Advanced searchCitation search
Skip main navigation
Close Drawer MenuOpen Drawer Menu
Academia and ClinicOctober 2, 2001

Alternative Medicine: A “Mirror Image” for Scientific Reasoning in Conventional Medicine

Author, Article and Disclosure Information
https://doi.org/10.7326/0003-4819-135-7-200110020-00010

A reflection on the scientific behavior of adherents of conventional medicine toward one form of alternative medicine—homeopathy—teaches us that physicians do reject seemingly solid evidence because it is not compatible with theory. Further reflection, however, shows that physicians do the same within conventional medical science: Sometimes they discard a theory because of new facts, but at other times they cling to a theory despite the facts. This essay highlights the seeming contradiction and discusses whether it still permits the building of rational medical science. We propose that rational science is compatible with physicians' behavior, provided that physicians acknowledge the subjective element in the evaluation of science, as exemplified in the crossword analogy by the philosopher Haack. This type of thinking fits very well with the Bayesian approach to decision making that has been advocated for decades in clinical medicine. It does not lead to complete and uncontrollable subjectivity because discernment between rivaling explanations is still possible through argument and counterargument.

References

  • 1. Wiersma TJ . Homeopathie als verboden spiegelbeeld van de reguliere geneeskunde. Kennis en Methode. 1988;12:295-314. Google Scholar
  • 2. Ernst E  and  Kaptchuk TJ . Homeopathy revisited. Arch Intern Med. 1996;156:2162-4. [PMID: 0008885813] CrossrefMedlineGoogle Scholar
  • 3. Kleijnen J ,  Knipschild P , and  ter Riet G . Clinical trials of homoeopathy. BMJ. 1991;302:316-23. [PMID: 0001825800] CrossrefMedlineGoogle Scholar
  • 4. Linde K ,  Clausius N ,  Ramirez G ,  Melchart D ,  Eitel F ,  Hedges LV , and  et al . Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997;350:834-43. [PMID: 0009310601] CrossrefMedlineGoogle Scholar
  • 5. Boissel JP ,  Cucherat M ,  Haugh M , and  Gauthier E . Critical literatue review on the effectiveness of homeopathy: overview of date from homeopathic medicine trials. Homeopathic Medicine Research Group. Report to the European Commission. Brussels European Commission 1996. Google Scholar
  • 6. Vandenbroucke JP . Homoeopathy trials: going nowhere. Lancet. 1997;350:824. [PMID: 0009310594] CrossrefMedlineGoogle Scholar
  • 7. Langman MJ . Homoeopathy trials: reason for good ones but are they warranted? Lancet. 1997;350:825. [PMID: 0009310595] CrossrefMedlineGoogle Scholar
  • 8. Juni P ,  Witschi A ,  Bloch R , and  Egger M . The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999;282:1054-60. [PMID: 0010493204] CrossrefMedlineGoogle Scholar
  • 9. Sterne JA ,  Egger M , and  Davey Smith G . Investigating and dealing with publication and other biases. In: Egger M, Davey Smith G, Altman D, eds. Systematic Reviews in Health Care: Meta-Analysis in Context. 2nd ed. London BMJ Books 2001. Google Scholar
  • 10. Ziegler EJ ,  Fisher CJ Jr ,  Sprung CL ,  Straube RC ,  Sadoff JC ,  Foulke GE , and  et al . Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. The HA-1A Sepsis Study Group. N Engl J Med. 1991;324:429-36. [PMID: 0001988827] CrossrefMedlineGoogle Scholar
  • 11. Warren HS ,  Danner RL , and  Munford RS . Anti-endotoxin monoclonal antibodies. N Engl J Med. 1992;326:1153-7. [PMID: 0001552919] CrossrefMedlineGoogle Scholar
  • 12. Bone RC . Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Ann Intern Med. 1996;125:680-7 LinkGoogle Scholar
