Tuesday, November 15, 2005

How did pseudoscience get admitted to medical school?

My recent post (scroll down) entitled “What is happening to our medical schools” took medical education to task for promoting pseudoscience. A commenter (Retired Doc) asked how this was allowed to happen and suggested in his own insightful post that it may be a form of political correctness.

Several trends over the past 15 years are at play. In his book review of the Institute of Medicine Report on Complementary and Alternative Medicine Stephen Barrett points to a subsidiary of the NIH which has poured large sums of money into the promotion of bogus claims. This funding was paralleled by an explosion of consumer interest in Complementary and Alternative Medicine (CAM) driven by the Internet. These two forces created a substantial financial incentive for medical institutions to become involved in CAM.

And although to a large extent it’s about money, it’s not entirely about money. There is also an important philosophical shift towards postmodernism, in which political correctness plays an important part. The postmodern view has influenced not only art, literature and politics, but also science. It places the individual’s internal reality above any external truth. To the postmodernist it’s not THE truth but rather MY truth and YOUR truth. It asks “Who is to say one version of truth is more valid than any other.” One can begin to see how this might lead to an eclectic view of medicine.

The movement’s influence is described in this important paper in Lancet entitled Postmodern Medicine. Author JA Muir Gray notes in the introduction that “Postmodernism is characterised by relativism, namely that there are no such things as objective facts…..” Good news there for the alt med folks. It goes on to say “Postmodernism also challenges the objectivity that science has claimed is its defining characteristic as spurious and unsupportable, and although many different theories are encompassed by the term ‘postmodernism’, a suspicion of science lies at the core of such theories.” Gray points out that postmodern medicine is driven in part by increasing regard for patient values and preferences, the rise of consumerism over paternalism and increasing concern for the unintended adverse consequences of science. These are beneficial trends to be sure, but in his defense of postmodernism Gray doesn’t seem overly concerned about its disregard for science. Citing a striking parallel to my previous commentary on the mixing of science and pseudoscience in medical schools Gray notes “The relativism of the postmodern world can be seen in Blackwells, Oxford's most famous bookshop, where evidence-based texts on gastroenterology are sold alongside a book on colonic irrigation.”

I am reminded of a conversation with an acquaintance extolling the benefits of her favorite alternative modality. As I pressed for a scientific defense she finally relented and said “well, OK, I can’t explain how it works, but I just know it works for me.” On a larger scale such thinking is behind the fallacious attempt to justify pseudoscience by citing its rising popularity among consumers. Perception equals reality in postmodern thinking, no matter the science. Postmodernism is a dangerous trend in medicine and is a driving force behind the explosion of CAM.


Anonymous said...

I am not an expert in postmodernism, poststructuralism, or any literary theory.
But it sure seems to me like an awful lot of people are abusing pomo in particular without even really knowing what the hell it is. Given that almost no one knows what the hell it is, this is almost forgivable, but the cost of being hoity-toity and a fan of intellectual rigor is that you can't just start banging on your drum with every mysterious snap of twigs and leaves.

Postmodernism, so far as I can tell, is a body of theory which seeks to show that there is no such thing as objective truth, but that truth is an understood--a constructed entity. It is constructed within the milieu of our prevailing ideas, our prejudices, and our pet hopes, and it is continually understood and reinterpreted within the same vortex. Meaning, as I said, there is no such thing as objective truth.

I mean--duh.

Scientists, of all people, are supposed to declaim knowledge of absolute truth. Theirs is the provisional, the so-far, the until-we-learn more. This is the archetypal discipline in which evidence accrues not wholly unencumbered, but imbued with every sort of meaning and expectation. Some examine the evidence looking for confirmation of their ideas, some to refute others. Some examine the evidence because they're convinced there's another way, but have not yet fathomed it. No one just looks at evidence--it would be meaningless. All of science begins not with evidence, but with hypotheses, and a hypothesis is just a big fat Greek word for a mental model. A constructed reality.

So what's the big deal? Is it just because, for instance, the alt.med people are using pomo as a big stick? Well, I say, call a douchebag a douchebag and be done with it. Leave the critical theory alone.

Robert W Donnell said...

Well, Tyson, I guess we can at least agree about postmodernism-- it denies objective truth. But I'm not sure I agree with you about science. I thought science started with observations. Then the mental model was formed in an attempt to give meaning to the observations. The mental model was modified by additional observations, and on and on. So yes, science is tentative. And while it declaims knowledge of absolute truth it doesn't deny the existence of such truth.

A world view that says there's no such thing as objective truth is an attack on science. That's why it fuels the alt med people and that's why it's a big deal.

EoR said...

Truth is truth. What do postmodernists think if there's a truck bearing down on them? "I wonder if the driver's truth about running me down is the same as my truth about apparently being run down"? A scientist would get out of the way. Unfortunately, homeopathy et al appear to be a very large truck indeed...

james gaulte said...

I might have no business in the postmodernism debate hall, but if pomo
denies objective truth,is that not self refuting ?

Anonymous said...

What is missing is the principle of reproducibility. Under scientific theory, a finding accepted as a fact should be reproducible by others under the same conditions. It is the antithesis of the relativist philosophy, or post-modernism, if that is what you wish to call it.