Shamans and Scientists: The Medical Science Wars

In much the same way that ancient societies often turned to the Shaman or another religious figurehead for support, direction, and advice, our society today increasingly turns to the scientist to lend support for a cause, answer questions, solve problems, or provide direction. Today, no other industry uses the Shaman-like influence of scientists more than does the practice of medicine. The market for selling wellness is rich. While being bombarded daily by science that is trying to convince us of how we can or should feel, do we stop to consider whether it is the services of a scientist or that of a Shaman that we truly desire? What do we expect science to do for us, or for society? Do we desire a pill to make us feel better, or a system of understanding about what makes us feel the way we feel?

Remembering the Sokal Hoax

Founded in 1979, the academic journal Social Text embraced ideas of radical politics and controversial views and, by 1996, had a readership base of a few hundred elite academics. The Spring 1996 issue of Social Text was devoted to a study of the so-called 'Science Wars' between the physical sciences, and the humanities or social sciences. In this issue was an article by an unlikely contributor, a New York University physics professor, Alan Sokal, titled: "Transgressing the Boundaries: Toward a Transformative Hermeneutics of Quantum Gravity." The point of the article's argument was that the (perhaps abstract) scientific concept of 'quantum gravity' would free scientists from the tyranny of 'absolute truth' and 'objective reality.'

On the day that the Spring issue of Social Text appeared in print, Sokal published a letter in the academic trade publication Lingua Franca stating that “Any competent physicist or mathematician (or undergraduate physics or math major) would realize that it [his Social Text article] is a spoof." The letter ridiculed "how readily they [Social Text] accepted my implication that the search for truth in science must be subordinated to a political agenda." Sokal, speaking of how his article exploited the lack of scientific logic used by Social Text academics wrote:

“I also employed some other strategies that are well-established (albeit sometimes inadvertently) in the genre: appeals to authority in lieu of logic; speculative theories passed off as established science; strained and even absurd analogies; rhetoric that sounds good but whose meaning is ambiguous; and confusion between the technical and everyday senses of English words.”

Commentary about the incident raged for several months in published scientific debate, spurred on by some apparent non-acceptance by the editors of Social Text to admit they were duped in publishing the Sokal article. Perhaps to Social Text, admission that they were duped was not important in the context of their cause. After all, they might argue it’s more important to recognize that other theories about the nature of science exist, even if some of them are silly or are discovered to be wrong.

Stanley Aronowitz, former Social Text editor, had the following comments: http://physics.nyu.edu/~as2/aronowitz.html

“What it [our increasing dependence of science] means is that scientific knowledge is not immune from broad cultural or narrow political influences and its methods cannot function as a filter. Cultural change, as much as internal debate among scientists, contributes to science -- social and natural -- as an evolving activity; what the scientific communities believe to be the case today may be revised, even refuted tomorrow. And, reasonably, logically, this must include the most accepted propositions. If this is so, and science reflects on the social and cultural influences, on its visions, revisions and its practices, and perhaps more to the point, on its commitments, then there is hope for a liberatory science.”

In an afterward, Sokal’s comments included the following:
http://physics.nyu.edu/~as2/afterword_v1a/afterword_v1a_singlefile.html

“…But they [public-policy or social, economic, political, cultural and ideological factors] have no effect whatsoever on the underlying scientific questions: whether atoms (and silicon crystals, transistors and computers) really do behave according to the laws of quantum mechanics (and solid-state physics, quantum electronics and computer science).”

Aranowitz may suggest that because how scientists interpret effects and observations about nature is greatly influenced by social and cultural biases, their conclusions should not be set up as scientifically indisputable. Scientists should be willing let go of even the most fundamental scientific theories in a search for greater understanding. Further, scientists shouldn’t have to use a supposed established scientific premise as a basis for new understanding, or even depend on current tools for observation to achieve a more pure description.

Sokal, on the other hand, may argue that regardless of the influences, practical observation and understanding leads to application of scientific theory to a useful end for society. Practical application also leads to further understanding. Whereas society and culture may drive the direction of science, the empiric knowledge gained is not changeable by either one.

Although the “Sokal Hoax,” as it came to be called, may have appeared to give a black-eye to the academics advocating the scientific ideals of Social Text, it has defined what they had described as the Science Wars. So, in that respect, it was a Social Text victory for legitimacy of their views of science. There was really no clear winner, and a debate over what is important about the nature and use of science lives on.

