Climate Change, Evidence and Back-Passages

A little while ago I attended a lecture at the university by an ex-speechwriter for Tony Blair. For those with short memories Blair was the Prime Minister in the UK pretty much throughout the first decade of the 21st century. In this particular lecture he addressed the global economic changes that were taking place, the fact that Europe was old, dead and buried, that the future belonged to China and that Blair and everyone subsequently, had got everything wrong. He alone had the answers and these were available in his new book…blah…blah…blah…

I hate to be hypercritical but I did think that his presentation, whilst so polished that I could almost see the reflection of my grimacing face, was pretty vacuous really, but then he said something, as a throwaway line, that I thought was terribly interesting and profound and has stuck with me ever since. He mentioned that when he had been in the inner echelons of political power he had come to realise that “politicians don’t do evidence, they do narrative”.

This lecture was before the arrival of the present government, but I doubt if much has changed. In the UK at the moment we have a coalition government formed by two political parties, the Conservatives and the Liberal Democrats, the main opposition party being Labour. They are curious bedfellows as the Liberal manifesto was undoubtedly to the left of Labour’s, yet they find themselves governing with a centre right party (many of whom would want the word ‘centre’ dropped). This partnership has led to the Liberal’s dropping a number of key policy ideas and commitments and to the Conservatives losing err… well not much really.

Most infamous amongst these for the Liberal’s was a very public commitment to no tuition fees in English Universities. This was dumped as soon as they came to power, with the sort of indecent haste that poses all sorts of questions about the true motivations of politicians. Now I am really trying to remain (sort of) neutral here and not just attack the Liberal Democrats as some sort of disillusioned voter (although I am) but rather to analyse some of the decisions that have been made subsequently since the formation of the government.

Let’s take Carbon. The UK has rigorous targets for CO2 reduction and has in fact reduced Carbon emissions by 10% in the last decade. Hoorah, Hoorah! Although some of that is almost certainly due to production moving overseas, in fact if you take that into account CO2 emissions went up! http://www.bbc.co.uk/news/business-22267231

Boo hoo! Boo hoo!

However, despite the United Nations recently stating that it is (95%) certain that Climate Change is anthropogenic and the serious weight of academic scientific evidence for this, the UK government is looking at ‘opting out’ of its CO2 reduction targets. Now the reasons for this are that the UK would be at a disadvantage compared to the rest of Europe and that the Government want to fill the predicted energy gap with a new generation of Gas Powered power stations. So despite the increasingly dire warnings concerning climate change, the scientific evidence is simply ignored. Economic growth (at seemingly any cost) is the paramount consideration.

This is despite the following quote from the Liberal Democrat manifesto for the last election:

“We now know, from climate scientists, that the next government will be the last that can stop dangerous climate change.”

This year (2013) they ditched their opposition to Nuclear Power and the Liberal Democrat Secretary of State for Energy is just about to sign-off on the construction of the first new nuclear power station in the UK’s new nuclear program. They argued their support for nuclear power was to reduce CO2 emissions. OK, but at the same conference they decided that fracking is a good idea and now wholeheartedly support it. This is the party that recognised that they are the last government to stop climate and yet they support fracking!

http://www.bbc.co.uk/news/uk-politics-24100833

To be fair, the Conservative are even worse and I doubt if Labour had won, much would be different. ‘Politicians don’t do evidence’.

Now it seems to me that scientists may have a role to play here. Back even further in time, a Conservative government had to deal with the arrival of HIV/AIDS. It was in the 1980’s when Margaret Thatcher was in power. Thatcher was so appalled by the idea of anal sex that according to the then Health Secretary’s diary she actually wanted it referred to as ‘back passage sex’ in any government information leaflets. Apparently, it was health professionals and senior clinicians who managed to talk the government into taking any action at all (she agreed to drop the term back passage sex when it was pointed out that this may be misconstrued as vaginal sex in an alleyway). The point being that the health community really pushed the evidence and eventually the government had to act.

We can’t push the evidence of climate change any harder, yet in the UK at least, we seem unable to influence policy. Economic considerations (and for the cynics – vote winning) seem to take precedence.

So, OK governments ignore scientific evidence. Governments have every right to – we live in a democracy, not a technocracy. However, every time they do so, they always question the science. Is global warming really anthropogenic? Is burning gas to produce electricity really that energy inefficient? Can we really provide 50% of our electricity from renewables? The answer to all of the above is yes by the way. Ignoring the evidence by doubting it, however tenuous and manufactured that doubt is, may be politically expedient, but it undermines the science. It would be far more appropriate (and honest) to accept the evidence, but then to state why they have decided to ignore it. It may well be for economic reasons, jobs, cheaper options, infrastructural investment, whatever, but it doesn’t challenge the science.

In an ideal world any government decision that choses to ignore overwhelming scientific evidence should have to be explained in this way. We should constantly be asking of our politicians ‘why are you ignoring the evidence?’ Or, in a way that gives them more room, “what evidence is your decision based on?”

We often talk about evidence-based practice, perhaps it’s time for our politicians to be encouraged to adopt similar methods, before we all end up a back passage.

