Sunday, December 30, 2007

Shades of bullshit

The saga continues

The terms used to describe the plethora of non-science based medical modalities has changed and transformed over time. Descriptors using the word “holistic” have given way to “alternative, complementary, and integrative” perhaps in an attempt to find ways to penetrate more effectively into mainstream consciousness.

Interestingly, Dr Novella and others have interesting posts about this phenomenon finding analogies in evolution-like processes where fringe pseudo-sciences continually mutate their appearance in an attempt to become “accepted” into the scientific fold much like creationism dressed itself in the mantel of intelligent design. This is reminiscent of the mimicry used by the chameleon and, unfortunately, has met with a measure of success.

The bottom line is, no matter how much complementary and alternative medicine or veterinary medicine (CAM or CAVM) would like to pretend they are something they are not; the concept of “holism” remains a steadfast pillar of this world view. Supporters of the The CAM model constantly remind us that they examine the “whole” patient with the obvious implication that science based medicine does not.

The fact is the claim that CAM is based on a true holistic foundation is nothing but a paper tiger. Though, an often discussed theme here, the importance of this fatal flaw deserves frequent mention. Much of CAM deals with rather nebulous concepts that involve often indefinable energy flows, channels, bizarre concepts and belief based philosophies. Approaches to therapeutic plans are often broad and unspecified. For example, straight chiropractic deals with yet to be identified subluxations, and much of acupuncture depends on undetectable meridians. Any holism here relates more to each practitioner’s particular orthodox and inflexible philosophy rather than a coherent medical model.

On the other hand, science based medicine works within a true holistic framework as a matter of routine. Done well, it takes into account a patient’s condition in the context of whole systems utilizing tried, tested, and effective methods. At the same time, the crucial pillars of science based medicine involve change, flexibility, and self-doubt which guard it, for the most part, against becoming excessively rigid.

Granted, there are huge problems, especially in human medicine with respect to the organization of health care. Though this is a topic well worth discussion, it has nothing to do with what science based medicine is. Unfortunately, this is an area where CAM attempts to wedge its way into the mainstream by confounding “traditional” science based medicine with larger political and socio economic problems- really a non sequitor.

Ramey and Rollins in their book “Complementary and Alternative Veterinary Medicine Considered” state CAVM practitioners may assert that it is necessary to consider an almost limitless number of factors in deciding which approach or combination of approaches is best suited for the diagnosis and treatment of the patient. However, all of the available evidence suggests that this is not the case. That is, a huge body of research has demonstrated that human judgment can not compete with a more objective process that involves evaluating a small number of relevant variables….There is, in fact, no indication that CAVM practices offer any diagnostic or therapeutic advantage over science-based approaches and every reason to believe that no such advantages exist or will be forthcoming, given the long history of their use and concomitant lack of supporting evidence.”

In essence, because of this, CAM and CAVM now more often seem be taking the tact of attempting to blend in as “complementary” or “integrative” to science based medicine; subtly infiltrating areas of science based medicine including academic institutions and hospitals in a bid for legitimacy.

Sadly, as they succeed, the doors towards medical anarchy open a little wider.

No comments: