One of the major themes of science-based medicine (unsurprisingly) is that medicine should be based on science. We consider ourselves specialists in a larger movement defending science in general from mysticism, superstition, and spiritualism. We are not against anyone’s personal belief, and are officially agnostic toward any faith (as is science itself), but will vigorously defend science from any intrusion into its proper realm.
The so-called alternative medicine movement (CAM) is largely an attempt to insert religious beliefs into the practice and profession of medicine. CAM is also an attempt to create a double standard or even eliminate the standard of care so that any nonsense can flourish and con-artists and charlatans can practice their craft freely without being hounded by pesky regulations designed to protect the public. These are both insidious aspects of CAM that need to be exposed and vigorously opposed.
A recent article by Dr. Michel Accad demonstrates how brazenly some are trying to insert faith healing and spiritualism back into medicine. He does so by couching his arguments in philosophy and marketing terms, but in the end he is essentially saying that doctors should practice his faith. He doesn’t really make any arguments for this position, but rather simply gives a history of progress in Western thought as if that is sufficient.
Why Medicine Needs to be Science-Based
Before I deconstruct Accad’s article let me explore the arguments for SBM. As a profession medicine enjoys a special privilege in our society. Practitioners are licensed, which is a contract giving them exclusive rights to practice their trade in exchange for requirements to ensure quality control and ethical behavior. The health professions also benefit from public funding, for research, to pay for education, institutions, and patient-care.
In exchange for this public support, the public has a right to demand regulations to ensure honesty, transparency, and quality in healthcare products and services. Such guarantees are only possible within a strictly scientific practice.
Science is transparent, and fairly and thoroughly considers all evidence in order to determine safety and efficacy. A science-based system is the only system that can ensure claims are fair and accurate. Once you erode the scientific basic of healthcare, then anything goes, and there is no possible way to maintain standards. Anything you do to ensure quality standards is essentially doing science, and then the only question is – are you doing it well?
CAM proponents want to allow what is essentially magic back into the practice of medicine precisely because magic cannot be held to any standard. Magic can also be optimized for marketing purposes – you can make grandiose claims without having to back them up with rigorous evidence. It if for this reason that CAM proponents have been attacking science and the scientific standard in medicine from every angle.
Accad falls for many CAM tropes in his article, but the main one is to confuse religion-based medicine for “holistic” medicine. He writes:
So why does conventional medicine seem so unable to attend to the complete welfare of the patient? Why, despite the manifest efficacy of scientific treatments, do growing numbers of patients consider their medical care altogether unhealthy?
The answer may have to do with what is meant by a whole person.
Each of his premises is false. First, medicine does address the whole patient. This is referred to as the “biopsychosocial” approach to medicine, and I learned it in medical school long before “holistic” medicine became hip. Every medical student at some point in their training will be told by an attending that they cannot treat their patient as if they were a disease – they have to treat the patient. You need to understand the patient’s psychological and social background and how that influences their understanding of their own symptoms and disease. Treatments need to be individualized to the patient’s values, desires, goals, and beliefs. This all needs to be done while respecting the need for informed consent.
Accad and other CAM apologists, however, ignore this reality. They have created the fiction that “Western” medicine is mechanistic, cold, and reductionist. To be fair, the demands of modern medicine can make it challenging at times to maintain the more cuddly aspects of medicine. We do use procedures and diagnostic tools that can be scary and unpleasant. We do try, at least in principle, to manage the patient experience to mitigate the demands of the modern technology of medicine, and don’t always succeed. This is not a philosophical problem with “Western” medicine, however, just a practical challenge of trying to balance the benefits of modern technology with the patient experience. We don’t always succeed, but good doctors, practices, and hospitals do this well.
The second premise is simply a naked assertion, also part of the CAM mythology. Surveys do not support the notion that people are increasingly seeking CAM because of negative attitudes toward scientific medicine. People who use CAM generally report they did so for philosophical reasons, or because they heard it might work, not because they are unhappy with their doctors. In fact, people are not increasingly seeking CAM, the numbers are stable and low (unless you artificially inflate them by including things like prayer and nutrition in CAM).
These CAM claims are all about marketing – this is one brand trashing a competitor. For the record, I don’t think there should be any “brands” within medicine. There should be one fair and consistent science-based standard of care.
“What is meant by the whole person”
Accad has set up his false premise, that “Western” medicine is not holistic, and then defines “holistic” in a specific way that leads to the specific point he is trying to make. He asks, “what is meant by the whole person,” and his answer essentially encompasses his religious faith. “Holistic,” he asserts (again, he doesn’t actually make any arguments) means treating the soul.
