The Hot Take Part
I think people I interact with, mostly tech-associated folks in the SF Bay Area, are too skeptical of alternative medicine. (Blogs are for hot takes, right? I can do hot takes.) The correct level of skepticism isn’t “half eaten bagel in a dumpster,” it’s “hole in the wall cash-only shop with no prices and a ‘tourist friendly’ sign.”
The Story Part
When I was 11, I told my pediatrician I had back pain. He asked me to touch my toes and confirmed that my spine was twisty – “scoliosis.” It wasn’t severe, but doc recommended we keep an eye on it. If it got any worse and if the pain was still there in a year, there was a surgery that would straighten it out. Spines are scary, surgeries are scary, and we were spooked.
She took me to a chiropractor, Dr. Wright. On the way there, we joked about how “Wright” was a great name for a chiropractor, and nominative determinism, and Dennis the Dentist. We arrived, and Dr. Wright joked about how “Wright” was a great name for a chiropractor. He also mentioned Dennis. We were not spooked. It was very nice.
Dr. Wright listened to the story about the doctor and the scoliosis and the surgery, looked at my back, and asked if I played any sports. Yes,played for a little league baseball team and played tennis about as seriously as an 11-year-old can. Yes, in fact I did spend most of my time practicing pitching and serving. No, I never did anything more stressful than take balls out of my pocket with my left hand or arm.
As a formality, Dr. Wright put me on a table and played accordion on my spine. But the real diagnosis was to do something with my left arm. I stopped playing tennis, took up swimming and Tae Kwon Do, and never thought about scoliosis again.
The Model Part
If you Google some keywords about alternative medicine and controversy, you’ll find some variation of “If alternative medicine worked, they would just call it medicine.” These people overestimate modern medicine. The state-of-the-art method for deciding which antidepressant to give you is actually “try them in order of increasing side-effect miserableness.”
Modern medicine is a community of practice. It’s very big, and has a few good mechanisms for sharing skills between practitioners: Medical Schools, Studies & Papers, etc. They do this based on a knowledge framework consisting of… a heck of a lot. Biology, Kinesiology, Statistics, all that. Cell model, Germs, Viruses. There’s a massive global effort to expand this body of knowledge and practice. Research, trials, observational studies, conferences. If something works, and works consistently, someone will probably notice, and eventually get around to proving it in a study. Then someone tries to figure out why, and updates Biology accordingly.
This system is amazing and beautiful and responsible for a lot of good, but it’s not perfect. Treatments that only work on a small, hard-to-identify subset of the effected population are hard to prove out. Doing science is expensive, and hard to fund for rare diseases. Treatments that are complicated and have to be fitted specifically to a patient by an expert are hard to scale globally. If something is simple and easy and not part of modern medicine (or nutrition or whatever), it’s very likely fake. But if it only works for some people, or works on a poorly understood part of biology, or is very individualized… well, harder to say.
Identifying Effective Communities of Practice
All the best explanations come in threes, but there are really only two things here, so that’s what you get. Tough.
A Knowledge Framework
Biology + Kinesiology + Chemistry + Germ Theory + … is good, but you don’t need all of it. You don’t actually have to be right to learn. When we thought the Sun and planets orbited the Earth, we still managed to mostly track where planets were going to be, using epicycles. The model was wrong, but if you mashed enough raw information into it, you could still write down what you saw in a way another astronomer could understand.
Consider tennis serving technique. When they’re teaching you how to hit various serves – smash, slice, drop – they hold a ball up in front of you and draw a clock on it. You’re told to hit at various numbers on the clock and go around the back of the ball, to impart spin. It’s nonsense – the ball is going forward, you’re going to hit it right in the middle. The mental image is just there to give you something to say, that both the coach and the player can understand, about what went wrong and what you need to change about the angle of the racket.
I’m not a chiropractor, or an accupuncturist, or a masseuse, or a homeopath, or a faith healer, or a tarot reader. But I hear how they talk about what they do. Chiropractors talk about alignment (aligned is better), homeopaths talk about dilution (less concentration is more potent). As a customer of one of these, ask this: If something somebody tried really, obviously worked, could they explain it in a way they could share? For chiropractors, clearly yes. If Dr. Wright notices that all the baseball players come in with scoliosis, he can say “using one side of your body mis-aligns the spine and causes a nerve pinch in the hip. Fix it by using the other side of your body, to balance it out.” I expect alignment and nerve pinches really exist, but even if they didn’t, the knowledge framework has encoded the symptom and the treatment and can be distributed.
If a homeopath discovers that some herb treats a cough, they can write “A 2C (dilution by 100:1, repeated twice) dilution of lavender brewed in tea treats a watery, hacking cough.” But then the broken knowledge framework damages the observation – if a 2C lavender solution doesn’t work, another homeopath might try a 3C solution, and would then certainly find no effect.
Clearly, it’s better to have a knowledge model that matches reality pretty closely, and to update that model as new discoveries are made. But you can get a long way with a model that’s just sane enough to stay out of your way.
A Knowledge Distribution Channel
The second element to check for is, if someone in a field figured out something that obviously worked, would your personal practitioner have a way to know about it? If the channels are good, then there are probably years of “who knows why it works, but it does!” stored in your practitioner’s mind, ripe for the buying.
Generally, the channel will be a school. Sometimes, as in sports, it’s a network of coaches and seminars and workshops and pro players who go coach high school after they retire. Good running coaches, in my experience, are better sources of information about knee pain that starts while you’re running than General Practitioners! But, as the distribution channel gets weaker, expect the quality of care to get worse – especially among young practitioners.
The Conclusion Part
Basically, it’s possible to know things without the scientific method and PhDs, and people are pretty good at teaching each other stuff. But keep an eye out for whether it’s possible for your practitioner to have done something like that. If possible, get them to tell you about the field. Standard “watch out for obvious high-pressure sales tactics” advice applies. Doctors don’t have a monopoly on being right about stuff.
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Tags: Timeless