On Epistemology

health, philosophy, Philosophy of Science, science Leave a reply

This is my position on epistemology. Actually not just my position, but the position held by many people. While the route taken to this judgement is uniquely mine, the judgement itself (if not this exact expression of that judgement) is shared by many others the world over.

I’m going to deal with a few notions, and I’ll try to be as explicit as possible. If I say that “if you believe that it’s ok to sell alt-med services without some sort of concerted effort to determine if the actually work or not, then you are a moron”, then I will try to define “alt-med”, “alt-med services”, “selling alt-med services”, how “to determine if they actually work or not”, and (of course) “moron”.

First, I’m going to open with some generally held beliefs. I’ve veered away from my usual polemical style, though I have no doubt that certain people will find the below outline to be controversial nonetheless. To them I can only say: please make explicit your disagreement. If you disagree with my conclusion, then you must (as a matter of rationality) disagree with something prior in the argument. If you accept all the premises but disagree with the conclusion (and have no additional reasons to present), then your disagreement is most likely a matter of personal investment and emotion, not of rationality. It has been said to me that “I don’t believe you to be capable of making a reasoned and unbiased judgement on this issue”. Well now. Let’s begin…

Let’s start with the idea that we must respect one another’s beliefs. This is part of that horrible, horrible line of nonsense that is Post-Modernism.

Respecting Beliefs

So the idea here is that somewhere along the lines, the concept of mutual respect came about. That we must all start from a position where we treat each other with respect, and try to maintain some veneer of civility around one another. The idea has expanded beyond that, though, in that a disagreement with someone’s beliefs is, itself, seen as disrespectful to that person. So in order to avoid disrespecting the person, we must refrain from pointing out to the flat-earthers that they are, in fact, empirically incorrect.

Joking about the flat-earthers to one side, let’s take this seriously for a moment: how do we operate in a world where we must “respect each other’s beliefs”? What if those beliefs conflict? Does it really matter if beliefs conflict? I mean… Aren’t beliefs simply just concepts and ideas that we have in our heads?

No. Beliefs are not inert idea-objects that passively sit in our brains doing nothing, and interacting with nothing. We act on our beliefs. The way in which we perceive the world is filtered/altered by the beliefs that we hold. A belief is something that affects our thinking, frequently in ways that we’re not even aware of. The usual exemplars in Philosophy are Nazis and Slavery, and they’re boring as all hell. And they’re not contemporary. I mean… No-one really keeps slaves any more, right? Cf. Human trafficking

So… How about the idea that it’s ok, in fact that it’s desirable to sew shut a woman’s vulva (and/or remove her clitoris) while she’s a young child? It leads to all sorts of dysfunction, including many immediate medical complications including “severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue.“, nevermind the long term consequences. But… We’ve got to respect the beliefs of others, right?

But it’s also a well known fact that the body parts of Albino kids are good for all kinds of magic. So some people sneak into villages in the dead of night, and hack off the limb of a random albino kid, and run off to the local witch doctor to get their spell done. Seriously, you want to interfere with their beliefs? What kind of a cultural imperialist are you…

How about the idea that if one has contracted HIV, having sex with an infant (yes, an infant) will cure you? Even if you’re 10th in line for the infant, it’s still good for a cure? Again, though, we must respect the beliefs of these people. Right? I mean, sure, infant-rape is bad… But these are people’s beliefs that we’re talking about… Some things are just sacred.

Some things are sacred: a woman’s right to her own body (including, but not limited to, promiscuity), a kid’s right to their own limbs, and an infant’s right not to be raped. (If you need a reference for this: tough. For the purposes of this article, the concept of “Human Rights” (with regards to physical restriction or harm) is axiomatic)

Because beliefs are acted upon, and some beliefs lead to harmful action, it may be necessary to intercede and argue with someone regarding their beliefs. Yes, even if those beliefs happen to be legal in their particular region of the world: while it would be nice if “legal” was synonymous with “just” , “moral”, or “ethical”, it isn’t. Some things that are simply downright evil (Cf. Ok Tedi environmental disaster) are, in fact, legal. Kind of the point of this whole post.

