think that overall they do a great deal of good for a large number of people. But the kind of good they do is psychological and spiritual; not medical. They are about making people feel better (‘healing’) not mending their dysfunctional brains and bodies (‘curing’). Alternative therapies certainly are not a part of medical science. So, on the one hand, I would like to see alternative therapies thrive and spread, and on the other hand they should drop all their pretensions to ‘scientific’ validity. In future, alternative medicine should explicitly become part of New Age spirituality, and thereby clearly be differentiated from orthodox medicine and biological science.
He argues against the relevance of randomized trials to test alternative therapies:
...when randomised trials are used in alternative medicine, the usual process of therapeutic development is turned on-its-head. Instead of coming at the end of a long process of scientific evaluation, randomized trials are placed at the beginning of evaluation, and are indeed expected to be the only form of scientific evaluation – with randomization used in isolation with no possibility for cross-checking using other scientific methods...The problem is not so much that alternative therapy systems are scientifically primitive; it is that alternative systems are not scientific at all. By definition they do not have scientifically-grounded explanations. When the constraints of randomized trials are properly understood, it becomes clear that 'positive' trials in alternative medicine are irrelevant.
His summary:
Orthodox medicine is based on scientific theories and is properly characterized by objective evaluation criteria and formal professional structures of education and certification. Alternative healing deploys a wide range of intuitively-appealing but non-scientific explanations, and constitutes a consumer-dominated marketplace of ideas and therapies which are personally-evaluated by the client...Orthodox medicine focuses on curing disease and promoting health. But alternative therapies should be based on promoting well-being and personal fulfillment. To do this they need to be able freely to deploy poetic explanations and charismatic healers as part of the wide and growing practice of New Age spirituality.

1 comment:

  1. Anonymous1:08 PM

    Well, just to give some off-the-cuff commentary since I don't really have the time which this topic warrants... I'll limit myself to two points which have related to personal experience of mine so as to limit the widespread "hot wind" factor which plagues both sides of this general question.

    First, it is correct that the double-blind trial as a methodology for 'proving' alternative therapy claims is completely unsuited -- but this is NOT for the reasons as quoted. As anyone who has spent any amount of thoughtful time working with alternative case studies would know, the holisitic imperative of the alternative therapy outlook is what actually makes double-blind trials irrelevant. The current en vogue deeply analytical process of chopping away factors and criteria (and of course also usually physical components such as molecules or compounds) in order to design a proving experiment already automatically disqualifies itself from proving or adequately studying any alternative therapy which bears holistic hallmarks. (Another way to see this is to think along the lines discussed in Craig Holdrege's intereting book "The Forgotten Factor of Context" which analyzes the pitfalls of genetic engineering.) Basically put: context is everything in undertanding the holistic case, and you artificially describe the case to be studied out of existence as soon you begin cutting away facets to analyze for a coherent double-blind study. No single other person or case is equivalent to Molly's symptomology, mental and physical, when taken by a good homeopath or Bach Flower therapist or depth psychologist or even acupuncturist. Even Molly in 2008 will be different from Molly in 2009. So the province of strictly analytical testing does not actually comprehend the holistic therapies it is often attempting to debunk. We paint things with our favorite colors in order to see what they look like.

    The second very important point to be aware of is: why do alternative therapies exist at all, and why do they appear to be thriving as cultural choice? It has very much to do with the perceived ineffectiveness of mainstream healing, or as you have suggested, mainstream curing. The literature is riddled with cases of professional medical specialists having made their diagnostic pronouncements, dooming the patient within X months, nothing can be done by "science" unfortunately -- only to see these same practitioners arrogantly refusing to consider the matter further when their patients return in a few years telling of having managed their own healing (and curing) process successfully by having investigated many alternative routes and settled upon such and such a therapy.

    You cannot faithfully or legitimately study anything you are not willing to consider on it's own terms.

    One does not profitably consider the paintings of Picasso's blue period by analyzing the molecular makeup of the blue tint in his canvases or by statistically measuring the percentages of which brushstrokes fall where. One, instead would have to immerse oneself in topics like the artistic and cultural milieu of the times and also have a look at Picasso's own biography and psychology to get a true picture and in-depth feeling. Similarly, there is a big "artistic" component, for lack of a better term, within all good, effective alternative case-taking. And that is precisely because it is accepted and valued that CONTEXT MATTERS with the patient.

    By contrast, the increasing dissection of natural phenomena relating to health and illness which has been undertaken by the mainstream medical profession and espcially the pharmaceutical industry, which the former kowtows to economically, explicitly works against understanding or weighing CONTEXT. This is directly why our often-heralded technological medical progress has produced bizarre and miserable real-life situations such as elderly people needing management systems to keep track of all the maintenance (or would you still insist upon "curing"?) pills they must take, and why many die each year iatrogenically. Where has the classic doctorly understanding of the individual patient gone in our modernity?

    Seen in this light, it is easy to recognize Bruce C.'s suggested neat categorization of professional mainstream medicine = curing while alternative therapies = merely healing or making the client imagine they fell better, for what it really is. An apology for "science" and a minimizing of the alternatives, simply because he cannot become comfortable wrapping his mind around antyhing too real, i.e. anything with too much context. Natural reality is cancelled away by analysis, progressively so with more and more analysis, and many, most, modern thinkers are very immuned to this basic realization.