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Public policy decisions should be based on evidence. So why are taxpayers funding faith schools and alternative therapies?

February 28, 2008 7:30 PM

"We're an empire now, and when we act, we create our own reality," a senior adviser to President Bush told the New York Times in the summer of 2002.

It might seem obvious that public policy ought to be based on reality and evidence, but the implications of taking seriously an evidence-based worldview are far more radical than most people realise.

Here's one example: the British government is now introducing standards of competence in homeopathy, aromatherapy, reflexology and other "alternative" therapies, in order to protect the public from inadequately trained practitioners. That sounds nice, at first glance. But what, precisely, does it mean to be "competent" in a system of pseudo-medicine that has never been demonstrated to be efficacious beyond the placebo effect? Perhaps for its next act, the NHS will introduce bloodletting and trepanation, duly guaranteed by rigorous standards of competence for practitioners.

Despite the utter scientific implausibility of homeopathy - in which the "remedies" are so highly diluted that they contain not a single molecule of the alleged "active ingredient" - the NHS actively promotes homeopathy on its website and provides homeopathic "treatment" at the taxpayers' expense. And there are five homeopathic hospitals in the UK, of which four are funded by NHS money.

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It's a full-length show (47 mins) but well worth the time.

http://video.google.com/videoplay?docid=-4720837385783230047

Finding and pointing out biases in scientific argument is itself still science, if you have evidence of those biases.

Saying that the evidence must be scientific doesn't answer the question, beacuse science is also a matter of bias and fashion. One day, telling doctors to wash their hands is a heresy punishable by hounding to death; the next day, antisepsis is holy writ. Science changes. Attitudes and perceptions change. Science is never a finished product. If the ruling elite of science and medicine were wrong about something in 1840, they can be wrong about something in 2008.

So, how can you measure competence in "shit people make up"? by putting the people who made up the shit in charge of testing, or at least the people who have studied the particular brand of shit for a long time.
Because, people didn't really just make up all this shit out of nothing for no reason: they had a theory and a method and sometimes it worked. That's how science happens: people make shit up out of a theory and a method, and if it works, they keep doing it and refining it. If it doesn't work, eventually they try something else. Allopathy didn't work, yet Science was stuck with it for half a century, because that's generally how long it takes for the guys in charge, who have a vested interest, to die out.

A lot of homeopathy works. God knows why. Maybe a few people also know why - or think they do. A lot of science works. God knows why, and a few people know why - or think they do.... until somebody comes along tro prove them wrong.

Knowledge is always conditional. Evidence is always tainted by power, procedure, preconception and prejudice.

Science provides a probabilistic framework for building knowledge about the universe. Yes, we are human and we make mistakes and we have biases, but these are problems with its application, not the framework itself. And there is no reason to think any isolated error or bias is insurmountable -- each can be identified and corrected over time.

But the main point is that there is no other such framework. When you work outside the science, you cannot reasonably justify your work as contributing to human understanding of the natural world.

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Allopathy didn't work, yet Science was stuck with it for half a century...

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Originally posted by nonsuch:
Saying that the evidence must be scientific doesn't answer the question, beacuse science is also a matter of bias and fashion.

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That is simplistic and incorrect.

ETA: As an astronomer, a lot of people I get to know randomly make comments about astrology, and sometimes they ask questions. It doesn't bother me that some people are ignorant of some things, not everybody can be in the know. It would definitely bother me if the government implemented accreditation programs for astrologers.

I worry someone will respond that the distinction between astrology and astronomy is due to "fashion".

[ 09 April 2008: Message edited by: 500_Apples ]

Well, did it? Show results and sequelae.

[ 09 April 2008: Message edited by: nonsuch ]

[ 09 April 2008: Message edited by: nonsuch ]

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Originally posted by nonsuch:
One day, telling doctors to wash their hands is a heresy punishable by hounding to death; the next day, antisepsis is holy writ. Science changes. Attitudes and perceptions change. Science is never a finished product. If the ruling elite of science and medicine were wrong about something in 1840, they can be wrong about something in 2008.

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"Science is an integral part of culture. It's not this foreign thing, done by an arcane priesthood. It's one of the glories of the human intellectual tradition," said Stephen Jay Gould.

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A lot of homeopathy works. God knows why.

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Why is it a Bad Thing that science changes?

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An assertion, delivered with ever-so-much conviction, is still not a proof.

It's impossible to prove most assertions pertaining to health and sickness in humans. The psycho-somatic bond is too strong for science to break - at least, to date. When/if science succeeds in breaking it, we may find that we've broken people into too many antagonistic pieces ever to re-assmble into a functional unit... but who cares? as long as our side wins. Who cares whether the patient feels better or worse, as long as we prove a point?

