“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?

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.

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?

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”.

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.