So here’s your choice, dear reader: either you are steadfast in your belief that beliefs should be protected come-what-may (which means you’re defending people who rape infants), or you’re considering the idea that it’s acceptable to challenge people’s beliefs under certain circumstances. I’m not advocating that we be contrarians, someone who endlessly argues with everyone over every little thing. But that if a belief seems to lead to harm, we should be unafraid of discussing it. Just to rephrase that point so that I’m crystal clear: I’m not advocating that we should all challenge those whose beliefs cause some level of harm, but if we object to the harm being done, then “please respect my right to that belief” shouldn’t hold us back from remonstrating with that person. Clear? Good.

Evidence

Ooh… I bet you think I’m going all “sciency” here…

You’d be wrong (or else I am, which is fine): we receive evidence all the time. It never ends. It comes pouring into us in the form of perceptions, and we can’t turn it off. It’s so bad, in fact, that if you find your way into a sensory deprivation tank, your sense organs (including, but not limited to, the brain) will just start making up perceptions for you to have (aka hallucinations). I can have evidence that I’m hungry (my stomach aches slightly), which is a different ache to being over-full. I can have evidence that I’m loved (on those rare occasions that I am), and evidence that people read my journal (statistics). I have evidence that the sun goes around the earth, and I have evidence that the earth goes around the sun. And I have evidence that eating toast cures cancer. Seriously, I do.

There’s a few key points here.

  1. All evidence is evidence for a belief. A perception, in and of itself in isolation, isn’t “evidence”. It’s just a perception, just a form of sensory information. My perception of overwhelming brightness isn’t evidence all by itself, but it’s evidence for the belief that I’m staring at the light bulb.
  2. We receive a ridiculous amount of sensory information every moment of every day.
  3. “Sensory information” is often in the form of “the washing machine is making too much noise”: our sensory information (by and large) appears in our conciousness pre-filtered by our beliefs. To a limited extent, our beliefs determine our evidence. (If you take this idea and get “Ah, so science is all based on beliefs, and is no more valid than anything else!” you’ve misunderstood what I’m saying here, and need to keep reading)
  4. We frequently have insufficient information to make a judgement (but do so anyway)
  5. The information we have frequently supports contrasting/conflicting beliefs (yet we frequently pick one anyway).

If you just live a normal human life, you typically regard all this information passively, unless there’s something of immediate interest to you. Like a moving shadow in that dark alleyway over there. Or that small group of people who are moving all too directly towards you. In many cases our snap judgements are wrong, but we choose to err on the side of caution. In other cases, we err on the side of “Oh… the voice in my head, that’s telling me to kill my son, is god”. Typically, though, we tend towards “hmmm…. I’m comfortable with Belief A, as it fits in with my other views. Belief B, though strongly supported by a wealth of evidence, contrasts sharply with the beliefs that I’ve accumulated over the last 10 years. I think I’ll go with Belief A”. There’s a wide range of belief-formation going on, it’s largely unconscious, and we tend to form new beliefs that sit comfortably with older beliefs. Cf. Wiki’s list of cognitive biases. If you think “oh, but that’s not me”: you’re wrong. And yes, that goes for me too.

Now you’ll note that I haven’t made any claims regarding whether or not anything other than the five empirical senses are valid pathways for “sensory data”. The content of your thoughts, for example, could be considered sensory data and that data could be evidence for your belief that you love your boyfriend. The type/manner of your thoughts are also data, and could be considered evidence for a mental illness (ie Depression, if the thoughts were more-often-than-not melancholy (and I’m super-simplifying here)).

