In addition to substantive arguments about evidence, clinical studies, and underlying biological or physical rationale, many arguments between supporters and skeptics of veterinary CAM involve myths, stereotypes, logical fallacies, and other rhetorical devices or conceptual errors unrelated to the actual merits of the case being made. The recent discussion in response to Narda Robinson’s article on the Pet Connection Blog has revealed some of the archetypical forms of these, and I thought I’d offer a few possible responses.
1. Argument from Faith-
This, of course, underlies much CAM. Supporters “know” things work because of their firsthand experiences or they have faith in the wisdom of tradition or individual gurus. Apart from the cognitive errors that make anecdote and firsthand experience rather unreliable, the propensity for self-validating belief is a problem in itself. Faith is, by its very nature, self-reinforcing. Belief begets belief, and humans are notoriously loath to give up beliefs regardless of evidence. We hate to have to accept the ambiguity and uncertainty of knowing our personal impressions are less reliable than the objective and impersonal process of science. There is a powerful psychological incentive to reject evidence-based medicine because it takes away our illusions. Supporters of CAVM can claim that because they have believed and practiced these methods, because they have “seen for themselves,” that their wisdom and position of authority must be respected. Sadly, their intelligence and passion and conviction may make them convincing to others, but they don’t make them right. Only well-designed and conducted research which take the biases of passion and conviction out of the evaluation process can prove their case, and they often disdain such because it seems to them beside the point, a mere frill to “prove” what they already “know.”
The emotional intensity of true faith also contributes to the tendency of CAM supporters to perceive disagreement as disrespect, or to act as if respect ought to be a substitute for evidence, but such is the nature of faith-based medicine.
While we should be free to disagree about facts, I find CAM proponents often identify disagreement with suppression of the truth, ignorance, or some sort of political conspiracy. This is part of the David and Goliath Myth I’ve written about before. I try to take their belief in the benefits of the methods they espouse in good faith, and I believe they have their patients’ best interests at heart. Mature and respectful disagreement requires that they treat dissenting opinions likewise because their belief is often a matter of personal faith, they can be quick to dismiss other opinions as disingenuous or motivated by something other than the best interests of our patients.
There are several versions of the “you too” argument. One is that mainstream medicine is itself not evidence or science based and so CAM has an equal claim to legitimacy and efficacy. The specific citation that “only 15% of allopathic medical treatments were based on scientific studies” has been well-debunked.
There is a grain of truth to this assertion. Many mainstream practices have been “grandfathered in” (as, I might add, has the US Homeopathic Pharmacopeia, which was automatically exempted from proving safety and efficacy when food and drug safety laws were instituted in the U.S.). These practices do not have the level of evidence behind them they would require if newly discovered today. However, the level of evidence behind mainstream medical practices is far higher than for alternative practices. And the underlying principles are not grossly inconsistent with established principles of the biological or physical sciences, as is often the case for CAM methods. And rather than considering centuries or millennia of unquestioned use to be a point in favor of a therapy, as does the CAVM community, scientific medicine holds all practices as open to criticism based on logic, reason, general scientific principles, and of course clinical evidence.
Another fallacious form of this argument says that because mainstream scientific medicine makes mistakes and there are bad doctors in scientific as well as alternative medicine, that this is somehow evidence in support of homeopathy, TCM, or other alternative therapies. There is no connection. Scientific medicine makes mistakes, but science is always changing and improving and these mistakes eventually get corrected. Scientists are imperfect human beings, but the scientific method applied over time but many individuals compensates for our flaws. Therapies based on unwavering respect for ancient traditions and validated primarily by personal experience and belief, on the other hand, have no reason to seek and correct mistakes. If Palmer and Hahnemann and the ancient Chinese physicians had it right, then our duty is to follow their advice and not question or challenge it. Western mainstream medicine made this mistake in canonizing Galen and the other Greek physicians and accepting without question both what they were right about and what they were wrong about. And medicine stagnated in a miserable state for centuries. The scientific method changed that and made active questioning and critique a virtue. I know some CAM proponents will disagree and say that we are all drowning in toxins and disease and that the pre-scientific age was a Golden Age, but the history of the succeeding couple hundred years suggests to me that the scientific approach works much better.
In any case, the lack of perfection in scientific medicine is not an argument that no progress has been made or that the method doesn’t work. And it’s certainly not an argument that the exact opposite philosophy is the better alternative.
3. Health Care Choice
A popular defense of CAM in the U.S. these days if the argument that consumers (not “patients”) should be free to choose what kind of health care they want, apparently regardless of whether it works or not. The “free choice” argument is a popular strategy as it plays into the general cultural suspicion of government and the respect for individual freedom. But the “choice” between methods which help and those which do nothing or even harm a patient is not a truly free choice. If one accepts that the government has any role at all in protecting public health, than one has to accept that establishing some reliable and objective standards of safety and efficacy is an appropriate government activity. If, of course, you believe government should stay out of everybody’s business altogether, than you won’t accept this, but that’s really a political not a scientific debate. There is a segment of the libertarian movement that aggressively supports CAM for clearly political reasons, though thankfully there are also many solidly skeptical libertarians as well.
History suggests to me, that the methods of science are better at determining safety and efficacy than tradition and personal experiences. For a thousand years doctors and patients believed bloodletting, purging, cupping, casting out demons, and lots of other non-scientific method of treatment were helpful. Those people were just as smart as we are, but they had the same flaws and cognitive vulnerabilities. We now live longer and healthier lives and eschew those methods because we have developed a better way to determine what works and what doesn’t. This is not cultural chauvinism, it’s just a pragmatic evaluation of reality. And if this is true, then a caveat emptor approach to health care where we are “free” to choose whatever snake oil is sold to us, and the salesmen are free to claim whatever they like without reasonable proof, seems a step backwards and a guarantee of much unnecessary suffering.
The history of government regulation of food and drugs shows some real benefits to limiting the medical therapies that can be made available to those which have some reasonable, scientific plausibility, and the weakening of such laws through legislation such as the 1994 Dietary Supplement and Health Education Act have clearly led to harm, and this argues against the benefits of so-called “health care freedom.”