Evidence-based Boulevard

Just like the book of love, the road to evidence-based medicine is long and boring. The following is an excerpt from an article on the use of black cohosh as a botanical treatment for menopause and dysmenorrhea. It illustrates the tedious process of coming to a reliable conclusion on not only whether a drug works, but exactly how much is necessary.

In clinical studies before 1996, the dose was […] equivalent to 48–140 mg of black cohosh extract per day. A recent clinical trial comparing two different dosages of Remifemin® (40 mg vs. 127 mg daily), for six months, in 116 women with menopausal complaints, found similar safety and efficacy profiles for both doses (Liske et al., 2002). Based upon the results of this trial, a recommended dose equivalent to 40 mg of black cohosh (dried root) daily is currently recommended (Liske, 1998).

Science vs. Scientism: A Rebuttal

Dr. Christopher Kent, chiropractor and subluxation activist, recently wrote an interesting post about Science vs. Scientism. His basic thesis was that Scientism is the habit of accepting scientific evidence as the only way to understand the world, excluding philosophy, aesthetics, etc. I don't disagree with this premise, but his conclusion - that anyone who fails to accept subluxation or innate intelligence as a valid construct must be adhering to Scientism, not science - seems to be a misconstrual of the scientific process.

[W]e cannot measure innate intelligence. Does this mean that it is not “real” and that we should abandon the concept merely because we have no technology to detect or quantitate it? I think not.

Straw man. Or red herring, I can't remember which.

Scientists do not suggest that we should abandon concepts merely because we don't yet have the technology for it, but rather that we should not blindly accept these hypotheses until we have evidence to support them. Kent mentions previously unproven concepts such as DNA and viruses, suggesting that we never would have benefited from understanding these ideas if it weren't for an open mind accepting ideas outside of what science can quantify. That isn't how science works, as I understand it. We would not have DNA technology if it weren't for the scientific process which has since substantiated it, not because of an acceptance of unproven hypotheses. DNA was accepted as the container of the code of life since Miescher first identified it in the 1860s long before it's structure was discovered circa 1953. But, read Watson's account of him and Crick stumbling upon The Double Helix and you clearly see that the process was one full of struggle, push-back, and incredulity among colleagues. Slowly the scientific community came to agree upon the structure we now accept – but only once the evidence was sufficient.

The concepts of subluxation and innate intelligence have been around for well over 100 years. There has yet to be convincing evidence of its validity as a construct other than anecdotal evidence which may or may not be explained by other well understood mechanisms.

Kent's argument that "doctors must not lose sight of the fact that science may not be the only valid method of inquiry" is accurate but not complete, because science is still the best method of inquiry.

As Carl Sagan shared in Demon Haunted World:

The difference between physics and metaphysics […] is not that the practitioners of one are smarter than the practitioners of the other. The difference is that the metaphysicist has no laboratory.

And so it is with chiropractic. The study of subluxation cannot be conducted in a laboratory, so cannot be considered a science and therefore is not a valid comparison by which to call others out for scientism.