Well, clients are using some criteria today, aren't they? A health care provider should use the criteria that (s)he finds trustworthy. Of course you cannot test everything under the sun, etc. You can use your theoretical framework to limit what you even consider, or Ockham's Razor, or your trust in the proponent of the idea, etc. Ignoring a solution is not the same as rejecting it, much less the body (that you -- the author of the piece -- allege) it belongs to.
> --"Well, there's no
> systematic research now that supports the use of treatment X, but
> scientific theories and methods change, so you shouldn't rule out
> treatment X". By this logic, if I claim that eating skinny vegetables
> like green beans will make me skinny, I should consider green beans an
> "alternative" treatment for weight loss, and even if there's no clear
> research that supports my claim--hey! science is fallible, so we need
> to keep my "alternative" treatment on record!
Well, if you believe that green beans help you lose weight, of course you should keep that notion under consideration. Why wouldn't you?! I might choose to ignore it since I do not have the time and energy to investigate it. Surely you are not suggesting that you can actually rule out something without testing or evaluating it in some way? Its words like "systematic", "research" that prop up the argument!
But these are not pragmatic considerations (or representations) at all. This is an argument from the extreme, the outlier, the corner case. Alternatives did not arise out of some guy shouting about them from the street corner and a million people deciding to try it out on his word.
> The practical problem that ravi keeps dodging is this:
No Miles, I am not "dodging" anything. What I am refusing to do is fall in with the way you are re-characterizing this debate. Everything I write is relative to that one article, and I will keep bringing my responses consistently back to that article.
> there are
> numerous potential therapies to treat a particular ailment, so we can't
> just say "keep everything under consideration". To provide people with
> access to effective therapies, we need some systematic process for
> identifying effective therapies and recommending those therapies over
> others. In my view, the scientific process accomplishes this pretty
> effectively. Informal "trial and error" or isolated case studies are
> not scientific research, and it is a gross misrepresentation of both
> "traditional" cultures and the current culture of science to say that
> people in hunting and gathering tribes used the "scientific method" to
> discover the analgesic effects of (say) willow bark. Sure, they used
> trial and error, but they were not doing science, because science is a
> complex product of organized social relations in certain types of
> societies.
I have no idea what that last line means, but I have no intention of claiming that earlier societies were carrying out science. It is a "gross misrepresentation" by whom? Do you see me making any such claims?
What I refuse to accept is this notion that they were not using some mechanism to investigate remedies, choose one over the other, etc. What you have not shown me (at least without resort to phrases like "complex product of organized social relations in certain types of societies") is that science is consistently distinct from such methodologies (I can think of one way to show that, which would involve a commitment -- the lawfulness of the universe, and a tool -- mathematics. But I will not venture into that in detail, and wait for someone to bring it up before I offer my reasons on why I think that would be an instance of what Joanna aptly calls "shouting 'science' from a megaphone") -- from the perspective of elimination of methodologies or bodies of knowledge.
Further, the study of the history of science is filled with examples of the non-mechanistic reasons used by practising scientists to narrow the innumerable choices that confront them, even within their own framework. The literature is replete with references to "elegance", "parsimony", etc while counterarguments persist within the community (ref: Bohr's responses to Einstein).
> Now, I'm no dogmatic fan of the scientific process; if ravi could
> identify some specific, nonscientific means of identifying truly
> effective treatments, I'm happy to jettison medical research.
Huh? Who is asking you to jettison anything? Is this the false dichotomy that so inflames Woj and others? Stick to your body of knowledge, and that alone, if that helps you through the night. As Joanna's examples point out, scientific means of identifying effective treatments turn out to yield false results. On the other hand, what we often do use to identify things that have a decent probability are methods that have been available to us and used by us for thousands of years.
Here, spelled out, off the top of my head, is one alternative non-scientific means of selecting possible treatment: (a) use a conception of the world and its components, (b) choose theories (in this case treatments) in the order of least inconsistency with this conception, (c) use the conception to device tests on the efficiency of the theories (treatments), (d) evaluate the test results to ascertain a possible best candidate, (e) apply the best candidate to the world and (ii) monitor its effectiveness, (f) either as a result of e(ii) or because you have the energy or time, evaluate in reverse order other theories, (g) use the theories and findings to revise your conception of the world, (h) design counter-tests that challenge your conception and your theories.
As noted, I see my 19 month old use a mechanism very much like the one I describe above to formulate his thoughts and actions on a project at hand (walking, talking, etc). It seems to serve him quite well. No amount of parental pride however will convince me that he is a scientist or is pursuing a "scientific method".
Look, since you want to introduce a puzzling "science vs whatever" tone to this discussion and want to prevent my "dodging" things, why not go ahead and define what "science" is, and what "scientific method" is? It would help (at least me) if you did that without assuming that the reader has nothing more than a postgraduate degree.
> The
> appeals to tradition, though, are not adequate, because some traditional
> medicines are effective and others are not (tradition or custom alone do
> not reliably identify effective cures). So once again: if we don't use
> scientific methods, how do we decide what therapies to recommend and
> administer?
I have already, in my very first response, pointed out the difference between the "we" doing recommending and the general targets of the original author's attack. I am not sure I can clarify that any better.
--ravi
-- Support something better than yourself: ;-) PeTA: http://www.peta.org/ GreenPeace: http://www.greenpeace.org/ If you have nothing better to do: http://platosbeard.org/