[ 09 April 2008: Message edited by: nonsuch ]

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Originally posted by nonsuch:
It's impossible to prove most assertions pertaining to health and sickness in humans.

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[ 09 April 2008: Message edited by: nonsuch ]

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Originally posted by nonsuch:
Umm... Allopathy didn't work? What?

Well, did it? Show results and sequelae.

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Originally posted by nonsuch:
The psycho-somatic bond is too strong for science to break - at least, to date.

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There isn't any need to break such a bond. All that's needed is for it to be understood and accounted for.

That's why controlled studies use placebos.

If you develop a treatment for a disease, and in a double-blind study with a control group and a treatment group you find that 20% of placebo-takers have relieved symptoms, while 90% of treatment-takers have relived symptoms, that is pretty conclusive evidence that the treatment is effective.

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Originally posted by triciamarie:
It's important not to confuse science with logic. In my experience as an outside observer, scientific practice is largely blind to its own assumptions and conventions and other sources of bias. These can be identified logically and then tested scientifically, if one is inclined to do so, and if the resources are available -- usually not, because the practice of science does not require this; far from it.

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Do you understand the difference between astronomy and astrology, between alchemy and chemistry, between creationism and evolution, and between the flat earth and round earth?

If science is illogical and blind to conventions, perhaps we should always look at both sides.

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I always find it amazing that people who don't know calculus, who couldn't name the first few elements on the periodic table, who don't know kepler's laws, et cetera, always think they have a "bird's eye view" of science and have an understanding of the limitations of science that no scientist does. They come up with criticisms. And then instead of realizing immediately that surely a lot of very intelligent people must have dealt with these criticisms a long time ago, they take the arrogant route. They think they are the first ones in history to come up with these criticisms, and that they have discovered a great flaw, in their singular wisdom. Must feel good to be so confident.

[ 10 April 2008: Message edited by: 500_Apples ]

These latter can be fun: let's see what my horoscope says!

Scientists do have biases. They're only human. And there are a lot of conventions built into each scientific discipline that may not be the best possible for working out accurate theories. Methodologies do change over time.

One can reasonably ask whether the peer review system is flawed, making it too heavily slanted toward currently held theories.

Where I don't agree with triciamarie is where she dismisses introspection by scientific fields because "the practice of science does not require this; far from it." I don't think this is true, because there are debates about how to improve scientific mechanisms, account for biases, modify methodologies, etc.

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Originally posted by Proaxiom:
While I don't totally agree with triciamarie, I don't think 500_Apples totally understood what she was saying.

Scientists do have biases. They're only human. And there are a lot of conventions built into each scientific discipline that may not be the best possible for working out accurate theories. Methodologies do change over time.

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If you're going to argue that "I don't understand" basic things like freshmen level epistemology - please read my post first and make sure you yourself understand what was written.

1) Scientists have good reasons to be theoretical conservative. Not conservative in that they support bush though some do, but conservative in that they're skeptical of change. They have good reason for this, changing the existing body of knowledge requires a lot. That is a bias yes but it's a good one. That's very different than dismissive nonsense such as "fashion".

2) Watch your language please. saying Methodologies change is incomplete. They evolve.

[ 10 April 2008: Message edited by: 500_Apples ]

You then went on to theory of knowledge issues such as bias and methodologies.

I don't know much calculus but that doesn't mean that I believe I am the first person to criticize science. Not by any means am I the first person to do so. The criticisms range far beyond the simple, basic concern that I noted.

I'm not the one who is being arrogant.

And since my point also seems to have been entirely missed by some, I will give an example.

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Originally posted by triciamarie:
...many or most approved drugs in use today were not tested on women.

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Why should we care that women, especially minority women, aren't well represented in studies of new drugs? For one thing, we have to worry about hidden health dangers. Back in 2001, the Government Accountability Office issued a report noting that 8 out of 10 prescription drugs withdrawn from the U.S. market from 1997 to 2000 posed greater risks for women than for men. And Duke University researchers reported this week that women's participation in some areas of research is so low that the findings may not actually apply to them. For example, women account for only 17 percent of participants in studies of cholesterol-lowering drugs, yet millions of women take them; researchers still aren't sure whether statins, the most popular, reduce cardiovascular deaths in women. And anecdotal reports suggest that women suffer more side effects from statins, like muscle pain and mental fogginess. What's more, since women represent only a quarter of those in coronary artery disease trials, we may not be able to trust findings on beta blockers for heart attacks or drug-eluting stents to clear blocked arteries, say. Black women, under-represented as both women and as minorities, might be putting too much hope in tamoxifen. The drug appears to be less effective at preventing breast cancer recurrences in them, possibly because of gene variations that make it harder to metabolize the drug.

