A reader sent me an interesting post from her own blog. It’s well-written, compelling, and betrays an exceptional intelligence. It’s also completely wrong.

The piece is called, “Bias, Racism, and Alternative Medicine”, an intriguing title. The first part tries to establish that “Western medicine” in one of many ways of understanding health and disease. She starts with some personal anecdotes—always interesting, rarely generalizable:

While receiving Western biomedical treatment for ADD, the side effects of my therapy convinced me that western medication alone would not provide a solution to my problems.

One of the author’s fundamental misunderstandings is that the failure of a particular treatment to make her feel better does not invalidate all of medical science, and more important, it does not validate “other ways of thinking”. Still, I can understand how this happens. Personal experience is powerful; unfortunately, it is also misleading. I like this writer. She seems very kind. She goes on to describe her enlightenment further, but this is where a pleasant anecdote goes terribly wrong:

It was because eating the wrong kinds of foods, along with other stressors like studying all night, raises the inflammation of the body.

I worry for her medical soul.

Her statement about inflammation is just flat out wrong. If this is what she’s learned from medical school, she deserves a refund. “Raises inflammation in the body” is simply a meaningless statement. The author is trying to leverage her anecdotes about medical conditions that naturally wax an wane into a general statement about alternative medicine. This is a mistake.

This first part establishes her belief that so-called Western medicine is missing something, and that “other ways” of understanding disease have value. Having established that “Western” medicine doesn’t know everything, she tries to explain why this may be, not on the basis of scientific knowledge, but on the basis of cultural hegemony. Bad idea.

But neither am I in the group of Western medicine trained students or doctors who refuse to see other medical systems in their own rights, and therefore cannot make sense of why patients seek alternative treatments.

This statement rests on a faulty assumption, namely that we “Western” docs have failed to properly examine other medical systems, and have failed to understand why people believe in them.

I understand other systems—they are based on false, vitalistic, pre-scientific beliefs about nature. Understand, that’s not a moral judgment but a factual one. I also understand why people believe in things. We all have our own cultural context, our own baggage. We all wear blinders of one kind or another. I can’t tell you how many minority patients I’ve had who don’t trust doctors because of larger cultural experiences; it’s a lot though. But none of this changes what is biologically so. The fact that the Tuskegee Experiment allowed African American men to suffer and die from untreated syphilis does not change the biology of the spirochete; it changes the relationship of individuals and groups to the system as a whole. Failing to understand this can lead from one kind of neglect (e.g., Tuskegee) to another (e.g., Ayurveda).

An important thing to understand as a scientist (or as an “applied scientist” like a doctor) is that while what we do and how we do it is suffused with cultural biases and stereotypes, the physical reality is not. We may choose to ignore the genetic and cultural reasons that a minority group is more affected by a particular disease, but the genetics do not change. This is something the author has yet to learn:

Why do we lump all of these very different systems and practices of medicine into one category called CAM? What are these alternatives to? Missing from the picture is that CAM is only alternative to a Western biomedical system of medicine, and one form of CAM might be considered an alternative by a practitioner of a different CAM. This Eurocentric attitude, that the traditional Western biomedical system is the epitome of medicine itself, exists in even international organizations like WHO.

The answer to the question, “what are these alternatives to?” is “science-based medicine”, not “hegemonic, Eurocentric medical beliefs”. We consider science-based medicine to be the “default” because it is the one that reflects scientific reality. This doesn’t diminish the important role played by religio-medical beliefs in many people, but it does place them in the proper context: the are quasi-religious beliefs, not scientific ones, and people hold to them for various cultural and economic reasons—important reasons, but not science-based reasons.

Why are Africans and Asians said to use “traditional medicine” but not Europeans or Americans? In America, the Western biomedical system is our tradition.

Actually, our “tradition” has its roots in the vitalistic and humoral beliefs that we held to for most of our history. Our current understanding explicitly rejects these as pre-scientific and rather than forming a new “tradition” sets tradition aside for a reality-based system.

I understand where writing like this comes from. Many voices in this world are not heard, especially voices of women, non-whites, and the poor. These voices are particularly important in medicine, since we do not normally choose to serve only one population (although some do). The historic dearth of women and minorities in the sciences is an important fact, one that needs fixing for many reasons. One of these reasons is that we must serve everyone, and to serve everyone it helps to be everyone. Serving may mean understanding where someone’s beliefs come from, and even respecting these beliefs, but it does not mean endorsing these beliefs. They may be morally equal beliefs, but they are not scientifically equal.

She is right when she says we are biased, but not in what way we are biased:

Have we really recognized our own bias when evaluating a CAM therapy? We haven’t even removed the biggest bias of all, which is to see the Western biomedical system as the one and only valid form of science and medicine, instead of admitting that it is one system among many.

No. Our bias is not failing to recognize other ways of knowing, but in failing to treat other human beings with respect.

Our brave author closes with this:

I cannot comment on the efficacy of each non-Western medical system, because I’m not being trained in any of them, and I don’t have the understanding to praise or criticize those systems. Our version of medical reality has receptors, hormones and nerves, etc. Someone else’s medical reality includes energies, meridians, or doshas. We may be so ingrained in the traditional Western biomedical model that we’re unable to make sense of anything that doesn’t use the same concepts or language. However, many patients accurately see that there seems to be different ways of understanding a health condition, and they will choose the one that makes them feel the best at any given point in time. Even if we can’t accept their logic, we’ll have to accept that traditional medicine from other cultures will gain a stronghold in our population, just as we have imposed our traditional medicine on theirs.

In fact, as a trained physician and scientist, you can comment on “non-Western” systems quite effectively. You are in a special position to do so. This isn’t about “concepts and language” but truth and non-truth. To be better physicians and scientist we must understand why people believe what they do, and we must find ways to help our patients take advantage of real medicine in a way that does not violate their basic values. That is moral. What is not moral is placing other’s health at risk by declaring all knowledge equal but different, or in someone else’s words, “separate but equal”.

Posted by Peter Lipson

Peter A. Lipson, MD is a practicing internist and teaching physician in Southeast Michigan.  After graduating from Rush Medical College in Chicago, he completed his Internal Medicine residency at Northwestern Memorial Hospital. He currently maintains a private practice, and serves as a teaching physician at a large community hospital He also maintains appointments as a Clinical Assistant Professor of Medicine at Wayne State University School of Medicine and at Oakland University William Beaumont School of Medicine, the first being a large, established medical school, the latter being a newly-formed medical school which will soon be accepting its first class of students.  He blogs at White Coat Underground at the Scientopia blog network. A primary goal of his writing is to illuminate the differences between science-based medicine and everything else.  His perspective as a primary care physician and his daily interaction with real patients gives him what he hopes is special insight into the current "De-lightenment" in medicine.  As new media evolve, pseudo-scientific, deceptive, and immoral health practices become more and more available to patients, making his job all that much more difficult---and all that much more interesting. Disclaimer: The views in all of of Dr. Lipson's writing are his alone.  They do not represent in any way his practice, hospital, employers, or anyone else. Any medical information is general and should not be applied to specific personal medical decisions.  Any medical questions should be directed to your personal physician.  Dr. Lipson will not answer any specific medical questions, and any emails and comments should be assumed public. Dr. Lipson receives no compensation for his writing. Dr. Lipson's posts for Science-Based Medicine are archived here.