My last posting, asking whether the National Center for Complementary and Alternative Medicine should be shuttered, has generated some interesting comments. The most interesting was provided by reader Alexandria Kung, who suggested that any movement to banish NCCAM constitutes medical ethnocentrism (see the fifth comment here). Her idea is that westernized medicine is not the only way to heal people, and that we need something like NCCAM to investigate healing approaches from other cultures and traditions. We have more common ground than might be expected.
In my response, I would like to be clear that I strongly believe a proposition that I’ve learned is viewed skeptically by many in the complementary medicine community: science is not just another religion.
That is, the results of science cannot be viewed with the same relativism that would be appropriate when considering, say, different moral attitudes about wasting water in desert versus temperate cultures. Science is a method of inquiry for obtaining understanding about natural phenomena. We demand certain things to be true for it to be subject for scientific study, such as that a process or experiment is repeatable and subject to carefully controlled interventions (though there are special exceptions, such as studying the Big Bang). Its purview, in the grand scope of all of human experience, is narrow; what it knows with confidence is far, far narrower.
If we can agree that medicine is about making people feel better, we can further agree that the line between distress due to psychogenic factors (such as having a stressful family or work life) and distress due to an organic pathology is quite murky. But, it is clear that there’s a few organic pathologies, such as infections, or leaky heart valves, where years of scientific effort have led to ways to dealing with those organic pathologies which leaves a person feeling better for a long time. That’s not to say that the track record of science/evidence-based medicine is stellar across the board – far from it. Look at “Overdosed in America” by John Abramson for counterexamples.
But for those kind of interventions where the evidence is clear, I cannot see any room for a “medical ethnocentrism” argument. I would claim that no matter what part of the globe or culture you are in, if your child is dying of an infection, or of a leaky heart valve that can be corrected by surgical intervention, then you would do whatever you could to get the antibiotic or surgery for your child. And, you should. Similarly, I think that female genital mutilation is wrong, and I don’t think that this view is western ethnocentrism. Let’s agree that the bulk of cultural practices are things science has nothing to say about, nor should it. But with respect to certain organic pathologies or physical interventions, there are clear guides to action that transcend cultural boundaries.
Now, people go to doctors for a lot of reasons. Only some fraction of them are things that are either treatable or need treatment (as opposed to simply letting the body heal itself). Be that as it may, and given that some of these will be psychogenic in nature, clearly not all such people are in need of a pill or a surgical intervention. For these, I do think that there is a role for healers of all kinds of culturally-contingent stripes, from witch doctors to faith healers. Whether they also dole out what are placebos or not is irrelevant. Placebos, in the hand of someone you trust, are effective facilitators of the body’s own natural healing processes, since they give you a psychological boost, and probably reduce your cortisol levels and improve physiological functioning in all sorts of ways. For a thought provoking discussion of how a rational person should pick the right placebo purveyor, see the last bit of the Snake Oil Science book I recommended in my last posting. But such a healer, in a country where options exist, would be rightly accused of criminal negligence if they provided their treatment to someone dying of an infection or desperately needing surgery.
I’m against NCCAM spending money on the scientific basis of homeopathy, because the combination of the meta-analyses done so far plus the lack of any credible mechanism means that there is no scientific basis to homeopathy. I think it has come time to make the call, in terms of science, and move on. While I’m against spending funds on the scientific basis of homeopathy, I am certainly for continued research on alternative medicine (just not, as I stated at the end of my last posting, under the aegis of NCCAM, unless it is reformed). There are other once-alternative approaches, such as the use of willow bark starting in 400 BC, which have been found to have a scientific basis, and I’m sure there are more out there which will be found to have a scientific basis.
But most importantly, perhaps, I think that our finding no scientific basis to homeopathy does not have the implications that many who find this approach helpful may fear, and here is precisely where I have some agreement with the “medical ethnocentrism” argument. One of those fears may be that, in a culture which holds science to such high esteem, anything that is found to not have a scientific basis might be outlawed. This is clearly a decision that is beyond the power of science to make. We do many things, and specifically, many things that make us feel better, without scientific basis. I can’t imagine a world otherwise, but Aldous Huxley did a reasonable job of trying in his “Brave New World.”
So long as people want the service of them, homeopaths will continue to exist. Likewise with marriage counselors or yoga instructors or dietitians. I don’t expect to find a scientific study that proves the efficacy of marriage counselors or yoga instructors or dietitians any time soon. I don’t think I need one to decide whether to seek their services. Homeopaths, like marriage counselors and yoga instructors, and hugs from someone you love, make a lot of people feel better, and that’s a good thing.