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Strange ideas about science from some medicos.

July 16, 2012

There’s a debate happening in Australia, as in many other countries, about whether universities should offer courses on complementary medicine. It was sparked in March, by an article in the Medical Journal of Australia, which called for such courses to be scrapped (actual article here – subscription required). The authors are founding members of the Friends of Science in Medicine (FSM), led by the respected medico and academic John Dwyer.

Today, on the ABCs The World Today program, Ashley Hall very ably interviewed Paul Komerasoff, who has co-authored a reply to the March article in this month’s MJA (article here – subscription required). I haven’t read his article, but I hope to do so soon. What I’d like to do is look at some of the ideas Professor Komerasoff expressed in his radio interview, because I find them very disconcerting.

These remarks are taken out of context, so be sure to check the whole interview (transcript and mp3 here). Here’s the first excerpt:

What I object to is the use of power and authority to exert influence on the institutions and on individuals to achieve an aim that they think is appropriate. It’s clear that complimentary medicines are widely used by the community, there are many people in the community who feel that they are helpful and it is part of democratic process to engage in debates about what’s the best or most appropriate form of health care and the distribution of public resources.

This looks remarkably like a straw man argument to me. FSM isn’t calling for an end to debate about CAM. It’s calling for an end to pseudoscientific university courses. There’s a big difference between what’s debated in the public sphere and what’s taught as empirically-derived knowledge in university courses.

Here’s the second:

But in addition to that, the nature of evidence and the nature of science and its relationship to medicine is itself contestable. Medicine claims to be evidence based and I’m a practising physician and a scientist and I spend much of my time trying to collect data and evidence.

But I’m very well aware that the clinical decision-making process is not a rigorous process of the application of scientific data. Rather, it utilises background theories of philosophies and concepts and a very large body of knowledge and evidence, in order to pose hypotheses that we test in the clinical setting.

And this is exactly the same for complimentary medicines as it is for Western medicines.

Another straw man. FSM is not claiming that clinical practice follows scientific guidelines. It’s insisting that what’s taught in medical courses has an evidence-based foundation.

Ashley Hall tries to question him on that very point.

Isn’t that though grounded in work that has been tested and retested to validate the findings, so that any hypothesis you suggest is grounded in evidence?

But here’s the reply:

Yes indeed that’s the case and that’s the really valuable aspect of the method of Western science, and it’s something that I am personally very committed to. But I recognise also that other people in the community have different approaches to health care and different approaches to what constitutes evidence.

I myself operate within the Western paradigm, but there are many people who accept that certain traditional practices or different philosophies of the body are just as applicable and valuable.

And whilst I myself don’t practice in that way and indeed I don’t even avail myself of those therapeutic practices, I respect their right to do so and I respect especially their right to raise these issues and ideas in the context of open debate within the university.

There’s that straw man again. But what Professor Komerasoff is saying here, it seems to me, is that truth is culturally determined. “Different approaches to what constitutes evidence”!!!? “Different philosophies of the body are just as applicable and valuable”!!!? Sounds awfully like cultural relativism to me.

It’s a real worry that science can be interpreted in this way by anyone.

Update: Orac at Respectful Insolence has the sad story of a similar situation in the US.

  1. Martin Lack permalink

    Hi Graham. I am afraid I don’t have the money to pay to breach paywalls or the time to listen to entire interviews (but then I do not doubt the fairness of your criticisms), even if you are guilty of carrying out a “contextomy” on Komerasoff…

    However, for what it’s worth, I think there is a world of difference between:
    1. Acknowledging that herbal remedies can and do work because many things plants contain have observable and repeatable affects on people that can now be explained by modern microbiology and biochemistry… and…
    2. Believing in homeopathy, aromatherapy, reiki, acupuncture, crystals and pyramids, etc..

    In addition, even if some aspects of Chinese medicine may be in Category 1 rather than Category 2 (personally I doubt it), there is no getting away from the fact that it drives much of the now illegal trade in endangered species.

    To be blunt, almost all complementary and alternative medicine (CAM) is very likely to be peddled by people whose only motivation is to make money out of human suggestibility and the placebo effect. They are no better, IMHO, than ‘no-win-no-fee’ ambulance chasers…

    • I’ll look at doing a another post when I’ve read the MJA article, Martin. It will be interesting to see what the arguments look like on paper.

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