Roger (Bernie posted this for me due to network issues)

Musings on CAM, University Education and Falsifiability

…or do Amethysts emit high Yin energy?!!

Roger is tied up this week, so I am filling in, and this story on Complementary and Alternative Medicine (CAM) and university education caught my eye this week.

Some Australian health care researchers have set up an organization (Friends of Science in Medicine ) to discourage universities from offering accreditation for programmes supporting unproven health treatments and therapies. The group is also campaigning for such therapies to be removed from claimable benefits by health funds.

This is quite an interesting issue as it contrasts the principles of Evidence Based Practice (EBP), and publicly funded healthcare with the freedom of public to choose whichever healthcare therapies they wish, and arguments supporting alternative explanatory discourses.

The members of the Friends of Science in Medicine make it clear they are not trying to muzzle CAM practitioners but distinguish teatments that are known to work from those that are unproven.  They argue students should be given the analytic tools to enable them “to separate fact from fantasy” and particularly support Karl Poppers Principal that any hypothesis must be falsifiable.

Popper published the book Logik der Forschung (The Logic of Scientific Discovery) in 1934 in which he argued that the Logical Positivists‘ criterion of verifiability was not suitable for scientific enquiry. He suggested  falsifiability was a practical and more deductively sound alternative to verifiability. Verifiability supposed that only meaningful propositions were scientifically relevant, i.e. those that could be “translated” as reports of direct observation. He argued for testability, and suggested falsifiability was a much better criterion for science than verifiability, because it did not invite the problems inherent in verifying only experienced inductive inferences. For example we can inductively hypothesize “all cats have tails” on the basis of our experiences observing cats and is “verifiable” by observing cats. Nevertheless the problem with verifiability is that it restricts inquiry to only focus on inductive observational phenomenon (as we have to be able to directly experience them). Popper argued for testability, and suggested “falsifiability” was a much better criterion it also allowed statements from the physical sciences that supported phenomena that were not directly observable, and would not have satisfied the strict verification criterion; the law of thermodynamics, for example.

Popper used his principle of falsifiability to separate science from metaphysical non-science. Simply put, his falsifiability principle stated that for any hypothesis to be credible, it must be inherently disprovable before it can become accepted as a scientific hypothesis or theory (also known as naïve falsifiability). For example, the hypothesis that penicillin will kill streptococcus bacteria is easily testable and falsifiable, as a single incidence of the antibiotic failing to do so would make the hypothesis questionable, and it can be easily tested in deductive experiments. This is a scientific hypothesis, and an example of a hypothesis worthy of investigation in Popper’s view. The hypothesis intercessory prayer will speed up healing is not a scientific hypothesis according to Popper, as it is impossible to falsify. There is no empirical way to ascertain if it is false.

From this philosophical perspective a lot of CAM frameworks become problematic as they rely on what we would call unscientific unprovable hypotheses. There are some problems that remain with the principles of falsifiability, however:

1)   Currently unfalsifiable hypotheses could at a later date, (with an identified and empirical theoretical framework, and observational technologies established) become falsifiable and thus become scientific. For example for the ancient Greek’s the notion of the atom was unfalsifiable at the time, but is not so now.

2)   It has also been argued that falsifiability cannot effectively discriminate, and Sokal and Brickmont have noted falsifiability can’t distinguish between astrology and astronomy, as both could be used the basis of falsifiable hypotheses make predictions that are incorrect

3)   The so-called Duhem-Quine thesis (Gillies, 1998) also argues very convincingly that we cannot test a single hypothesis in isolation, and that falsifying one has implications for others.

Overall, we find Popper’s principle of falsifiability is generally accepted as useful in the scientific community, and in EBP in hypothesis formation, although a review of recent research journals will identify it is not extensively used amongst healthcare disciplines. Although a number of philosophers have since criticized his views on inductive reasoning and other aspects of his critical rationalism, it is now generally accepted that scientific induction can lead to worthwhile conclusions that have been established to such a degree that we can comfortably assume they are true. Stephen J. Gould (1941-2002) exemplifies this notion nicely in this quote:

“In science, “fact” can only mean, confirmed to such a degree that it would be perverse to withhold provisional assent. I suppose that apples might start to rise tomorrow, but the possibility does not merit equal time in physics classroom.” (Gould, 1981)

So from the Friends of Medicine perspective the clear division between falsifiable medical scientific work and unfalsifiable CAM work as being not suitable for public funding is not as simple as it first appears. Nevertheless, they do have an excellent point, in that using public money to promote dubious and clearly barking-mad therapeutic practices is not a good idea.

There are some pretty awful examples out there. David Colquhoun published some worrying handouts from CAM university programs here in 2009. These are worth a look, and I particularly liked that Westminster College was teaching that Amethysts emit high Yin energy!

Using scientific principles to establish which subjects should be taught at public universities and which not is a complex endeavor (at the extreme end of this argument arts and theology programmes would all go to start with)! Nevertheless the idea that we should restrict publicly funded university healthcare programmes to those that support EBP has some merit. What do you think? We would love to hear your ideas, particularly those of you living in areas where CAM has a strong public healthcare presence.

