A canna’ change the laws of physics

Scotty, The Naked Time, stardate 1704.3, Episode 7

Lost In Translation? Part II: Kuhnian Incommensurability

Posted by apgaylard on March 5, 2008

In part I we saw that the partisan incommensurability many CAM proponents and apologists like to invoke is vacuous: self-refuting.  Therefore, it should not be surprising that this does not figure in the philosophy of Thomas Kuhn; it only appears as a straw man in the work of Kuhn’s critics: or a facile philosophical redoubt for those who want an excuse to believe in the demonstrably false.

Are there other sorts of incommensurability? Yes, there are; philosophers have identified many different versions of this idea (for example, see here and here).

It is only under the unsupportable scheme of complete incommensurability that communication, and hence comparison, between ‘paradigms’ impossible; in the others it becomes a matter of translation.

So what sort of incommensurability did Kuhn argue for?  This has been debated by expert philosophers for many years.  What follows is my own amateur summary of the ideas Kuhn elaborated in SSR.  As usual, page numbers to the third edition (1996) appear in square brackets.

Incommensurability makes its first substantial appearance in chapter IX: “The normal-scientific tradition that emerges from a scientific revolution is not only incompatible but often actually incommensurable with that which has gone before.” [p.103].

At this stage in the discussion it is not altogether clear what type of incommensurability Kuhn has in mind.  However, this passage does not insist that all normal-scientific traditions are incommensurable with their forebears.

Jastrow, J. (1899). The mind's eye. Popular Science Monthly, 54, 299-312. There is certainly a global aspect to Kuhn’s view; striking a parallel with gestalt switches (like the famous duck/rabbit) he proposes that: “Only after a number of such transformations of vision does the student become an inhabitant of the scientist’s world” [p.111]. If the trainee is to be inducted into his world of science, “he must learn to see a new gestalt”: the result is, “the world of his research will seem, here and there, incommensurable with the one he had inhabited before.” [p.112]

Another, more moderate version is nestled alongside his global incommensurability:  a local one; incommensurability appears, “here and there“: not everywhere.

When Kuhn moves on to discuss the resolution of scientific revolutions his incommensurability is clearly partial and more than just semantic [pp.148-149].  For example, he identifies incommensurability as the reason, “why the proponents of competing paradigms must fail to make complete contact with each other’s viewpoints”.

The nature of paradigmatic disagreements goes beyond language.  It encompasses which problems “any candidate for paradigm must resolve”, includes standards (or definitions) of science, the meaning of and relationship between terms, concepts and experiments.

The failure to communicate is not just about sense and meaning; during a revolution, for Kuhn, “the whole conceptual web” is “shifted and laid down again on nature whole.”

Although he seems here to be espousing a kind of global incommensurability once more, it is not an impenetrable barrier:  “proponents fail to make complete contact” and, “Communication across the revolutionary divide is inevitably partial.” 

Next Kuhn moves on to, what he calls, “the [...] most fundamental aspect of the incommensurability of competing paradigms”: that their, “proponents [...] practice their trades in different worlds.” [p.150]

Again, this underlines that at this stage in his career the incommensurability of scientific paradigms was indeed global.  However, it’s not a relativist position:

“Practicing in different worlds, the two groups of scientists see different things when they look from the same point in the same direction.  Again, that is not to say that they can see anything they please.  Both are looking at the world [this must now be the natural world, rather than the different paradigmatic worlds they are alleged to inhabit], and what they look at has not changed.  But in some areas they see different things, and they see them in different relations to each other.” [p.150]

Regardless of which ‘paradigm’ they inhabit, scientists views are conditioned by what they observe in the unchanged (natural) world.

It is also clear that Kuhn mixes global incommensurability with a local kind: “in some areas they see different things”.  I’m not at all convinced that this is valid; if you live in different worlds then surely everything is different?  If they can be mostly the same, then why invoke this metaphor?  Surely the image of inhabiting different countries would be more apt? (It is interesting to reflect that in his later years Kuhn reformulated his incommensurability as a local property.)

