This week’s post was triggered by several things. The brief discussion Roger and I had in the commentary to Roger’s last post, Paul Offit’s excellent new book (Do you Believe in Magic?) and a visit to the pet store. Let me explain…
Following Roger’s posting on science in the UK National Curriculum (and consideration of the possibility jesus rode a dinosaur), we had a short debate on the the issue of when it is and when it isn’t appropriate to challenge beliefs, and of the use of humour to challenge ideas. Rog made an excellent point with an example from a colleague about guidelines on use of electronic resources. Most of us get this sort of guidance (or similar) from our IT departments:
“Users must not knowingly, through use or personal behaviour, cause any annoyance, inconvenience, offence, distress or nuisance to other users of those facilities or individuals within or outside the University.”
As his colleague, Robert, rightly pointed out, this seems to suggest universities are NOT the place for radical thinking that will cause anybody any annoyance or offence!
I find this very pertinent here in Canadian west coast where there is a particularly strong ethos of respect for diversity and plurality. Overall, “dude, its all good” would be an apt summary, but the problem is this neo-liberalsim seems to be taken to such extreme levels now that it has simply become another form of constrained thinking causing more problems than it solves. This reminds me of the time in the UK in the 1990’s when I was told in a diversity seminar that I should not use the term “black coffee” as it was offensive to black people (confused, I actually asked a black colleague if this was so, and he laughed so much he almost fell over).
In the age of Web 2.0 and a variety of blogs of every description we are be seeing some interesting challenges to ideas presented. For example, some opinionated bloggers (such as David Colquhoun,’s Improbable Science, and Ben Goldacre’s Bad Science blogs) have both had complaints and threats to have them closed by opponents, and although I find both rather intolerant at times (and fixated on RCTs as a solution to all) it is good to see they are still running to challenge nonsense and make compelling arguments.
The problem is the division between criticizing an idea and what is seen as a personal attack on an individual. In our view the former should always be open, but the latter is simply bad-form, egregious and uproductive. Nevertheless critiquing and challenging ideas is what science is all about. If ideas become seen as sacrosanct, unchallangable and absolute then it becomes impossible to move forward. Science has long ago abandoned the notion of absolute truths and modern post-positivist science recognizes that our current ideas seem a good approximation of a truthful explanation of a phenomenon, but are flawed by a) our limited understanding of the universe at this point, and b) that the human mind’s understanding of the world is itself a particular interpretation. However, that does not equate to a position that ergo: anything goes. In science, any idea or theory is seen as fair game, as long as you can argue a better theory and demonstrate it represents a better explanation.
However, it seems overall the human mind has a predisposition for absolutes, and concrete thinking and that is where the problem arises. We see it a lot with criticism of religious ideas, which in some countries results in the death penalty, but also in science and my field, nursing. As we know, medicine has dumped many unsatisfactory theories over the years, such as blood letting, putting infants on their front to sleep, or the use of frontal-lobotomies to cure mental illness. The advent of evidence-based practice (EBP) has accelerated this progress; as one theory is shown to be at fault, another one that better explains the phenomenon arises, and supplants it.
This is far from the case in the world of complementary and alternative medicine (CAM) though, where debunked theories are still advocated. Before I go on, I should point out that I have been trying to avoid spending a lot of time on CAM issues in this blog, as numerous others do it so much better (see the links section on the right of the blog main page for good examples) and in nursing here it is like putting a stick in a veritable hornets nest resulting in being labelled as an allopathic dinosaur or similar. Nevertheless, it is it is difficult to get around the fact that paradoxically it is from some CAM practitioners (the latest term for which seems to be “Integrated/IntegrativeMedicine”) that the most extreme forms of absolutist thinking arise.
Firstly let us be clear, there are complementary therapies that make excellent adjuncts to modern medicine, such as massage, exercise-based therapies (such as Yoga) and meditation for relaxation and mental health. On the other hand, if we think about it “alternative medicine” does not really exist. There is simply medicine (things that have been demonstrated to be the most effective treatments/interventions) and the alternative, belief-based health practices: things that currently have no-evidence of efficacy, or even evidence they do not work. Herbs and remedies that are shown to have efficacy become medicine (such as folic acid, to prevent birth defects). As Joe Schwarecz, Director of the Office for Science and Society at McGill University put’s it: “there is a name for alternative medicines that work: it’s called ‘Medicine’ (Offit, 2003).”
Yet people (including intelligent individuals) continue to believe in the absolute ideas of many CAM therapies that have clearly been demonstrated to be nonsense, and CAM practitioners refuse to amend or update their positions, instead claiming the same theories are misunderstood, conspired against by big-pharma, or worse beyond scientific explanation. That brings me to my visit to the pet store. My cat Holmes, has been rather ill over the last few weeks (probably on her last legs poor thing, as she is now 19 years old) and I went to the pet store to pick up some cat snacks. Whilst in aisle with worming remedies I came across the following:
Homeopet, homeopathic pet remedies at $18 a box no less! This raised my ire, as it is basically as clear a case of exploiting peoples health concerns as you will find (admittedly with pets). This is a problem that underpins the whole industry (and make no mistake CAM is a multi-million dollar industry).
Firstly homeopathic theory is barking-mad (sorry could’t resist the pun). The idea that a single molecule of a substance in a volume of material that stretches from the earth to the sun could have therapeutic benefit makes no sense at all. Consider that drinking water from your tap probably has more homeopathic properties than anything costing $18 a pack. Secondly numerous studies over the years have shown no benefits with homeopathic remedies compared to placebo. And yet, homeopaths and naturopaths swear that the theory is sound, and their remedies work, despite clear evidence and theoretical argument to the contrary. Nevertheless, they represent a growing segment of the health care sector here in BC.
