I want to try to summarize my responses on a whole lot of branches that have evolved on this thread. The response below addresses the following issues:
* 'western' medicine and its claims to progress in health, etc * the pragmatism of Miles * the issue of science, and establishment medicine as a science * the issue of who "speaks for the people" * Doug's response to Joanna on what I wrote (see quoted sections)
====================
Doug writes:
> On Aug 8, 2006, at 12:50 PM, Andy F wrote:
>>
>> Vaccines and germ theory have nothing to do with Western medicine?
>
> Evidently epidemiology & public health don't either.
>
But this reasoning flips the consideration. The question is not whether "western" medicine contributed to public health, but whether it has unique claims (over "alternative" methods) for doing so. Hence, your showing that 'western' medicine contributed to vaccines, germ theory, epidemiology, public health does not make the case against 'alternative' medicine. What you need to show is that 'western' medicine is the sole contributor to these issues, or equivalently, that 'alternative' medicine did not. For unless you can demonstrate such uselessness of 'alternative' medicine, how else can you write "NO ALTERNATIVE"?
Well, there are two other ways you can establish what you may not be able to demonstrate empirically:
(a) "end of history" or "exceptionalism" claims: End of history claims go like this (as the author in fact sort of writes): they were stumbling along and found things. We admit we did that too. But now they are still stumbling while we are on sure ground, so they can be ignored and we should be trusted. Our own history no longer applies to analysing our current claims or predicting our future performance.
(b) theoretical absolutism: We are special because our foundations, our methods, our actions, are special. Special in an absolute sense also in that they are designed in such a manner as to remove [the errors of] agency. Or while human fraud is always a possibility, the reasoning itself is foolproof. We are right because the universe is lawful and our methods have access to, use and obeys those laws.
Now I am not sure I can offer an argument against (a), especially if it is presented without (b), since in that form it reduces merely to an authoritarian claim. While (b) buttresses (a) it suffers from various philosophical problems. I am assuming (in order to keep this post within acceptable length) that you are familiar with these problems.
This brings us to Miles' "pragmatism":
> I have to say I don't follow this line of reasoning at all. If we do
> careful experimental studies comparing the efficacy of St. John's
> wort to other treatments for depression and find that the SJW is no
> more effective than a placebo, we can quite clearly eliminate SJW as
> a "alternative" treatment for depression. Color me a naive
> empiricist (on pragmatic grounds), I guess: without systematic
> research, how can we figure out what therapies to recommend for
> people? Perhaps we should examine the entrails of chickens?
Pragmatism is a funny thing, since it takes us away from the world of logical certainty into the messy world of rocks and emotions. It is interesting what pragmatic actions you may take if someone you love is suffering or dying and establishment medicine is willing to take as much of your money as they possibly can, without any assurance of positive outcomes. I hope that you (Miles) have not had to deal with such situations. In those cases, you may to your surprise find that your pragmatic self quite willing to even examine the entrails of chickens, though that latter act has little to do with all possible alternative remedies.
To address your argument: there are two points that can be offered to counter it. The trivial counter-argument: the problem of induction should give pause to any sort of absolutism. The substantive argument: the softer the science the less autonomous the units under consideration and less rigid the behavioural variance. Confidence factors gained from limited studies and testing are less representative of individual possibilities, I will submit (albeit without the data), without knowledge of variance within, across individuals and populations, histories, environmental factors (hence my questioning the ceteris paribus claims of such studies), etc (there is also a third methodological argument based on Bayesian vs other interpretations of probability and statistical distributions, but I am nowhere near competent to get into the details of that argument, though I am convinced its a legitimate one from talking to those who know better. I throw it in here in case someone more knowledgeable might wish to expand on it).
In your argument you bring up two different (if overlapping) viewpoints: "we" that eliminates SJW, and "we" that figure out therapies to recommend. The author of the original article starts out pointing to what might be the real motivator for this fight: and the usual suspect emerges: money. Last year individuals spent $40 billion on 'alternative' remedies. These *individuals* are the first "we" in your argument, the ones who choose or eliminate SJW. This "we" has to deal with the real world, the opinions of experts, their own monetary constraints, anecdotal information, emotions, hopes, etc. This "we" can never really "eliminate" anything unless they are convinced that it is harmful to them. The second "we" that recommends therapies -- those are the "experts". I have no issue with your applying your pragmatism (or as I would term it: Ockham's Razor) to them.
