Education And Debate

Alternative (complementary) medicine: a cuckoo in the nest of empiricist reed warblersCommentary: A warning to complementary medicine practitioners: get empirical or else

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7225.1629 (Published 18 December 1999) Cite this as: BMJ 1999;319:1629

Alternative (complementary) medicine: a cuckoo in the nest of empiricist reed warblers

  1. Leonard Leibovici, professor (leibovic@post.tau.ac.il)
  1. Department of Internal Medicine E, Beilinson Campus, Rabin Medical Centre, 49100 Petah-Tiqva, Israel
  2. Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario, Canada L8N 3Z5

    Proponents of alternative medicine can be compared to cuckoo chicks in that they are using false signals to gain nourishment from a legitimate scientific and medical frame. Rather like the reed warbler parent,1 the guardians of this frame are not equipped to recognise loud signals as false.

    Warbler chicks increase both their gapes and calling rates as they grow hungry. When the parent is a reed warbler and the nestling is a cuckoo chick, the cuckoo produces a loud begging signal. The sound not only matches the total calling rate of four warbler nestlings but rises so fast as the cuckoo grows that it soon sounds like eight little warblers. This signal fits overwhelmingly with what the warblers want to hear, if only imperfectly with what they expect to see. Still, it is so clamorous that the warbler parents ignore the missing visual cues and feed the cuckoo chick—to the detriment (and ultimately death) of their own offspring. 1 2

    Summary points

    Empiricists are not equipped to recognise the loud signals of alternative medicine as false

    A deep model of the physical world is essential for choosing hypotheses to be tested and for learning from failures

    Practices of alternative medicine that do not fit even at the far fringes of the model should not be tested in humans

    Our decisions on which practices to test and which to adopt should be based on three things: empirical evidence; our deep model of physical world; and our commitment to the wellbeing of our patients

    Two conceptual frames are relevant to the present discussion. One (the empirical-social construct) is ill equipped to deal with the clamour of alternative medicine. Like the warbler, it ignores the absence of vital cues because of the loud signal. The other frame (the “deep model” empirical one) has deficiencies …

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