The tricky distinction between innovative practice and quackery.
The evidence-based medicine (EBM) movement has heralded increased emphasis on basing medical practise on the best available clinical evidence, although as Greenhalgh stated recently, there are problems with the implementation of EBM. It would be a false dichotomy to divide medical practice into evidence-based and non-evidence based; the principles of EBM recognize that there are different levels of evidence.
There are some treatments that are acknowledged as being unproven. All treatments must be unproven at one time, just as all adults were once children. Penicillin and heart transplants were radical new treatments once. It can be argued that in modern medicine, a great deal of work goes into discovering new modalities of treatment, so compounds are not found by the process of trial and error of previous eras. This is not strictly true - although drugs are designed on the basis of known receptors (beta blockers being the first example), new compounds are screened using a number of techniques to assess them for particular effects. Antibiotics are still found by sampling bacteria in various places. So there are still treatments developed where it is not known exactly how they work. Where there is a known mechanism of action, there may be as yet unexplained actions that actually explain the therapeutic effect. For example, statins have an anti-inflammatory effect.
Even where there are logical reasons why a treatment might work, there is still a requirement to demonstrate empirically that it does in fact work. So prior to the completion of definitive trials, all unproven treatment are on an unequal footing.
So how do we distinguish innovative practice from quackery? In some cases, the brand of alternative medicine in question has been investigated extensively and been found to be ineffective. There may be good reasons to suspect that on the basis of the assumptions inherent to the modality or the known science that it will not work. But in the absence of empirical evidence, this cannot be definitive. Although the principles of homeopathy are absurd, nonetheless without good evidence we could not dismiss the possibility that it works. There is good evidence that it doesn't.
However, where the treatment proposed is new, how can we distinguish quackery from bona fide responsible innovation? Really only on the basis of biological plausibility, with all the problems noted above. Only empirical evidence of lack of effect can really divide quackery from medicine. It cannot divide quackery from innovative practice.
There are some treatments that are acknowledged as being unproven. All treatments must be unproven at one time, just as all adults were once children. Penicillin and heart transplants were radical new treatments once. It can be argued that in modern medicine, a great deal of work goes into discovering new modalities of treatment, so compounds are not found by the process of trial and error of previous eras. This is not strictly true - although drugs are designed on the basis of known receptors (beta blockers being the first example), new compounds are screened using a number of techniques to assess them for particular effects. Antibiotics are still found by sampling bacteria in various places. So there are still treatments developed where it is not known exactly how they work. Where there is a known mechanism of action, there may be as yet unexplained actions that actually explain the therapeutic effect. For example, statins have an anti-inflammatory effect.
Even where there are logical reasons why a treatment might work, there is still a requirement to demonstrate empirically that it does in fact work. So prior to the completion of definitive trials, all unproven treatment are on an unequal footing.
So how do we distinguish innovative practice from quackery? In some cases, the brand of alternative medicine in question has been investigated extensively and been found to be ineffective. There may be good reasons to suspect that on the basis of the assumptions inherent to the modality or the known science that it will not work. But in the absence of empirical evidence, this cannot be definitive. Although the principles of homeopathy are absurd, nonetheless without good evidence we could not dismiss the possibility that it works. There is good evidence that it doesn't.
However, where the treatment proposed is new, how can we distinguish quackery from bona fide responsible innovation? Really only on the basis of biological plausibility, with all the problems noted above. Only empirical evidence of lack of effect can really divide quackery from medicine. It cannot divide quackery from innovative practice.
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