Sunday, July 15, 2007

Alternative medicine

What exactly is western/conventional medicine? Why do i trust it so much? Why do i oppose Chinese and alternative medicine so much? Am i biased against alternative medicine because of my training in western science?

First of all, i am not specifically against alternative medicine treatments for diseases. I couldn't care less what type of medicine is used as long as it works. Before advocates of alternative medicine jump at this opportunity and point out that certain treatments under alternative medicine are indeed efficacious, let me say that while certain type of alternative treatments do work, this does not mean that alternative medicine as a whole is effective. It's like saying all dogs are animals and since all dogs have four legs, all animals have four legs. That's a logical fallacy known as Hasty Generalization.

The reason why i am opposed to alternative medicine is because it is used without sufficient evidence to prove it's safety and efficacy. By proof, i do not mean anecdotal evidence. That in itself is also a logical fallacy know as Proof by Example. An example of that would be by saying

"I've seen a person shoot someone. Therefore, all people are murderers. "

When one tries to use anecdotal evidence as proof such has knowing people who have been cured by alternative medicine or hearing stories about such beneficiaries, even if we play the devil's advocate and assume that the people who told such stories did not lie, one should consider the following:

1) Would they have recovered without any treatment in the first place?

2) Could it be the placebo effect which has been proven to be pretty powerful indeed?

3) How about those who died and hence were unable to tell you how "effective " those treatments were?

4) Is there a biased that enhances the circulation of such sucess stories? Eg. Those that benefited from alternative medicine seeking out others who have similar experiences and then spreading such stories together?



So proponents of alternative medicine might be tempted to attack western medicine by using the same arguments as i have put up above. To answer the question of how scientists determine if a particular drug is useful indeed, scientists frequently use a method of testing called a Double Blind test. The following description of a Double Blind test is taken from Wikipedia:

"Double-blind describes an especially stringent way of conducting an experiment, usually on human subjects, in an attempt to eliminate subjective bias on the part of both experimental subjects and the experimenters. In most cases, double-blind experiments are held to achieve a higher standard of scientific rigour.
In a double-blind experiment, neither the individuals nor the researchers know who belongs to the control group and the experimental group. Only after all the data are recorded (and in some cases, analyzed) do the researchers learn which individuals are which. Performing an experiment in double-blind fashion is a way to lessen the influence of the prejudices and unintentional physical cues on the results (the
placebo effect, observer bias, and experimenter's bias). Random assignment of the subject to the experimental or control group is a critical part of double-blind research design. The key that identifies the subjects and which group they belonged to is kept by a third party and not given to the researchers until the study is over.
Double-blind methods can be applied to any experimental situation where there is the possibility that the results will be affected by conscious or unconscious
bias on the part of the experimenter.
Computer-controlled experiments are sometimes also referred to as double-blind experiments, since software should not cause any bias. In analogy to the above, the part of the software that provides interaction with the human is the blinded researcher, while the part of the software that defines the key is the third party. An example is the
ABX test, where the human subject has to identify an unknown stimulus X as being either A or B."
So would you choose to believe anecdotal evidence or a randomized double blind test?
Have all alternative medicine treatments undergone such rigourous testing before it is deemed to be effective?
Have they been all tested for safety/toxicity?
Say if such treatments are rigourously tested and are proven to work, i would be most delighted to accept them. I'm not closed minded, taking the stand that anything unconventional is bad. But the fact remains that alot of alternative treatments have yet to be tested rigourously. Let's see what happens when those treatments are scrutinised.
According to the article Acupuncture: Nonsense with Needles (1993) by Arthur Taub, M.D., Ph.D. a neurologist and clinical professor of anesthesiology and a lecturer in neurology at Yale University School of Medicine
"In 1974, I was a member of the Acupuncture Study Group of the Committee on Scholarly Communication with the People’s Republic of China. Our group visited the Acupuncture Research Institute in Peking as well as traditional medical hospitals in the Shanghai region. There I observed one patient receive acupuncture treatment beginning two weeks after a stroke. Patients of this type tend to recover spontaneously and gradually. In fact, this patient, who had received acupuncture for six months, recovered no more and no less quickly than would be expected with no treatment or with a minimum of physical therapy. Several young women I examined had monthly migraine headaches associated with nausea, vomiting, spots before their eyes, and sensitivity to bright light. They told me that monthly acupuncture treatment limited their headaches to several days per month. They apparently did not know that this is the usual state of affairs without treatment."
This is his view on anesthetic accupuncture
"Acupuncture is not widely used in China as an “anesthetic.” A reasonable estimate of the total use of “acupuncture anesthesia” is approximately 5 to 10 percent. During our visit to China, the Acupuncture Study Group was able to substantiate a number of previous reports that almost all patients operated upon under “acupuncture anesthesia” received other agents in addition. This almost always included phenobarbital (a sedative) and meperidine (a narcotic painkiller) before and during the operation. Local anesthesia was also used liberally. I personally witnessed operations in which local anesthesia was used from beginning to end, but which were nevertheless classified as done under “acupuncture anesthesia.”"
And his view on accupuncture for pain relief
"It is reasonably clear that acupuncture cannot cure any disease. Does it relieve pain? My clinical experience with acupunctured patients suggests that any pain relief following the procedure is short-lived. Formal studies have shown conflicting results. In most instances, acupuncture produced no better relief than was produced by a placebo. In other studies, acupuncture did produce some degree of difficulty in distinguishing a previously painful stimulus from a nonpainful stimulus, but this relief was minimal, of short duration, and not at all comparable with the degree of relief claimed for conventional acupuncture therapy. In 1990, a trio of Dutch epidemiologists analyzed fifty-one controlled studies of acupuncture for chronic pain and concluded that “the quality of even the better studies proved to be mediocre. . . . The efficacy of acupuncture in the treatment of chronic pain remains doubtful.”"
And here's one of the many dangers of accupuncture.
"Stimulation of the so-called Ya-men point is recommended for the treatment of nerve deafness in children. Scientific study has demonstrated that this technique is useless. The Ya-men point is located directly above the most sensitive part of the human nervous system, the junction between the spinal cord and the base of the brain. A needle entering this sensitive area can produce instant paralysis of arms and legs, stoppage of breathing, and death."
This is a list of articles done on the subject of accupuncture with proper referencing done so that in case you dispute any more the claims made in the papers, you can refer back to the original study done that brought about that conclusion.
And a piece of news from BBC
While there are many studies suggesting alternative treatments are efficious, i can say that most of not randomised, double blind and reproducible. This is not to say that i deny accupuncture has zero benefits at all. The question is are the benefits due to inserting needles at the right acu-points? Are the benefits the same as those needles inserted at random points? Are the benefits due to the placebo effect? Are the benefits due to experiment bias?
So why western medicine? This letter to the Straits Time will explain it much better than i can.