What about “feeling a spirit in the room” or “seeing someone’s aura” or “sensing someone’s chi”? These all sound like judgements to me, not just “I feel/see x, and x is evidence for the existence of y”-type statements. If you have a sense of something, then that something must be real and open to others to also sense in a similar way. If, however, this sense is inconsistent… If you occassionally were subject to hallucinations, either auditory or visual, do you feel that you could “trust” that sense? If your eyes worked sometimes, but not others, with no way to predict when they would fail (sometimes you just wouldn’t see ‘trees’ for example), would you consider your eyes a reliable way to know the world?

No, you wouldn’t.

How do we know when our senses are reliable? Read on…

Knowing

So how do we “know” anything? If our perceptions are hopelessly screwed up, if everything is filtered through our consciousness, then how can we possible know anything ever?

Because our perceptions are *not* hopelessly screwed up. Because we can figure out what our filters are, and what our biases are, and figure out methods to reduce (eliminate, ideally, but let’s just aim at reduction to start with) those cognition errors. If we’re really lucky, we’ll start to figure out how to do ‘stuff’.

Initially, we need to restrain ourselves when it comes to making judgements. That is to say we need to hold off on declaring something to be ‘evidence’ before we seriously think about it. If I see someone get slapped, and the fall down dead clutching their heart, I need to hold off on the conclusion that “the slap caused a heart attack”. The human body is complicated. It may turn out, after an autopsy, after a lot more sensory data has been collected, that it was the slap. Or it may turn out that the heart attack started several hours before that point, and just happened to coincide with the slap. We need to affirm what we perceive, without immediately drawing a conclusion.

That’s all: just wait. Think. Pause. Reflect. And collect more information.

If I’m worried that my mythical girlfriend is cheating on me, then does the simple existence of my worry demonstrate that she is? I mean… I wouldn’t be worried if she was faithful, right? If she drops a scrap of paper with a phone number and the name “Rick” on it, and ‘guiltily’ hides it, is that evidence that she’s cheating on me? Do I need to wait until I catch her in the act before I can draw the ‘cheating’ conclusion? What if I’ve been cheated on before, and I ‘know al the signs’? Do I need to wait out the whole torrid affair until I get dumped? Or do I simply realise that prior to this we’ve had an open, communicative relationship, and her secretive behaviour is a change of behaviour, and that change concerns me.

Is it possible for me, given the information to date, to know if she’s cheating on me or organising a surprise party (for anyone)?

No, it’s not possible. Any judgement made at this point is unwarranted. Why?

Because there are a multitude of possibilities that her actions indicate (ie the surprise party). I don’t even have enough information to warrant assigning probabilities to the various ideas. But I do need to think about potential ideas: sure, it’s possible that she’s cheating on me. But the fact that that was my *first* thought says more about me than her. That’s a bias, right there. Anchoring: focusing on the dropped phone number. Attentional bias: deciding that the only possibilities are cheating/not cheating. There’s many more, feel free to go through the Wiki List of cognitive biases and pick out ones that apply, even if only tenuously.

So that’s everyday life. Simply stopping and thinking about possible options can reduce the impact of our biases. Getting someone else’s input (“Hey… can you make out what that is over there?”) can help reduce our perceptual errors (but watch out for the Herd instinct). And all that’s fine for everyday life. Most decisions that we make, day to day, don’t have life or death significance. They don’t affect the world as a whole. They don’t have ramifications for almost 7,000,000,000 human beings (http://www.ibiblio.org/lunarbin/worldpop).

But some of those decisions do have life or death significance. Those would be medical matters. But since it’s important to put medicine in the context of “science”, I’m going to talk about that first.

Science

Here’s where, I’m sure, many readers stop. Because “science” is big, and evil, and wrong. It’s a corporate enterprise that is utilised to further the interest of a small group (compared to 7,000,000,000 people, pretty much any 7 figure number is a “small group”), in contrast (and occasionally conflict) with the interests of the rest of humanity.