In 1969 Kuhn published a Postscript to SSR.  In it he sought to correct, “gratuitous difficulties and misunderstandings” [p.174].  As part of this effort he sought to clarify his position on incommensurability and theory choice.  He summarised his position in these terms:

“I have argued that parties to such debates inevitably see differently certain of the experimental or theoretical situations to which both have recourse.  Since the vocabularies in which they discuss such situations consist, however, predominantly of the same terms, they must be attaching some of those terms to nature differently, and their communication is inevitably only partial.  As a result, the superiority of one theory to another cannot be proved in the debate.  Instead, I have insisted, each party must try, by persuasion, to convert the other.” [p.198]

Gone are ideas about different worlds; replaced by something which seems more like semantic incommensurability.  Nevertheless, communication is not totally blocked: it is partial. 

Also, this should not lead to disengagement; with both sides pulling away from each other to allow separate conflicting ‘paradigms’ [by this point re-cast as disciplinary matrices] to co-exist in the long term.  Rather, each party must try to persuade the other to their view.

This, after all, is science: the quest to determine the best description of nature, not negotiate a political compromise or ignore anomalies.  It is this insight which provides the proper context for dismissing the use of the incommensurability gambit by CAM advocates.  Their plea to ‘leave us alone so we can continue to ignore the contradictions within our world and take money from the public purse’ places them in a position where an appeal to the philosophy of science is entirely inappropriate.

It is also important to note that when Kuhn talks here of “proof” it is, “logical or mathematical proof.”  Scientists are completely comfortable with the idea that theories cannot be proven by formal logic or mathematical manipulation.  Those of a falisificationalist persuasion don’t talk about proof, but the survival of theories in the face of stern testing.  Whatever their philosophical leanings, scientists are overwhelmingly happy to view current knowledge as provisional, always open to improvement.

Kuhn then moves on to insist that, “philosophers have seriously misconstrued the intent of these parts of my argument.”  His summary of this misrepresentation strongly evokes the philosophically illiterate use of these ideas by CAM apologists:

“the proponents of incommensurable theories cannot communicate with each other at all; as a result, in a debate over theory-choice there can be no recourse to good reasons; instead theory must be chosen for reasons that are ultimately personal and subjective” [p.199].

This is an interpretation that Kuhn flatly rejects.  I wish all those CAM practitioners who lazily write, “(Kuhn, 1970)” straight after espousing this kind of complete incommensurability would actually do the man the service of reading what he wrote.

How did Kuhn think that the process of persuasion could be carried out?  First, he outlines what he considers are the real difficulties; those involved in this kind of scientific dispute, “employ the same vocabulary” and therefore, “must be using words differently” [p.200].

However, their difficulties will, “not be felt in all areas of [...] their scientific discourse” but will, “cluster most densely about the phenomena upon which the choice of theory most centrally depends.”  Here we can see that Kuhn’s incommensurability is becoming more of a local property.

Dr Alexander Thorkel (en:Albert Dekker) from en:Dr. Cyclops (1940)Since scientists (contrary to some speculation) are all human, inhabit the same physical world and share a common profession Kuhn notes, “Given that much in common, they should be able to find out a great deal about how they differ.”

With this common background they can, “recognize each other as members of different language communities and then become translators.”  This is not an easy task.  Accepting the ‘language’ metaphor, anyone who has ever tried to translate from their mother tongue to a different language realises that the task reaches beyond vocabulary and grammar to encompass shared cultural references and style.

Nevertheless, although this may be a difficult process, it is often accomplished both in literature and, metaphorically, science.

So, Kuhnian incommensurability (in the context of SSR) does not prevent communication and rational theory choice.  It ends up being partial and local in character.  Overcoming it is a matter of translation, an imperfect but an entirely viable and rational process.

I think that Kuhn scholar Rupert Read summarises Kuhn’s legacy eloquently, “he advocates something profound but modest: an attempt to understand what it is that is lost if one translates (say) one paradigmatic theory into the terms of another.”

Kuhn does not provide a fairly-tale castle, where gentle souls can comfort themselves with nonsense, safe from the ogre of reality.

Conclusions.

So what conclusions can we safely draw from this epic journey?  Well, I would suggest never accepting protestations of complete incommensurability: Kuhn never made them and they are self-refuting. These are merely excuses.  If they are made, ask what philosophical work they are based on.  If anyone says, “Kuhn”: ask them to actually read his work before relying on it!

