Wednesday, June 27, 2007

On the ethics of bullshit

Clinical trials, CAM, and roads to nowhere

One recurring theme through many of the medical posts on this blog has been to ponder the “humanness” that necessarily forms part and parcel of all our actions as patients and healers. The fascination regarding this grey fuzzy area has been to probe that point where the “right” balance between the unique idiosyncrasies of humanity and the “cold edge” of scientific medicine co-exist. Perhaps this is, as experience seems to reveal, an ever changing place that finds a slightly different equilibrium in each case passing through the examination room.

Be this as it may, how healing practitioners come to terms with this uncertainty provides the basis for understanding that therapeutic modalities can actually impact healing or pretend to impact healing. This is where a dichotomy appears between the scientific “one medicine” model (medicine based on efficacy and evidence) and the confusing morass that is described as complementary and alternative medicine (CAM).

In general, when you claim to be a healing practitioner, you are implying that you have a more intimate understanding of the processes of disease and have access to knowledge that facilitates an approach to effective treatments. Right off the bat the CAM modalities run into the problem that there are, depending on the topic, huge swaths of this healing model that are not based on reality as I’ve pointed out before.

However, here is a pivotal issue. The fact that many of these CAM modalities are made up versions of human imagination in and of itself is not the problem. The problem is that they bill themselves as actual healing practices and build this illusion with deceptive claims utilizing the tools of science such as clinical trials to shroud themselves with a legitimacy of sorts.

What if these practices turned away from these futile efforts and took a more open and honest tact? How about frankly admitting they rely on non science based beliefs and placebo effects. This approach fits better with the already pseudo-religious spiritual tact CAM modalities commonly take anyway.

Ben Goldacre in The Guardian touches on this idea describing the light hearted view that many CAM practitioners ultimately work using psuedo-science or more aptly “bullshit”. This element, even if mostly oriented towards belief and placebo effects comes with some inherent risk (think about the placebo-nocebo effect). Therefore these practitioners need to formulate an honest, ethical system considering bullshit, its belief based orientation, and any risks involved- especially if used as a medicine in a complementary or alternative fashion referencing science based practices.

He states that: “…there is a real issue that quacks undermine the public understanding of science when they promote their trade with dodgy research claims, or distortions of the very nature of evidence. So bullshit is risky, but these problems could be addressed… I can’t help thinking that if complementary and alternative medicine practitioners insist on their right to use bullshit, then maybe they have a responsibility to recognise the risks of bullshit, and to manage these risks, ethically and considerately, like any other byproduct of any other industry. I am calling, in effect, for a new ethics of bullshit.”

Though this is partly in jest, it serves to illustrate one of the key issues when considering whether much of CAM can fit into an effective “one medicine” model. It also helps bring to light the fact that CAM has tried, with success, to claim the human element of healing as their own.

Would this approach threaten the very foundation of CAMs’ existence? Who knows? At the very least, this tact would be a less confusing position and from here they could go on to represent themselves to the public in a truer light.


bengoldacre said...

v interesting. and it wasn't even slightly in jest...

Luella said...

This article is idiotic. You're judging PCRM based on a totally random Google excerpt? Please. PCRM has nothing to do with "animal rights extremism." The extremists are people who believe that factory farming is acceptable.

Dr G said...

Uh, I think you got the wrong post...but I do touch on PCRMs loony antics in another post.

Yawn...your attacking the messenger approach gets you no-where my dear.

Careful reading might lead you to a more thoughtful'd also sound a bit less close minded, inflexible (not compatible with reality) and mind numbingly vacuous....