ideology and debate\ faith and evidence

[Guest guest]

I do not view faith and evidence as separable categories. Think about the

basic faith that we go by every day, trusting in degrees depending on our

judged reliability of the sources. Should I buy a water filter? What kind

of chair will be good for my back? Should I use lead oxide externally?

:')(My first email face!) Living by what we really " know " is hopeless. We

are constantly making decisions based on degrees of certainty. As the JAMA

guide to reading medical research (which I'm sorry I can't reference right

now but which is excellent reading and should be easy to find) points out,

the studies with the most clinically useful design, the ones to look for,

are those that test caregiver decisions. In the end, a caregiver needs to

make decisions in a clinical setting, and wants to know whether there is a

reliable source of information to guide that decision.

 

When you criticize those with " blind faith, " it's code for the accusation

that their sources of information aren't reliable. If the bottom line in

clinic is how it affects decision-making, than instead of endorsing the view

of a vast dichotomy and the polemic between opposing world views, it makes

sense to me to think about why people accept certain evidence and not other,

and how it leads to one decision over another. " What is my best source of

evidence or most relevant piece of trustworthy information to guide this

decision? " This question can involve so-called traditional, spiritual,

scientific, legal, cultural, as well as social forms of knowledge, methods,

and practices, and cannot be completely represented by any one discipline

alone; these complexities refuse simplification.

 

Some of these decisions can be resolved through simple dichotomies, but just

as " This initial bifurcation of all phenomena was soon replaced by a

two-fold subdivision of yin and yang into yin-in-yin, yang in yin, and yang

in yang, yin-in-yang, and a three-fold subdivision of each into great yin,

minor yin, ceasing yin, and great yang, brilliant yang, minor yang, " , so we

have come to a point where we must use multiple axes of analysis to evaluate

and prioritize the evidence for our decisions (Unschuld, Medicine In China:

Historical Artifacts and Images, Prestel). Further it should be noted that

our decisions are also processed through the patient's own evaluations;

often we are offering options and the patients are making the decisions.

 

As we collectively presume to judge the responsibility (and whose: mine?,

patients'?, schools'? governments'?) implied by these decisions, it's

necessary to admit all the details, avoiding simplifying labels that obscure

particulars.

 

And what of Chinese herbs? What are the most important factors that go into

prescribing-decisions for CM herbal therapy? How useful are the many

publications of varying quality which offer evidence for Chinese herbal

therapy? Which are the best sources? What evidence do we go on when

deciding what deserves clinical study?

 

Sincerely,

 

Jonah Hershowitz