To be fair, if you come across a criticism of Kuhn, make sure it’s not directed against the straw man of complete incommensurability.

It is also helpful to reflect that Kuhn was actually talking about how science progresses.  His philosophy was based on a study of the history of science.  The clue is in the title of the book I’ve been rambling on about, The Structure of Scientific Revolutions.  Application of this philosophy to other non-scientific disciplines is, of course, possible but must be justified.

Just quoting Kuhn and going on about ‘paradigms’ doesn’t mean that a particular branch of knowledge shares enough in common with science to make the application valid.  I certainly think that homeopathy is a good example of a ‘discipline’ that does not share enough of the character of science to justify recourse to Kuhn.  I suspect that trying to justify the application of a Kuhnian structure to much of the world of CAM would have similar difficulties.

It’s worth re-stating that Kuhn’s comments on theory-choice are about comparing science with science.  Nothing in Kuhn concerns the comparison between science and non-science. For Kuhn, a revolution replaces one scientific paradigm [disciplinary matrix] with another: there is no long-term co-existence. His work is about how science progresses: not trying to parcel off ideas and protect them from that progress.

Are there any bits of Kuhn’s ideas on incommensurability and theory-choice that I don’t agree with?  Yes, I’m no Kuhnian.  A weakness of his historical analysis is that it assumes that the future ‘structure’ of science will look like that of the past.  Given the upheavals in science, society and industry that have happened since the 1960′s I have my doubts as to the validity of that assumption.

Also, as Sokal and Bricmont have pointed out, just because a particular theory-choice may not have been made for the most objective reasons at the time; it does not mean that we should overlook the way successful theories accumulate good objective evidence in their favour as time passes.

Thinking about the language metaphor that Kuhn relies on to describe scientific theories and the communities that embrace them, makes me think about the way that scientific theories and languages differ.

When comparing scientific theories and deciding which to choose, it  is usually a choice between the old and new.  Their communities of supporters are not necessarily geographically separated.  On the other hand, languages commonly develop along side each other within communities that are, necessarily, geographically separated.

So what would I like to say to CAM advocates who would still persist in playing the incommensurability gambit, even in the absence of support from Kuhn?

Simply, that the proof of the pudding is in the eating.  We all live in the same physical world; we all want a long, healthy, disease free life.  This makes available to us common units of measure: the presence of virus, bacteria or tumours in our bodies and ultimately death. 

CAM advocates need to get real; stop this silly pretence that somehow, by the magic of philosophy, they are not living the same natural world that the rest of us are.

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12 Responses to “Lost In Translation? Part II: Kuhnian Incommensurability”

  1. gimpy said

    Thank you for this clear and insightful piece. I suspect most proponents of CAM, like most scientists, aren’t particularly interested in the philosophy of what they do. However, as you say, the scientific method has provided universal systems of measurement applicable to any field of science while CAM has merely collected a morass of contradictory ignorance that is utterly dependent on the subjectivity of the CAM practitioner interpreting it. It is a shame CAM practitioners cannot recognise the flaws in this approach.

  2. apgaylard said

    Gimpy:
    Thanks for the comment. You are right, of course: scientists just want to get on and do their job. From what I have seen alties are only interested in philosophy to the extent that they think it gives them an exemption from scrutiny, or a way to undermine science. I guess you could characterise both as defensive: passive and active, respectively.

    I think it’s a shame that many scientists are not more interested in the philosophy of what they do. My personal experience living in the borderlands of science/engineering is that a bit of philosophical reflection enriches what I do. It’s also helpful to be able to confront misconceptions of what you do.

    One other thought that occurs is that none of the well-known philosophers quoted by the alties ever complained that their philosophy couldn’t be critiqued by others. Kuhn never cried ‘incommensurable’ when Popper, Lakatos and others crticised his ideas.

    In the late 60s and early 70s Feyerabend and Lakatos made mutual criticism into a small cottage industry – even though they were close friends – very much the Vroomfondle and Majikthise of their day!

