This is going to be a mostly reference free blog entry. Mostly a rambling opinion about my biases and opinions about science. And you know what they say about opinions.

I seem to fret an inordinate amount about adjectives. So often they do not belong in front of the nouns found here at the blog. I remain a touch annoyed at the need to put ‘Science-Based’ in front of ‘Medicine ‘ in our title. But given the unneeded and misleading adjectives like complementary and alternative that can also modify Medicine, I see the need. I would have gone with Reality-Based, but that is just me.

As has been noted, what do you call alternative medicine that works? Medicine. Some nouns just should not need modifiers to understand what they represent. So when I received my weekly copy of Science I saw the title of editorial

Time to support Indigenous science

I cringed. First, I wondered, just what is Indigenous science? How does is differ from science? Except for the prefix ‘pseudo’, science doesn’t require a modifier. I read the editorial and, as we will see, it gave neither a definition nor an example as to what constituted Indigenous science.

So I went to the Wikipedia:

Indigenous science refers to the knowledge systems and practices of Indigenous peoples, which are deeply rooted in their cultural traditions and relationships understanding of an Indigenous Nations territory or place.

Knowledge system and practices, while valuable and important, does not science make. So not helpful in seeing why the adjective needs to be added.

Indigenous science is holistic.

Holistic. Of course. Like ‘organic’ or ‘natural’, advertising copy that sounds good but in practice adds nothing to understanding. Usually it means a patina of the supernatural or the spiritual. Again. Ain’t science, more the opposite of science. Doesn’t mean unimportant or lacking value. Just not science. As an aside if you really want holistic, in medicine the only truly holistic practitioner is an infectious disease doctor, who has to understand disease at the molecular through the cell to the organ to the human to the family to the city, country and the world. All others, alternative or real, are posers. Just sayin’.

It follows the same methods of Western science including (but not limited to): observation, prediction, interpretation, questioning

Nothing unique there. These are the methods by which humans have always evaluated their environment. It is how I figured out why my kitchen light wasn’t working. But, again, while part of science, it isn’t science. The same processes have given us homeopathy, Tong Ren and the world’s religions.


Indigenous knowledge and experiences have traditionally been passed down orally from generation to generation.

Like how most human knowledge and experience is passed on. Be it Traditional Chinese Pseudo-Medicine, how be a master carpenter, or how to become a doctor. The most important part of medical education is at the bedside where a more advanced practitioner demonstrates how to obtain a history or do an examination, which they learned at the bedside from their attendings and so on back to the beginning of medicine. An important and valuable way to learn that is not unique in any way to Indigenous people. Look at all the meetings people have. And podcasts. And YouTube. And more. Blah blah blah. If anything, we have more oral information being passed on than ever before. Not necessarily accurate or correct. To determine that, one often needs, hmm, lets see. How about science?

Some societies have supplemented the learning with writing and videos but the passing on of knowledge the person to person through the generations thrives in all societies.

Another site noted that, in contrast, Indigenous science

“… also encompasses such aspects as spiritual experience and relationships with the land.” It is a “way of life, rather than being just the knowledge of how to live, it is the actual living of that life”.

Which is not part of science. Important? Of course. But it ain’t science.

It is why when I read the title, my heart sank. Like alternative medicine, it appears the same mindset is leaking into the sciences.

Why are modifying adjectives superfluous with that particular noun?

I suppose that begs the question, what is Science? The Britannica definition is as good as any:

Science, any system of knowledge that is concerned with the physical world and its phenomena and that entails unbiased observations and systematic experimentation. In general, a science involves a pursuit of knowledge covering general truths or the operations of fundamental laws.

And there is the whole Karl Popper theory of falsification, which is always popular.

But neither is much help in understanding the accompanying editorial.

Because terms used are not defined or used in a sloppy manner. There is Science, whatever that is. There are the numerous disciplines, chemistry or biology or physics, etc. that make up the sciences, plural. Those areas of the pursuit of knowledge to understand the nature of reality. There is the scientific method, whose application and methodologies vary from discipline to discipline. Finally, there is the application of that knowledge, like in medicine or engineering.