Some gains have been made. The Duke researchers noted that women today make up nearly 31 percent of participants in cardiology trials overall, up from 9 percent in 1970. But policymakers at yesterday's press conference said more needs to be done to make it easier for women to participate: providing such services as transportation to medical facilities and "patient navigators" to help with consent forms and roadblocks like baby-sitter coverage. I think, though, that more women need to understand why they should even bother to participate in a clinical trial in the first place. – Source

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But can that be laid at the door of “science” (or, to return to the thread topic, “empirical evidence”)? I don’t think so. We’re talking about social problems – problems relating to biases and social barriers that make it less likely that women, children, and minorities will be included in study groups. With effort, those barriers and biases can be neutralized to some extent, as the quotation above indicates, but they will likely never be eliminated completely until there has been a radical change in society.

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Originally posted by triciamarie:
I don't know much calculus but that doesn't mean that I believe I am the first person to criticize science. Not by any means am I the first person to do so.

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Originally posted by unionist:
Can you refer us to some other people that "criticize science", please?

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triciamarie has been criticizing application of science, not the principles of science.

I think 500_Apples thought she was criticizing the latter, and I disagreed.

It's easy to find people criticizing how science is done.

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By Richard Horton, editor of the medical journal The Lancet:
The mistake, of course, is to have thought that peer review was any more than a crude means of discovering the acceptability -- not the validity -- of a new finding. Editors and scientists alike insist on the pivotal importance of peer review. We portray peer review to the public as a quasi-sacred process that helps to make science our most objective truth teller. But we know that the system of peer review is biased, unjust, unaccountable, incomplete, easily fixed, often insulting, usually ignorant, occasionally foolish, and frequently wrong. A recent editorial in Nature was right to conclude that an over-reliance on peer-reviewed publication "has disadvantages that should be countered by adequate provision of time and resources for independent assessment and, in the midst of controversies, publicly funded agencies providing comprehensive, reliable and prompt complementary information"

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ETA: Source

[ 11 April 2008: Message edited by: Proaxiom ]

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The concept of `evidence-based medicine' has now been in widespread use in clinical practice for over a decade.

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This is great in many respects. It certainly contrasts with the approach to AIDS and HIV by conservative ideologies and/or moralistic approaches:

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“The most effective approaches for preventing HIV/AIDS are not being used,” said Joe Amon, director of the HIV/AIDS program at Human Rights Watch. “Governments are refusing to adopt evidence-based programs that respect individual rights, and are instead promoting ideological campaigns that make people more vulnerable to infection.”

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Having noted that, it's also very important to point out that, due to factors that are not intrinsic to science itself, evidence based approaches also have the effect of excluding non-approved approaches to health by insisting on evidence that does not yet exist.

Take the example of marijuana. The government of Canada, and funding bodies in general, have effectively blocked research on this substance, on its possible positive uses, etc., in favour of piggybacking the US war on drugs. It's just ignorant.

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Originally posted by triciamarie:
There is no requirement that a scientific hypothesis address the most significant or relevant aspect of the subject being studied. So, many or most approved drugs in use today were not tested on women.

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Of course there is no such silly requirement of only addressing the most significant issues, and ignoring all others. Most people don't realize this, but the body of human knowledge is vast, very vast. In mathematics alone, there are about 50, 000+ research papers published every year. And mathematics is a relatively small field out of countless many fields - but still a single person reading only mathematics 24/7 would fall behind.

In any given field of knowledge (including the liberal arts and everything else), there are countless many problems that need to be solved. A lot of problems are known, but most problems are still not known about. Some problems are considered of more critical experience, but overall, you never know until you see what the solution looks like.

I am quite thankful that science is not as you wish. It is not directed towards 2 or 3 things considered "the most significant or relevant aspect of the subject". People have broad interests, and so rather than have everybody work on one thing, a lot of people work on many different things, which is inherently more productive anyway due to the arrow of time.

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consequent belief that I am the first person to criticise science.

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You didn't understand.

You, like everybody else participating in this thread including myself, have only a scintilla of relevant knowledge. These issues we're raising have been available to be thought of by many tens thousands of people with more experience than us, with more intelligence, and more time. Under those conditions, it is extremely unlikely we are thinking up of something new. That you would think you've come up with a fundamental criticism is extremely arrogant. What is far more likely is that these questions have been raised before, and dealt with. Instead of saying "This is a huge problem!!!" what you should instead be saying is: "How is this problem in fact not a problem? Or if it indeed a problem, how is it dealt with?"

