(OK, I promised no more. But this time, I can’t constrain the rant. Warning evolution RANT ahead.)
This,
my friends, is Utah state senator D. Chris Buttars. State senator Buttars opinions in today’s USA today, that
The trouble with the “missing link” is that it is still missing! In fact, the whole fossil chain that could link apes to man is also missing!
To which I can only respond with “The world is flat! The world is flat! The world is flat!” Nothing to see here. Or here (a picture I call…Earthdisk.)
Why, oh why, should anything a scientist do benefit this man? If he wants to be so anti-scientific as to believe that every single scientist is just spouting a bunch of bull, in effect insulting every single one of us, why should I (we) do anything to help improve his world? If he wants to go back to before the enlightenment, he’s welcome to take that step. All he needs to do is give up every single modern convenience which science led to.
Oh, and why does there have to be such great skiing in Utah?
(Update: After calming down, no I don’t advoate withholding medicine etc. from this kind Senator. But “When in the course of human events”…and I must say that my bond with him is pretty much ziltch.)
It would be one-sided to withhold scientifically grounded medical treatment from losers like State Senator Buttars. Notwithstanding the fact that the homonid lineage actually has one the best fossil records of any mammal species.
It would be one-sided because you can find unscientific superstition on all sides of the political spectrum. I think that “alternative medicine” is a good example. It is fated to the same failure and illogic as alternative physics. Because, of course, the precept that medical researchers are intellectually monolithic and merit alternatives is just wrong.
Greg I suspect you are pushing me to write a long rant about “alternative medicine!”
I think I’ve got it! HE is the missing link we were looking for! 🙂
I’m not sure your rant is so much more controlled than mine…
Not that I’m being critical, I’ve said almost the same thing a few times about the anti-global warming movement.
Jon: Your comments remind me of the line from a foul-tempered king complaining about his food in a Bugs Bunny cartoon: “Every day it’s the same thing – variety! I want something different!” (As you might expect, he wanted stewed rabbit. But I digress.)
It’s not as if conventional medical researchers are averse to alternatives, or to folk remedies, or to natural cures. Beetle secretions are used to remove warts; fish oil is prescribed as heart medicine. And what is said about aspirin is not true — it is ubiquitous in clinical trials. Conventional medicine is already meant as the sum of all rational alternatives. So if you throw that out and demand yet other alternatives, you reject reason and reduce your useful options.
It is certainly understandable that desperately sick people might desperately reason that logical medicine has done them no good, so maybe unreason will save them. But it’s still a mistake. In many cases it doesn’t look like a mistake, because logical vs illogical treatment is not a matter of certain cure vs certain failure; it’s a matter of what the best or most likely cure. You can easily be fooled by inferior treatment that seems to work.
Along the same lines, my answer to Dave’s question: It’s 100% bunk, by definition. If it worked, who would call it alternative medicine?
Let me amplify the point about aspirin and similar example. On some days, advocates of alternative medicine remember that aspirin, flouridation, penicillin, and so on all have natural origins. So they take them as evidence that natural alternatives work. But on other days, they reject aspirin, flouridation, and penicillin as conventional and demand alternatives. This is contradictory — but that’s okay in the alternative realm, since logic itself is conventional.
But it’s just not true that aspirin would fail to be approved under today’s system. On the contrary, it repeatedly has been approved under today’s system for many new treatments. Evidently aspirin does have disparate medical effects. But the same is true of more recent medicines, for example accutane. I don’t know whether that is because its mechanism is non-specific or for some other reason. But I really doubt that the FDA has it in for non-specific mechanisms.
Frankly I have little patience for the fuzzy logic that comes with spectra of meanings. Your explanation (and not to pick on you — really it’s everyone’s explanation) of alternative medicine wanders all over the map. At different points you have characterized it as an alternative to specific mechanisms, to double-blind trials, and to vested interests. Certainly if you reject double-blind trials, it suggests a flight from reason.
It’s also an interesting argument that we should consider alternative medicine because there are many things left to discover in medicine. Unlike in physics.
