Intended for healthcare professionals

Letters

Doctors and complementary medicine

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7242.1145 (Published 22 April 2000) Cite this as: BMJ 2000;320:1145

“Deep model” that is probably true should be used

  1. Mary S Norrie, medical advisor, GS Medical Advisors (Maureen.Norrie{at}onyxnet.co.uk)
  1. 8 Abbey Close, Stockton-on-Tees, Cleveland TS19 7SP
  2. Department of Sociology, Staffordshire University, Stoke-on-Trent ST4 2DE
  3. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    EDITOR—Leibovici suggests that, in the real world with limited resources, “a deep model of the physical world is essential for choosing hypotheses to be tested and for learning from failures.”1 This point is applicable to any area of research, but it makes the assumption that one's deep model of life/the physical universe/whatever is full and accurate. In turn, this implies a certainty we cannot possess. We cannot state that our deep model is certainly true, for it allows only for what we already know and not for what we have yet to learn or discover.

    History is littered with examples of deep models that were later found to be inaccurate or incomplete. In Galileo's time, a deep model held by senior Catholic clergy was that the earth was the centre of the universe. Later, use of an extremely accurate, reliable timepiece to measure longitude at sea for the first time was long delayed because the experts to whom the timepiece was presented held the deep model that no mechanical clock could possibly be sufficiently accurate for this purpose. Modern nuclear physics has probably turned much of the previously held scientific deep model on its head.

    The discovery of penicillin may have owed much to Fleming holding a slightly different deep model from that of his peers—one that resulted in him being open to the possibility that mould was not simply a domestic and laboratory nuisance. And modern day psychotherapy aims to help people identify and correct errors in their own deep model of life.

    It is more valid to consider that our deep model of the physical world is probably (perhaps very probably) true. Such an approach will allow for a degree of caution in decisions on where and how to use our resources in medical (or indeed any other) research, and in evaluating the results. It should also allow for the open mindedness needed when an unexpected and possibly major discovery is in front of our eyes.

    References

    1. 1.

    Are medical dinosaurs heading for extinction?

    1. Peter Morrell, honorary research associate, history of medicine (pmorrlsc{at}stokecoll.ac.uk)
    1. 8 Abbey Close, Stockton-on-Tees, Cleveland TS19 7SP
    2. Department of Sociology, Staffordshire University, Stoke-on-Trent ST4 2DE
    3. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

      EDITOR—Modern medical dinosaurs like Leibovici seem doomed to face a similar fate to that faced by the original dinosaurs when they became extinct.1 Medicine is undergoing rapid change under the impact of complementary treatments and the patients who demand them. How can doctors be more answerable to science than to their patients?

      Leibovici dismisses the abundant evidence in favour of complementary medicine. Admittedly, there is an abundance of the “wrong type” and a dearth of the “right type” to impress clinicians who insist on what is right and wrong. Dictators so detest competition, yet competition is the dynamo of change. Medicine is changing, and complementary medicine is a form of competition.

      Branded an unacceptable medical heresy in the 1850s, complementary medicine has lived in the shadows of science as a professional outcast. Now it returns with public support, and the medical majority has become uncomfortable once again. A threat to clinicians' monopoly of power and a challenge to the entrenched dogmas of medical science, it demands to be accommodated.

      Leibovici uses the term “politically dominant” carelessly. In countries such as India and China it is not true that only scientific medicine is endorsed by governments. Ayurvedic medicine and homoeopathy are popular in India. In China acupuncture and Chinese herbal medicine coexist equally with allopathy. If we are moving into an age of medical pluralism we should ask: on what basis can politicians repeatedly endorse scientific medicine yet deny endorsement to complementary medicine?

      Patients are consulting complementary therapists in increasing numbers. Scientific medicine dominates all medical beliefs and practices, power, finances, research funding, and legal and political muscle. That dominance is being eroded as complementary medicine therapists use public pressure to remould outdated power structures into more pluralistic power sharing. Such a medical metamorphosis will lead to clinicians sharing power, ideas, and patients. If India and China can do it then why not everywhere?

      Patients demand complementary medicine—safe and natural medicine—available everywhere. Whether it is philosophically acceptable or efficacious is irrelevant, as is empiricism. Being ultimately answerable to the public it serves, medicine must adapt and supply these demands; complementary medicine is here to stay. Clinicians' chief benefactors are not scientists or philosophers or, indeed, professors of medicine but patients. Clinicians will ignore their patients at their peril or suffer the same fate as the dinosaurs.

      References

      1. 1.

      Author's reply

      1. L Leibovici, professor of medicine (leivovic{at}post.tau.ac.il)
      1. 8 Abbey Close, Stockton-on-Tees, Cleveland TS19 7SP
      2. Department of Sociology, Staffordshire University, Stoke-on-Trent ST4 2DE
      3. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

        EDITOR—I agree completely with Norrie's definition. The deep model that we use should be regarded as probably true until proved otherwise. The potential to falsify our model or a part of it should be the essential part of any experiment. The problem with hypotheses that cannot be accommodated even at the far fringes of our model is exactly that: experimenting with them does not have this potential.

        The instant when a model stops being a flexible tool for advancement and becomes a harmful dogma is difficult to define. To advocate the use of deep models I should be able to show that my use of the term excludes notorious examples from the past: the defence of the geocentric model by the Catholic church, Lysenco's genetics, race theories. The willingness to admit that our model is probably true until proved otherwise, and that nothing in it is sacred, is probably the best defence. However, to falsify the model we must use one.

        Morrell's main point seems to be that modalities of treatment should not be tested by efficacy and philosophical (and moral) acceptance but by some sort of public acclaim. I would guess that not only I but most of my patients and colleagues will opt for evidence of efficacy and efficiency and for the treatment being acceptable to the patient and the provider of medical care.

        I was always partial to dinosaurs. I hope that Morrell will assign me the role of a brontosaurus, gently browsing the ferns, unaware of the threatening asteroid and the shrew-like mammals waiting behind the scenes tens of millions of years in the future.

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