This line of thought leads us nicely into the next issue: the one of science and if and to what extent establishment medicine is a science.
Joanna writes:
>
> "Science" takes place in the real world; it is carried on by real
> people who are motivated by greed for money, fame, or security as
> much as they are motivated by respect for truth. To shout "science"
> through a megaphone does not obviate these realities. You will argue
> that bad
>
To which Wojtek responds about the wonders of science, its internal mechanisms, the difference between technology and use of technology, along with some amount of abuse thrown in about pomo-babbling, etc. Of course irrespective of all this, scientific abuse does take place (as he pretty much concedes) despite all of this, and Joanna's point stands as a beautiful anticipatory critique of Wojtek's own reasoning: for in waxing on about the greatness of science, he is, as she points out "shouting 'science' through a megaphone" while seemingly ignoring her point: that science may be the pursuit of truth, but often scientific activity is not. By writing about what the abuses of science say about science, he is converting (the much talked about strawman finally appears) this to an argument about science rather than the abuses of science.
But if Wojtek wants to argue about science, let us follow that thread:
> Certain technologies may have a greater potential for abuses than
> others (we all read Foucault), but that works in favor of modern
> science vis a vis "nonconventional" "traditional" folk wisdom (which
> in fact is quite conventional for those who believe in it.) You see,
> modern science - while certainly not panacea and free from error - at
> least has built-in mechanisms for systematic critical evaluation and
> verification of its claims. "Traditional" wisdom has few or none such
> mechanisms. Its claims are accepted basically on faith and authority
> and disproved, if ever, only accidentally, if someone happens to
> stumble into contradicting evidence.
>
> Stated differently, traditional wisdom may be true or false but its
> practitioners have no rational way of knowing which. They accept or
> reject claims based on tradition and belief. Science, on the other
> hand, not only can disprove itself, but attempts to do so are an
> integral part of its basic methodology. Therefore, traditional
> wisdom/medicine etc. has a much greater potential for abuse - it
> simply lacks sufficient verification mechanisms.
Interestingly, this seems to be an example of what he calls:
> In fact, those phrases are rather short on empirical meaning, a
> classic example of pomo-babbling that confuses reciting mantras with
> research.
For what can Wojtek, sitting in his air-conditioned office in Baltimore, know about what the practitioners of Ayurveda do, or have done over a thousand or more years? Or that "conventional wisdom" does not have a rational framework or is not subjected to empirical verification? Again, as I responded to Doug, one needs an assumption that people are 'idiots' in order to believe such things.
On the other hand, it seems almost naive (for someone who quotes Quine, who is by the way, largely unknown to practising scientists) to believe that (a) tradition and belief do not form a part of the context of either discovery or justification in any system of knowledge, and (b) empirical "evidence" and theoretical claims are co-verified, and some findings are in fact questioned and discarded on the basis of their theoretical improbability.
Interestingly, traditional wisdom is subject to one additional verification process: democracy. The people can have a say in shaping such wisdom. Establishment science, in practice, mostly rejects such considerations.
Wojtek ends his message so:
>
> The value of any form of knowledge is determined, for the most part,
> by its internal ability to empirically prove or rather disprove
> itself. In that respect, modern science stands head and shoulders
> above traditional forms of knowledge, medical or otherwise.
>
Without entering the question of the universal validity of such an evaluation criteria, it is worthy of note that there is a circularity in this, when seen in the context of the totality of Wojtek's argument. Perhaps the value of any form of knowledge should be determined by its utility? Or its ability to validate itself against external criteria?
Now that is about science. The more pertinent question is how much of a hard science establishment medicine is.
The talk of air-conditioned offices brings us to the following from Wojtek, the issue of who talks for the "people":
Colin Brace:
>
>>> somewhere that critiqued a predominantly "high-tech" approach to
>>> public health problems.
