Guest guest Posted March 28, 2011 Report Share Posted March 28, 2011 Hi Sally, maybe I didn't make myself clear enough - if so - apologies: My concerns were not about the components of EBM and their application (I would not be an expert on that..), but I was trying to make a far more general point about epistemic justification and the coherence of epistemic systems. While some of the content of tradition may be justifiable or even true, _tradition as a concept_ is not a source of justification in and of itself. Just because something is part of a tradition, does not necessarily mean it is justified or true. Tradition is based on testimony, which " is a pervasive and natural source of beliefs " . However, " [t]estimony-based beliefs are, then, source-dependent though not premise-dependent. As a source of knowledge and justification, testimony depends both epistemically and psychologically on other sources. " (Audi, R. 2003. Epistemology - a contemporary introduction to the theory of knowledge. 2nd Edition, p.148) (see * for plainer English below;-) Despite the above, tradition can be an epistemic principle in certain specified circumstances: " If traditional source X, which I believe to be divine revelation/authoritative and therefore true, says y, I am justified in believing y to be true " (e.g. the Bible is a source of justification for believers). My point was that if herbalism was to subscribe to scientific methodologies (such as EBM) whose epistemic principles require _replication and demonstration of causality_ (regardless of source) for a belief to be justified and true (i.e. knowledge), the _content_ of tradition can still be a candidate for being justified true belief. But you cannot use _tradition as a concept_ as an epistemic principle for justification as part of an EBM approach. Doing so would lead to incoherence, and most importantly inconsistent verdicts ( " I am justified in believing y to be true, and I am not justified in believing y to be true " ). I hope I got this across right - this is stuff I've only explored myself in the last few months, and the conclusions of which didn't really suit me at all... But I better not spend more time on this discussion at the moment, as I'm in the last stages of writing up my thesis... Btw, Godwin's law " does not make any statement about whether any particular reference or comparison to Adolf Hitler or theNazis might be appropriate, but only asserts that the likelihood of such a reference or comparison arising increases as the discussion progresses. It is precisely because such a comparison or reference may sometimes be appropriate, Godwin has argued that overuse of Nazi and Hitler comparisons should be avoided, because it robs the valid comparisons of their impact. " (wiki) Best regards, and thanks again for the stimulating discussion, over and out for me unfortunately.. (btw, I also find Charlotte's contributions very useful) Sabine * " source-dependent though not premise-dependent " means it's the source that counts, not the veracity/falsity of the idea itself. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 28, 2011 Report Share Posted March 28, 2011 Dear Sally, beautifully said, your clear light shines, thank you Therri From: Dr S Gascoigne Sent: Monday, March 28, 2011 8:59 AM To: ukherbal-list Subject: Re: Anne's initiative Dear Sally, Thank you for your clear exposition. Absolutely spot on! Regards Gascoigne > > > > The problem is, one either follows an EBM approach or one doesn't. > > NO. EBM is the INTEGRATION of best evidence with clinical > expertise. It is not only using medicines supported by research, it > is rather improving current practice where there is new evidence that > can improve current practice. > > > Even if herbalists were able to argue for a tweaking of existing > > guidelines, > > No, Herbalists are arguing for evidence that is appropriate. Mel > mentioned my pet favourites, case series and outcome studies., cohort > studies (Many GPs I believe, consider these would actually furnish > them with better evidence than DBPCRCTS, as being less expensive, they > can be carried on for longer, avoiding the danger of missing slow > developing side effects, and also can furnish useful evidence on other > practice relevant information. Also, sometimes the conclusion of a > paper or article is really not adequately supported by the data > presented. So well designed and carried out research that has good > external and model valiidity would be good. > > > exclusion criteria have to be applied uniformly, not randomly, > > otherwise you may as well have no exclusion criteria at all. > > What do you mean by " exclusion criteria " Do you mean those decided > upon by someone conducting a systematic review or meta- analysis? The > idea of only using RCTs because of their excellent specificity (I > think of them as like " spotlights " ) is that you feel as if you > understand something, when