The principles behind homeopathy (like cures like) actually arise from medieval belief that there was a causal metaphysical link between a weapon and the wound it caused that persisted after the injury. Even Francis Bacon wrote of it, describing how a salve applied to the weapon, could cure a wound made by it; “bind the wound and grease the nail.” This seems like nonsense now, but the practice of applying weapon salve persisted up until the beginning of the last century with the reported case in the British Medical Journal of a woman, Matilda Henry in 1902 using it for a nail injury (from which she died shortly afterwards from tetanus). Most of the educated world abandoned those beliefs, but a version of the theory persists in homeopathy despite no good theoretical basis, or evidence it works.
Likewise in Chiropractic, there is a battle going on between Chiropractors who simply use spinal manipulation to relieve back and muscle pain (which can be effective in some cases), and those that claim the theory of subluxation works and spinal manipulation can help cure any number of diseases from diabetes to heart disease. There is no evidence (despite numerous studies) to support the theory of subluxation, and yet again practitioners defend the theory as an absolute truth, with no thought of throwing it out or even amending it.
The most extreme example of belief-based heath practice is of course the faith-healer. Recently a very earnest RN sent me a link to this guy (Adam McLeod – the dreamhealer) who claims to be the real thing. She was keen I should attend his show, to see for myself. Now, I admit to a certain degree of skepticism here despite having never seen him work, as these practitioners have been shown to be bogus charlatans over and over again, and he is obviously doing big-business . The usual website testimonials are present (of the “I was healed by the dreamhealer” variety as well as some from people with postgraduate qualifications). None of this really help dispel the image of quackery. Again this looks like a classic case of exploiting people’s beliefs, particularly when they are in a vulnerable state. Personally, I find this kind of thing highly offensive, and although it is of course possible that he actually believes he has a gift, I have to consider; what are the odds he really does? The image presented is one of a new-age health guru (complete with mandatory picture with a stethoscope round the neck – to affirm scientific validity). If you were a real believer in your own magical healing powers, why wouldn’t you want to subject this to some empirical trials to show the world this miracle rather than performing private shows at $169 a shot?
Even established nursing organizations condone some of this. An Australian RN colleague Joanne Benhamu, recently tweeted it was embarrassing that North-American Nursing Diagnosis Association (NANDA) still supported the nursing diagnosis of “disturbed energy field” in the latest NANDA diagnostic terms handbook (2012-14). Quite frankly, I find that astonishing and it makes nurses look ridiculous, devaluing the public image of nurses as evidence-based practitioners. That aside from the fact that such a diagnosis is as practically useful to a nurse as the proverbial chocolate teapot. It makes as much sense as diagnosing the patient is “feeling under the weather” or maybe “a bit peaky.” Maybe NANDA would like to add those to its diagnostic statements too? I dispair.
I could go on, but to be frank, it get’s boring, and has no effect on those who believe in this sort of thing despite all the evidence to the contrary. So why do people continue to believe in this sort of thing despite all of the evidence? Worse still why are people happy to be exploited by these sort of shenanigans? It has been going on for centuries, and these folks are still doing big-business. Well, I can understand why the public want these services. As Paul Offit points out in his book, modern technological medical healthcare is far from perfect. There are many things modern medicine cannot cure, and it is particularly ineffective at helping with many chronic conditions (such as acne, or tendonitis). It is also a victim of its own success. Most patients now receive very depersonalized care with rapid visits for screening, to see physicians or nurses, or for medical and surgical procedures. Also, modern medicine is usually very unpleasant, and as the predominant form of healthcare has rather a significant error rate. Procedures go wrong, people are frequently misdiagnosed, and sometimes people are injured or die as a result of medical practice.
CAM practitioners, on the other hand operate primarily as primary healthcare providers, rarely deal with acute or emergency care, spend considerable time with patients and develop good working relationships with them over long-consultations. Their practices are generally quite non-invasive, often pleasant, and to paraphrase Douglas Adams “mostly harmless.” Likewise contemporary postmodern nursing approaches taught in many Canadian universities are generally supportive of CAM practices so nurses graduate with the notion that these are generally harmless practices, and we should support this plurality. However, we should be clear, accepting a fashionable anti-science agenda and adopting constructivist philosophical arguments about the nature of evidence also has implications for our professional status. Both homeopathy and opposition to vaccination (naturopaths) are in clear conflict with current EBP, and whilst homeopathy is pretty harmless, opposition to vaccination is certainly not. The “dude, its all good” approach in healthcare can actually result in real suffering, ill-health or worse. That is what academic discrimination is for.
Overall, I think we all want some certainty in our lives, and most practices that support absolute fundamental belief (from religious fundamentalism and cults to modern day magical health practitioners) provide this. Science on the other hand doesn’t provide this or teach us what to think, but focuses on how to think, and sometimes the results can be threatening to our own beliefs and values. Maybe others have some ideas why despite several hundred years of scientific development people still choose faith-based solutions over evidence-based ones, especially with healthcare. I welcome your thoughts.
That wraps up our last post before the summer break as Roger and I are off on various travels for the next few weeks, but we will be back in September. Have a great summer all (in the northern hemisphere) and a good winter to all you folks down-under: surfs up!
NANDA (2012) Nursing Diagnoses: Definitions and Classification 2012-14. Available from: http://www.nanda.org/nanda-international-nursing-diagnoses-definitions-and-classification.html
Offit P.A. (2010) Do you Believe in Magic The sense and nonsense of Alternative Medicine? New York, Harper Collins