Bernie

References

Gillies, D. (1998). The Duhem Thesis and the Quine Thesis. In M. Curd, & J. A. Cover (Eds.), Philosophy of Science: the central issues (pp. 302-319). New York, NY: Norton.

Gould, S. J. (1981). Evolution as fact and theory. Discover Magazine, 254–55.

Popper K. (1934)  Logik der Forschung (The Logic of Scientific Discovery)

Sokal, A. D., & Bricmont, J. (1998). Fashionable nonsense: Postmodern intellectuals’ abuse of science. New York: Picador USA.

Thornton, S. (2009). Karl popper:  The Stanford encyclopedia of philosophy. Retrieved 10/28/2011, 2011, from http://plato.stanford.edu/entries/popper/#ImmLawConTre

Science and Non-Science!

Well we are back into a new term here, and the trend in advertising to equate scientific and non-scientific ideas seems to be as strong as ever here in Canada in the new year. Interestingly, I saw a television advertisement last Friday for a new hospital information system being employed in Canada (Ontario I believe). The advertisement made a point to explain how the system incorporated patient information from both modern medicine, alternative Eastern medicine and natruropathic medicine.

Now this public affirmation of all encompassing healthcare struck me as interesting and I have long been trying to get my head around what naturopathic medicine actually is. I have read a variety of literature on the subject and still find it rather a confusing area, and have come to the conclusion it does not seem to be a scientific endevour. It is of specific interest to us nurses here in BC as naturopaths are one of the few listed health professions (including physicians) who are explicitly identified as being able to give orders to nurses under our professional regulations:

Section 7: Restricted Activities that Require an Order

Health professionals authorized to give orders to registered nurses under the Regulation are dentists, midwives, naturopaths, nurse practitioners, physicians and podiatrists.

(CRNBC 2011)

I must admit I have always found this rather puzzling, as to why naturopaths were selected but not other alternative health practitioners,  and the rationale for this seems to be rather arbitrary.

If we take a look at the statement of the Canadian Association of Naturopathic Doctors they state:

“Naturopathic medicine is a distinct primary health care system that blends modern scientific knowledge with traditional and natural forms of medicine. The naturopathic philosophy is to stimulate the healing power of the body and treat the underlying cause of disease. Symptoms of disease are seen as warning signals of improper functioning of the body, and unfavourable lifestyle habits. Naturopathic Medicine emphasizes disease as a process rather than as an entity.”

This seems not really that different than modern medicine, other than the limitation of focus to primary healthcare. However, reading further we find that  their natural/traditional interventions are based on a range of some decidedly dubious practices, including homeopathy (which despite what many advocates will tell you, is well established as bunk, and neither its theoretical basis or the empirical evidence of its effectiveness stand up to scrutiny).

It seems naturopathy attributes illness to the violation of “natural laws” suggesting that standard medical practices merely treat or suppress symptoms. Naturopathy has some other rather non-scientific ideas in that it does not accept the germ theory of illness, or more worryingly support vaccinations (see http://www.cand.ca/Position_Papers.papers.0.html?&L=0).

Scientific practices have a clearly stated and straightforward underpinning philosophy. We can consider science as:

“Science is the pursuit of knowledge and understanding of the natural and social world following a systematic methodology based on evidence.”

(UK Science Council, 2011)

Philosophically we can resort to the “problem of induction,” and related epistemological arguments to question the nature of evidence, but what is the rationale for blending scientific and non-scientific practices? This seems a very weird thing to want to do in the first place, a bit like saying I believe in chemistry and vodooo to explain the nature of matter, or lets blend astrophysics and astrology to explain the function of the solar system. I know there is this desire to be holistic, but it seems to publicly support disciplines that seem to have a catch-all basis, with rather vague and mystical rationales should be something we should seriously question, especially when dealing with publicly funded healthcare.

This view is growing very untrendy in my profession, and I know Roger and I are likely to be considered dinosaurs in this perspective as the adoption of postmodern notions of holistic being (although we prefer the term “old tuskers”). So I ask, should we be concerned with this trend for non-scientific alternative health practices being increasingly equated with science and evidence based practices? Scientific knowledge may well be flawed, but this all-inclusive approach seems to reflect more of a politically “right-on”stance rather than reflect a real interest in the quality of public healthcare. Its one thing if you or I want to go and pay for a round of crystal therapy if we wish to, but buying into services (with public money) that are popular but have no established utility seems a dubious undertaking in these times of economic woe. Certainly some traditional and alternative health practices have value, but exploring alternative health practices to establish their value using well established scientific methods for evidence based practice  would seem to make more sense for public health care.

All this writing has made my arm ache, now where did I leave my Q-Ray bracelet…

Bernie

CRNBC (2011) Scope of Practice for Registered Nurses. Retrieved from https://www.crnbc.ca/Standards/ScopePractice/Pages/Default.aspx  on 12/01/2012

UK Science Council. (2009). What is Science? | www.sciencecouncil.org Retrieved 8/25/2011, 2011, from http://www.sciencecouncil.org/content/what-science