Wednesday, June 13, 2012

The Dawkins Appropriation: Not just wrong, dangerous

Richard Dawkins is credited with the observation:
there is no alternative medicine. There is only medicine that works and medicine that doesn't work. [italics added]
Sounds reasonable, sounds obvious, sounds good. But it is wrong.

As Medical practice subsumes other techniques and modalities, how well does it do it? How well can it do it?

What is lost in translation?

This is the same problem as learning a new language.
Without the Culture and Context, the learning is seriously compromised.

Yes, you might have some fluency, some ability to get yourself understood and able to hold modest conversations.

Do you understand the humour? Know the sensitivities and 'no-go' areas? Do you have dreams in the language?

My thesis:
 the Culture, Theory, Practices and implicit knowledge and models underpinning a technique, therapy, practice or modality cannot be separated from it.
 Secondly, it's called "practice" for a reason. Like playing a musical instrument, to become accomplished in the art, you need a lot of practice to build the skill. But then you have to maintain the level of practice to maintain the skill. Mere performances won't maintain concert-level skill, and worse, infrequent performing result in lessening of skills. At some point you are back to "amateur" status.

"Cherry Picking" can only lead to sub-optimal results, or worse, real harm to patients through ignorance and poor techniques.

There is massive Hubris and Arrogance that's implied by the thought: "I can learn a technique in a single day/week that dedicated practitioners take years to learn and much longer to refine and perfect."

Can Doctors perform Acupuncture or Spinal Manipulations as well as native trained, specialist practitioners? Those who practice their craft daily.

I argue, not nearly.

Can cross-trained MD's perform basic practices? Possibly.
Can they perform those practices consistently well? Unequivocally, No.
Can they blindly stumble in and screw things up for the patient, errors that no competent specialist practitioner would make? Not only assuredly, but guaranteed to do so.

The test ('razor') is simple:
If Primary Care Physicians (G.P.'s) don't ordinarily perform specialist procedures like surgery, why would they take it on themselves to perform other specialist procedures they are not constantly practicing? It's unsafe, unethical and unprofessional.

Similarly, in hospitals and specialist clinics, would the specialists expect to perform procedures that are the domain of other specialities? Again,  unsafe, unethical and unprofessional.
The only way for new treatments, techniques, procedures and modalities to be introduced into Medical Healthcare is for new specialities to be formed and codes of practice developed, including guidelines for occasional, low-skilled use, or non-use.

So why does Dawkins make his statement, if it works, it ours? It's so trivially wrong and dangerous as to be absurd.

At best it is an ignorant and unwise sentiment, at worst disingenuous and mendacious.

It's a great sound-bite and simplistic rationalisation - and has been endlessly repeated by the proponents of the Medical Healthcare Treatment Only (all other banned/illegal) school of thought.

If Dawkins had said:
Medical Healthcare will embrace and accept as whole specialities what are now regarded as Alternative Modalities or Treatment when they are shown "Safe and Effective",
then I'd agree with him.

Dawkins thinking on this seems to be mechanistic, based on the Classical Science/Physic notions of absolute knowledge and predictability. The Universe as a set of Billiard Balls, once set in motion, everything is deterministic. There is no uncertainty, nothing subject to probability and no free-will. A single cause and a slow, unalterable, inevitable unfolding of events...

Quantum Physics destroyed the Deterministic model of Classic Physics and replaced it with a far more complex, nuanced world: Odd things happen, accept it.

We are very far from knowing everything about our bodies and how they work and fail. The worldview underlying the Fundamentalist Evidence Based Medicine Only movement/school of thought is this Deterministic Classical Physics model, with the tacit assumption:
 we currently know everything there is to know about human biological processes, their problems and correction/amelioration.
Hence anything outside our current understanding and worldview is, ipso facto, "non scientific" and invalid.

Here's a News Flash: We don't nearly understand everything about our human biology, individual differences and the idiopathic progression of diseases and conditions.

To imply or accept that "There is Only One True Way of Medicine, Science as 'we' define it", is ignorant, arrogant and self-delusional - and if you're in the Profession making your livelihood from it, self-serving.

Acknowledging ignorance is the first step towards knowledge...
Accept that we don't nearly know everything that's needed for Healthcare, preserving Health and improving "Wellness".

If current "science" can't understand or disprove a modality or treatment, perhaps its like Mr Rutherford's little alpha-particle that bounced straight back at him, leading Physics to abandon a couple of Millennia of "proven Classical Physics" and to discover Quantum Physics, sub-atomic particles and the basis for the semi-conductor revolution amongst other things.

As an aside, the Medical Establishment appropriating treatments, procedures and methods from other modalities is similar to the Microsoft strategy of "Embrace, Extend, Extinguish".

It is a short-term tactic design to "crush the opposition". As such, it is amoral and many regard it as dubious or outright unethical.

For Microsoft, the paucity of this approach has become apparent:

  • In 2000, they were Kings of the Industry,
  • In 2005, they were The Corporate Desktop Owner.
  • In 2012, they are a joke with a stalled share-price, poor public image, unloved software and a CEO whom Forbes has publicly assessed as "the worst there is".
 Compare them to Apple who've always had a positive, service-based design ethic. Apple has defined three brand new markets (iTunes-music, smartphone, tablets) in the last decade - whilst achieving massive sales growth and 40+% annual returns to stockholders.

Yes, "Embrace, Extend, Extinguish" did crush some of their opposition. But it didn't win them the War, nor assure them of on-going success.

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