>
> [WS:] It is easy to sit in air-conditioned office in New York or
> Amsterdam and "critique predominantly 'high-tech' approach to public
> health problem. If on the other hand, one lives in countries like,
> say, Ethiopia where people are mostly free of the "evils" of high
> tech medicine, one takes a different view. If I were to choose
> between being a limbless (due to untreated leprosy) beggar on the
> streets of Addis and an overmedicated New Yorker, thank you, but I'll
> keep my high-tech medicine.
>
Well, yes, perhaps Colin is sitting in an air-conditioned office, but he is talking about the opinions of others. And perhaps these are organizations and individuals who have spent a lifetime considering these problems, working on the ground, *listening* to the people they are trying to help.
The choice is not the false one Wojtek presents, in his sudden turn away from the scientific approach to a more flamboyant populist one, of high-tech vs nothing, but between a high-tech approach and *other* approaches. From his air-conditioned office in Baltimore, Woj is able to divine the options available and the preferences of the beggar in Ethiopia. Come on Woj, I am used to better flames from you!
And finally a response to Doug's response to Joanna:
> On Aug 8, 2006, at 1:06 PM, joanna wrote:
>
>>> there is (in the above article) a bit of attention (in the
>>> manner of Fox News "Fair and Balanced") to the excesses and
>>> accuracy of professional-racket-medicine medicine. Nor is the
>>> promiscuous nature of professional-racket-medicine made obvious,
>>> as remedies stolen from "alternative" medicine are quickly
>>> incorporated into professional-racket medicine, and even claimed
>>> as one of its successes.
>> Right on ravi!
>
> Except that what Ravi writes isn't true.
>
> These are quotes from the article that started this - by a prof at
> the Harvard Medical School - it doesn't get more establishment than
> that:
>
>> But it is not a matter of geography or culture. Until the 19th
>> century, Western practitioners were badly wrong, attributing
>> diseases to an imbalance in humors, bleeding patients and
>> prescribing poultices and purgatives. Modern Western medicine has
>> also embraced therapies that were later disproven. In the 1960s,
>> surgeons tied off an artery under the breastbone in patients with
>> angina, believing this increased circulation to the diseased heart.
>> Many patients swore by the surgery, but when the procedure was
>> subjected to a clinical trial, it turned out that the sham
>> operation was equally beneficial.
>
>> On the other hand, one of the most important new therapies for
>> leukemia is an arsenic derivative identified in western China as
>> part of traditional practice that resulted in well-documented
>> remissions; its effects on key molecules in the malignant cells
>> have been elegantly mapped by scientists. And qualified researchers
>> are testing components of tumeric and other spices than can inhibit
>> melanoma and breast cancer cell growth. Science is enthusiastic
>> when it meets reality.
>
I wrote: "alternative" remedies are stolen by establishment medicine and claimed as one of its successes. The last bit above does not say that at all. For instance, it does not address my underlying point that some of the successes offered in favour of establishment medicine are ideas that were discovered and appropriated from "alternatives" **AND** therefore these successes demonstrate the usefulness of alternatives, and IN FACT not that of establishment medicine.
With regard to the excesses and accuracy of establishment medicine, consider once again the quoted text above. Here is a sentence:
> Until the 19th century, Western practitioners were badly wrong,
And afterwards? Well, not badly wrong I guess, just this wrong:
> Modern Western medicine has also embraced therapies that were later disproven [sic].
And so (setting aside the implication that "Modern Western medicine" went from "badly wrong" to just "embracing later disproved theories" and perhaps to zero errors?) what are we to take from this? This is "fair and balanced" in that some opposing facts are thrown in. But how do these opposing facts alter the argument? Seemingly not much. As I pointed out in another message, the only place I found this incorporated further on is this bit:
> The
> difference is that these companies rely on biological mechanisms to
> select candidate drugs for testing, rather than unsubstantiated
> testimonials and anecdotes.
(hence my reference to theoretical claims, very early on in this message)
It is of passing interest that the good doctor picks up as an example not from medical research (his home Harvard) but the real home of establishment medicine: drug companies. Well, I leave you with this question. Do you believe that these companies rely on biological mechanisms to select candidate drugs for testing?
--ravi
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