Maybe. I’m not sure that it isn’t, but I’m not so sure that it is either. I get the feeling that the above is a bit of an oversimplification of the whole thing. Or, to be more clear: the above is a complete and utter oversimplification of the whole thing. Cf. Attribute Substitution.

First, let’s start with what science isn’t. Science is not:

  1. a collected and unified enterprise
  2. completely controlled by corporations
  3. unbiased
  4. egalitarian
  5. the pure and clean search for knowledge to better the human species

Point by point:

  1. Science is the collective name we give to people performing a similar kind of task, in a variety of different areas. In fact, it’s those areas of work that are grouped as “Science”, not the tasks themselves: compare a geologist in the field (a geologist’s blog wot I googled) with an astronomer in the observatory (http://history.nasa.gov/EP-177/ch4-4.html), and the physicist in the Large Hadron Collider in Switzerland (this could be an Engineer, but even if so my point stands): on the face of it, their work is radically different. But we have declared “Geology”, “Astronomy” and “Physics” to be sciences, thus anyone involved in a task in those fields are “doing science”. The names are collected, but the tasks and people are not.
  2. These people are distributed across the globe, in almost every country, in almost every culture, doing a wide variety of work, largely in ignorance of each other (especially of people in different fields), occasionally in conflict with one another (especially with people in the same speciality in the same field). To claim that that these people are somehow unified in purpose, or that they are generally guided by ‘corporate interests’, is a statement that has no basis in fact. Yes: many of these people work for corporations. But many of them don’t. Many of them work for governments. But many of them don’t. Many of them work on their own. But many of them don’t. There are many ways to group these individuals, but your grouping is an abstract construct that you have placed onto these individuals. That a particular scientist is driven to get money out of people no matter how they achieve it says nothing about the other people working in their field, never mind the rest of “Science”.In the same way that you can’t infer the behaviour of Woman A from the behaviour of Woman B, or Black guy A from Black guy B, you cannot infer the behaviour of Scientist A from Scientist B. Any attempt to do so is foolish, and open to the same arguments as are used against racism and sexism. If you accept that racism and sexism are irrational (not merely wrong), then you must also accept that inferring judgement on the basis of similar occupation is also irrational. If you were to counter this argument by asking if I would infer that an illegal narcotic dealer is a necessarily unethical person, you would be missing the point entirely and I would sigh in your general direction. Please read this section again.
  3. That said: of course any individual scientist has biases. They have biases in the same way that we have them, and perceptual filtering issues just like the rest of us: they’re human too. Yes, they are also driven by self-interested (and sometimes selfish) goals. Yes, some of them want to make money. Yes, some of them are “corporate sell-outs” (whatever that means). Yes, each scientist has their blindspots. Yes, some of them will just reject certain ideas out of hand, and won’t want to discuss every idea that someone else wants them to listen to.So what? Are people not allowed to pursue their life in a manner of their own choosing? Must someone stop every single time that someone else asks a question that largely relies on the basis of not understanding basic physics/chemistry/biology? If you want to stop someone to ask a question about their area of expertise, isn’t there some obligation on your part to examine the area of inquiry first? To have some idea of what you are asking? Basically, don’t be Dr. Charlene L. Werner. If you don’t see what’s wrong with her ‘explanation’, then you need to review high school physics, chemistry and algebra. Yes, high school level education will teach what’s wrong with what she’s saying.
  4. Science is not egalitarian. It’s not about equality. It’s not about everyone having an “equal say”. If the topic at hand is how one puts a machine in orbit around Jupiter, I’m really not interested in the opinion of someone who isn’t “a rocket scientist”. To get a PhD typically takes around 10 years of post-secondary education, that usually ends up be pretty specialised. To think that the opinion of someone who has not studied (at all) the specialised field should weigh somehow about equal with someone who has dedicated 10 years of their life to the study of that field… That would be the height of arrogance.
  5. This is just a naive view.

So what is Science?

