SCIENCE BASED MEDICINE TAKES ON ALL COMERS
(THE DEBATE BETWEEN MECHANISM AND VITALISM)
I receive any number of daily subscriptions concerning medical news, including one from MEDPAGE TODAY. Friday’s column carried the headline, “A handy point-by-point refutation of common chiropractic arguments by Science Based Medicine’s Steven Novella, MD.” Although I myself have taken certain chiropractic practices to task in the past (HERE is one of them), why would MedPage link to such self-serving garbage, then refer to it as “handy” — particularly considering that the writers over at Science Based Medicine are some of the most vitriolic on the web when it comes to any healthcare they declare to be “alternative” (DAVID GORSKI and HARRIET HALL are two of many).
Although I can be rather polemic at times, I try to save the vitriol for others. As defined by Webster’s, the word vitriolic describes, “abusive or venomous language used to express blame or censure or bitter deep-seated ill will“. SBM’s latest posts have addressed such dangerous and quack-like practices as DRY NEEDLING, NUTRITIONAL SUPPLEMENTS, FASCIA, Tai Chi and CHIROPRACTIC. The funny thing is, these folks don’t know when or where to quit. They routinely take on health-related issues that are overwhelmingly supported by decades of peer-review (INCREASED INTESTINAL PERMEABILITY is one of the biggies, along with FUNCTIONAL NEUROLOGY, NCGS, and who knows how many others).
The author of the article on Chiropractic, Dr. Steven Novella, is a sharp guy — in fact you could probably describe him as brilliant. Not only does he practice one of the most difficult and complicated of all the medical specialties (Neurology), he happens to be a professor at Yale University as well. His board certifications include Psychiatry, Neurology, and Neuromuscular Medicine. My question is why he is so dedicated to taking on alternatives — particularly when the practice of medicine has so many problems of its own to deal with?
It’s not that the practice of medicine is all bad (although much of it is — HERE is a recent example), it’s that no matter how hard it tries to be all things to all people, it can’t. No one would argue that medicine frequently does great — even miraculous — things. However, so can ‘alternatives’ (HERE). Novella’s bio says that his, “research interests include ALS, myasthenia gravis, neuropathy, and erythromelalgia“. I’m not completely sure why someone studying ALS, NEUROPATHY, and specific AUTOIMMUNE DISORDERS would not be interested in at least trying natural methods to treat their patients — especially when such methods often times work far better than the drugs (HERE).
In his post against Chiropractic, Novella takes on its founder, Dr. DD Palmer (his son was BJ PALMER). Novella takes exception to the fact that Palmer gave an adjustment to a deaf patient that restored his hearing. I myself have had varying degrees of this happen any number of times, including one that is truly amazing (HERE). Novella refers to this as “psudoscience” as he likewise says of EARLY OSTEOPATHY, decrying it all as “vitalistic“. In an article on the site written by a different author a few days ago, SBM slammed chiropractic for children as well. Really? Take a look at THIS, THIS, and THIS, and then tell me if there is not a time and a place for “Pediatric Chiropractic“. Novella goes on to say……
“The chiropractic profession, in my opinion, does not deserve professional respect. They tolerate pseudoscience in their ranks, and do not have a reasonable standard of care. They are not science-based as a profession. The claim that chiropractors have more education than most MD’s is pure propaganda, and is very telling. We have covered the issue of chiropractic education before, so I won’t go into it again in detail. Suffice it to say chiropractic basic science and clinical education is not even close to what MDs receive.”
Firstly, saying that an entire profession should be disrespected because one disagrees with vitalism (we’ll talk about what it is it in a moment) is rather ridiculous. Secondly; as for the whole chiropractors-are-not-scientific thing, lets be honest for a moment. I have shown you OVER AND OVER AND OVER AGAIN that despite hiding behind the mantra of “Best Evidence”, one of the medical community’s dirty little secrets is that they continue to pick and choose the evidence that they want to follow (HERE). And finally, as far as Chiropractic education is concerned, I would never — for even one second — say that our education is superior to medical education (I have a brother that is a practicing MD, and I know better). However, it is different. Most of my “Basic Science” professors at Logan taught the same courses at SLU’s Medical School. Naturally (no pun intended), chiros will have greater emphasis on subjects like MUSCULOSKELETAL HEALTH and NUTRITION, while the medical profession will concentrate more on their standbys; DRUGS and SURGERY. It’s probably not quite as important for me to have numerous classes in MICROBIOLOGY as it is for their MD.
