I have written frequently about the tendency of leaders in the alternative veterinary medicine community to talk about science as if they valued it while really either not understanding how science actually works or simply rejecting its basic principles (e.g. 1, 2). Alternative medicine, at its heart, is philosophically opposed to the method for understanding nature that has been so successful when applied through science. Supporters of alternative therapies will cite scientific evidence when it supports their beliefs, but they generally ignore or dismiss it when it does not, and they nearly always believe individual personal experience is a better guide to the nature of reality than controlled research. Science is more a means to advertise and promote their beliefs than a method for discovering which of those beliefs are true and which false.
A recent article in the Integrative Veterinary Care Journal by Dr. Nancy Scanlan, another leading figure in the alternative veterinary medicine community, illustrates this problem.
Choosing the Best Models for Integrative Research. IVC Summer 2015, 60-62. By Nancy Scanlan
It sounds pretty good, right? Looking for the best approach to do scientific research on so-called integrative therapies? However, the piece starts and ends by questioning the basic premises of medical research and suggesting science isn’t really needed to understand the truth about alternative therapies.
Conventional medicine focuses on separating out the individual actions of substances that have an effect on systems or diseases defined by conventional research.
To an extent, this is quite true. Science does make use of the principle of reductionism, minimizing the number of variables and potential sources of error in research studies to help separate out which effects are most significant. This does not deny the importance of complex interactions within systems, but it does recognize that human beings simply don’t have the ability to keep track of every element and every interaction in such systems, and when we try to view them without simplification, we are often wildly wrong about the true cause and effect relationships at work. Reductionism does have limitations, but it’s been a very successful tool in compensating for our own limitations in understanding how nature works.
Dr. Scanlan also tosses in the phrase “defined by conventional research” to suggest that this is simply one arbitrary way to define health and disease and that there may be others equally legitimate. This is a very post-modern view that rejects the concept of a stable and definable natural world that has whatever properties it has regardless of our beliefs and instead suggests that all human understanding should be viewed as no more than metaphor, with one set of metaphors being as “real” as another (though they often inconsistently choose to prefer their own paradigm over that of science-based medicine even while insisting that scientific rejection of their claims is merely bias in favor of one of multiple legitimate world views). She expands on this later in the article:
When traditional medicine [whatever that is] looks on disease and physiology as circular, as seen in the Five Element cycle of Traditional Chinese Medicine (TCM), different practitioners may decide to attack the same disease process at different parts of that cycle. The treatments may be seen as different by conventional medicine, but…final conclusions should be based on two criteria: were the cases treated successfully, and were all cases within the series consistent based on the traditional, not the conventional, view?
Essentially what she is saying here is that the problem, the method of treatment, and the outcome should all be defined by the standards of the alternative therapy being tested, not that of scientific medicine. We should view a series of case reports that have, by scientific standards, different diseases and which receive different herbs or other treatments and have success defined differently and however the practitioner chooses to define it, as legitimate scientific proof of the practice being tested. It is just like real science, except it ignores all the principles of scientific research and presumes the legitimacy of its own principles from the beginning.
Similarly, Dr. Scanlan argues that it is not legitimate to try and isolate individual compounds, or even individual herbs, when testing herbal remedies because the effects we are evaluating likely come from the specific combination of herbs ina remedy. And how do we know this? Because, “If a formula has withstood the test of time and has been used for decades or even hundreds or thousands of years, it is most likely there’s a reason for using a specific combination of herbs.” In other words, if people claim to have used an herbal remedy successfully for a long time, without any proof of this claim, then the only appropriate way to test that remedy is to assume those claims are true and structure our research around them, rather than following the standard scientific practices that have so far proven far more successful in improving human health than thousands of years of uncontrolled, trial-and-error folk medicine did.
While Dr. Scanlan makes a few reasonable suggestions, such as encouraging standardization of herbal formulas so different researchers studying them are at least studying the same thing, she makes it clear throughout the article that the purpose of research is not to find the truth but to use the marketing value of science to convince others of what alternative practitioners already “know” through unscientific means. The possibility that these therapies might not work or that research results may necessitate abandoning any practice is never once even hinted at in this article.
“Studies structured to meet the expectations of conventional medicine…will encourage a better understanding and wider acceptance of integrative medicine.”
“When designing a study for integrative medicine, this approach can help satisfy both the conventional method of choosing treatments, and traditional methods that ensure better outcomes.”
“A standardized formulation and dose meets the conventional need for studies of a standard disease with a standard treatment. Once acceptance occurs, individual variations can be introduced.”
“In order for acceptance to occur, initial research may need to be more standardized…the fact that a remedy consistently “improves” (to the conventional eye) symptoms of a specific “disease” (as defined by conventional medicine) may open the door to acceptance of homeopathy as a valid part of integrative medicine.:”
“Echinacea…has usually been studied with the expectation that it will increase immune reactions in some way. [based, she neglects to mention, on claims by herbalists that it “boosts” or “strengthens” the immune system] However, it may have more of an immune-modulating effect, as evidence by at least one trial showing a decrease in WBC activity. Instead of viewing this as conflicting evidence, it would be better to examine herbal tradition…to see whether this herb has been used as an immune “normalizer.” If so, the conflicting evidence is actually supporting evidence for the original premise.” [In other words, any result can be viewed as supporting the hypothesis if we simply interpret it through the lens of pre-scientific folk medicine texts or our own experiences, and we never have to judge any practice to be inconsistent or ineffective.]