you have no information on the area outside > your focus (not alternative information or magic - rather important > stuff like the other groups of patients not studied, long term side > effects, the mixtures of drugs commonly prescribed together. > > You need to employ an approach like that of a detective, employing > best available evidence. As Jane Gray said, a RCT is like an > eyewitness in a criminal investigation, pretty good if you can get it, > but if not, you have to intelligently form a picture with the best > evidence you can assemble. Also the eyewitness or RCT is only as > good as its understanding. Much time has been wasted by the dismissal > of the traditional knowledge you so readily dismiss. eg RCTs carried > out using inadequate doses; isolated " active ingredients " that are > inactive without their adjuvant substances, routes of administration > that do not reflect normal practice. (I have recently listened to a > medical education podcast that explained that they are coming to > realise that whole plant extracts and plant combinations are more > effective. This is a case of the traditional view being proved right. > > > > > EBM resolutely rejects tradition and authority as sources of > > justification, and as far as I understand it (from earlier posts), > > you seem committed to tradition. > > I have been astounded by the fact that the critics of herbal medicine > will say this, and then set up authorities of their own , Dawkins, > Singh, Goldacre, etc.......... and the process of peer review > references authority fundamentally references authority.. > > Also Expert opinion is a form of evidence on the Jadad scale. The > Jadad scale when formulated, was intended to be flexible and to be > adapted to the uses it was employed for. Inflexibility implies lack > of understanding and confidence in the system one is using. Science > is all about testing your hypothesis, not clinging to these strange > absolutes you propose. > > Sometimes it seems to me that the antipathy to religion and magical > thinking found in rowdy proponents of science alone is akin to a > religion in itself. There is a view that the human psyche has a need > for belief. Beware the pitfall of filling the vacuum by making > science itself into a religion. (There are signs this may have > already happened ?...... the intolerance to ideas that do not fit, the > rooting out of heresy, the exposition of the one true faith, the high > priests, the high emotion...... > > > As I have found out myself, > > Details please, in what context? And don't forget that the current > interpretation of EBM practice you have encountered may not be the > only or best one. (Sackett, who introduced the concept became very > disillusioned by the way that it developed, and withdrew from > engagement with it) > > > the adoption of EBM will require you to relinquish this commitment. > > One cannot use EBM " as far as it goes " , and then fall back on > > traditional knowledge or intuition when EBM does not come up with > > the goods. > > Actually Sabine, this is exactly what orthodox medicine does, it only > demands evidence for " novel treatments " and for treatments whose > efficacy is in doubt. Research is very expensive, and extremely > competitive. Only areas of high priority, for whatever reason, can > access funding., and views are constantly changing. Science does not > give us " the answer " it just implies the best possible available > answer to a question at the time > > I sometimes think EBM is a bit like a train timetable, if you are > using a route you are familiar with, you don't need to look at the > timetable. If not, or if something has changed, you do. So you keep > up to date with new information on stuff you know about, and if you > encounter something new, you research it thoroughly. > > You seem to be accepting unquestioningly the misconception that herbal > medicine should be treated as wholly " novel " . It is not. Just > because Mainstream medicine and pharmacology may have become > separated from it, and their knowledge of it, it does not need to be > reinvented, as we have kept the careful science and detailed > observation of our forebears in practice continuously since the time > of the physiomedicalists, who incidentally employed evidence based > medicine to abandon the practice of bloodletting at a time when it was > extremely popular with modern medicine. > > Our history is not that of the bloodletting we are sneeringly accused > of wishing to return to, ours is the careful empirical observation and > reflection of the herb doctors who eschewed that debilitating practice > alongside the use of the new wonder drugs calomel lead and antimony. > (And lead ointment was only abandoned in the last century, my > godmother, a wonderful pioneering gynaecologist rather shocked me by > praising its efficacy in pain relief) > > What you dismiss as tradition is the herbalists " clinical expertise " > equally as valid as that of mainstream medicine is in its own field. > > There needs to be an atmosphere of mutual respect. > > Sally Owen MNIMH > > PS I am off now to read " Hidden Histories of Science " edited by > B Silvers, published by Granta, and a copy of which I > fortuitously acquired today. It seems remarkably apposite - " This is > a book about the ways in which science is influenced by culture. It > highlights the misleading images that have distorted our view of the > history of life; it explores the use of darkness and forgetting in > scientific research, and the use of inappropriate mechanistic > metaphors in our understanding of biologic systems; and it considers > the neglect of useful research that does not fit the current > intellectual fashion in science. " > > > best wishes > > > > Sabine (sorry, I had really been determined to say no more on all > > this...) > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 28, 2011 Report Share Posted March 28, 2011 Seconded! > > > > The problem is, one either follows an EBM approach or one doesn't. > > NO. EBM is the INTEGRATION of best evidence with clinical > expertise. It is not only using medicines supported by research, it > is rather improving current practice where there is new evidence that > can improve current practice. > > > Even if herbalists were able to argue for a tweaking of existing > > guidelines, > > No, Herbalists are arguing for evidence that is appropriate. Mel > mentioned my pet favourites, case series and outcome studies., cohort > studies (Many GPs I believe, consider these would actually furnish > them with better evidence than DBPCRCTS, as being less expensive, they > can be carried on for longer, avoiding the danger of missing slow > developing side effects, and also can furnish useful evidence on other > practice relevant information. Also, sometimes the conclusion of a > paper or article is really not adequately supported by the data > presented. So well designed and carried out research that has good > external and model valiidity would be good. > > > exclusion criteria have to be applied uniformly, not randomly, > > otherwise you may as well have no exclusion criteria at all. > > What do you mean by " exclusion criteria " Do you mean those decided > upon by someone conducting a systematic review or meta- analysis? The > idea of only using RCTs because of their excellent specificity (I > think of them as like " spotlights " ) is that you feel as if you > understand something, when you have no information on the area outside > your focus (not alternative information or magic - rather important > stuff like the other groups of patients not studied, long term side > effects, the mixtures of drugs commonly prescribed together. > > You need to employ an approach like that of a detective, employing > best available evidence. As Jane Gray said, a RCT is like an > eyewitness in a criminal investigation, pretty good if you can get it, > but if not, you have to intelligently form a picture with the best > evidence you can assemble. Also the eyewitness or RCT is only as > good as its understanding. Much time has been wasted by the dismissal > of the traditional knowledge you so readily dismiss. eg RCTs carried > out using inadequate doses; isolated " active ingredients " that are > inactive without their adjuvant substances, routes of administration > that do not reflect normal practice. (I have recently listened to a > medical education podcast that explained that they are coming to > realise that whole plant extracts and plant combinations are more > effective. This is a case of the traditional view being proved right. > > > > > EBM resolutely rejects tradition and authority as sources of > > justification, and as far as I understand it (from earlier posts), > > you seem committed to tradition. > > I have been astounded by the fact that the critics of herbal medicine > will say this, and then set up authorities of their own , Dawkins, > Singh, Goldacre, etc.......... and the process of peer review > references authority fundamentally references authority.. > > Also Expert opinion is a form of evidence on the Jadad scale. The > Jadad scale when formulated, was intended to be flexible and to be > adapted to the uses it was employed for. Inflexibility implies lack > of understanding and confidence in the system one is using. Science > is all about testing your hypothesis, not clinging to these strange > absolutes you propose. > > Sometimes it seems to me that the antipathy to religion and magical > thinking found in rowdy proponents of science alone is akin to a > religion in itself. There is a view that the human psyche has a need > for belief. Beware the pitfall of filling the vacuum by making > science itself into a religion. (There are signs this may have > already happened ?...... the intolerance to ideas that do not fit, the > rooting out of heresy, the