  • 13. Westendorp RG ,  Langermans JA ,  Huizinga TW ,  Elouali AH ,  Verweij CL ,  Boomsma DI , and  et al . Genetic influence on cytokine production and fatal meningococcal disease. Lancet. 1997;349:170-3. [PMID: 0009111542] CrossrefMedlineGoogle Scholar
  • 14. Vincent JL . Search for effective immunomodulating strategies against sepsis. Lancet. 1998;351:922-3. [PMID: 0009734931] CrossrefMedlineGoogle Scholar
  • 15. Connolly SJ ,  Sheldon R ,  Roberts RS , and  Gent M . The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol. 1999;33:16-20. [PMID: 0009935002] CrossrefMedlineGoogle Scholar
  • 16. el-Bedawi KM ,  Wahbha MA , and  Hainsworth R . Cardiac pacing does not improve orthostatic tolerance in patients with vasovagal syncope. Clin Auton Res. 1994;4:233-7. [PMID: 0007888741] CrossrefMedlineGoogle Scholar
  • 17. Djulbegovic B ,  Lacevic M ,  Cantor A ,  Fields KK ,  Bennett CL ,  Adams JR , and  et al . The uncertainty principle and industry-sponsored research. Lancet. 2000;356:635-8. [PMID: 0010968436] CrossrefMedlineGoogle Scholar
  • 18. Rochon PA ,  Gurwitz JH ,  Simms RW ,  Fortin PR ,  Felson DT ,  Minaker KL , and  et al . A study of manufacturer-supported trials of nonsteroidal anti-inflammatory drugs in the treatment of arthritis. Arch Intern Med. 1994;154:157-63. [PMID: 0008285810] CrossrefMedlineGoogle Scholar
  • 19. Bodenheimer T . Uneasy alliance—clinical investigators and the pharmaceutical industry. N Engl J Med. 2000;342:1539-44. [PMID: 0010816196] CrossrefMedlineGoogle Scholar
  • 20. Vandenbroucke JP . 175th anniversary lecture. Medical journals and the shaping of medical knowledge. Lancet. 1998;352:2001-6. [PMID: 0009872263] CrossrefMedlineGoogle Scholar
  • 21. Haack S . Manifesto of a Passionate Moderate. Chicago Univ of Chicago Pr 1998. Google Scholar
  • 22. Browner WS  and  Newman TB . Are all significant P values created equal? The analogy between diagnostic tests and clinical research. JAMA. 1987;257:2459-63. [PMID: 0003573245] CrossrefMedlineGoogle Scholar
  • 23. Goodman SN . Toward evidence-based medical statistics. 2: The Bayes factor. Ann Intern Med. 1999;130:1005-13 LinkGoogle Scholar
  • 24. Cornfield J . Recent methodological contributions to clinical trials. Am J Epidemiol. 1976;104:408-21. [PMID: 0000788503] CrossrefMedlineGoogle Scholar
  • 25. Benson K  and  Hartz AJ . A comparison of observational studies and randomized, controlled trials. N Engl J Med. 2000;342:1878-86. [PMID: 0010861324] CrossrefMedlineGoogle Scholar
  • 26. Concato J ,  Shah N , and  Horwitz RI . Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000;342:1887-92. [PMID: 0010861325] CrossrefMedlineGoogle Scholar
  • 27. Pocock SJ  and  Elbourne DR . Randomized trials or observational tribulations? [Editorial]. N Engl J Med. 2000;342:1907-9. [PMID: 0010861329] CrossrefMedlineGoogle Scholar
  • 28. O'Brien E . The Lancet maketh the man? Sir Dominic John Corrigan (1802–80). Lancet. 1980;2:1356-7. [PMID: 0006109167] CrossrefMedlineGoogle Scholar
  • 29. Gould SJ . Pathways of discovery. Deconstructing the “science wars” by reconstructing an old mold. Science. 2000;287:253-5, 257-9, 261. [PMID: 0010660425] CrossrefMedlineGoogle Scholar
  • 30. Skrabanek P . Demarcation of the absurd. Lancet. 1986;1:960-1. [PMID: 0002871250] CrossrefMedlineGoogle Scholar
  • 31. Sutton R ,  Brignole M ,  Menozzi C ,  Raviele A ,  Alboni P ,  Giani P , and  et al . Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope: pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators. Circulation. 2000;102:294-9. [PMID: 10899092] CrossrefMedlineGoogle Scholar
Previous
Next

Submit a Comment

Contributors must reveal any conflict of interest. Comments are moderated.
Cancel