The Life of the Positivist Dinosaur

I was recently categorized as being an “allopathic positivist dinosaur” by a student in an online course. I must admit I quite liked the dinosaur bit (the Liopleurodon was always a favourite as a kid) , but apart form the obvious issues with ad-hominem arguments I was also interested to see what the students knew about positivism, and the ideas of Auguste Comte, but sadly (as I suspect is the case with many students) they didn’t know who he was.

The charge of positivist thinking seems to be rather a common position taken in modern thought in my discipline and seems to give opponents to science a convenient label to apply to anyone who holds contrary views to their own, or challenges non-scientific healthcare or supports evidence-based practice. As with most arbitrary labels used to create binary opposite catagorizations, they seldom reflect the  complex reality, but I suspect that very few of my students, and quite a few of my academic colleagues really know what positivist thinking is and where it arose (otherwise, they probably wouldn’t misuse the label) .

Positivism was a school of thought originally advanced by the Frenchman Auguste Comte, often thought of as the founder of sociology. It was based on a return to the notion that the senses, experiences and their logical and mathematical treatment were the exclusive source of all worthwhile knowledge (i.e. positive experience). Comte proposed that systematic inquiry should be the same across both natural and social sciences and research findings could only be proved by empirical and testable means. He is most well known for his assertion that societies advance through three distinct phases:

  1. The theological stage; where the foundation of belief is faith and custom based, referring to deities for explanations and the social base of society is the family
  2. The metaphysical stage; where beliefs become based upon reason, thinking about the world, but without empirical foundation, and the state becomes the social base, and lastly
  3. The scientific stage, where belief is based upon scientific knowledge, and society turns to humanity as the social base.

Positivist philosophy was further developed by Emile Durkheim (1858-1917) who rejected many details of Comte’s philosophy, but accepted his ideas that the social sciences were a logical progression of scientific inquiry into the field of human activity. Durkheim supported the use of the hypothetico-deductive method in the social sciences and suggested the notion of social realism. This idea was an argument for a return to epistemological realism, in that Durkheim proposed that external social realities exist in an objective reality independent of an individual’s perception of them.

At the time this view opposed the empiricist viewpoint, as even empiricist thinkers such as David Hume had suggested that reality was altered by human perception, and realities were thus perceived, and did not exist independently of our perceptions having no causal powers of themselves (Morrison, 2006). Whilst Comte, argued social laws could be deduced from empiric work, Durkheim suggested that sociology would discover the nature of society itself. Overall, these positivist ideas are closely linked to empiricism, and strongly influenced the following development of logical positivism, and pragmatism.

Much of the criticism of modern science by postmodernists is focused on characterizing science as positivist thinking. But, this is rather a straw-man argument as modern science has moved far from these ideas, which came to their peak of influence in the 1930s and 40s. Modern science involves a wide range of tools and techniques and this sort of thinking is long-gone (like the dinosaurs). If anything, post-positivist modern science recognizes there are many different approaches to gathering data and examining evidence,and all still fall within the framework of empirical science. Following Kuhn’s  The structure of scientific revolutions  (1996) science has adopted a plurality of thinking in terms of how  human thinking influences human knowledge, and that our knowledge at any given point reflects the psycho-social limitations of our thinking at that time.

So if you are charged with positivist thinking, ask the person raising the challenge in exactly what way does modern science reflect the thinking of Comte, Durkheim and other positivists?  I suspect they won’t have a good answer to that.

Cheers

Bernie

References

Comte A. (1818) A General View of Positivism (translated by J.H. Bridges)

Kuhn, T. (1996). The structure of scientific revolutions (3rd ed.) University of Chicago Press.

Morrison, K. (2006). Marx, Durkheim, Weber: Formations of modern social thought.(second ed.). London: Sage.

 

 

 

 

 

 

 

Happy New Year: the tongue of all our fears…

Happy New Year to everyone.

Roger and I hope the return to work has not been too stressful for all. Given the world failed to end as predicted we have a good set of posts planned for 2013 to further the cause of the understanding of scientific philosophy and rejection of pseudoscience and bad science.

This week I received a copy of McLean’s magazine through the mail. To those outside of Canada  unfamiliar with this glossy periodical, it is basically a version of “Hello” for the “chattering classes” (to borrow Waugh’s term).  I confess now, I am only receiving it now as I got a free three month subscription from my cellphone provider as I am rather a skinflint and couldn’t bring myself to actually pay for a copy.

