While some of the disagreements between skeptics and proponents of complementary and alternative medicine (CAM) are disagreements about details, interpretation of data or the finer points of methodology, it is often overlooked that fundamental, irreconcilable philosophical differences also exist. Some CAM practitioners actively reject the whole model of science and scientific research as the best method for understanding health and disease. Whether this is a genuine a priori disagreement, or simply the result of casting about for some approach that will validate their beliefs once science has shown them to be false, we cannot know for certain. However, there is ample evidence that such radically alternative philosophical approaches underlie much of alternative medicine, despite claims that CAM practitioners value science and scientific evidence or that specific therapies are “scientifically proven.”
I discussed a number of the philosophical conflicts between evidence-based medicine (EBM) and CAM in a presentation given at the American Veterinary Medical Association (AVMA) annual conference in 2012, and in an article for the journal of the AVMA. However, I recently came across a new perspective on the subject in the Journal of Case Studies in Homeopathy, which claims to refute the entire basis of EBM and propose an alternative that supports the “radical-phenomenological approach of homeopathy.
Wittenburg, C. Cognition-Based Medicine: A new paradigm fro medicine- applied to Homeopathy. Journal of Case Studies in Homeopathy. 2013;1(2):7-16.
The article begins, humbly enough, by stating that its purpose is “to introduce the concept of Cognition Based Medicine (CBM) as a convincing alternative to Evidence Based Medicine (EBM). CBM was developed on the basis of a refutation of the positivist paradigm…Contrary to Hume´s ideas, we are well capable to discern causality by observation in single cases.”
The foundation for CBM appears to be on “single-case-cognition as the basis of progress in medicine.” Clinical trials involving groups are apparently not necessary because it is possible to identify the causes of disease and evaluate the results of our interventions solely on the basis of individual, uncontrolled evaluation of individual patients. Since that is largely how homeopathy is practiced, it would be nice for homeopaths if that were true. In fact, it is clear from the outset that the author’s goal is to replace science with something else more likely to validate her existing belief in homeopathy: “Where do we find an epistemological approach which suits homoeopathy? It has to be a theory which is substantially different to – and hopefully more convincing than – positivism.”
Such a paradigm shift would, however, require us to ignore the history of medical, and indeed all scientific progress in the last several centuries, and all the unprecedented changes in human well-being and longevity that have accompanied the rise of the scientific method. So how does this article make such an earth-shattering case?
As it happens, it never does. It merely identifies the principles supposedly underlying EBM and then asserts that they have been overturned. It cites simple thought experiments, and articles in the mainstream medical literature that show people drawing conclusions from single cases and then simply asserts that since we do this, it must be a reliable and effective method for establishing causality.
Duncker, a German philosopher, refuted Hume´s idea of causality. Based on simple examples from every-day-cognition he demonstrated that the ´singular causal-gestalt´ of the cause stretches into the ´gestalt´ of its effect. Gestalt means: form, structure, process. We recognize the gestalt of a car having crossed a field in the traces its wheels leave…
The idea that, perhaps the tracks we see might not have been made by a car, and thus our conclusion may be in error, appears not to have occurred to this clever philosopher.
Kiene and his colleagues undertook research on four years of published volumes of “The Lancet” (1996-1999), revising articles to find proof for the concept of singular causal-cognition. Interestingly, many of the articles gave evidence of application of convincing non-experimental evidence: skilled practitioners applied their ability, their personal judgement, based on ´tacit knowledge´ to solve therapeutic problems or to introduce new techniques.
Since clinicians clearly do make causal judgments based on non-experimental evidence, there must be no need for experimental evidence—QED (or not….)
Similar kindergarten logic (“I said it, so it must be true!”) is applied to the concept of the placebo effect, which the author blithely dismisses as not proven to exist and as merely a political tool to privilege the randomized clinical trial as the only legitimate kind of evidence for medical therapies (which is itself, a straw man fallacy often directed against EBM). The author even goes so far as to claim that homeopathy, and its inexplicable yet obvious success, was the primary motive for development of the RCT and of EBM:
RCTs become a dogma… All other forms of clinical trials and ways of judging the effectiveness of a given therapy are phased out. EBM is becoming the reigning paradigm, with RCTs as the gold-standard of clinical research.
…any drug-effect which is superior to “the powerful placebo” must be a really important one. This was a strategy to introduce RCTs as the gold-standard for scientific research in EBM, and is built on the good results of homoeopathy… Homoeopathy, which gave the ultimate push for the development of EBM, can´t make much use of RCTs itself. They merely serve for refutation of EBM´s assertion ´potentised homeopathic medicines are placebo´ through randomized, placebo-controlled experiments on plants.
Even making allowances for the problem of translation (the author is German and the article is in English), this is an example of the level of incoherence throughout the article, which verges at times on complete gibberish.
And after a few pages of such nonsense, the author declares the case proven: “By now, we have identified single-case causal cognition as the basis of progress in medicine… A new paradigm for CAM and homoeopathy was created through refutation of Hume´s definition of causality, replacing it by the concept of gestalt-cognition.” Wow, is that all?!
The author then goes on to explain why case studies in homeopathy can now be relied on as the best evidence on which to make diagnostic and treatment decisions.
Such a blithe dismissal, with nothing even approaching a coherent or cogent argument, of several centuries of progress in philosophy and science, is an illustration of just how out of touch with reality proponents of homeopathy often are. It also illustrates how disingenuous and self-serving their claims to respect scientific evidence are. As I demonstrated in my extensive evaluation of the homeopathy literature, including the studies cherry-picked by the Academy of Veterinary Homeopathy to defend their practices, homeopaths are willing to cite scientific studies, even of poor quality with significant uncontrolled bias, if they support what homeopaths believe. However, they are fundamentally unwilling to accept any negative verdict on their practices, so they either dismiss or ignore negative studies, or they seek out ludicrous alternatives to the epistemology of science and imagine they have successfully overthrown the methods of seeking knowledge that the rest f the world recognizes have been more successful than any other in history; the methods of science. It is hard to imagine a more compelling illustration of why the claims of judgment of such homeopaths should not be taken seriously.