  3. camwoo said

    Thanks for two thoughtful articles, and perhaps, pretty fair comment on some of my colleagues. I don’t really know what “woo” means, and I am not too certain of the applicability of the “Complementary” or “Alternative” tags that go into making up the acronym “CAM”, but I thought I had better point out at the outset (by my choice of user name) that I am a practitioner of acupuncture within the TCM system, for what it’s worth. Yet, I do not agree that our profession should be exempt from scrutiny. Everyone who treats patients certainly has a duty of care that necessitates openness to scrutiny (including self-scrutiny) as to issues of safety, efficacy, respect for human dignity, and many other issues of equal relevance and importance. I would also like to point out that many of my colleagues are putting this view into practice. Just to give you two examples, I would refer you to: 1) “Acupuncture Research: Strategies for Establishing an Evidence Base,” Hugh MacPherson et al, Churchill Livingstone, 2007, 2) ‘A review of Research into the Application of Acupuncture in Pregnancy,’ which is Chapter 26 in “The essential guide to Acupuncture in Pregnancy and Childbirth,” Debra Betts, Journal of Chinese Medicine (pubs), 2006. However, it is equally fair to say that testing TCM treatments, and acupuncture in particular, while certainly not impossible, does present certain difficulties. In particular, it is difficult to “blind” an acupuncturist as to whether they are providing an “effective” treatment or not. For this reason, testing acupuncture is somewhat more like testing a surgical procedure – a surgeon cannot be blinded as to whether he has, for example, actually replaced a knee, or simply provided a couple of convincing scars – and the blinding needs to take place at other levels of the trial – eg. analysis of results, etc. There are other problems which have to do with the necessary “translation” which arises from partially (though I certainly agree, not completely) incommensurable systems, but I will only go into these, if the response indicates a willingness to engage meaningfully with me on this extremely important matter.

  4. apgaylard said

    camwoo:
    Thanks for your kind comment; I always try to be fair. I’m not very convinced by the CAM acronym either, but it has some currency and it’s hard to find a suitable alternative (though I must own up to using more perjorative terms from time to time – I hope that I save them for the people and practises that deserve them; those, unlike yourself, who play the complete incommensurability gambit, for instance).

    I’d be interested in looking at your references; are they available anywhere on-line? I haven’t thought much about acupuncture, though I have reported some comments by R. Barker Bausell on the GERAC (chronic low back pain) trials. I guess that it’s fair to say he wasn’t impressed. To be clear: I’m sceptical, but I always try to engage with things honestly and fairly.

    Actually, his book “Snake Oil Science – The Truth About Complementary and Alternative Medicine“, does cover the problems you mention about blinding acupuncture trials.

    On incommensurability, I’m quite content with Kuhn’s later ideas on a local and partial concept (though as I have said my philosophical stance is not Kuhnian; I’m on a bit of a journey but I’d consider myself closer to Lakatos’s position than anything else I’ve come across).

    As I said in the piece I’m not totally convinced by the ‘language’ metaphor; but it’s hard to describe this kind of concept without a metaphor and, as they go, I don’t think it’s a particularly bad one.

    With that said, I’d be interested to hear what your take is on the difficulty of translation for acupuncture practised in the TCM context.