All are important, but not equivalent, and used interchangeably in the editorial that follows.

And one last note. My bias is there is one reality, independent of humans. Yeah, yeah, do not give me that multiverse hypothesis or the quantum ideas that human interaction i.e. measurement determines reality. As my quantum mechanics professor noted years ago, what happens at the quantum level doesn’t necessarily occur at the macro level. Fire single watermelons at a double slit, you don’t get an interference pattern of watermelons. You just get a mess,

So US culture notwithstanding, my bias is there is only one reality, as approximated by the sciences and the scientific method. How people respond to that reality or apply scientific knowledge to reality is as varied as there are humans on the planet

Faced with the profound challenges of a rapidly changing environment, society needs other ways of knowing to illuminate a different way forward.

Other ways of knowing. Sigh. Where have I heard that tired trope before? I write this on a computer at 35,000 feet on my way to SoCal to escape the Oregon winter. There is no other way of knowing to keep this plane in the air or the electrons from hitting my screen.

Trofim Lysenko is an example of another way of knowing. Like most alternative ways of knowing, the results were less than satisfying.

Thanks to the leadership of Indigenous scholars and allied collaborators, Indigenous knowledge is receiving long overdue recognition for its potential to provide solutions for the mutual thriving of lands and cultures. An urgent question is how institutions can appropriately support (and not hinder) Indigenous science’s key role in creating a sustainable future.

As Emily Latella would note, that’s different. Knowledge is not Science, and a lot of expertise and knowledge can be obtained without science. I had tremendous knowledge and experience in infectious diseases at the end of my career, none of due to my being a scientist. It is confusing at best to conflate knowledge and science. But they do.

After years of marginalization by Western science, regard for Indigenous knowledge is reaching high places. For example, in 2022, the White House called for elevating such knowledge in research, policy, and land management. This is extraordinary given the United States’ track record of attempted erasure of Indigenous thought through policies of removal and forced assimilation.

Which is, needless to day, entirely appropriate. Humans can have all sorts of specialized knowledge. I recently read a book about wolves, and they discussed how the observations of wolf behavior by Native Americans was now spot on and sophisticated compared to the biologists. But the acquisition of that knowledge ain’t science, and not necessarily correct.

There is a global groundswell of Indigenous-led research on stewardship of lands and waters, providing opportunities for Indigenous and Western knowledges to flourish together.

That is wonderful. The more people and cultures that participate in science, the better.

… The goal is to identify and advance models of ethical and effective integration of Indigenous and Western sciences by creating mutually respectful and reciprocal relationships between them. CBIKS will develop generalizable approaches for a diversity of scientific communities.

What, pray tell, is this Indigenous science of which you speak? Like Eastern and Western medicine? One that works and one that doesn’t? Is there a different methodology?

CBIKS is a prime example of a model that supports research guided by the worldview and priorities of Indigenous peoples around the world. Similar initiatives in Australia, Canada, Aotearoa/New Zealand, and elsewhere are also leading the way. For too long, Indigenous peoples have been fighting for a voice in decisions regarding their lands, waters, and lives. Indigenous-led research efforts will point to different paths forward—those in which Indigenous peoples do not merely have a seat at Western science’s table but are setting research agendas that reflect their priorities and protocols.

No problem here. People should absolutely have a say in what happens in their lands, waters and lives. Different people have different values, they should be respected and considered. But doing so ain’t science.

While celebrating these developments, the responsibility of institutions should not be overlooked. It is crucial that new enthusiasm not take the form of “knowledge mining,” akin to a company suddenly recognizing the value of a previously overlooked mineral, rushing in to extract the ore for its own benefit, and leaving behind toxic tailings. Supporting and engaging Indigenous knowledge first and foremost involves supporting Indigenous communities. Attempts of outside actors to “incorporate” Indigenous knowledge into their own work without full consent of Indigenous communities is highly extractive and undermines the sovereignty of these communities over their own knowledge.