If all you mean by alternative medicine is “alternative to FDA approval” or “alternative to insured treatment”, then of course you’re right: many rational treatment plans are not approved by the FDA or not covered by insurance. Every doctor that I know would say so.
But at other times you really seem to mean an alternative to the medical establishment, which is to say, an alternative to the scientific establishment. I think that that is rather closer to the operational meaning of alternative medicine.
After all, one of the points that you started with is clinical trials versus healing traditions. Well, you are absolutely right that clinical trials are the best that science has to offer, at least if you want direct experimental evidence. The scientific value of healing traditions before The Enlightenment is approximately zero in comparison.
(But note that even the FDA can be satisfied by less direct experimental evidence enlightened by theory.)
What do you mean by ‘alternative medicine’? Do you mean the agglomeration of: acupressure, therapeutic touch, chiropractic, phototherapy, homeopathy, herbalism, the power of positive thinking, ad infinitum? or some particular subset of these? Do you mean that these methods don’t work as they are currently practiced? From the studies I’ve seen, some of them don’t but others do.
I don’t agree that it is like alternative physics. There are few (zero?) fundamental laws of biology – we don’t even have a parts inventory for the healthy human. So who is to say that ‘alternative’ practices, healing traditions that may have existed for hundreds of years, have no value?
By my very broad definition, ‘alternative medicine’ exists outside the large medical and pharmaceutical establishments that have vested interests in maintaining the current practice of medicine. There are a number of people working on systematically studying these ‘alternative’ practices (see for example, Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin. Nature. 2000 May 25;405(6785):458-62 and subsequent publications from KJ Tracey et al) and bringing them into the fold of ‘conventional’ medicine.
If you are suffering from a debilitating disease and have exhausted the possibilities brought to you by ‘conventional’ medicine (http://wiki.hcvaction.org/hcvact/published/HomePage), what would you do next? If you weren’t covered by comprehensive medical insurance, what course of treatment would you take for a chronic condition? If you were acutely aware of the experiments performed in the name of ‘conventional’ medicine (including the Tuskegee Syphilis Experiment – http://www.infoplease.com/ipa/A0762136.html) and did not trust the medical establishment, what kinds of treatment would you seek out?
Double-blind, randomized clinical trials are not the be all, end all of medicine. There are often limitations based on patient demographics, study size, what endpoints are evaluated. Geographic disparity (a surrogate for differential environmental factors) is often overlooked, too. It is said that if aspirin were going through clinical trials today it would never be approved. Aspirin, an analgesic extract of the willow, known to Hippocrates (around 400 BCE), possibly the most successful therapeutic compound in the history of medicine, would be outside of ‘conventional’ medicine!
I agree that there is a lot of New Age Crap surrounding ‘alternative’ medicine, but I would hope that you take a few minutes to look under the hood, kick the tires and appreciate that there is much we don’t know about medicine and that some ‘alternative’ approaches may hold some merit.
Jon, what do you think the percentage of “alternative medicine” is that is not bunk. I agree throwing the baby out with the bathwater is silly, but the vast majority of what I see is a bunch of snake oil. Not all, by any means, but I can’t imagine the good is greater than 1 percent of the total. Perhaps my statistics are skewed by having lived in Santa Fe. I have a hard time with crystal healers.
Dave,
That’s a good question. I don’t really know. My mom sends me all kinds of new age-y crap. But there’s often a kernel of scientific data in it. For example, the most recent one I got was a ‘mosquito repellent made from catnip oil’. That’s actually based on a letter to Science (Science 1964, 146, 1318). A couple years ago there was an excellent science fair project (done by a girl whose mother was a nurse) that debunked the ‘therapeutic touch’ (IIRC) therapy.
I’m against homeopathy (infinite dilution) and crystals. I’m in favor of massage, phototherapy and the systematization of herbalism (ie, the reduction of complex mixtures to the essential component(s) – I don’t care so much about delivery vehicles or making them in to ‘conventional’ medicines, but I think understanding biological activity and mechanism of action of a therapeutic is a good thing). I’m wary of acupuncture/pressure and chiropractors. I don’t have any opinion about meditation, prayer, or positive thinking except insofar as they probably reduces stress levels which is rarely bad.