  5. camwoo said

    Thanks for not immediately jumping down my throat for being an acupuncturist. It is hard to engage meaningfully with the type of sceptic who basically wishes for me to bend over backwards and (in a manner eerily similar to the “born-again” churches I grew up in) admit my “sin” of being a cynical snakeoil saleswoman only interested in hoodwinking people for money. I do not believe this is the case. But, in common with many of my colleagues, I do have an academic background in the “soft” sciences (anthropology), am familiar with the processes by which scientific evidence is accumulated, challenged and gradually (but always tentatively) accepted. I therefore continue to have an interest in this type of debate, and cannot help but see it from the “two” sides, as it were. There are a lot of interesting points to make, but first I would like to address the issue of assumptions. The main one that powers “quacksceptics” (and also my own tribe of “quacks,” if you wish – and by the way, I still do not know how the term “woo” is derived), is that practitioners of CAM are not familiar with science and scientific protocols and scientific evidence. The second one, is that medical doctors, even those who hue most closely to the principles of “evidence-based” medicine, are treating their patients in a cold, analytical, reductionist way. I would argue (and this is based on long conversations on this subject with my best friend who is a local GP), that neither is the case. Most doctors, in fact, do provide in their clinics, a “warm,” individualised service, which, within the budgetary and time constraints that they are allowed, includes listening to their patients, taking their age, occupations, family difficulties, etc into consideration, and so on. Most GP’s – certainly the 5 or 6 in my own neighbourhood with whom I am well acquainted, and any I’ve ever spoken to or attended any where else – care deeply about the whole lives of their patients. In other words, for the most part, apart from the matter of writing prescriptions, they are providing the same listening,caring approach that CAM practitioners claim to, only, usually under a lot more time pressure. Most medical trials evaluate medicines and medical procedures only. Very few evaluate the totality of the clinical encounter, except to eliminate its “bias.” Some of the trials that have evaluated other aspects of the clinical encounter between doctor and patient are cited by Moerman (“Meaning, medicine and the ‘placebo effect,’” Daniel Moerman, Cambridge Univ Press, 2002), and throw up some interesting and useful insights. On the other hand, many, if not all, CAM practitioners are perfectly familiar with the nature of scientific evidence and discourse, but are also aware that a patchy and inconclusive research history (which is what we have to date – research into acupuncture accounted for less than 0.0002% of the UK’s medical research budget in 2005), is not in itself enough to invalidate many collective years of clinical experience. What “works” in a clinical trial and what “works” for patients are two different things, and this is true not only in a CAM practitioner’s clinic, but in your bog standard GP’s clinic, too. For translation of two orders of experience, try this – watch the sunset tonight, or on the next night that weather permits. You will know, as you watch it, with all of you, that the sun (relative to the earth) has not moved, but that instead the earth has turned. And yet, in another “dimension” of your experience, all of you will be in tune with the message your senses are giving you, which is that the sun is setting. Both are in some way absolutely true, and yet neither negates the other. The fact that we can hold these contradictory “knowledges” at the same time, is a part of our very human condition, and it feeds directly into the partial incommensurability problem. Take care.

  6. camwoo said

    PS, sorry I cannot provide you with online refs – I’m an old-fashioned book reader, and I also find it annoying that most of the academic articles I ever want to read online are not free. If I’m going to pay to read something, I’d prefer to be able to curl up somewhere comfortable with it.

  7. draust said

    Camwoo

    I don’t doubt the sincerity of many CAM practitioners, and I sympathize with parts of what you say. As the partner of a doctor I couldn’t agree more about GPs and other conventional doctors and their desire to give patients more than just pills. And in so far as some of the conventional doctors’ approach to patients is down to listening, understanding, empathizing, sympathizing and persuading – or should be – I would agree that some alternative practitioners do some of the same things.

    However, can you really deny the blanket hostility of many (most?) practitioners of the more “metaphysical” alternative traditions to conventional medicine? If you look at the website of (e.g.) the Society of Homeopaths it is right there on the webpage. The page on “What is homeopathy” is very specifically calculated to say “we will give you all the things you might think you’re not getting from your (time-poor} conventional doctor”. Ask your GP friend to look at it.

    I would say that much of what appears on the debunking sites (like Ben Goldacre’s BadScience and David Colquhoun’s site) deals with making explicit this belief of large swathes of the homeopaths and others in the Alt Med traditions – i.e. conventional medicine bad (certainly under all circumstances short of something needing urgent surgery), mystic healing good. And the CAM internet sites and blogs also make clear that a lot of the CAM people view the entire concept of “testing” and “evidence” and “accounting for possible confounding factors” as wholly irrelevant.

    I have little problem with conventional doctors practising CAM therapies, simply because I think they have the training to see where “real” medicine is needed, where the CAM approaches might be beneficial, and where CAM’s limits lie. For instance, people with chronic pain may well benefit from acupuncture – indeed my wife has sent a bunch of patients in that direction. BUT….there are so many fruit-loops active as CAM practitioners that I find it difficult to see how we can tell the sensible from the barking.

    Apologies. Rant over.

    PS Sympathise with your preference for books over reading a screen, BTW. If you can face a bit of computer reading, a site I have found very interesting in terms of CAM and conventional medicine is conventional medic and acupuncturist Anthony Campbell’s site, especially the page on “Come back science, all is forgiven”.