DR ANDY Ho, in his article, 'The metaphysics of existence' (ST, May 25), has confused the whole issue between science and religion.

First of all, to describe the difference between them as an adverbial one - between a 'how' and a 'why' - is very superficial.

All 'how' questions finally lead up to the 'why' question. Science is ultimately interested in the 'why' questions, the biggest of which is, 'Why is the universe the way it is?' In the broadest sense, this includes the question, 'Why does it exist at all?'

Both science and religion try to find answers to these same questions. There can be no comforting division of labour by which the areas of enquiry of the two endeavours can be kept nicely separate.

Because all the big questions are ultimately interrelated, the answers to the questions of value, meaning and purpose can only be glimpsed at through a proper understanding of how and why things are the way they are.

Science and religion differ on how they approach these questions. The processes they follow are diametrically opposite to each other.

Science follows a particular methodology for explaining the reality around us - the methodology of induction and deduction. Induction is based on data, and deduction on logic, which is formalised in the language of mathematics.

In fact, science is defined by this methodology, and not by the subject matter it studies, nor by its specific findings. As the scientist, John Casti, puts it in his book, Complexification, science is more of a verb than a noun.

Religion, on the other hand, has nothing to do with data or logic. Its approach to explaining the reality is based on speculation, dreams, mythologies, visions and subjective mysticism.

Dr Ho has got it completely wrong when he suggests that science defines reality by what can be studied by its method, that anything that cannot be so studied is denied existence, that all religious claims about transcendental non-material reality are 'defined away' and are 'not allowed' to exist.

This is a bad distortion of the scientific approach. In fact, Dr Ho turns the scientific epistemology on its head.

Science does not compartmentalise reality into that section which is amenable to its method, and that which is not and then 'define' away the latter. There is no reality, as experienced by human beings, either directly or indirectly, that cannot be studied by science. But it has one dogma. It will only follow the method of induction and deduction - data and logic - in trying to understand this reality.

But, why this dogma? What is so great about induction and deduction? Well, it is the only method that works. We survive in the real world (and have survived throughout the whole history of our existence on this planet) by applying consciously or unconsciously a myriad of technologies ranging from the simplest, such as a twig from a tree to scratch my itching back, to the most complex, such as the computer on which I am writing this.

All of these technologies are the result of understanding the nature of reality by applying the methods of induction and deduction, sometimes, almost intuitively, as in the case of the twig, and sometimes more deliberately, as in the case of the computer.

In contrast, there is not one single evidence of an alternative explanation of reality, through, mysticism, the supernatural, et cetera, actually working in the real world. There are millions of anecdotes, brilliant myths, evocative literature, but not one piece of verified evidence.
Now, in applying the principles of induction and deduction, there are many speculative hypotheses about the existence of various entities which do not pass the test - entities such as ghosts, angels and transcendental supernatural beings.

In this list could also be included things like unicorns and aether. Science does not believe in ghosts and spirits and God, not because they are not amenable to the scientific method, but because there is no evidence, empirical or logical, of their existence.

Science does not believe in unicorns and aether (any more), not because they are outside the scope of science, but there is no evidence of their existence. The supernatural is not 'ruled out by fiat', as Dr Ho says, but by lack of evidence.

