“This Mechanism Is Not Well Understood” – Lacunae in Science

Medline, that key repository of all things biomedical, holds more than 20 million citations.  Of those, over 1 in 200 state variations on one of my favourite sentences in science: today’s title theme (not well, not clearly, not yet, not currently…) – biomedical mechanisms defying science.  Searching Google at  ‘advanced reading level’ (aka ‘so not Yahoo Answers’) , the relevant terms turn up in 29% of indexed pages pertaining to health or science or medicine:  a rough measure to help along a general ‘I wonder’ about the Unknown in science and medicine.

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The ‘mechanism’ in many CAM therapies – notably in homeopathy – ‘is not well understood’.  Skeptics have been trying to transmute this – by media drip feed –  into ‘there is no mechanism’.  Or, as then-US-Defence-Secretary Rumsfeld explained to justify a war: stick with what we can see – ignore the ‘unknown unknowns’.

But even if all placebo-only allegations in relation to complementary therapies held true, would not this too mean homeopathy and other CAM must be ‘better understood’? Placebo is a frontrunner among the mechanisms in healthcare which are barely understood.  So where are the skeptic researchers investigating possible placebo aspects in CAM? Assumption, assertion and strange mud-slinging is all we get.

The louder skeptics in the UK have elevated themselves to a new science police, notably in the current ASA campaign that prompted this blog: persecuting individual practitioners, not large companies.  The ‘multi-million pound industries’ in CAM often cited by skeptic groups consist almost entirely of over the counter sales of vaguely alternative health supplements. Guess who owns Seven Seas, the biggest supplier in this market?  German pharma giant Merck.  Now there’s a really big target…  Yet the one-person CAM practices in little clinics up and down the country are what the right-thinking skeptic aims at.  Advice from the Woo-finder General to his hench-writers: pick anything on your chosen target websites – the ASA is duty-bound to investigate, and your complaint might just stick even if spurious.

One key argument between ‘science’ and ‘homeopathy’ (an arbitrary polarisation much fostered by skeptics) hinges around plausibility.  On whose authority?   Why would someone who readily accepts the wilder reaches of quantum concepts and the possibility of multi-verses, who expects that material proof of the Higgs boson is just around the corner, and doesn’t discount the graviton, insist so strongly that this one modality is simply impossible?  None but the most egg-headed of boffins have even a small proportion of the science pieces they need to puzzle together for themselves what makes sense in the big picture and what doesn’t.  Everyone else… takes it on trust.

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Here’s Brian Cox quoting a contemporary of Hahnemann’s , Humphry Davy – a ‘personal hero’ no less.  So let’s hear it for Samuel Hahnemann, pioneering thinker and embattled scientist, Professor Cox.  But no, he’s gone to the Dark Side: Brian Cox is proud patron of and speaker for those indiscriminate CAM-busters, the ‘Skeptics in the Pub’ movement – that’s the people who hire strategists to enthuse and instruct their acolytes in the art of malicious mass campaigning, the groups who teach debating techniques the better to hammer opponents with spurious ‘logical fallacy’ attacks, in short, the would-be freethinkers whose sole aim is to score points against what they present as rip-off pseudoscience (rolling everything from UFO conspirators to integrated medicine on the NHS into one tidy package).

"Fweee Bwian!"

But still we trust in Brian.  And Ben.  And Simon.  Even that dodgy Edzard with his movie baddie accent.  In spite of clear evidence of bias.  Trust – what a wonderful thing.  Safety, certainty.  If I trust that you tell me the truth, then I need look no further: a lot less hard work.  So if you adopt ‘the facts’ pre-digested from the Messrs Cox and Dawkins (sorry – Professors, to give them their correct, authority-bestowing titles), taking it in good faith that they have worked out the difficult bits you don’t quite get, then life is so much easier.  But isn’t that … just faith?  It certainly isn’t scepticism.

Meanwhile, lacunae of unknowing in the current information base of science and of medicine remain, the voids filled at need with apparently tidy cover stories. Like ‘it’s just placebo’.  Just?  Some things scientists know (and admit) they don’t know.  It’s the ‘unknown unknowns’ they struggle with but – unlike the benighted Rumsfeld – anyone, not just scientists, can embrace and face that completely open uncertainty… that’s how the ‘c’ gets back into scepticism.