Oct 30 2015

TCM on NPR

Journalists frustrate me. Whenever they cover a topic about which I have a fair degree of knowledge, or even expertise, they seem to do a generally poor job. There are excellent journalists out there, but the average mediocre journalist tends to fall for the fallacy of false balance, indulge in hype and sensationalism, overly rely on individual experts who may have quirky opinions, and often fail to put topics into a proper context.

These failings are exacerbated whenever the topic at issue requires critical thinking and a high degree of skepticism.

Even generally high quality news outlets, like NPR, tend to fail when they deal with topics which require both expertise and skepticism, such as alternative medicine. A recent episode of Marketplace with Colin McEnroe is an excellent example of how a generally reasonable journalist can completely fail when dealing with such topics.

The piece was apparently triggered by the recent Nobel Prize for anti-parasite drug discoveries. Tu Youyou shared half the prize for her discovery of artemisinin, an effective drug against malaria. When she was looking for possible candidates and how to prepare them, she relied on traditional Chinese medicine (TCM) texts. As I discussed recently, the prize was not awarded to TCM. Youyou won the award for doing actual science. Her experience actually shows that TCM does not work. The treatments were ineffective and poorly targeted. It took modern pharmacology to develop into an effective treatment.

Proponents of TCM and alternative medicine, and gullible journalists, however, are using the Nobel Prize to fuel another round of promotion of medical nonsense.

The recent NPR episode was particularly bad. The panel was packed with proponents without a hint of even token skepticism. This was a complete journalistic fail. It was a honeymoon interview, presenting anecdotes with a “gee whiz” gushing, and then asking the proponents to give their BS explanation.

All the usual tropes of alternative medicine were there. You can see this in the blurb for the show:

While the award legitimates Chinese medicine in the eyes of some who have long believed in its benefits, others worry that the award dismisses the cultural heritage of Chinese medicine, instead rewarding the very narrow aspects of the work that satisfy a Western definition of what medicine should – and can be. It raises the question of how we judge the legitimacy of medicine.

No, it doesn’t. We have spent over a century exploring and honing our knowledge of how to determine which treatments work and which do not. Going back to pre-scientific superstition is not an answer to anything, except the desire for snake oil salesmen to make more money by exploiting patients.

I want to focus on one theme that the panelists hit often during the program – that there is some validity to the “ancient Chinese wisdom” of TCM. Of course, they talk about “energy” as if Chi is a real thing, even though there is zero scientific evidence that it exists. At one point Mary Guerrera says that medicine already uses energy, electromagnetic energy (EEGs, EKGs, etc.), and that chi is just a different kind of energy.

The appeal to antiquity is woven throughout the show. The idea is that the ancients had a deep knowledge of the body that we lack today. The more you think about this, however, the less sense it makes. First, what passes for TCM today bares little resemblance to TCM of centuries past. If you went to a TCM practitioner 200 years ago, they would have done horrible brutal things to you, not the more gentle “spa” version of TCM that exists today. Acupuncture was just another form of blood letting. The claim that today’s TCM is ancient is therefore largely false (depending on what part you are talking about).

The most naive part of the argument from antiquity is that a pre-scientific culture could somehow come up with an elaborate and accurate system of medicine. This is not an insult, it is not cultural insensitivity – it is just a reality of the human condition.

The ancients had no knowledge of how the body actually worked. Their notions were little more than magical superstitions. On the show David McCallum tries to rescue these superstitions by calling them “metaphors” for real medical phenomena, but this is nonsense. This is little more than apologetics. Calling chi a metaphor does not solve anything.

In any case, how did practitioners hundreds or thousands of years ago figure out that sticking needles (again, they were blood letting, but let’s put that aside) in a particular point would be useful to treat a medical condition. This would be especially difficult when they did not even have a concept of disease, let alone knowledge of what causes specific diseases.

They would have had to rely on uncontrolled observations. Even a careful observer would be overwhelmed by confirmation bias, without the rigorously controlled methods of science. Think about the body of research that would be necessary to establish the 365 classic acupuncture points and their effects. This would be difficult to establish with modern scientific methods. It would be impossible with uncontrolled observations.

You can apply this logic to traditional herbalism as well. There are thousands of traditional herbs and countless combinations. They had no basic science to guide them. Sure, obvious immediate effects could be discovered with simple observation. However, treating actual disease or long term effects would be impossible to discern.

We also know from historical experience that it is possible for professionals to develop an elaborate system of pseudoknowledge, complete with all the trapping of professionalism and even scholarship, that is based entirely on nothing. Astrology is the classic example. Confirmation bias is powerful, and people are fairly creative. We are particularly good at seeing patterns and weaving narratives to explain those patterns, even when they are not real. Confirmation bias then gives us a powerful illusion that the patterns are real, and have explanatory power (because we can see connections).

Once we crawl inside a belief system, it can also be hard to get out. We start to see reality from the perspective of our belief system, and then a new generation is raised taking the belief for granted.

With medicine there is the added layer of placebo effects. Most illnesses are self-limiting, and we are good at convincing ourselves that we feel better when nothing has changed physiologically. If your method is uncontrolled observation, then when dealing with any subjective symptoms everything will seem to work. Everything. Those anecdotes then become powerful confirmation bias for whatever belief system happened to evolve.

Proponents of TCM and other “ancient wisdom” ignore all this. Whether stated explicitly or not, they have to believe that the ancients had some kind of supernatural power. They may use the term “wisdom” but this term just glosses over the fact that nothing short of psychic or divine powers could have discovered the knowledge they claim through uncontrolled observation.

In the end, belief in TCM amounts to belief in magical gurus who have special knowledge about mystical energies invisible to science. Dressing it up as a “metaphor” and looking for incidental physiological markers of stuff happening in the body does not change that.

Of course you will gain of this perspective from listening to the NPR piece. McEnroe (who admits to being a patient of one of the panelists) failed to even raise these issues, let alone explore them. His “journalism” turned into advertising for medical nonsense.

Oh, and by the way, acupuncture has been studied in thousands of clinical trials and it doesn’t work for anything.

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