Well, at it’s core, it’s just a way of knowing things that is exactly the same as how we know things in everyday life. The scientist can’t simply take any random sensory data and claim it as evidence for an idea, neither can we. The difference is largely in activity: we tend to passively absorb sensory information, whereas the scientist, in order to better understand a particular idea, creates situations that generate information regarding that idea. And the repeats the process over and over again. And then asks other scientists to 1) repeat the process and 2) try to create a process that refutes the idea. Now, they may not do so. If the scientist has done some research into an area that no-one else is interested in… well, they’re not interested. However, it’s typical that if one does research that turns our understanding on its head, then scientists the world over examine and try to refute your work. On Acupunture alone, there are over 2,000 medical papers.

A more concrete example: suppose I have a rock, and it’s slightly warm to the touch. I note that it’s on the ground, outside, sitting in the sun (sensory information). So I figure that it’s warm because it’s in the sun (judgement). I think: maybe that, in general, if I leave something outside, the sun will warm it up (idea). So I go get 100 rocks, of similar size and shape to the first rock, and lay them all out in the sun. I check their temperature every so often, but not by hand (perception can be wrong), but with a calibrated measuring device (aka a thermometer). I make a note of all the temperatures prior to putting them in the sun, and then after putting them in the sun, and at what time I took the measurements.

Then I get a new batch. And again. And again.

Finally, I lay out all my information. I look at the temperature differences for all the rocks, and then try to figure out all the different ways I could explain that, given the situation.

Let’s pause there for a second: here’s where one’s beliefs are going to influence (not control, not impede, not pollute, not corrupt: influence) the science. There could be a heating pad on the ground that I didn’t notice (because I’d never seen one before, and I never thought to look for one, and the heat was so low that I didn’t feel it). So my beliefs about what constitutes the world is going to influence what I look for in order to explain my perceptions. I.e. My beliefs will influence how I seek out evidence, and what I consider to be evidence.

Science has a solution to that: now that I have all my data, I go tell the other scientists “hey, check out this ‘rock in the sun gets hot’ study that I did”. They then take my information, the full report of how my experiment was set up, and then try to repeat (replicate) my results. If the cause was, we’ll say, the heating pad: they’re not going to have a heating pad at their location, so their results will differ, and more questions will be raised.

That is (very broadly) Science. Richard Feynman on “What Science is”, in 60 seconds.

Knowing that something “works”

We talk about things working in a couple of different ways. There’s knowing that something works, and knowing how something works. They frequently go together, but not always. I can know that my computer works, with knowing how my computer works. Conversely, I can know how my computer works without knowing that my computer works (if I haven’t touched it in a couple years, for example).

We can also talk about specific objects, practices or even ideas about the world ‘working’ or ‘not working’, and we can talk about how those same objects, practices or ideas work too. And this is where the distinction is important: if someone is asking me to try something new, initially I don’t really care how it works, but that it works. If it’s not the case that it works, then I largely don’t really care about the idea behind it. Sometimes the idea, itself, is interesting so I might look into the idea in more detail, but if the new gadget/treatment/whatever doesn’t actually work, then the theory behind it is largely irrelevant. And when I say “the new gadget doesn’t work”, I don’t mean “in this particular case”: none of them work.

With objects, this is usually easy to determine: trying to hammer a nail with a balloon just isn’t going to work. I don’t really care why a particular person would suggest that to me, it just simply isn’t going to work.

It gets more complicated the more complicated the idea is. With regards to a new medical drug that’s been developed, I don’t simply want to take a pharmaceutical company at their word that this product will fix my illness. And that’s where Science comes in.

The pharmaceutical company will have done (hopefully) some sort of test to determine if the drugs they are offering do, actually, what they claim that they do. They will have done several studies, first just on chemical reactions, then some computer simulations, then on animals, and then (finally) on humans. Each step gets checked by other scientists. In each case, the information (if positive) gets submitted to various scientific journals and is reviewed.