Greg,
My point is that aspirin would fail to be approved under today’s system. Not that it isn’t used. The mechanism of action of acetylsalicilic acid is far too non-specific (acetylation of random -NH2 groups in addition to its targets (COX1/COX2).
I think that you have very black and white definitions of ‘alternative’ and ‘conventional’ while in my experiences in the biomedical community have shown me that these terms cover a spectrum of meaning.
Rereading what you’ve said, your definition of ‘conventional medicine’ seems to be “anything that works.” My definition of ‘conventional medicine’ is anything that has been vetted by the contemporary drug approval process. So of course we disagree. Lots of things work that haven’t been through clinical trials.
Approval of an existing drug for a non-indicated condition is almost trivial. In fact, approved drugs are often prescribed for off-label uses as soon as they are first approved. When a body of positive clinical results emerges showing that the off-label use is safe and efficacious, the FDA pulls out its big rubber stamp that says OK.
Lets pretend I just discovered aspirin. Here’s my narrative to the FDA.
“I have a new drug candidate. I isolated it from a tree that was growing on a cliff in Greece. It non-specifically and irreversibly alters a bunch of proteins throughout your body. It also reduces pain from headache. There are not 100+ years of historical data suggesting that these non-specific, irreversible modifications are safe. Will you support my application for approval?” PS, headaches don’t kill people, so there really isn’t an emergent need for this drug.
Have you read any criticism of double blind, placebo controlled, randomized clinical trials? For example, Curr Opin Crit Care. 2004 Dec;10(6):579-82. There are significant issues with study design, therapeutic misassignment, inadequate comparison to current standard of care practices, and determination of appropriate end points, not to mention researchers who claim over-reaching conclusions. (and unresolved privacy rights issues leading to potential loss of insurability, don’t forget about ethics when we’re talking about medicine)
I don’t reject double-blind trials, they’re the best we’ve got right now. But they have significant problems.
Sometimes people use “alternative medicine” to refer to anything that isn’t Western medicine. Under that sort of dichotomoy, with Western being “traditional” and anything else being “alternative,” I
1) am skeptical of a lot of “traditional” medicine… notably, the FDA approval thing doesn’t do much for me. I guess it’s because I’ve seen many drugs marketed (which get FDA approval) which are total crap, and people know it. One example is Seasonale, which is marketed as something that reduces the number of periods women get, as a matter of convenience. However, the “breakout bleeding” one gets by using this drug is actually greater than the company claims, so the total amount of bleeding is the same as without the drug, it’s just that the bleeding is less regular. Nice. (This is from Joe Dumit, who is presently at MIT studying drugs and marketing. I think he is moving to UC Davis soon.)
2) am not feeling as negative about “alternative medicine” as some of the other commenters here. Sometimes the same drugs are classified as “alternative” merely because it’s in a natural form (like as a component of tea or turmeric) rather than a purified chemical extracted from tea or turmeric. Here’s a post from Rhinocrisy that I think illustrates some of the differences between the two:
http://rhinocrisy.blogspot.com/2004/04/insert-impotent-cry-of-rage.html
(Btw before some of you fly off the handle about scientist-haters, the person who posted it is a biologist. Like me.)
A huge caveat: the problem is a lot of stuff falls under “alternative,” so hokey things here and there malign the whole non-Western approach to medicine.
Also my family (as apparently all Vietnamese and Chinese families) always keeps a standard bottle of “green oil” (as it’s called in Vietnamese). It smells really strong, maybe like menthol with something else. It cures *everything*. Well, not cancer or idiocy. But if you have a headache or tummy ache, or muscle sore, just rubbing it on the affected area works. It’s probably got some chemical that just numbs your nerves so you don’t feel pain there anymore, but the point is, this mysterious green oil definitely falls under “alternative medicine,” but it doesn’t mean it’s junk.
Really the only thing that’s “Western” about conventional medicine is that The Enlightenment occurred in the West first. But it has now spread to Asia. I’m sure that a lot of medical researchers in Japan, China, and Korea would be irritated to hear their work downplayed as “Western medicine”.
