On Wed, 9 Aug 2006, ravi wrote:
> 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.
You're not following my use of the term "pragmatic". I have in fact had to deal with medical decisions for a number of close relatives (my family medical history on both sides is pretty dismal). In no case did I in desperation turn to untested treatments, "just in case" the alternative therapy might work. My grounds were pragmatic through and through: (a) if there is no systematic research, we can't effectively assess the risk of side effects; and (b) trying untested therapies increases the likelihood of using an ineffective therapy, and this is a waste of time and resources. Trying anything in desperation to save your loved one is not pragmatic. (And if I believed in Hell, I would say there's a special place reserved there for the charismatic hucksters who prey on sick people's fears by selling them untested "wonder cures" like shark cartilage.)
> 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).
Science is messy and the results of scientific research are never absolute and definitive, as Woj pointed out in an earlier post. I don't see how this supports your position. --Do you really mean to argue that we can ignore the data from any scientific study that demonstrates the effectiveness of one therapy over another, because science doesn't produce absolute knowledge? Again, and I'm not being facetious: if we don't use scientific research as the basis for deciding what therapies to use, what standard do we use? Anecdotes? The charisma of the treatment advocate? Intuition? Sure, the scientific method produces mistakes, but at least there is a systematic process to test, verify, and reject claims. Thus, on pragmatic grounds, scientific research as a reasonable--but not perfect!--basis for recommending specific therapies and discounting others.
Note that this does not entail dogmatic support for "western" medicine. For instance, clinical trials have clearly demonstrated the analgesic effects of acupuncture. In contrast, recent research on hormone replacement therapy for menopausal women has shown that the "pump em with estrogen" strategy has no positive therapeutic effects and actually increases a woman's risk of ovarian cancer. Thus the enthusiasm for systematically testing therapies is not necessarily enthusiasm for "western" medicine; it's enthusiasm for efficiently using resources to improve people's health and lengthen their lives.
Miles