So if a drug company says “This product will lower blood pressure”, then their study should indicate that it does actually do that. If the study has 200 people in it, but only 10 people have reduced blood pressure by the end… well, that’s not really “evidence” that the drug helps, right? If, out of the 200, 80 people have reduced blood pressure? On the face of it, it would seem that the drug company has a case. At this point, other scientists should be testing their drugs. The results need to be independently verified.

An objection to this argument may be “but this isn’t how things are done…”. That depends on the country. Each country has different laws regarding drug regulation: don’t confuse a legal regulation with how good science is done.

Broadly speaking, when we say that “something works”, we are saying “I observed situation x. Subsequently. I did y, and I noticed a difference in situation x after that change”. In essence, we notice an ‘effect’. If I have a headache, I subsequently take some ibuprofen and I notice that the pain is gone. If I’m under a lot of stress, I subsequently see my Reiki practicioner, and I notice that I don’t feel so stressed anymore. If I have a car, I subsequently turn the key in the ignition, and I notice that the cars engine starts up.

But there’s a fear we must have: sure, those things happened at the same time… but did the ibuprofen really take away my pain? Did the Reiki really reduce my stress? Did the turn of the key really start the engine? These questions are the basis of a rational enquiry into “what works?”. If two events happen at the same time, they may not be related in a causal sense: they might simply ‘correlate’. That is, they just happened at the same time. So we can count the occurrances of the conincidences. If I get 500 people, and get them all to take ibuprofen when they have a headache, how many of them notice a reduction in pain? Similarly, how many people experience stress-relief when undergoing Reiki, and how many engines start when keys are turned?

If a high proportion of people have the same experience (say 400 out of 500), we can say that “there’s a high positive correlation between x and y”. That’s so say that more often then not, these two events happen around the same time. That still doesn’t tell us that “something works”, though. Now that we’ve compared the two events, we should contrast them with something else.

In the case of ibuprofen, we can test it against (say) a pill made of powdered sugar. We get 500 more people, and tell them it’s a new pain relief drug that’s shown to be quite effective, and we ask them to take it in place of their usual choice (it’s also important that the person giving the fake pill not know that it’s a fake pill, but we’ll put that to oneside). We then note how many people experience pain relief. Because sometimes ones headache just goes away. Maybe we discover that only 100 of the 500 experience pain relief with this fake medicine, but 400 of the 500 experience pain relief from ibuprofen: clearly, when compared agains “not doing anything”, ibuprofen “works”.

What about Reiki? How could we possibly test that. I mean, I’ve been told that “Reiki is a very personal form of healing”, so it’s untestable. Right? Well… no.

See, if one claims that x works, then (as I outlined above) that’s because you’ve observed something which you have judged to be evidence for the belief that “Reiki works”. For example, maybe people said “hey, I feel much better now” or “I don’t feel as stressed as I did earlier”. So (at the very least) we can poll these people before and after a Reiki treatment: ask them to simply rate their stress out of 10 both before and after the treatment. Sure, these numbers are subjective but that’s ok: we’re not objectively trying to rate ‘how well’ Reiki works, but we’re trying to observe if these people feel that it worked ‘at all’. But that’s just the comparison step. Now we need to contrast.

But Reiki isn’t something that one can easily fake. A Reiki practicioner knows if they’re doing Reiki ‘incorrectly’, and that’s going to come across to the patient. So we have two options:

Option 1: find someone who has no exerience with Reiki at all, and “teach” them fake-Reiki. After the testing they will, of course, be fully debriefed, but for the purposes of testing they now consider themselves to be competent Reiki practicioners. We can now get them to test the stress-relieving power of fake-Reiki in exactly the same way as before (ie the polling of the patients).

Option 2: do something totally different, such as sit the same number of patients (one at a time) down with a counsellor and talk for one hour. Again, poll the patients before and after the treatment.

Then you can contrast the results of fake-Reiki with Reiki: if the results are the same, then Reiki is meaningless.