[ 11 April 2008: Message edited by: 500_Apples ]

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Originally posted by Proaxiom:

Allopathy == conventional evidence-based medicine. As opposed to homeopathy, which isn't. If you are suggesting allopathy doesn't work, I have to assume you are using a different definition.

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Well, not quite. Allopathy was conventional medicine of the day (c 1850) that believed in identifying the "essential" [as far as they could tell] characteristic of a disease and applying its opposite. Worked okay with a fever (submerge the patient in ice-water) but did no good whatever for depressed women (what the hay: put 'em all in ice-baths!).
See, the worst unscientific stuff you can think of, like blood-letting and lobotomy, were not far-eastern mumbo-jumbo, but the cutting edge of science, the mainstay of conventional, respectable western medicine. At the time, nobody dared to question these practices.
Today, nobody dares question the current practices. Just because they rule doesn't necesseraly mean they're right.

Yes, science is self-correcting. It corrects its mistakes .... eventually. Usually takes a generation of self-important sob's to die out and another for their less creative but more rigid students to give way to new ideas. And it happens over a lot of pain-racked bodies.

Allopathy is a term first coined by Samuel Hahnemann, the founder of homeopathy, along with the term "allopathic medicine," as a synonym for mainstream medicine and used by homeopaths to highlight the difference they perceive between homeopathy and conventional medicine...

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If somebody has an approach that may or may not work, but does a whole lot less harm, i'd give it a shot.

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May I presume that if you were diagnosed with cancer, and someone suggested to try wearing clown shoes 16 hours a day as treatment, because it may or may not help and is less harmful than chemotherapy, that you would not, in fact, listen to that person?

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Originally posted by nonsuch:

See, the worst unscientific stuff you can think of, like blood-letting and lobotomy, were not far-eastern mumbo-jumbo, but the cutting edge of science, the mainstay of conventional, respectable western medicine.

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I see. Completely wrong. Blood-letting was part of traditional european medicine - not science, not evidence based. That is one of the many reasons I don't submit myself to traditional european medicine - my ancestors were ignorant - not there fault, but regardless I won't take medical advice from them, nor will I from any other traditional medicine. Now if I was living a thousands years ago then sure that crap was the best they had, but now we have something called evidence.

As for your statement that blood-letting was not far-eastern mumbo-jumbo. Sounds good, so I decided to do a little research. Starting with the Caraka Samhita which "stands at the top of the ancient texts representing the School of Medicine in Ayurveda." and which Wikipedia says is the oldest of the three ancient treatises of Ayureda.

Chapter V Treatment of Phatom Tumour: Blood-letting page 263. Next page is "Utility of Blood letting.

Chapter VII Treatment of Kustha: Blood letting therapy page 333.

Chapter VII Treatment of Rajayaksma or Tuberculosis: Blood-Letting Therapy, etc. page 383.

Chapter IX Treatment of Unmada (Insanity): Blood-letting Therapy Page 435.

Chapter XIV Treatment of Piles (Arsas): Blood-letting Therapy page 594.

Caraka Samhita

But maybe the Susruta Samhita was different. Nope: "Sravana (blood-letting) is to be carried out in skin diseases, vidradhis, localised swelling, etc. in case of accidental injuries and in intentional incisions, the lips of the wound are apposed and united by stitching (svana)."

Sushruta-samhita

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Originally posted by nonsuch:
So how come so many people are still sicK?

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There was a quote in the movie old school which was something like: "Blue was old - that's what old people do - they die."

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Originally posted by Trevormkidd:

There was a quote in the movie old school which was something like: "Blue was old - that's what old people do - they die."

The reality is that so many people are not sick. We are most likely the healthiest we have ever been. I know many people will not accept that and yearn for the days when almost half of the children died before reaching adulthood and the life expectancy was 45 not 80.

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Originally posted by 500_Apples:
Of course there is no such silly requirement of only addressing the most significant issues, and ignoring all others.

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I didn't say that scientific hypotheses should only address the most significant issues. I suggested that it reflects poorly on the institution of science, not to mention its pronouncements, that the most significant and relevant questions can so often be overlooked -- a fact you don't seem to be disputing.

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I am quite thankful that science is not as you wish. It is not directed towards 2 or 3 things considered "the most significant or relevant aspect of the subject".

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You're thankful that drugs aren't tested on women?

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Instead of saying "This is a huge problem!!!" what you should instead be saying is: "How is this problem in fact not a problem? Or if it indeed a problem, how is it dealt with?"

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That is a truly impressive degree of respect for authority.

Personally, I left that church a long time ago.