Actually, the protagonists of religion and the supernatural are acutely conscious that they cannot stand up to the scrutiny of induction and deduction. So, they make out as if they are playing a different game, where the rules of induction and deduction do not apply; where a different epistemology rules.

They just postulate the existence of the supernatural and go on to build elaborate, but vague, speculative structures of concepts, not needing to be constrained at all, either by the demands of data or logic.

They package all that up in some obfuscating verbiage and call it a special kind of reality which science cannot penetrate, thereby hoping to gain legitimacy for their unbridled speculation. Dr Ho's article is another exercise towards that end.

Now, anybody has the right to withdraw from the real world and create an artificial construct for his own pleasure. It is like playing Monopoly with its make-belief currency and special rules of property ownership based on the throw of a dice.

Everybody is entitled to such indulgence. Enormous trouble would arise, however, if the player attempted to use the Monopoly money for real-world transactions. Unfortunately that is what happens when religion claims to have explanations for the real world phenomena and thereby provide answers to questions of values, morality and purpose.

A quick word about the Anthropic Principle that Dr Ho touches on. It is only the Strong Anthropic Principle that hints towards a purposeful universe created by an ultimate 'first cause' with a purpose of its own.

But, hardly any scientist of note believes in the Strong Anthropic Principle. Most recognise the Weak Anthropic Principle, which does not require the postulation of a God-like being. There are various interesting attempts to solve the riddle of the fine-tuned 'cosmic constants' which make us, human beings, possible. Current 'Inflationary' theories are also attempting to answer the first cause question using the rules of quantum fluctuations. But the moot point is that all of these theories are subject to the harsh scrutiny of induction and deduction. Only those that pass will have a claim to reality.

Dr Ho ends his piece by advocating humility on both sides of the debate. Here also, let us take a reality check. Science is the most humble and humility-generating human endeavour. Since it relies on data which are ever changing, all scientific truths are 'contingent' - till such time as contrary data do not overthrow current truths.

There are no absolute truths which are unquestioned for all times to come. No matter how exalted the position of Einstein, one verified evidence of contrary data, no matter how lowly the student or research worker who generates it, will overthrow the theory of relativity, and replace it with some other that is better able to explain the new data.

Science is the only human endeavour that progresses by trying to prove itself wrong. It accepts a theory only if it has failed to do so - and even then, temporarily. The only absolute for science is its epistemology - data and logic.

Contrast this with the posture of religion. All religions claim absolute, universal, eternal truths which can never be questioned. Even though different religions propagate different wisdoms, they all claim that their truth has come directly from God. How much hubris is required to claim that a book that was written 2,000 years back has the answers to the problems of life today! There is no humble egalitarianism in religions. All religions arrogantly claim special dispensation from God for their adherents.

So, how should we deal with religion then? With great respect. Everybody should study religion - all religions. But only as history; as a part of mankind's brave striving to make sense of his reality.

It does not matter that the religious explanations of this reality do not hold water any more in the light of modern scientific epistemology. The subsequent invalidity of a hypothesis does not detract from the glory of exploring it in the first place.

Ptolemy and Newton are no less revered figures today, even though their schemes were overturned at a later date. The problem arises when religion is yanked out of its setting in history and is made to masquerade as an explanation of eternal reality and a prescription for modern life.

All the views expressed in this note are far better explained in Richard Dawkin's latest book, 'The God Delusion', which I strongly recommend to all readers.
Shyamal Ghose
Western medicine VS Alternative medicine is not simply a "my belief is better than your's" kind of debate. From molecues to cells to organs to systems to your whole body, western science provides an explanation, backed by data from experiments all the way. It does not claim to be true because it has been used for the past 3,000 years. Mankind after all believed in ghost, witches, Sun revolving the Earth, Flat Earth for thousands of years after all. Besides believers in alternative medicine ought to take this perspective : Since alternative medicine has been around for thousands of years, why is it still not the dominant form of medicine?
And if you want to compare how effective Western medicine is compared to alternative medicine, just consider the following:
1) What wiped out small pox from the face of earth?
2) What dramatically increased the life expectanty of humans
3) What dramtically decreased infant mortality rates
4) What allowed the diabetic patient to live a much longer life than in the past?
5) What allowed the mentally ill to live relatively normal lives?
So you ask me: Why is Alternative Medicine so popular?
Perhaps it is can be explained by the seer-sucker theory: No matter how much evidence exists that seers do not exist, suckers will pay for the existence of seers.
When there are people who believe in the effects of alternative medicine, there will be others who will provide supply to such demand. Astrology, psychics, geomancers, gods, UFOs, lochness monsters etc. And speaking of geomancers, this incident illustrates why you should be taken in by unverified claims on the basis of "it might just work, no harm done"
Or perhaps most of us are gullible, unable to critically analyse the claims of others which is compounded by a lack of knowledge. After all when you know nothing, it is rather hard to refute the claims of others.

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