Last night, I attended Harriet Hall’s “I Don’t Need No Stinkin’ Science” at PSU. This got me thinking about ways that we might change society to eliminate the propagation of expensive placebos touted as effective treatment. Proposal #1: “Alternative Medicine” to “Experimental Medicine”
I think that lobbying to change the umbrella term “Alternative Medicine” to “Experimental Medicine” would have several positive effects:
Some Alternative Medicine practices have been under researched. Labeling them Experimental clearly defines their state.
Some Alternative Medicine practices have already been researched and proven ineffective. Labeling them Experimental gives immediate reason to end the practice, and will prevent future ineffective treatments from gaining ground.
The word “Experimental” carries a connotation of risk with the general public. People will ask more questions about procedures, effects and side effects, and weigh the risks for themselves. The public will be more skeptical of practitioners.
“Experimental” may encourage research. Proposal #2: An exit strategy for Alternative practitioners
Practitioners of Alternative Medicine have made a living for themselves and have incentive to promote and continue their practice. Once their practice is proven ineffective, currently their only alternative is to abandon their business and start over at great expense. They need a way to transition to a new lifestyle, else they will fight us tooth and nail at every turn. Let’s give them a “bailout” option by subsidizing proper education in established, well researched and effective practices for some ailment. Clearly, it is completely infeasible to send someone to medical school to learn how to cure cancer, which is why I say “some ailment”. We can give them a list of reasonable options to choose from.
What ideas do you have?
How can we begin implementing something?
Nah, experimental is a science related word so it would give “alternative medicine” more cashe. I suggest pseudo-medicine. Those areas which have not been researched could stand this title until the research is done. In most cases where there hasn’t been continuing research, the reason is that most scientists have enough broad experience that they almost intuitively recognize the low probability of successful outcomes.
Occam
Proposal #2: An exit strategy for Alternative practitioners
Practitioners of Alternative Medicine have made a living for themselves and have incentive to promote and continue their practice. Once their practice is proven ineffective, currently their only alternative is to abandon their business and start over at great expense. They need a way to transition to a new lifestyle, else they will fight us tooth and nail at every turn. Let's give them a "bailout" option by subsidizing proper education in established, well researched and effective practices for some ailment. Clearly, it is completely infeasible to send someone to medical school to learn how to cure cancer, which is why I say "some ailment". We can give them a list of reasonable options to choose from.
That . . . is not too bad, actually. Kind of like the Clergy Project for alt-medicine gurus.
In practice, psuedomedicine is impossible to completely eliminate because it will always be cheaper than actual medicine. But, the better tools we have to reduce it, the better for everyone.
Nah, experimental is a science related word so it would give "alternative medicine" more cashe. I suggest pseudo-medicine.
Pseudo- means false. I don't think we should label things false until they are proven false. In addition to that, pseudo- has negative connotations. It is an unfortunate fact of human nature that we are not governed by logic alone. In order to change people, we must appeal to their emotions, to validate them; only then can we guide them through a logical path to truth.
"Experimental" acknowledges their idea (however poor a hypothesis it may be according to a scientist's intuition), and gives it a chance to succeed (however statistically small that chance may be). Disallowing attempt disallows the experience of failure; people learn from failures, not from being told, "No." We should let them try and let them fail.
Pseudo- means false. I don't think we should label things false until they are proven false.
Wait - um, I thought that you were referring to Alternative Medicine as false medicine in the first place. The whole "it's either medicine or it's not, there is no alternative" vibe.
My understanding is that Alternative Medicine is an umbrella term for a collection of practices which did not originate from scientific medical research. Some of these practices need to be researched. Others have been and have been proven ineffective (or worse). There are people coming up with new ideas who begin practicing under the Alternative Medicine umbrella, but they should be stating that their ideas are hypotheses and that they are conducting experiments and collecting data. (They should also be held to scientific standards in this regard.) The word “Alternative” does not necessarily mean “Not”; they are not Alternatives To Medicine, they are different medical possibilities.
I still like pseudo- since it also can mean close to reality.
I really don’t care for experimental since all standard medicine has gone through the experimental process and is therefore experimental. Would you prefer: quasi- or hypothetical-? This last does really fit since the tenets of “alternative medicine” are unproven hypotheses until properly researched at which time they would move either to standard medicine or to the domain of fairytales.
Occam
I still like pseudo- since it also can mean close to reality.
I really don't care for experimental since all standard medicine has gone through the experimental process and is therefore experimental. Would you prefer: quasi- or hypothetical-? This last does really fit since the tenets of "alternative medicine" are unproven hypotheses until properly researched at which time they would move either to standard medicine or to the domain of fairytales.