A quote from Harriet Hall from the previous day’s post (Uncertainty in Medicine) about how tough it is to practice medicine, was telling. As part of the book review, she said that, “Medicine is an uncertain business. It is an applied science, applying the results of basic science knowledge and clinical studies to patients who are individuals with differing heredity, environment, and history. It is commonly assumed that modern science-based doctors know what they are doing, but quite often they don’t know for certain. Different doctors interpret the same evidence differently; there is uncertainty about how valid the studies’ conclusions are and there is still considerable uncertainty and disagreement about things like guidelines for screening mammography and statin prescriptions.”
The problem is that until very recently, these sorts of things have not been publicly admitted. In fact, they’ve frequently been purposefully hidden (for instance, how many people are aware that research was showing the annual physical to be a “DINOSAUR” a quarter century ago?). That’s why so many people don’t realize how dangerous and controversial things like STATIN DRUGS can be, or that ADVERSE EVENTS are so radically underestimated, or that MUPS is an American epidemic, or that OVERIDAGNOSIS & OVERTREATMENT are problems that make “early” diagnosis and treatment (“PREVENTION“), moot points. But lest I throw the baby out with the bathwater, I want to give these authors some kudos as well. For instance, it was Hall who gave DR. MARTIN BLASER’S book, Missing Microbes (Antibiotics -vs- Microbiome). On top of this, they frequently take their own profession to task.
The cool thing about it all is that no matter how much doctors rant and rave about alternatives, alternatives work for lots of people (HERE are some examples from my clinic). Furthermore, patients are going to seek out and find whoever is getting the best results, whether those people have letters behind their name or not. Our mower repairman (Larry Davis of Larry’s Small Engines) literally lives out in the middle of nowhere, about 10 miles from the nearest town, near the JACKS FORK RIVER. He’s always busy. Truth is, if you do good work, treat people like you would treat your own family, and do what you say you’re going to do, people will beat a path to your door (HERE and HERE), whether “SCIENCE” says there’s evidence for what you do or not.
VITALISM -vs- MECHANISM
Because Dr. Novella brought it up, I can’t leave today without having a brief discussion of vitalism and the differences between mechanistic thinking and vitalistic thinking as they relate not only to the practice of healthcare, but to life in general. As defined by that pinnacle of truth and knowledge (Wikipedia), vitalism is, “a discredited scientific hypothesis that “living organisms are fundamentally different from non-living entities because they contain some non-physical element or are governed by different principles than are inanimate things.” This definition actually begs a much deeper question — a question that sooner or later we will all come face to face with; why am I here?
Mechanists (sometimes called materialists or naturalists), as you might suppose, believe that everything that happens in nature (including the human body) can be explained by purely natural, material, or mechanical principles — it’s all physics and chemistry if you will. If this sounds like the same principles that govern EVOLUTIONARY THOUGHT AND THEORY, it’s because they are. Mechanists believe that humans are essentially meat puppets animated solely by electrochemical reactions. The only difference between life and non-life is whether these reactions are taking place or not. Wiki says that mechanistic thinking is…..
“the belief that natural wholes (principally living things) are like complicated machines or artifacts, composed of parts lacking any intrinsic relationship to each other. Thus, the source of an apparent thing’s activities is not the whole itself, but its parts or an external influence on the parts. The doctrine of mechanism in philosophy comes in two different flavors. They are both doctrines of metaphysics.” Wiki goes on to describe metaphysics as, “a branch of philosophy concerned with explaining the fundamental nature of being and the world that encompasses it…”
How in the world can science explain metaphysics? Metaphysics as well as other philosophies, by their very nature and definition, lie outside the realm of explanation by standard scientific methods of analysis via our five senses. To say otherwise is to deny science itself. Still, denying metaphysics is extremely popular within certain aspects of the scientific community — particularly the biological sciences. It is important to understand that the denial of metaphysics is itself a religion. Although there have been countless books written on this subject (the Bible and Darwin’s Origin of the Species are a couple that come immediately to mind), one feature of this debate is that the individuals preaching against vitalism will almost always be atheists (HERE). Although I wholeheartedly advocate their freedom to believe whatever they want to believe, I myself remain vitalistic in my thinking.
This is because even though we may not be able to explain it, in our heart of hearts we all know that there is something inherently / fundamentally different between life and non-life. My guess is that children coming face to face with a dead pet would agree. As humans, I would argue that we are far more than the chance sum of billions of years coupled with trillions upon trillions of chemical reactions. Although healthcare must, by its very nature, involve dealing with mechanical, electrical, and chemical processes, healing itself is always vital.