Moreover Europe has its own slew of pre-Enlightenment folk remedies; the mode of thought behind them is really about the same as the Asian version. Turmeric may be from Asia, but St. John’s Wort is from Europe. Maybe leeches are a little further than most alternative medicine fans want to go.
This story about “green oil” that “cures everything” is a case in point. Before The Enlightenment, when chemistry was not developed, it was impossible to know the active ingredients in substances. So instead the emphasis was on color, smell, taste, geographical origin, and so on. Since most people were illiterate then, they could not receive expert advice, so they relied on word-of-mouth wisdom that this or that preparation cures everything.
I’m not saying that everyone who buys into alternative medicine is strictly anti-medicine. At least, not consciously or not always. I just think that if you have advanced training in science, you ought to know better. When presented with green oil that smells like menthol, you ought to put on your thinking cap. It probably is menthol, right? Do you really think that menthol cures almost everything?
Actually, there is one treatment in medicine that is proven to at least alleviate all symptoms of all diseases: placebos. If you want a placebo, you could hardly do better than a strong-smelling, brightly colored liniment promoted by relatives.
I didn’t mean enlightenment with a lowercase “e”. I understand that different cultures can be enlightened in different ways. I meant The Enlightenment, capitalized. This is a specific period of European history, marked by people like Newton and Lavoisier, in which scientific reason replaced religious and political control of knowledge. It also challenged a lot of folk superstition.
The Enlightenment could have come first to China as far as I know. Human history would have been very different if it had. But as it happened, it developed first in Europe and then spread to the rest of the world. My point is that just because it came first in Europe, that does not make it inherently European. Just like I do not regard civil service examinations as inherently Chinese, even though they were first developed in China.
It’s true that you can know that some things are good for you without knowing their specific ingredients. For example you can know that orange juice is nutritious. But it is a precept of science that biology is based on chemistry, and therefore chemical ingredients matter. It doesn’t matter whether they are listed on the label of course, only whether they are actually present. And I agree that if you are expect medicine in the form of pills and labels, then pills will undoubtedly have a placebo effect in addition to their chemical pharmacology. The placebo effect applies to everyone, even to people who know full well that it exists.
I still think that the dichotomy between “Western medicine” and “Eastern medicine” is false, and ultimately bad for Easterners. It’s just nonsense to say that chemistry is the “Western Way”. Chemistry is for the benefit of all of humanity, not just Westerners. And Western regions have their own folk remedies just like China and Vietnam do.
You’ll notice that I never used the word “stupid”. People who put more stock in folk remedies than in science can be very intelligent — after all, before The Enlightenment all medicine was guesswork. But it’s still a mistake, even if there are elements of truth in some folk remedies.
Well, that placebo thing is actually a good point.
I guess the dichotomoy I was trying to illustrate would be better put as this:
One way of looking at medicine is that it’s something that’s in a pill or a bottled liquid with long names of chemicals on the ingredients list. This is the “Western” way.
Another way is in that medicine can come in the form of whole ingredients that have been shown to work through hundreds or thousands of years. People might know “there’s something” in ginseng or tea that’s good, but they may have not given it a chemical-sounding name (like “anti-oxidants” in tea), but it doesn’t mean
1) it doesn’t work
or that
2) those people are stupid.
A lot of people grow up thinking that things coming in the shape of a pill or having a chemical name will work, and their belief in that is much stronger. This is also a placebo effect.
If you want a placebo, you could hardly do better than a white pill in a box with chemicals listed under “active ingredients.”
I just don’t think “Western medicine” is necessarily better than “Eastern medicine” or other “alternative medicine.” It’s just what YOU believe in.
Also I hope you were being sarcastic here:
“Enlightenment occurred in the West first. But it has now spread to Asia.”
unless by “enlightenment” you meant thinking in a euro/Western-centric, narrowminded way.
I hate that Buttars… he is a wacko religious nut. How did he ever become senator even in Utah
I don’t understand that..
Hey watch out what you say about chiropractors!