by ggex
3 min read

9

Disclaimer: this is my first post and so is extra moderated. For the intended reading experience, kindly skip the next 2 sentences. I am trying to convey: ideas based on broken epistemology can be useful and have working components, and you should not reject them automatically. Similarly, when ideas do work, it doesn't prove the supporting theory correct.

Have you heard the truth about chiropractics? If not, sit down.

They're quacks. Their entire field was created in nineteenth century America by a magnetic healer with no medical training.

I made the mistake then of sharing this with my parents at thanksgiving; their responses were predictable:[1]

"But chiropractics are covered by our insurance." - Well yes, but only because they sued the American Medical Association for anti-trust violations.

"Who is this American Medical Association? Surely the state of the science has advanced since this lawsuit took place.

 -The AMA is exactly what it sounds like: a professional association of physicians in the United States of America. Also this lawsuit was settled in the 1990's; chiropractic was developed in the 1890's.

"Chiropractics are doctors, I'm sure they know more than you do" 

- Ok first - weird ad hominem - of course chiropractors know more about chiropractic than I do, just as clerics know more scripture than you do; this isn't good evidence. Besides, my appeal to authority trumps yours. Yes, they successfully lobbied the American legal system for the title of doctor - arguably this degrades the meaning of the word. Do you take physicians or the American legal system to be the higher authority on matters of health? The physicians aren't convinced.

"I can't believe you would say such a thing. My chiropractor helps me." - And that's where I didn't have a good answer.

Because they were right of course. Going to a chiropractic had helped them. Arguably chiropractic "helps" most as a very clear signal that you are being cared for by your tribe. And perhaps the title of doctor and it's presentation alongside more rigorous practices (ie. physiotherapy or speech therapy) simply makes it a strong placebo. Or just maybe, after years of practice, they have a treatment that sometimes works. Nonetheless it does seem to make people feel better, even if the treatment itself is an offshoot of nineteenth century magnetic healing.[2][3]

Recently I went to a buddhist retreat to learn a little more about the religion. Part of the retreat was spent with a lay buddhist and we got to hear their perspective on the religion. I couldn't help but wonder how someone comes to believe so much spirituality as written. They would talk on how meditation helped them grow as a person and lead to their conversion, but in-between they would mention the karmic cycle or tree spirits as literal facts of reality. I saw some people shift their weight when he mentioned it but no-one asked about it (we were sworn to silence on the temple grounds). When people had many questions about reincarnation, I held my tongue. Whether meditation and mindfulness can help you find inner peace is orthogonal to the karmic cycle.

Don't let your identification as a rationalist stop you from trying things on merely epistemic grounds. Even if the theory is wrong, often these practices may still work. You do not need to accept another's ontology uncritically to accept that their methods work. 

As Feynman said

The witch doctor has a theory that a disease like malaria is caused by a spirit which comes into the air; it is not cured by shaking a snake over it, but quinine does help malaria. So, if you are sick, I would advise that you go to the witch doctor because he is the man in the tribe who knows the most about the disease; on the other hand, his knowledge is not science.


 

  1. ^

    I could be kinder to my parents. These are largely my responses and lines of inquiry. But that makes for a weaker framing sequence.

  2. ^

    This is also not meant as a vindication of chiropractics. Their presentation as anything but alternative medicine is deceptive, as is their use of the title "doctor". I am not arguing whether or not their methods work, but rather, I'm arguing it is reasonable to expect that some of their methods may be beneficial even though chiropractic theory is not supported scientifically.

  3. ^

    I am not claiming you are obligated to try everything. Please continue to use your own ontology to sanity check claims. Can acupuncture relieve muscle pain? It seems plausible. Can chiropractic cure cancer? Almost certainly not.

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Besides, my appeal to authority trumps yours. Yes, they successfully lobbied the American legal system for the title of doctor - arguably this degrades the meaning of the word. Do you take physicians or the American legal system to be the higher authority on matters of health?

The AMA advocates for US physicians, so it has the obvious bias. Adam Smith:

People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.

I do not consider the AMA an impartial authority on matters such as:

  • Are chiropractors doctors?
  • Can AIs give medical advice?
  • How many new doctors should be trained in the US?
  • Can nurses safely provide more types of medical care?
  • How much should doctors be paid?
  • How much training should new doctors receive?
  • Should non-US doctors practice medicine in the US?
  • Should US medical insurance cover medical treatments outside the US?
  • Should we spend more on healthcare in general?

I therefore tend to hug the query and seek other evidence.

"Medicine" is itself an example of the "noncentral fallacy" you criticize: it includes great things like surgery and trauma medicine, vaccination, treatments based on actual understanding of biology like insulin, and  miscellaneous drugs that are claimed to do useful things for mysterious reasons. While there are certainly effective things in that last category, like antibiotics and painkillers, the "epistemics" of the field strike me as pretty shit: if quinine were proposed as a treatment for malaria today, I expect the medical establishment to say things like "that's tree bark juice. You are not a squirrel."

The local flavor of quackery where I grew up was Ayurveda, and my view of the herbal remedies suggested by its practitioners is they're no worse than what they called "allopathy": try the thing, and if it works, it works.

Surely the state of the science has advanced since this lawsuit took place.

Yes, it does. We now have meta reviews which were not common back in 1990.

Cochrane is one of the best sources for metastudies and their read of the scientific evidence for chiropractics is: "The review shows that while combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute and subacute low-back pain, there is currently no evidence to support or refute that combined chiropractic interventions provide a clinically meaningful advantage over other treatments for pain or disability in people with low-back pain."

While it's not shown to be superior to conventional treatment it's also not shown to be without effect. Given that insurance covers a variety of treatments for back pain that are just as effective as chiropractics, the AMA has been essentially shown wrong. 

To me, it's quite strange to advocate "Don't Dismiss on Epistemics" while at the same time ignoring scientific meta reviews on the topic.