"Scientific Medicine" dates from William Harvey in 1628. (It directly inspired "scientific economics". Dr François Quesnay, a French physician created his Tableau Économique in 1759 as a direct analogy with Harvey's circular flow model of the circulatory system.) Can we say that all cures carried out since Harvey's day in the name of scientific medicine have been effective? If not, how can we assert that some of today's scientific cures will not seem like barbaric travesties tomorrow? We only have to think of Janet Frame, and what the doctors wanted to do to her.

Science involves both theory and experiment. Received theory dominates the wisdom of the scientific establishment. Thus, a medical practice that has been proved, statistically, to be effective but that has no "credible" theory to explain it, is regarded as inferior to a practice based on received theory, even if the treatment based on that theory is less effective. (The economic reforms after 1984 were said to have taken place because the old system worked in practice but not in theory.)

Science - indeed all branches of natural and social science - is notoriously conservative in overturning received theories. To many interests and careers get tied up within an "establishment" based around the received theory.

The case of 3-year old cancer victim Liam Williams-Holloway, on the run with his parents from the medical establishment and the Family Court, is making New Zealanders very uneasy about totalitarian practices that they thought couldn't happen here. The word "science" is being presented to us as a justification for hideous breeches of the civil liberties. Our faith in science is likely to be highly tarnished as a result of the Williams-Holloway manhunt.

A central issue in the treatment of cancer is the role of the immune system. The medical establishment has a received theoretical view of the immune system. That is, the immune system is said to recognise foreign matter, and to activate itself when foreign bodies are detected. From that perspective, the immune system is seen as having little effect on cancer, which is an internal malaise. Chemotherapy, in attempting to kill the cancer, has severe debilitating effects on the immune system.

Alternative therapies are generally based on healing through the immune system. Thus, alternative practitioners prefer to see patients who have a healthy immune system, and not one disabled by chemotherapy.

The received view of the immune system is now untenable. Science itself has now proved that there is a direct link from the mind to the working of the immune system [PS]. This was the conclusion of a 1997 BBC Horizon documentary, called Mind over Body. Under controlled conditions, people under stress have been shown to have reduced antibodies and white cells in their blood.

Another recent Horizon documentary (Turned on by Danger) discussed a new theory which has ruffled many feathers in the establishment. The new theory claims that the immune response is triggered by whatever the immune system recognises as "dangerous" rather than "foreign". Of course many foreign bodies are dangerous, and are interpreted by the body as dangerous. Some cancers trigger the danger button, while others do not.

Treatments based on this theory seek to use rather than to abuse the immune system. The trick is to find a way of triggering a powerful immune response in cancers which, in themselves, have failed to do so. Interestingly, that's probably what some alternative treatments do. Theory may only now be catching up with past practice based on many years of inductive rather than deductive knowledge. (Also, the new theories suggest that there are much better ways of treating organ recipients than through the anti-rejection drugs that disable their immune systems.)

Another key aspect of the issue relates to the whole spectrum of outcomes that can follow treatment. Broadly speaking, treatment can cure a condition, place that condition on hold, have no effect, or make that condition worse. Further, any treatment can have negative side-effects, positive side-effects, or no side-effects. That's 12 combinations.

Let's assume that chemotherapy on children has a 50% "cure" rate, and an 80% chance of brain damage. By "cure" I mean the complete removal of the disease. Children's - especially very young children's brains - are not fully formed at the time of their chemotherapy treatment. With these odds, the child has only a 10% chance of a cure without brain damage. An alternative treatment, with no side effects, might have a 20% cure rate, a 20% chance of stabilisation and a 60% death rate. The chance of a cure without brain damage is 20%, and the chance of a high quality life is 40% if the stabilised condition can be paused indefinitely.

A rational caring parent or patient might well prefer the outlook promised by the alternative treatment, despite its higher death rate. Does the Family Court have any moral right to override parents who make that choice because the cure rate of the chemotherapy is higher? Will they take any responsibility for the stress that could trigger a relapse of the cancer?

We encourage women carrying Downs Syndrome foetuses to have abortions. If the side effects of chemotherapy are going to have effects on both child and parent that are as significant as the effects of Downs Syndrome, is it not right that side-effects should play an important role in the decision as to which treatment or mix of treatments is most appropriate?

Medical practitioners all need to ask themselves the following purely hypothetical question. What would be their response to an experimentally proven breakthrough that created a very cheap cure for a major disease; a cure that made their current jobs superfluous, and that also meant that they had spent their whole careers making practising a form of medicine that was, at best, ineffective. How many professionals would really welcome such a career-destroying discovery? The sociological history of science suggests that most scientists find any and every excuse to resist a theory that displaces the received theory. Changes to received theory have only really taken place when generations of scientists wedded to the old theory grow old, retire and die.

The medical establishment, which gains much research funding from large companies that are not disinterested in the results, denies alternative practitioners the resources they need to do scientific testing to the level of proof demanded of them. There are other problems relating to the ethics of experimenting on human beings. Given this last problem, it should come as no surprise that many scientific treatments have not been tested exhaustively through double-blind trials. It is actually as hard for the medical establishment to substantiate its claims as it is for alternative practitioners to substantiate theirs. Repeating the word "scientific" like a mantra is not good enough.

It would be nice to see a bit more modesty from both the established "scientific" practitioners and the alternative practitioners. They both play an important role in the contest of ideas, and in the learning about the ways our minds and bodies work, and interact. We can do without the little Hitlers who would rather destroy a family than admit that they might not have all the answers.

Notes:

1. My "Science, Demons and Econophobia" (NZ Political Review, June 1997) contains an extensive discussion on scientific rationalism.
2. In "Out to Please; one of the most powerful cures from ancient times is the placebo" (NZ Listener, 27 February 1999), Noel O'Hare states that "in 1996 the Cancer Journal described the placebo effect as 'the healing force of nature'." A placebo is defined as "a substance, device or procedure that brings improvement to the patient but that has no intrinsic medical value". I might note though, that in the context of double-blind trials, there is no presumption that the placebo - ie dummy or control treatment - has any benefit. In an ideal medical experiment, a significant proportion of the subjects should be taking a such a placebo while fully believing that they are taking the drug being tested. The persons conducting the experiment should not know which of their subjects are taking the placebo treatment. Hence, in a trial, both patient and doctor are blind to the treatment the patient is taking.
3. Jim Allan ["Not all beliefs are valid and worthy", NZ Herald Dialogue, 3 March 1999] uses ridicule rather than scientific criteria to make a point ostensibly about the superiority of scientific procedures. He is really arguing about the virtues of conservatism - of established over novel practices. In the 15th century, Dr Allan would have made a similar defence of Ptolemaic astronomy, rejecting the novel ideas of Copernicus.

© 1999   Keith Rankin

Rankin File | 1999 titles