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The Dynamics of Belief in Medicine
A terminally ill columnist once impressively wrote for a British broadsheet newspaper "there are only two kinds of medicine ..... ones that work and ones that don't" (As I am perhaps paraphrasing his words for lack of recall see also a quotation from Dawkins.) . The implication was that it does not matter whether or not you label your medicine, mainstream, conventional, alternative, complementary or holistic. You need to address the simple question does it work? The relevant questions to the seriously ill person are; is the medication effective; is there good observational evidence about its efficacy and side-effect profile? The ill person should also ask what is the probability that it will work on me and how good will the effect be? It is also highly likely that where no side effects have ever been recorded there will be no beneficial effects either. I would therefore add to that journalist's words by saying 'work to a greater or lesser extent on an individual basis'.
A limitation of today's medical practice is that it is tested on groups of people. One group is treated with the approach under test and one receives a placebo or a treatment that is currently thought to be effective. The average response between groups is usually then compared despite the fact that we can predict individual variability of effect. Clearly it is a limitation of 'conventional' medicine that the 'gold standard' in research is presently the statistically-verifiable double-blind placebo-controlled randomised trial, which operates on defined population groups rather than the individuals. However the discipline of modern 'evidence based medicine' is such that during the coming century we expect practice of this technology to change toward a more individualised approach. Rather than breaking the test group into 2 (one with the treatment and one without) it will be possible to define sub-groups of people based on genetic differences. Making such progress will of course require more discoveries in genetics and biochemistry and a better understanding of how our individual genotype affects our phenotype. Furthermore we will need to see a very radical shift in the design of medical trials and the basis on which they are analysed. Even then one must ask will those that refuse to see the value of reductionism and the power of identifying distinct disease entities be satisfied by anything other than the mysticism of holistic metaphors.
By evolving a critique of current beliefs and practices we can have grounds for optimism both in medicine and elsewhere. If, like metaphysics, the conventional becomes educationally supplanted by another branch of natural philosophy with greater explanatory power we should welcome this change. We should not think like the religious fundamentalist and be threatened by adaptation. We can have much to gain by accepting change. If by some unlikely course of events a 'holistic therapist' should make some genuinely important medical observation then that too should be welcomed. The question still remains: what is the evidence?
(For further reading see Randomised, placebo-controlled, double-blind trials, The gold standard in medical testing, The Placebo Effect and related articles at www.skeptics.org.uk/health.php )
On the Philosophy of Belief
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Scotland, 12th October 2007 and thereafter
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