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On Science and Scientism (Vodcast: Evidence based Medicine)

There can be no doubting the achievements of medical science and this is particularly true of the last century. Less than 100 years ago we did not have effective treatments of serious diseases such as diabetes mellitus, mind syphilis, viagra order tuberculosis and killer bacterial  infections such meningitis and pneumonia – to name but a few examples. Science can be justifiably proud of what it has accomplished in medicine and the consequent reduction in human suffering.

In recent years, viagra however there has been an aggressive and arrogant support in some medical quarters for scientism which can loosely be defined as ‘excessive belief in the power of scientific knowledge and techniques’. The key word in that definition is of course ‘excessive’ as anybody denying belief in science needs to be made an object of medical science with an MRI of the head for starters. The scientism I’m referring to is the jeering superiority being spouted by the scientists and doctors of the ‘school of Naïve Realism’, many of whom I’ve referred to on these pages before. In a recent article, Lionel Milgrom has launched a robust, no-holds-barred attack on scientistic doctors – in particular those who attack and sneer at homeopathy. It is bound to be a controversial article (the editor warns readers they are unlikely to agree with everything said) but it is certainly an opinion worthy of generating vigorous debate.

Personally I like to keep things very simple. Let’s look once again at the issue of NHS homeopathy.

FACT: 70% of patients (many of whom were referred for homeopathy because they were not helped by conventional approaches) report satisfaction after attending the Bristol Homeopathic Hospital on the NHS.

SCIENTISTIC INTERPRETATION: “Homeopathy is implausible scientifically. Therefore although these patients improved, this must have been due to the placebo effect. This means patients are being ‘misled’ and this should not happen on the NHS. This justifies homeopathy being demonised with removal from the NHS as a goal.”

Now consider what  a genuinely scientific (as opposed to scientistic) interpretation might be: “This is interesting. There must be something to learn from this. Whether these ‘difficult cases’ got better because of the homeopathy itself, the belief in the medicines by the doctors prescribing them, the placebo effect or the excellent bedside manner of homeopathic doctors is very important for us to understand because that 70% satisfaction figure is impressive.”

Open minded scientists and doctors genuinely concerned about the welfare of patients, instead of attacking NHS homeopathy, would seek to understand how NHS homeopathic hospitals get such good results and why many UK families (including the Royal Family) have used it for generations.

By | 2010-04-21T14:25:47+00:00 April 21st, 2010|Current Affairs, Video|4 Comments

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4 Comments

  1. Dr Amit Habbu April 22, 2010 at 10:53 am

    Dear Dr Kaplan,

    I am trying to look at the situation from what i consider to be a totally unbiased view. I agree with you that many conventional medicine therapeutic interventions are not necessarily evidence based. As you know there are various “levels of evidence” – level 1 to 5, if i remember right. Certain interventions are level 1 evidence eg aspirin in Acute myocardial infarctions. Going down the ladder, level 5 evidence is anecdotal reports / expert opinion. For long, steroid therapy in tubercular meningitis was level 5 – experts saw that there was a clinical improvement and hence this treatment was given right since the 1950’s. Now we have been able to show ( i think in the 1990’s ) that the level is perhaps 1/2 and not 5.

    We can always generate this kind of evidence in greater volumes for homeopathy very easily. Sure different conditions will result in different levels of evidence.

    However, i come back to the point that i am making in my previous posts. The problem with homeopathy, as i understand anyway, is not the lack of “evidence” in the form of double blind studies. It is the complete lack of information as to the mechanism of action.

    I will give you an example — we know that aspirin is a cyclo-oxygenase inhibitor leading to inhibition of platelet aggregation. This results in aspirin having a level 1 evidence for AMI’s. On the other hand giving aspirin to elderly patients just for stroke/AMI prevention is not level 1 evidence. We can always dispute the prudence of giving aspiring in these settings and probably it does more harm than good. However the basic rationale of blocking the cyclo-oxygenase pathway to produce clinical benefit has an irrefutable foundation.

    Unfortunately, this is something we dont have in homoeopathy and we will always be at the receiving end till we can show that “XYZ” is the pathway by which these medicines act.

    Personally, i am not too perturbed by a “clinical evidence” argument against homoeopathy. This can easily be defended and if all of us conduct studies in disorders like migraine, irritable bowel syndrome and the likes, i am confident we can show that homeopathy is better than standard of care, leave alone placebo.

  2. D Grech May 3, 2010 at 5:54 pm

    I agree. Good points made. However, I’d like to make the point that when one reads through MIMS or any other Pharmology text, one becomes aware of the fact that day by day new mechanisms of actions are always descoeverd. This begs the question; what is truth in pharmacology, what is the absolute reality of how drug a or b actually works in the human organism? For eg;

    The exact mechanisms how COX is inhibited in various circumstances is still subject of discussion. Because of differences in the activity of paracetamol, aspirin and other NSAIDs it has been postulated that further COX variants may exist. A recently discovered COX-1 splice variant termed COX-3 was considered to explain some of the knowledge gap, however newer findings do not support the hypothesis that it plays any significant role in the functioning of paracetamol.

    One theory holds that paracetamol works by inhibiting the COX-3 isoform of the COX family of enzymes.

    My point is, there are many theories when it comes to mechanisms of action with so many drugs, and yet they can still be used with clinical outcomes.

    We don’t exactly know the mechanisms involved with the gracity and matter, however we can still utilise the law of gravity and build a rocket. Same with Homoeopathy.

    • Dr. Kaplan May 3, 2010 at 8:53 pm

      @ D Grech. Thanks for that and I especially like the point made in your last sentence.

  3. Sastry.M May 7, 2010 at 7:30 pm

    Drs.Kaplan and Grech-The mechanisms of action of Aspirin and Paracetamol as explained above has one thing in common,viz.”Inhibition” of whatever consequences of dis-eased conditions. This is due to pharmacological effects of drugs that can be verified within our means of perceptions and concepts as relating to material influences.But the failure of such verification in the case of Homeopathy and yet producing far superior therapeutic results inspite of material evidence goes to show that the very concept of ‘matter’ is at loss compared with experiences of sensory perceptions. In order to understand the concept of matter we have to make closer rewiew rather than a casual acceptence of daily experiences. For example the very principles of Electricity and Magnetism exhibiting individual properties and electromagnetism as a radiative form of energy were developed by the cotemporary researchers of Dr.Hahnemann’s time based on the perceptible influences without direct material interlinking and yet producing actions named as “Action at a distance.”This establishes the fact that actions can take place without direct mechanical link or material permeation as shown by T.V monitors and Cell phones etc.in daily experiences. What do we mean when we say what is the matter? Usually it questions actions directed by psyche and performed by body (soma).The Psycho-somatic nature of all actions is a well known fact first recognized and incorporated by the new Homeopathic School and later adopted by the clssical one.While Homeopathic Philosophy implicitly admits psyco-somatic nature the Classical School accepts only “In Principle” as far as pharmacological influences on psyche by direct action are concerned.If some actions and results take place in body under diseased conditions inhibiting certain consequences to gain clinical advantages does not constitute a complte therapy but forceful influence depending on drug toxicity.The exact mechanism under material toxic influence is never logically understood but can be rationally interpreted as to the primary effects.Based on the scientific ‘principle of duality’inhibitive actions are only one sided affair with no regard to consequences of reaction. That the Authoritative School forces and the Homeopathic fails to substatiate based on the common factor of “Materialistic Influence” is due to a common flaw of both which is related to the very basic concept of “Matter” What is the matter? Equate things that relate to Soma coefficiently and relate things that influence Psyche Characteristically and define the meaning of therapeutics relating to human beings.

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