My bias? There is no sovereignty to knowledge. One of the aspects about human knowledge and the sciences is it should be available to all so all can benefit from each other. This seems to be the equivalent of the ever so aggravating paywall that slows or prevents the acquisition of knowledge that could improve patient care. Knowledge of reality belongs to all of us.

Collaborators intent on supporting Indigenous knowledge systems might instead listen, learn, and, if requested, contribute their own knowledge or research resources to communities. They might support local governance sovereignty, the return of expropriated land, and the rematriation of ancestral remains and cultural treasures held in museums, universities, or private collections.

Certainly. But that ain’t science.

Supporting Indigenous-led research also requires addressing the well-documented institutional barriers that limit full participation and visibility of Indigenous worldviews.

Again, worldviews ain’t science, any more than, say, the worldview that the Earth is 6,000 years old is science.

Certain embedded protocols may be at odds with Indigenous ethics, values, and processes. For example, Indigenous-led research is supported by environments where the metrics of success not only include the number of scholarly papers published, but also recognize the enhanced well-being of land and culture.

Patronizing much? I read this paragraph, and the whole editorial, as implying that Indigenous people don’t have what it takes to play in the big leagues, which is nonsense and will only lead to mediocre science and scientists. Understanding reality with the sciences is extremely difficult. Just go through the (to me mostly incomprehensible) papers that make up the content of an edition of Science, I assume a journal that only publishes the best of the best. Amazing stuff. And like any human endeavor, it isn’t easy to be the best of the best. Suggesting some shouldn’t bother or are not up to the task is not the road to success.

Countries must advance policies that support, rather than infringe upon, the wisdom, sovereignty, and rights of Indigenous peoples. To realize the transformative potential of this approach, a climate must be created that values pluralism while protecting sovereignty of diverse knowledges. In this way, solutions can emerge from the symbiosis between Western and Indigenous knowledges that benefit everyone.

Sounds good. Except what is “protecting sovereignty of diverse knowledges”. If you assume, as I do, that there is but one reality, then there is one knowledge, one template for understanding reality and, my bias, it belongs to all humans.

For centuries, Indigenous scientists have had to adapt to, and develop fluency in, Western modes of knowledge making.

Because, um, I don’t know, it works? Its application can suck, no doubt about that. But there is no Western mode of knowledge making, at least not one that has lead the understanding of reality demonstrated every week in the pages of Science. The beauty of science is that at its best, it is one of the few human endeavors that can be universal and whose results can be independent of human culture.

It’s now Western scientists’ turn to learn from, and respect, Indigenous science.

We reach the end and still have no idea this Indigenous science is and how it differs from knowledge acquisition. And respect? That is a curious word. I was taught that respect was something earned on the basis of words and deeds. Everyone gets the benefit of the doubt at the start. Homeopaths, chiropractors and acupuncturists, as an example, have diverse knowledges and some even play at science. If your medical worldview is based on a fiction, the science is at best play, I have no respect for either the worldview or the science. It hasn’t been earned

I was always picky with housestaff in how they described cases, of the opinion that precision of speech represented precision of thought. Knowledge = science?

This would get a fail.

If the headline had read Time to support Indigenous scientists or Time to support Indigenous knowledge, well sure. Of course. Duh.

And how are we to determine if the knowledge and understanding gained by Indigenous peoples is a valid understanding of reality? Science. What else? Because Indigenous people are first and foremost, humans, and so heir to all the biases and flaws of the species. Science is is the only human endeavor that attempts, however imperfectly, to rise of above our biases and flaws, rather than being based upon those flaws and seeks to reinforce, rather than overcome, them.

But instead the editorial presents same old same old nonsense that medicine has endured with SCAM appears to be metastasizing. Science does not need a modifying adjective. So now with science.




  • Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at