Relativistic versus Purist Science

As the Sokal Hoax demonstrated, the schism among scientists lies within a basic scientific philosophy. There is what could be called purist science that is perhaps more concerned with discovering a pill to make you feel better. Relativistic science, on the other hand, could be the term to describe the emphasis on discovering and manipulating what influences our feeling better. An advocate of relativistic science will put the greater emphasis on understanding science as a social and cultural process and entity, much like Shamanism or religion of past cultures. The advocate of purist science emphasizes understanding science as nature and physical processes in order to discover practical applications for humankind.

Physicists and mathematicians usually delve into the purist science. Perhaps like Sokal, they have a rigid definition of science and put priority on using objective testing and the scientific method. They attempt to control or calculate for every variable, and to eliminate any human influence of data in order to reach valuable scientific conclusions.

The other type of scientist is described as more relativist, and involve many (but not all) social scientists as perhaps were the editors of Social Text. Rather than eliminate the human variable, they attempt to use it to make their findings more useful. They might argue that since science is ultimately done by and for humankind, trying to remove the human variable from science is not only impossible but renders the end product less valuable.

The War

Given the same scientific challenge, the purist scientist and relativist scientist will likely come up with different data sets, have different theories based on different (not necessarily opposing) conclusions, and predict different phenomena. The Science War is about the legitimacy, validity, and usefulness of the alternative conclusions, which are ultimately based on a difference of scientific philosophy.

The Shamanistic ideal that our society seems to expect of medical science is fertile battleground for the two types of science. Should scientists focus on finding a pharmacologic agent to reduce an “epidemic of obesity?” Or, should scientists focus on discovering what “obesity” truly means in our society and create strategies for improving public health associated with weight? How should scientists address or respond to social issues surrounding the epic use of psychotropic drugs in children? Who should decide what treatments health insurance or Medicare covers: the practitioner or payor? How should scientists respond to the rising costs associated with science and technology in health care, and the inequality in its availability to the masses? To each of these challenges, purist and relativist scientific ideals will accordingly emphasize the importance of different points and formulate different strategies.

Evidence Based Medicine and its Antagonists

Evidence Based Medicine (EBM) is a term being heard more and more. EBM is perhaps a purist view and practice of medicine that is based on what we can conclude using the scientific method. The gold standard for EBM is the randomized controlled trial (RCT), which is a scientific study that attempts to account for the especially human variables that are seen to confuse data in a scientific analysis. The ultimate goal of the RCT is to be able to accurately predict how a medical intervention will impact the health of the individual. The objective of EBM is to identify the value, or the benefits as compared to the risks and costs, of using any medical intervention.

There are medical practitioners, scholars, and professional medical organizations that give little credence to the practice of EBM. They advocate a more relativistic view of medical science. Akin to the academics of Social Text, they disagree with rigid definitions within the practice of science in medicine for a more broad view of what constitutes health and wellness. They are more prone to use terms like holistic medicine, natural medicine, or alternative medicine.

The ideals of what is important within these two views of medical science are radically different. Whereas better health is the common goal, the EBM purist may place more importance of demonstrating wellness, while the medical relativist may put more importance on feeling better. For example, practitioners with a more purist philosophy will advocate that treatment of back pain focus on the apparent physiologic pathology within the anatomy that’s creating the pain. The more relativist practitioner will focus on all factors that may influence the individual’s perception of pain in an attempt to custom formulate an effective individual treatment regimen.

Trench Warfare

In contrast to the battle waged only among the purist and relativist scientists of the Sokal Hoax, the science wars in medicine are a kind of trench warfare where the battles mostly involve non-scientists and are often over public or social policy. Consider the purist versus relativist approaches or attitudes toward the following issues, as they have to do with medical science:

Nearly every recognized professional medical organization advocates routine childhood vaccination based on consensus of scientific analysis of data. The American Chiropractic Association, however, officially states that individuals should have the freedom of choice to not immunize themselves or their children, and provides speculative comments about the legitimacy of the scientific data and how it was used to instigate government vaccination programs without a complete understanding of safety.

Research scientists continue to be at the forefront of the stem-cell debate when the debated issues more keenly impact political influences and cultural values.

The State of Washington's health commissioner is an elected, versus appointed position.

Alaska almost passed a law that Naturopaths can be primary care providers (i.e., gatekeepers for Medicare patients access to coverage.)

Government funding of the Center for Complimentary and Alternative Medicine within the National Institutes of Health (NIH) is both criticized and praised by scientists

Who’s Winning?

