Statistical inference - invalid research

[Guest guest]

Rory,

 

Off the top of my head, I can think of two approaches for research,

that I think apply to your suggestions:

 

1) Develop a paradigm for the purposes of research. This paradigm

should ideally have enough objectivity to enable two practitioners to

come to the same conclusions about a patient, and carry out the same

treatment. One could even develop a method of tabulating findings,

from questioning, tongue colour, etc., and produce a scale that could

then be used to obtain the units that Emmanuel has pointed out are

missing.

 

Advantages: It is more objective, and research can be reproduced

straightforwardly. Yields information about treatment techniques, and

these techniques can be refined with further research.

Disadvantage: this isn't how CM is practised in reality. Yi, according

to Volker Scheid and Dan Bensky, the most essential aspect of CM, is

factored out. It's essentially a mechanical system of treatment, part

way on the path towards biomedicalisation

 

2) Approach diagnosis and treatment as a black box - essentially, what

goes on in that black box is outside the observation of the research,

and only outcomes are measured.

 

Advantages: reflects how CM treatment is done in practice

Disadvantages:

'Placebo effect' is hard, or impossible, to measure - this may not be

such a disadvantage after all

Research can't be reproduced

One doesn't learn much, or possibly anything, about the treatment

modality itself, besides its overall outcomes

 

Of course, it is important to question how we determine outcomes,

among other things - for example, learning to accept having an illness

could be a positive outcome.

 

As I said before, I hope we can follow through with considering this

topic - feedback (supportive or critical) is welcome.

 

Wainwright

 

 

 

-

" Rory Kerr " <rory.kerr

 

Tuesday, October 28, 2003 1:05 PM

Re: Statistical inference - invalid research

 

 

> At 9:39 AM +0000 10/28/03, wainwrightchurchill wrote:

> >If we accept this heterogeneity in approaches as an important reality

> >about CM, it seems to me that it makes CM increasingly inappropriate

> >for scientific investigation, except perhaps of a very crude kind.

> --

>

> Wainwright,

>

> Depends what you mean by scientific investigation. If you mean double

> blind studies looking at bio-medical criteria, then I agree with you,

> it would not be appropriate. If, on the other hand, you mean research

> on the basis of the science of Chinese medicine in it's own terms,

> then it is appropriate and possible. It is quite possible to factor

> out heterogeneity, for example by making the study of the work of

> only one doctor, or one style, or one type of treatment, or making

> the study disease based rather than pattern based, or studies of the

> prevalence of certain patterns in particular diseases. How about

> comparing the use of a single standard herb formula to treat a (CM)

> disease, and comparing that the same disease using pattern based

> treatment.

>

> In other words, there are plenty of possibilities for research

> completely according to the terms of CM, even allowing for the fact

> that the practice is heterogeneous. Such research could be of value

> to practitioners in clarifying clinical issues, even though not each

> research study would of value to all CM practitioners.

>

> Rory

[Guest guest]

Wainwright, Stephen, Rory, and All,

 

One thing that I think would be nice

to include in the consideration, discussion

design and conduct of research is a bit

of attention paid to why we need research.

 

Is it to serve the third party payers

who want to know whether or not a

particular practice, method, substance,

etc. qualifies for reimbursement

and if so how much?

 

Is it to write dazzling articles in

Time and People that will drive in

the teeming masses begging for this

that or the other procedure?

 

Is it to be able to stand on the podium

with arrogant doctors and sneer with

satisfaction as we seethe between

clenched teeth that We are every bit

as scientific as You!

 

Who needs proving to?

 

I've been talking to the trees around

here, and they want to go on record

as stating that their meridians need

no defining, to which they added, I

must report, a particularly snitty little

Thank you very much.

 

I believe that the reason boils down

to an attempt to gain marketing advantage,

and there's certainly nothing wrong with

that, now is there?

 

Everyone assumes that scientific proof

will lead to an easy life. That was

the whole assumption of post WWII

America in embracing modernism.

If you can just get it scientific

enough it will, go to the moon, cure

cancer, raise the dead and keep the

paint from peeling.

 

But as always, the unintended consequences

rule and you get endless variations of

that lugubrious scenario in which ten

thousand Einsteins write ten thousand

letters to ten thousand Trumans bleating

like lambs or TS Eliot, That is not what

I meant at all.

 

No one intended the current antibiotic

nightmare, for example. It happened because no

one stopped to realize that selective

breeding of strains of antibiotic-resistant

organisms was the obvious consequence

of a medical strategy that attempted

killing the organism as a way of dealing

with the disease that it is associated

with, which is " causes " . No matter that

on one intended this consequence.

 

Isn't that the kind of thinking that

we want to be supplanting with other

methods that make more sense?

 

Doesn't the broader message of Chinese

medicine need to be included in the

marketing materials? Isn't that what

people want?

 

The patient who just recovered is not

primarily concerned with proving that

what just happened to her happened.

 

So I'd like to ask Who needs proof?

 

And why?

 

Might we want to just stop and consider

what might be the unintended consequences of proving

scientifically that Chinese medicine works.

 

The growth in popularity, i.e., the increased

dollar volume in the field, inevitably brings

about the confrontation with mainstream

medical marketing. But how we choose to

deal with that confrontation remains a

matter of free will, at least it was when

I last checked.

 

Do we really not have time to study the

subject adequately?

 

Well, the redwoods are about to launch

an instantaeous method for teaching Chinese

medicine.

 

So stay tuned.

 

Ken