Recently there is some controversy about Ayurveda, Homeopathy and alternative Medicine. Many Modern Medicine Doctors and Rational Scientists deride them as pseudoscience.
Some of these attacks are not fair. For example, Ayurvedic and Homeopathic practitioners undergo years long training program. They are registered by a national body and they are authorized to practice their version of Medicine by the Government of India. Any foundational problems has to be taken up with the Government, not the individual practitioners.
Quacks , have to be dealt with severely. Cross- system practice should be banned. Modern Medicine Doctors should stick to evidence –based medicine. There is no leeway for them. They have to adhere to the truth.
But what is truth? What is scientific truth?
We assume that the truth is out there somewhere. Early Philosophers like Aristotle believed that truth can be ascertained by logical arguments. The problem is what is logical may not be true.
All birds walk on two legs.
All mammals walk on four legs.
Man walks on two legs.
Man is a bird.
This is the logic fallacy. Aristotle stated that thinking logically; men will have more teeth than women. The fact was accepted as conventional wisdom for over a thousand years before a few sceptics in the budding age of reason decided to count and see for themselves. I am sure there must have been lot of resistance to the idea. “What! Equal number of teeth? It cannot be!”
But a philosopher who certainly got close to the truth was Pythagoras. Geometry is as close to the truth as you can get. Mathematical truth.
Scientific truth follows these paths:
Mathematical formulation of theories.
Experiment and observation- then inference.
Just observation and inference.
Continuous and constant review by peer experts and revision.
In clinical medicine, there is little mathematical theorisation. So we might as well forget it. The only mathematics routinely used in clinical studies is Statistics. And we cannot do without statistics.
There is NO ABSOLUTE TRUTH in Medical Practice, just like in Biology, Psychology, Mechanical engineering or theoretical physics, Just varying degrees of confidence.
Can we do experiments in clinical medicine? We can study the effect of drugs or chemicals in cultured cells or tissue systems in a test tube (in vitro). We can give medicines to or do surgery on or alter the diet or living conditions of experimental animals like rats and study the effects. This process can be done in human beings also, with strict guidelines, consent, ethical committee approval etc.
These experimental studies are called trials. A Randomised Controlled Trial (RCT) is the most reliable type of trial in which there is randomised allocation of subjects into groups that will receive one intervention and a different or no intervention. It can also be placebo controlled and double blind. Placebo is a benign substance or intervention that has no effect. It is given to the group that is to receive no intervention. Double blind means that neither the patients nor the medical scientists evaluating the study know which group receives which. Then bias can be minimised. RCT or a Meta analysis (Statistical evaluation of many trials) of many RCTs provides the highest level of evidence possible in medicine. It is by no means infallible however.
In studies of lifestyle factors that influence human health and disease, trials have no role. Here we have to rely on pure observation only studies. Simplifying a bit, these are:
Case- control studies- To assess the factors leading to lung cancer, we can take a group of people having the disease and a comparable group of normal persons. Then we can assess how many smoked in each group, how many were exposed to pollution etc, and then compare the differences using statistical methods.
Cohort study- Here we follow-up an entire subset of population and assess characters and habits that might be relevant, on a continuous basis. Then we observe the diseases that develop in that population. Then do the same comparison. This is a better study design, but much more difficult to do.
Descriptive studies- In this we just note the diseases affecting a group, for example of obese people and then compare it with the general population of comparable characteristics.
Expert advice and recommendations of a panel of experts etc comes after these levels of evidence. These are the least reliable in scientific terms. But these are sometimes necessary to consolidate and evaluate the different study results. Conventional wisdom comes under the very bottom. Sometimes it is right, and sometimes not.
Through constant application and thorough audit and review of what we are doing, we get closer to the truth. We also get more effective. The process takes time. Modern Medicine is like any science, similar to an organism, built by incremental processes.
Some truths about health and various attempts at getting to the core of preventive health is interestingly brought out in my book, ‘Health and Happiness Without Bullshit’.