If his essay can be construed as an argument, through inference, he is only making an argument from antiquity – we should treat the soul because people did it in the past. He writes:
St. Thomas Aquinas, borrowing from Aristotle’s philosophy of nature, explained that a human being is a substantial unity of body and soul or, to be more technically precise, a composite of “prime matter” (the principle of potency) informed by a rational soul (the principle of act).
He never states why we should care what Aquinas or Aristotle believed. Ironically, he reviews the progression of thought in this area sufficiently to explain why science has rejected the notion of a soul. He acknowledges:
The heightened attention given to the material aspects of the universe promoted the achievements of a bewildering revolution in the empirical sciences. And under the influence of the new sciences, diseases came to be conceptualized in similar terms: illnesses are accident of nature due to defective arrangements or to faulty motions of material stuff. Fix the defect and you fix the patient. This approach has yielded such astounding benefits to mankind that Descartes’ dream of conquering illness through the methodical application of empirical science seems to be well under way.
That is a wordy way of saying that “science works.” Over the centuries we tended to go with what works, and science undeniably “delivers the goods,” as Carl Sagan said. Why would we stick with a pre-scientific philosophy of illness that accomplished nothing in thousands of years, when a scientific approach revolutionized healthcare in tens of years.
Accad still has to cling to this notion that, despite scientific medicine’s undeniable success, something is missing. He accomplishes this by confusing “mind” and “spirit.”
But when medical science rests on a basis of material reductionism, the human mind—the intellectual and willful aspects of the soul—has a hard time finding its proper place. Descartes dealt with this difficulty by splitting apart the body and the soul of man…
The human mind is not an aspect of the soul, it is what the brain does. The material reductionist approach to the mind is progressing quite well, thank you, without the need to appeal to any dualist notions. The mind, the psychological and social aspects of patients, is fully considered in modern medicine. We do not have to appeal to a “ghost in the machine” to be holistic. The only reason to appeal to such notions is to open the door for religious belief to enter into medicine.
Accad himself gives a partial explanation for why this is:
Following Descartes’ conceptual sundering of body and soul, scientists sought for a time to identify and isolate the vital principle of living organisms—as if that were possible. Vitalism, mesmerism, romanticism, and idealism became influential currents in Western Medicine in the eighteenth and nineteenth century. But when these efforts at grasping the essence of life proved futile or problematic, the inconvenient soul fell into neglect and was finally abandoned altogether as a subject worthy of inquiry or acknowledgment in polite scientific company.
That’s right – scientists gave a fair hearing to the notion of a vital force or spirit. In fact, this was the default assumption for a long time, it is what scientists assumed to be true. After a couple centuries of failing to find even the slightest bit of evidence for a vital force, scientists properly dropped the concept as a dead end.
There is another aspect to this that Accad misses, however. The vital force was also dropped because it ceased to become necessary. In the early days of science, before much was known about biology, vitalism was used to explain biological processes that were currently mysterious. It was a placeholder for our ignorance. Over time, however, everything that the vital force was supposed to do was eventually explained as a natural biological process. The role of the vital force shrank and shrank until it finally disappeared.
Can you blame scientists for discarding a pre-scientific notion that was of no value (it had no explanatory power and made no predictions) and for which there was no evidence? The history of progress in science is largely a history of discarding such notions. Scientists today don’t even think about vitalism because it’s “not even wrong” – it is of no scientific value.
The same is true of dualism, the notion of a spirit separate from the functioning of our brains. Neuroscientists have no need for such a notion, which adds no explanatory power, solves no problems, and makes no successful predictions.
Science-based medicine not only works, it is necessary if we are to have any effective regulations and standard of care. Introducing philosophical and religious beliefs into medicine goes hand-in-hand with eroding the standard of care and failing to protect the public from false or misleading claims, and unsafe or ineffective practices.
Further, similar to creationism and other anti-science movements, CAM proponents want to role back the clock to a pre-scientific era. They want to rehash a fight they lost a couple centuries ago. Vitalism and dualism were given more than a fair chance, and they completely failed, because they are not scientific notions and they are not based in reality.
We should no more integrate these discarded notions back into science than we should reintroduce astrology back into astronomy, phrenology back into neuroscience, or alchemy back into chemistry. These ideas are best left on the trash heap of history.
Trying to Impose Religion on Medicine Steven Novella