Compared with the ‘other option’, we can determine if Reiki is more, the same, or less effective than the other option. It won’t be as definitive as the other option, but it gives us a baseline to measure against.

To claim that “something works” in one breath and in the next claim that “it can’t be tested” is to fundamentally contradict oneself: one is talking nonsense at that point. To claim that “something works” is to acknowledge some testing criteria that the ‘something’ met. To then claim that it can’t be tested is to deny that acknowledgement; to claim that something can’t be tested is to deny that “something works”.

Medicine/Medical methodology

So what’s “medicine”?

Medicine is nothing less than the practice of science with regards to ideas that promote health and well-being. That is the methodical testing and examination of those ideas that are considered to be relevant with regards to improving our health or preventing our illnesses, and the implementation of those that are effective as determined by testing.

That is (very broadly) “Medicine”.

Everything that I said above about Science applies equally to Medicine, because Medicine *is* Science: Medicine, like Geology or Physics, is one of the many areas of knowledge that is grouped under the heading “Science”. I’m not going to reiterate any of the above points here.

Now some people will object to this definition. What I call “Medicine”, they would call “Allopathic Medicine”. And they’d be wrong: the “Medicine” that I’ve outlined above doesn’t care if you are using “like cures like” to heal someone, or if you’re using something completely random. Medicine, as I’ve defined it here, is about “methodical testing and examination of those ideas that are considered to be relevant with regards to improving our health or preventing our illnesses, and the implementation of those that are effective as determined by testing”. I.e. Medicine cares THAT your method works. We can worry about how your method works if it’s the case that it works.

Clear?

Complementary

“Complementary” has one core meaning: “that which completes”. If A is complementary to B, then A completes B. Which is to say, of course, that B was incomplete prior to the addition of A.

This isn’t quite the literal usage. For example, if we say that “the after-dinner brandy complemented the steak rather well”, we’re indicating that the brandy completed the *meal*, not the steak. But still, ‘something’ is being completed.

Complementary Medicine/Alternative Medicine/Alt-Med

Now if we’re to look at these phrases literally, we have some interesting ideas.

Complementary Medicine: that which completes medicine, which is to say that “medicine is incomplete without this particular practice”.

Alternative Medicine: that which is an option different to another option. This could be interpreted as that which is different *to* medicine, or simply a different medical choice under the umbrella “medicine”.

Alt-Med: a common contraction of “Alternative Medicine”.

Oddly enough, people tend to use these terms interchangeably, which means that a literal interpretation is incorrect. To understand what people mean when they use these terms, we need to look at what they’re talking about.

Alt-Med is collective term for a number of different treatments that aim to to improve our health or prevent our illnesses. This definition, it should be clear, is quite different from the above that I gave for Medicine. The manner in which Alt-Med performs testing is significantly different to the testing in Medicine.

If Alt-Med differs in testing from Medicine, then it differs in testing from Science. Science is, however, just a formalisation of the ways we know things. If Alt-Med differs in testing from Science, then it argues for a way of knowing that is different from our everyday way of knowing.

Is the problem that the Alt-Med practitioners (AMPs) don’t restrain their impulse to jump to conclusions? Or is the problem that they simply can’t get past their biases? Or is it some other reason?

I don’t have any answers to these questions. To claim that there is one problem inherent in all AMPs would be making the same mistake when people assume that all Scientists are unified in their outlook: I cannot infer a belief to all these people from the one or two that I’ve interacted with. I would be factually mistaken if I did so.

So herein lies the problem:

  1. AMPs proclaim that their method works
  2. AMPs proclaim that their method cannot be tested ‘according to Science’
  3. Science is simply the formalised careful examination of effect
  4. When Alt-Med is carefully examined, no effect is found.
  5. Therefore proclaimed method doesn’t work.

And that’s all one needs to know.