Over the last several years there has become a strong influence of EBM in our society’s approach to medical care. The FDA demands RCT's for new medications, and health insurance companies use scientifically formulated technology assessments as a guide to insurance coverage. Society has placed value in having a mathematical prediction versus basing health decisions on apparent opinions or consensus. Society has made it a priority to try to understand whether or not any chosen health intervention will cause more harm than better health, and to determine a way to place a value on care in a communally-funded health care system. An EBM approach has provided a means for society to find answers that are convincingly applicable to a majority.

Advocates of a more relativist approach to medicine will view EBM as ignoring the unique needs of the individual. Practitioners and scientists who subscribe to a more relativist-based approach to medicine use similar strategies that the academic relativists of Social Text used in order to counter the emphasis that society has placed on EBM. They publish scientific journals on MEDLINE. They discredit RCT's and the practical value of structured medical studies. They accuse the FDA’s actions as biased and mock the social standing of EBM advocates, while claiming their own view toward medical science is just as pure, and more practical. They point out how much the purists do not, and cannot know about the cause and effect relationships of their rigorous studies, and how their “placebo effect” tends to cure more ills than their pills.

Who Will Win?

Despite EBM’s proven ability to provide society with quantitative answers about costs and effectiveness, the plain nature of purist science (for instance, the scientific method of merely proving the negative, Popperian theory, and such) doesn't lend itself or its proponents as decisively authoritarian as were the Shamans of old. An apparent cold and callused, mere prediction is not always what society wants to hear.

The edge for the purists of EBM is that the capitalistic nature of our social healthcare system cannot in wisdom base financial decisions without a sense of mathematically valid data. Therefore, the purists of EBM currently have most of the money, or at least more credibility among those with the money.

The subtle edge that the relativists have is that they may be better able to see how science drives public policy and social attitude, and are more capable of using this to their advantage. They are better able to influence the masses and direct the mob, so to speak. Perhaps they better understand the role of the Shamans of old.

Conversely, the bane of the medical relativists, as Sokal very well demonstrated, is that their scientific views or conclusions can't maintain the intellectual integrity that they very often portray. There is some tendency that their scientific suppositions and theories of cause and effect, much like the ancient Shamans, often require an allowance for the existence of the super-natural, can be mathematically shown to be essentially implausible, or simply boil down to a jargon of pseudo-science similar to Sokal’s spoof article in Social Text.

The medical science war continues to wage on within our courtrooms, legislative sessions, campaign trials, and budget meetings. The medical science wars will be won by whatever point of view best provides that which society demands (or is perceived to demand) of its system of healthcare. Should society demand the socially influenced answers of a Shaman, it will seek out a relativist. Should society require the cold hard predictions of a scientist, it will look to a purist. More likely than not, society will take the answer that suits the current need, and then sell it as either the relativistic feel-good choice, or the purist’s mathematically calculated best choice, or both, regardless of from which side it originates.

To the Victor go the Spoils

It is an understatement to say that there is much at stake in the medical science war. The influence that medical science has on markets, public and social policy, and the power it has in commerce threaten to totally alienate the true purpose of the original intent. The actual health and well-being of humankind becomes all but lost to ulterior motives and money-based agendas. This insight can cause anyone to become dismayed at the prospect of being misled or cheated in any personal attempt to rid oneself of disease, or to surrender any altruistic ideals of creating a healthier society. However, one must not loose sight of the ability to understand the motives behind the participants in the medical science wars, and true intent of medical science to improve health.

There is an epic individual obligation in choosing a relativistic approach or a purist approach to any given medical science issue. In making the choice, it is important to remember that the basic difference between the two resides in philosophy that may be based on an ideal of what is right or wrong, or for better or for worse. Given the situation, does the decision require the advice of a respected Shaman or relativist, or that of a scientific purist? Is the true hope for a pill to make one thin, or a better understanding of obesity? Is the true priority the feel-good approach to coping with cancer, or the best way to rid a tumor from the body? This kind of inner understanding can challenge some long-held beliefs, but is essential in making the proper choice.

The second obligation in making a choice is to understand how answers are presented, and the influences, motives and integrity of anyone with an answer. The decision-making individual must learn and recognize marketing psychology, fallacies of logic, and human tendencies. A part of this is to recognize how both one’s own common sense and emotions can be manipulated equally as well as scientifically derived statistics to wrongly convince a point.
The individual’s, and therefore society’s understanding of science from a contrasting relativistic and a purist point of view ultimately drives how medicine is practiced. Only through wise understanding of science and how it is used can the individual avoid adverse influences and pitfalls inherent in the marketing and commerce of medicine. Thus, there is a tall order for knowledge demanded upon the individual consumer of health care if society is to continue to advance its overall health.

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