Occam
Folk medicine, I'd call it. Mostly unproven. Most of it probably won't hurt us and might make us feel better that we're doing something, but if it keeps us from proper evidence-based diagnosis and treatment, we're playing with fire.
Lois
“Hypothetical” medicine seems best to me. Words matter. It seems nice to have an “alternative” but people might have a second thought before subjecting their body to something hypothetical.
I really don't care for experimental since all standard medicine has gone through the experimental process and is therefore experimental.
As I understand it, medicine as practiced by MDs is the application of processes developed from confirmed medical hypotheses. An experiment is a test of an unconfirmed hypothesis. Medicine as practiced by MDs is not experimental.
Would you prefer: quasi- ...
Quasi- means resembling. I agree that quasi-medicine is a better term for what Alternative Medicine is today. The goal, however, is to change what Alternative Medicine IS, not just the words we use to describe it.
Alternative Medicine is the application of processes developed from unconfirmed medical hypotheses. This is bad. Practitioners should be performing experiments to test their hypotheses; we don't just want to change the words, we want to change the state of the practice.
... or hypothetical-? This last does really fit since the tenets of "alternative medicine" are unproven hypotheses until properly researched at which time they would move either to standard medicine or to the domain of fairytales.
A hypothesis is a possible explanation for an observation. People cannot practice hypothetical medicine. This would equate to merely thinking about practicing medicine.
OK, I was trying to conserve words. I should have said, “experimentally derived” rather than just experimental.
The goal, however, is to change what Alternative Medicine IS, not just the words we use to describe it.
that may be your goal, but it's certainly not the goal of most who practice alternative medicine. The probablity of getting them to change the name of their area is exceedingly small.
A hypothesis is a possible explanation for an observation. People cannot practice hypothetical medicine. This would equate to merely thinking about practicing medicine.
No, hypothetical medicine could also mean a body of ideas which, while not yet experimentally verified, can be practiced.
The goal, however, is to change what Alternative Medicine IS, not just the words we use to describe it.
that may be your goal, but it's certainly not the goal of most who practice alternative medicine. The probablity of getting them to change the name of their area is exceedingly small.
Without incentive, yes. If we give them a strong enough incentive to change, they will.
Human behavior is mostly driven by three motivations: fear, reward, and self-motivation (truth seeking, as an example). I would guess most Alternative Medicine practitioners are out to make a buck (reward driven). They fight against change because they are afraid of losing their income (fear driven). My second proposal was mostly about alleviating this fear which prevents change. They may also be afraid to let go of supernatural beliefs and face a reality they do not understand (fear of the unknown, psychologically defended by delusion, denial and/or fantasy, alleviated by education). We cannot force self-motivation; this comes from within the individual. So how do we reward people for applying proper science and practicing proper medicine? How do we draw them in, encourage them to join our side? Let's brainstorm.
“Experimental” medicine would likely be viewed more perjoratively by potential customers, than “alternative” medicine. Thus the practioners of “alternative” medicine would have little motivation to be behind a moniker change.
Although what you are proposing is a worthy goal, I think, that realistically, we might most easily have an impact by, ourselves, adopting and spreading a moniker for the industry that is more descriptive than “alternative”.
I think the OP may be ignoring the fact that Alt Med isn’t simply “unproven” techniques (like most herbal therapies), or even techniques tested and disproven (like homeopathy). It is a category that contains many mutually incompatible philosophies and practices that are united by some common values, philosophical principles, and aesthetics. While some of the resistance to challenging Alt Med is financial self-interest, this is a relatively small part of the equation IMHO. Most of the folks in my field who use and promote also make a substantial portion of their living from conventional care and consider They could make a living without the Alt Med stuff, they simply genuinely believe in it. And honestly, there is a component of quasi-religious faith to people’s attachment to alternative theories and practices which resists rationale rewards, incentives, and disincentives.
I think the best hope for separating the potentially valid stuff in CAM (which I suspect is a small fraction of it) from the nonsense lies in strict regulation that requires demonstration of legitimate scientific evidence sufficient in quality and quantity to justify use of specific practices before they can be sold/employed to treat patients. This is how science-based conventional medicine initially separated itself from the competing schools of thought in the early 20th century after the Flexner report convinced people we needed medical licensure and uniform standards for MD education. Without the coercive role of government, we can only marginalize even grossly ineffective or dangerous practices to a certain extent through education and lobbying the general public. HERE] is a link to an article I wrote for the Journal of the American Veterinary Medical Association, and to a narrated slide deck, in which I talk about the fundamental areas of conflict in the world-views of science-based medicine and CAM. Dry stuff, I suppose, but I think it illustrates why applying science to CAM isn’t sufficient to cause people to discard the chaff even after the wheat has been identified. People simply don’t care that much about what science demonstrates to be true or to actually work when it conflicts with their hopes, values, and personal experiences. I agree with Occam that relabeling CAM “experimental” will only create the false impression that it is distinguished from science-based medicine primarily by the state of the evidence concerning it, which seems to folks like us to be what matters but which actually has very little to do with the popularity of CAM.