One doesn’t need to know the Chi pathway layout of Reiki (and each tradition of Reiki has different pathways), one doesn’t need to even try to understand the concept that water has memory (Homeopathy), one doesn’t need to understand how bringing blood to the surface of one’s back cures ailments (Cupping): one only needs to know if they work.

Medicine is testing. If there is no testing, then it’s not medicine.

It’s not “Alternative” Medicine, nor is it “Complementary” Medicine:

  1. If tests are not performed, then it’s not medicine
  2. If the tests are failed, then the implementation of that method is not medicine

If something gets tested, and it works (and subsequent repeats of that test also show a similar result (Science is about replication)), then what you have is Medicine. Not Alt-Med, and not Complementary Medicine: you have Medicine.

That’s about as clear as I can make it.

If, for example, one were to make the argument that [such and such] a treatment is too personal to be tested, then I’d have to ask: the test is “does the person get better?”. The Medicine is “If we do this on 100 people, do a significant percentage of them get better”. If you’re claiming that you can’t detect that “the person gets better”, then you cannot claim that your practice works. In fact, you have no basis whatsoever for claiming that the practice works if you’re unable to tell if the person gets better.

And that segues nicely into

Selling Alt-Med Services

So you have a method of healing that you wish to charge people for using. You have resisted testing, or the testing has failed yet you still consider your method to “work”.

What is the basis of your belief? If you reject the evidence of your senses, I really don’t know what you have left. If you believe that you can heal people, yet the people you work on are not healed… How can you still remain convinced that you can heal? This strikes me as an odd epistemological state to be in.

And asking money for this service?

Let’s try a metaphor…

Imagine a street in a city. There’s a guy there, with a table, and some cards. He’s running a Three Card Monte. He’s saying that anyone can win $20 if they guess the card right. In fact (he claims), 1 in 3 people do win. I mean, they’d have to, right? But as you watch, no-one wins. 10 people play. 20 people. No-one wins.

So you ask the guy “so… I just watched 50 people play today, and not a single one won. How can this be? I mean… the game works, right?”. The guy looks shocked. “Look, buddy, I don’t guarantee that any individual person will benefit. I can’t promise specific results, but playing this game can complement any other form of income someone is currently pursuing”. Upon being pressed “sure, maybe everyone today didn’t win. But yesterday, yesterday many people won. Come back tomorrow, you’ll see.”

If pressed further, he might say something like “I know you think this is a scam. But I don’t ask that others believe in it, just that they respect the fact that I do.”

Do we accept this argument? Absolutely not.

Let’s pretend for a moment that the guy running the game is unaware that he’s palming the card. He is completely oblivious to the fact that he removes the red card and replaces it with a black card everytime. So he’s not intentionally scamming people.

Do we accept his argument now? It is, after all, a genuinely held belief that the people can win.

No, we don’t. It’s still an empirical fact that he’s scamming people, whether or not the person running the game knows that it’s a scam or not. We might find them less morally responsible because they don’t know, but that doesn’t mean that the scam isn’t occuring.

Now, a counterargument to this metaphor is that it’s an unfair metaphor, that I’ve chosen a metaphor in which the guy running the game is scamming people, and knows that it’s a scam. They want to argue that I’m presupposing that Homeopathy (for example) is a scam by way of this metaphor.

I’m not presupposing anything. What matters is that the method (3 Card Monte) can be tested with regards the claim that “you have a 1 in 3 chance of winning”.

Again: So you have a method of healing that you wish to charge people for using. You have resisted testing, or the testing has failed yet you still consider your method to “work”.

If we test the guy running the 3 Card Monte, he will either resist testing, or testing will fail (ie show a rate of success to be much much less than 1 in 3). He will still claim on the street that his method works.

Likewise, if we test Homeopathy, Acupuncture, Reiki and all those other things, and they are shown to have no effect… Should we regard them the same as the above ignorant 3 Card Monte purveyor?

[This was originally posted on March 25th, 2010. It has been modified slightly from the original]

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