Anyhow, apart from the usual doom and gloom stories predicting the collapse of the housing market in Canada and the imminent fall off of the Fiscal Cliff stateside, there was an article on Chinese medicine and diagnosis of illness by clinical examination of the tounge.

It described the use of using tongue examination as a standard diagnostic practice used by traditional Chinese medical  (TCM) practitioners and Naturopaths. Apparently by examining your tongue you can diagnose anything from GI problems, allergies, asthma and  some practitioners even claim cancer (OK, not of the tongue – as that would be a tad obvious). There is a website by the Miami TCM practitioner James Rohr explaining the use of this technique and a video of the same. He has even produced a very cool “Tongz” App for smartphones so people can self-diagnose. The argument given is that western invasive diagnostic tools (such as blood lab work or radiography) are expensive and inaccessible to many and that the same results can be obtained by clinical examination of the tongue.

Practitioners make the usual non-science claims for efficacy; i.e. has been used for thousands of years, appeal to the masses (of patients who believe in it), bad western “allopathic” medicine vs good Eastern holistic medicine etc., and explain the  theory behind it being disorders of the flow of the bodies natural “chi” energy with disease processes causing abnormal presentations of the tongue. Quite remarkable really, but to be fair there is a grain of truth (as with many CAM therapies) in this. Unfortunately, there is also a lot of nonsense too.

Clinical examination of externally visible tissues and organs is very much a part of modern medicine. This is an art studied and practised by doctors and nurses, and assessed in their education and training particularly in the notoriously difficult Objective Structures Clinical Examinations or OSCE’s doctors and nurse practitioners have to pass. You can lean a lot by clinical examination. e.g. anaemia indicated by pallor, jaundice indicating liver disease or renal dysfunction, or barrel chest indicating chronic asthma. Indeed examination of the tongue and oral mucosa can give some useful diagnostic information (particularly about oral hygiene standards), but to suggest you can diagnose Asthma from a ridge in the tongue as one practitioner claims, or insomnia is clinical nonsense. There is no evidence base for this, and so far no rigorous scientific studies have been able to identify the presence of any chi energy flow in the body. Indeed, practitioners  explain this as an energy flow that cannot be detected by modern scientific instruments, and so falls into the realms of magical explanation.

That is not to say that there isn’t some form of chi energy flowing through all of us, and that its disorder is associated with disease, and manipulation of it can improve health. Scientific inquiry may simply not have discovered it yet. However, if that were the case we would at least expect some clearly demonstrable results and consistent repeatable instances. What’s more it would seem there is a massive conspiracy by the scientific medical profession to ignore the evidence of thousands of years that we can diagnose a whole range of illnesses by simple examination of the tongue.

What is worrying is that people accept these explanations without questioning this. Naturopaths claim to be (and in many places are accepted as) scientific doctorly prepared practitioners, but then support this sort of mystical nonsense. If it works, why can’t we measure the results and devise a clear set of clinical guidelines for tongue diagnosis that are effective in scientific terms?  This is really the same argument that traditional healers in some countries use when explaining how they diagnose illness by examining the entrails of slaughtered animals (i.e. resorting to magical explanations).

Unfortunately, it just doesn’t work, and if we look at most of the diagnoses made by tongue analysis, they are more easily explained by other more obvious signs. For example I can tell if someone is tired without looking at their tongue (wrinkled skin around the eyes, bloodshot eyes, rubbing of the eyes, yawning, and cognitive slowness) or constipated (by asking when they last had their bowels open) or eats a lot of sugar (by their dental status), or is anaemic (conjunctival and skin pallor) etc.

The diagnoses given through tongue examination are also generally very vague. Frankly, looking at the tounge and claiming “you are tired and eating too much sugar” is not an astounding diagnosis, but claiming it represents a diagnostic science does smack of quackery. That is not to say many TCM and other CAM practitioners are not bonafide genuine practitioners, who actually believe in this stuff, and I am sure many do. But, I must admit when I see CAM holistic practitioners championing natural traditional therapies, with cool websites, awesome tans, and enough cosmetic dental work  for my local dentist to retire to the Bahamas, I do being to ask “what is the probability…”

Bernie

References

Eckler, R. (2013) Tongues are Wagging, Maclean’s Magazine, January 14

http://www.jamesrohr.com/