I have to second McKenzie’s comments. The few medical doctors I know who promote this sort of thing have no good scientific reasoning to support their position. They claim they are just being open minded but “open minded” in this case really just means " I think it works so I don’t care what the science says". When belief trumps reason we are dealing with something that is essentially a religion.
I think the OP may be ignoring the fact that Alt Med isn't simply "unproven" techniques (like most herbal therapies), or even techniques tested and disproven (like homeopathy). It is a category that contains many mutually incompatible philosophies and practices that are united by some common values, philosophical principles, and aesthetics. While some of the resistance to challenging Alt Med is financial self-interest, this is a relatively small part of the equation IMHO. Most of the folks in my field who use and promote also make a substantial portion of their living from conventional care and consider They could make a living without the Alt Med stuff, they simply genuinely believe in it. And honestly, there is a component of quasi-religious faith to people's attachment to alternative theories and practices which resists rationale rewards, incentives, and disincentives.
I think the best hope for separating the potentially valid stuff in CAM (which I suspect is a small fraction of it) from the nonsense lies in strict regulation that requires demonstration of legitimate scientific evidence sufficient in quality and quantity to justify use of specific practices before they can be sold/employed to treat patients. This is how science-based conventional medicine initially separated itself from the competing schools of thought in the early 20th century after the Flexner report convinced people we needed medical licensure and uniform standards for MD education. Without the coercive role of government, we can only marginalize even grossly ineffective or dangerous practices to a certain extent through education and lobbying the general public.
HERE] is a link to an article I wrote for the Journal of the American Veterinary Medical Association, and to a narrated slide deck, in which I talk about the fundamental areas of conflict in the world-views of science-based medicine and CAM. Dry stuff, I suppose, but I think it illustrates why applying science to CAM isn't sufficient to cause people to discard the chaff even after the wheat has been identified. People simply don't care that much about what science demonstrates to be true or to actually work when it conflicts with their hopes, values, and personal experiences. I agree with Occam that relabeling CAM "experimental" will only create the false impression that it is distinguished from science-based medicine primarily by the state of the evidence concerning it, which seems to folks like us to be what matters but which actually has very little to do with the popularity of CAM.
Must you come on and make the rest of us look dull in comparison, with our petty suppositions?... Oh well... I supose you must.
HERE] is a link to an article I wrote for the Journal of the American Veterinary Medical Association, and to a narrated slide deck, in which I talk about the fundamental areas of conflict in the world-views of science-based medicine and CAM. Dry stuff, I suppose, but I think it illustrates why applying science to CAM isn't sufficient to cause people to discard the chaff even after the wheat has been identified. People simply don't care that much about what science demonstrates to be true or to actually work when it conflicts with their hopes, values, and personal experiences.
Thank you, McKenzie, this was very informative. I especially appreciated the "Can CAM be EBM? Yes If / No If" section.
I still disagree with the idea that all CAM should be thrown out as unscientific nonsense; I think that there are bits of CAM which should be researched and extracted from the spiritual / energy sets of beliefs. I suppose we're already moving in that direction, though, as EVERYTHING must be KNOWN!
I still disagree with the idea that all CAM should be thrown out as unscientific nonsense; I think that there are bits of CAM which should be researched
I absolutely agree. I'm a pretty strong critic of CAM, but I also suspect there are bits of useful therapy stuck in the morass of pseudoscience that are worth digging out. Herbal remedies, for example, undoubtedly have biologically active compounds which could potentially have real value (and, of course, real risks), we just won't know what they are until they are properly studies. The resistance to researching CAM comes almost entirely from the CAM proponents, who believe their methods have already been clearly established to work and who see research as, at best, a marketing tool to quiet skeptics and, at worst, a deliberate effort by Big Pharma to quash "natural" therapies.
Of course, there are some CAM methods that have been studies and have failed clearly and consistently such that further research is an unjustified waste of resources (e.g. homeopathy, most applications of chiropractic other than musculoskeletal disorders). And there are others that are pure religion and can't/shouldn't be treated like scientific hypotheses at all (e.g. Reiki,"energy medicine" of various sorts). But I agree that there are elements of CAM which are worth investigating. I'm just not sure separating the effective from the nonsense will be achievable given the deep philosophical/epistemological differences between the scientific world view an that informing most CAM approaches.