  8. camwoo said

    Draust said: “However, can you really deny the blanket hostility of many (most?) practitioners of the more “metaphysical” alternative traditions to conventional medicine? If you look at the website of (e.g.) the Society of Homeopaths it is right there on the webpage. The page on “What is homeopathy” is very specifically calculated to say “we will give you all the things you might think you’re not getting from your (time-poor} conventional doctor”. No, I can’t deny that they have said what they’ve said. And it stinks. But individuals should only be held to account for what they themselves have said. And so I do not particularly feel the need to defend any stance except for the ones I myself adopt.

    And what I read into these sites is that in most cases the hostility goes two ways. And while science provides us with a useful way of judging the world, there is nothing scientific about hostility. So where does it come from? I believe that hostility generally comes from a natural emotional response to either 1) a perceived threat to oneself, one’s reputation, one’s calling, or 2) an individual (anecdotal) experience of harm. Because we are human (and scientists are not immune to the human condition) we find it easy to extrapolate from that perception of threat or from that single instance of harm to classing a whole swathe of people as being threatening and harmful. We often do this subconsciously, or at least unreflectively, even when our perception may be faulty, and/or the harm done may have been an isolated instance. This then shuts down the possibility of dialogue, to the detriment of everyone. And the problem with being too rigid a sceptic, is that it forces one to live in a world almost entirely populated either by conmen or by gullible fools. Fortunately, people are much more complex than that, and not nearly as easily fooled as the “badscience” type sites would suggest. On the other hand, our ape-ish tendencies to rivalry between in-groups – and thus the need to find ways of letting people know, by the phrases we choose, the positions we adopt, etc, what “in-group” we belong to, is perennially with us. And, by the way, does anyone actually know where the word “woo” comes from?

  9. camwoo said

    Just one other point. Re your point: “I have little problem with conventional doctors practising CAM therapies, simply because I think they have the training to see where “real” medicine is needed, where the CAM approaches might be beneficial, and where CAM’s limits lie. For instance, people with chronic pain may well benefit from acupuncture – indeed my wife has sent a bunch of patients in that direction.” I would just like you to know that it was a feature of both my training and my practice to stress that the primary care person is always the GP – for the reasons mentioned above. We did not – as you rightly point out – receive the extensive training that GPs have, and are not in the business of providing primary care, any more than nurses, physiotherapists, occupational therapists, etc. And, in any case, it would be rare for people to consult us with life-threatening illnesses, while in emergencies, people naturally call for an ambulance not for an acupuncturist. I think most people are quite good at “self-selecting” the kinds of problems they would take to their GP and the kinds of problems they take to an acupuncturist. People go to their GP’s, not their acupuncturist, when they have a genuine worry about their health. People come to their acupuncturist when their GP has referred them for all relevant tests, and assuaged their worry (by finding nothing wrong), but their symptoms persist. They come, usually, in a “it can’t do any harm to try” spirit, and are pleased if they get relief – which, in my own, singular, anecdotal experience, is about 60-70% of the time, and if not, they are still not displeased to have made the attempt. In my clinic they can read the sign on my wall that says – “you are entitled to a refund if you are unsatisfied with any aspect of your treatment”. In three years I have not been asked for a refund, even though some, unfortunately, have found little relief. Generally, people are happy that both they, and I, have tried. It certainly helps them to have their genuine, if unexplained, suffering acknowledged. In any case, it is always my practice to ask every patient whether their problem has already been investigated by their GP, and on a few occasions, when I felt unsatisfied on this point, I have referred them back to the GP to ensure that nothing serious has been missed. The types of problems that patients have found usefully treated in my clinic involve, first and foremost pain of all kinds, and in this regard, acupuncture provides a very valid alternative when analgesics are contraindicated – eg. pregnancy, gastric problems; also, for some reason, sinusitis and rhinitis have a great record in this clinic – which I did not myself expect; period pains and premenstrual syndrome respond very well, menopausal problems less so. This is my experience. For what it is worth.

  10. draust said

    Thanks for the responses, Camwoo. If the mass of Alt therapists were like you I would be much happier. But they are not, I fear.

    For the record, when I started blogging about CAM a couple of years ago I was broadly of the opinion that the more rational practitioners provided a useful service in exactly the sorts of settings we are discussing, provided there were appropriate safeguards in place (which at present I don’t think there are in the UK) and provided the practitioners had enough insight, self-discipline and humility to stick to what they could sensibly tackle. This view was influenced by my other half,who trained in medicine in Germany where things like herbal medicines and acupuncture are more mainstream than in the UK.