[ 12 April 2008: Message edited by: triciamarie ]

Yes, radical surgery and chemotherapy do, in many cases, extend life. In many other cases, they simply extend suffering.

I'm going to die. No philosophy, no methodology can prevent it. I've pretty much decided how far and in what direction i'm willing to go to prolong my life, and where i'll quit. Everyone needs to have such a plan these days, because Science has devised means to prolong lives that may not meet one's standard of ethics, self-esteem and aesthetics.

This is not the best we can do: it's just the best we can do right now. This is a stage along the road. Science has done some wonderful things and some really awful things; has made great leaps forward and terrible mistakes. Science is no more perfect than the people who practice it; it's no more finished than evolution. It's just one of the marvellous, absurd things humans do.

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Originally posted by triciamarie:

That is a truly impressive degree of respect for authority.

Personally, I left that church a long time ago.

[ 12 April 2008: Message edited by: triciamarie ]

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The church's authority is derived from a divine command, and that authority whithers away when people either don't believe in this divine command or don't believe the church represents it.

That's not the respect I'm talking. What I'm talking about is being respectful rather than condescending to those who are a lot more experienced at a subject on discussions related to that subject A good analogy to what you're doing would be if I were to criticize the methods of all salsa dancing instructors in the world, even though I've never done any salsa dancing. I'm not doing that... I'll pick modesty over arrogance.

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I didn't say that scientific hypotheses should only address the most significant issues. I suggested that it reflects poorly on the institution of science, not to mention its pronouncements, that the most significant and relevant questions can so often be overlooked -- a fact you don't seem to be disputing.

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In the distant (1950s and 1960s) past many female health issues were overlooked. That was a significant social problem. Today there is plenty of funding for breast cancer, ovarian cancer, osteoporosis, et cetera.

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You're thankful that drugs aren't tested on women?

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I am very thankful that drugs are tested on women.

[ 12 April 2008: Message edited by: 500_Apples ]

One the one hand you're saying that you're happy that science doesn't necessarily attend to the most significant or relevant questions, because that would be, I guess, banal, not worthy of the scientific canon. Now you say that there has been "plenty" of attention paid to a laundry list of issues.

For such a true believer, your analysis doesn't show much scientific rigour.

It may relieve you to know that some of my friends are professors of science. I have talked to them about these questions. They're not personally offended; they don't think it's presumptuous for a non-scientist to have an opinion. They don't feel so threatened that they have to lash out with personal insults. They find it intriguing.

Of course, if you're talking to salsa instructors youll probably get another point of view.

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And since my point also seems to have been entirely missed by some, I will give an example.

There is no requirement that a scientific hypothesis address the most significant or relevant aspect of the subject being studied. So, many or most approved drugs in use today were not tested on women.

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A "scientific hypothesis" is different from a test of the hypothesis. If the hypothesis is that men will achieve benefit X from drug Y, the test of that hypothesis does not require women to be tested.

If the hypothesis is that both men and women will achieve benefit X from drug Y, then science absolutely requires that both genders be tested.

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Originally posted by triciamarie:
Says who, 500?

One the one hand you're saying that you're happy that science doesn't necessarily attend to the most significant or relevant questions, because that would be, I guess, banal, not worthy of the scientific canon. Now you say that there has been "plenty" of attention paid to a laundry list of issues.

For such a true believer, your analysis doesn't show much scientific rigour.

It may relieve you to know that some of my friends are professors of science. I have talked to them about these questions. They're not personally offended; they don't think it's presumptuous for a non-scientist to have an opinion. They don't feel so threatened that they have to lash out with personal insults. They find it intriguing.

Of course, if you're talking to salsa instructors youll probably get another point of view.

That wouldn't surprise me, actually. On the topic of the thread: the biggest, most self-righteous advocates of evidence-based medical practice I know are not family doctors or specialists -- they're insurance carriers and employment lawyers. Doctors are the ones calling for a broader recognition of, for example, clinical symptoms for which no so-called objective proof may be available.

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So, yes, I would say that the problem is in the practice. But that problem is so pervasive, even inevitable in the real world, that it undercuts the whole scientific enterprise, to this extent: it is illogical to say that science has exclusive possession of knowledge -- that we can't know something unless it has been subjected to scientific study, or that once something has been studied we can feel confident and rely absolutely on the results.

I don't think most scientists would even want to make those claims, of comprehensiveness or certainty. They know that their conclusions are inherently focussed and provisional. It's the rest of us who a lot of times want to put more stock in the results than is really warranted.

That's where we get into the headlines about medical breakthroughs based only on small, individual studies.

[ 13 April 2008: Message edited by: triciamarie ]