    However… my experiences in the Blogosphere,and my investigations over the last 18 months, have hardened my attitudes, simply because of the huge number of Alt therapists and CAM boosters I have come across who:

    (i) won’t stick to what they can reasonably handle;
    (ii) make ludicruous claims for what they can “treat”;
    (iii) have no insight into the limits of their “craft” and routinely present it to the punters as an entirely sufficient alternative to conventional medicine – and:
    (iv) loudly insist that their modality should be treated as equally valid and important “because it’s what the patients want”.

    The great difficulty is how to deal with the current scenario where it seem to me that this second group are dominant within the CAM world in the UK. Until I see CAM proposing regulatory systems which will have professional codes with teeth, e.g. “the GP is the primary healthcare person, and if you bypass them and give nonsense therapies you will be busted and struck off”, I remain sceptical. For instance, I would say that it is utterly clear that the homeopaths, to take the most glaring example, simply lack any insight at all and will never put any sort of “restrictive” Code of Practice in place. The Society of Homoepaths do not even enforce their current anaemic Code of Practice, as has been well documented on the blogs.

    While I agree with you that the public are not totally gullible, people facing something like a chronic relapsing / remitting disease, or a degenerative condition, may be pretty desperate, at which point the rationality gets rather shakier. There is also a strong tendency of people – especially men – with certain types of troubling symptoms to postpone going to doctors on the “if I don’t tell the GP then it isn’t happening” basis. If this last group of people consult the “wrong” kind of CAM therapist instead then their symptom may never get seen by a conventional GP.

    So acupuncture for chronic pain with the inevitable strong “symptom perception” issues and psychological aspects, delivered by a therapist with a good grip on reality, is one thing. No real issue there for me, though I think trials supporting the intervention are still useful.

    On the flip side, homeopathy or “energy healing” for someone with MS, or even asthma, and delivered by a person who basically does not believe in the organic basis of disease…. ’nuff said.

  11. camwoo said

    Draust said: “However… my experiences in the Blogosphere,and my investigations over the last 18 months, have hardened my attitudes, simply because of the huge number of Alt therapists and CAM boosters I have come across…” Draust, thanks for chatting. I would just like to offer a word of caution. Your experience in the Blogosphere may not be that representative…I would tend to think that most of my colleagues, those I meet at professional gatherings, etc, feel more like I do, and as I said, this is the way in which we were trained. We share a common distaste for those of our colleagues who seem to be all about personal aggrandisement and money – the type who devote themselves to getting radio/television airtime and newspaper coverage, rather than to improving their patient services – and the Irish ones would be known to me, although it seems it is unprofessional to name names. To get involved in the blogosphere, though, if you name yourself a CAM practitioner you generally immediately get such venomous flack that it is not worth staying there unless you have an appetite for conflict and a neck of brass and don’t mind if no one really hears what you have to say. Most people I know try to keep the head down and do the best they can for those who come seeking them. I don’t sell any product or teaching – only the best skill and care my eye and hand can offer. I don’t even advertise, apart from listing my number in the golden pages. I may be one of the (to borrow a phrase) “silent majority.”

  12. camwoo said

    Draust says:

    “So acupuncture for chronic pain with the inevitable strong “symptom perception” issues and psychological aspects, delivered by a therapist with a good grip on reality, is one thing. No real issue there for me, though I think trials supporting the intervention are still useful.
    On the flip side, homeopathy or “energy healing” for someone with MS, or even asthma, and delivered by a person who basically does not believe in the organic basis of disease…. ’nuff said.”

    Yes, but, upon reflection, here is the exact point where the debate can get interesting – while remaining friendly, I hope. What would make you think that “symptom perception” and “psychological aspects” are less “organic” than say, a cut finger? Our “psychologies” are a function of brain, nerves and hormones, just as our blood circulation is a function of the heart, nerves and electrical conduction. There is nothing I’ve ever read in biology to indicate that the mind has a non-organic reality. If you think that acupuncture is “only” affecting the mind and not the body, are you not admitting that there is a non-organic, transcendent reality apart from “this” one?

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