exposition of the one true faith, the high > priests, the high emotion...... > > > As I have found out myself, > > Details please, in what context? And don't forget that the current > interpretation of EBM practice you have encountered may not be the > only or best one. (Sackett, who introduced the concept became very > disillusioned by the way that it developed, and withdrew from > engagement with it) > > > the adoption of EBM will require you to relinquish this commitment. > > One cannot use EBM " as far as it goes " , and then fall back on > > traditional knowledge or intuition when EBM does not come up with > > the goods. > > Actually Sabine, this is exactly what orthodox medicine does, it only > demands evidence for " novel treatments " and for treatments whose > efficacy is in doubt. Research is very expensive, and extremely > competitive. Only areas of high priority, for whatever reason, can > access funding., and views are constantly changing. Science does not > give us " the answer " it just implies the best possible available > answer to a question at the time > > I sometimes think EBM is a bit like a train timetable, if you are > using a route you are familiar with, you don't need to look at the > timetable. If not, or if something has changed, you do. So you keep > up to date with new information on stuff you know about, and if you > encounter something new, you research it thoroughly. > > You seem to be accepting unquestioningly the misconception that herbal > medicine should be treated as wholly " novel " . It is not. Just > because Mainstream medicine and pharmacology may have become > separated from it, and their knowledge of it, it does not need to be > reinvented, as we have kept the careful science and detailed > observation of our forebears in practice continuously since the time > of the physiomedicalists, who incidentally employed evidence based > medicine to abandon the practice of bloodletting at a time when it was > extremely popular with modern medicine. > > Our history is not that of the bloodletting we are sneeringly accused > of wishing to return to, ours is the careful empirical observation and > reflection of the herb doctors who eschewed that debilitating practice > alongside the use of the new wonder drugs calomel lead and antimony. > (And lead ointment was only abandoned in the last century, my > godmother, a wonderful pioneering gynaecologist rather shocked me by > praising its efficacy in pain relief) > > What you dismiss as tradition is the herbalists " clinical expertise " > equally as valid as that of mainstream medicine is in its own field. > > There needs to be an atmosphere of mutual respect. > > Sally Owen MNIMH > > PS I am off now to read " Hidden Histories of Science " edited by > B Silvers, published by Granta, and a copy of which I > fortuitously acquired today. It seems remarkably apposite - " This is > a book about the ways in which science is influenced by culture. It > highlights the misleading images that have distorted our view of the > history of life; it explores the use of darkness and forgetting in > scientific research, and the use of inappropriate mechanistic > metaphors in our understanding of biologic systems; and it considers > the neglect of useful research that does not fit the current > intellectual fashion in science. " > > > best wishes > > > > Sabine (sorry, I had really been determined to say no more on all > > this...) > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 28, 2011 Report Share Posted March 28, 2011 I agree - thank you Sally. love Jean Re: Anne's initiative Dear Sally, Thank you for your clear exposition. Absolutely spot on! Regards Gascoigne > > > > The problem is, one either follows an EBM approach or one doesn't. > > NO. EBM is the INTEGRATION of best evidence with clinical > expertise. It is not only using medicines supported by research, it > is rather improving current practice where there is new evidence that > can improve current practice. > > > Even if herbalists were able to argue for a tweaking of existing > > guidelines, > > No, Herbalists are arguing for evidence that is appropriate. Mel > mentioned my pet favourites, case series and outcome studies., cohort > studies (Many GPs I believe, consider these would actually furnish > them with better evidence than DBPCRCTS, as being less expensive, they > can be carried on for longer, avoiding the danger of missing slow > developing side effects, and also can furnish useful evidence on other > practice relevant information. Also, sometimes the conclusion of a > paper or article is really not adequately supported by the data > presented. So well designed and carried out research that has good > external and model valiidity would be good. > > > exclusion criteria have to be applied uniformly, not randomly, > > otherwise you may as well have no exclusion criteria at all. > > What do you mean by " exclusion criteria " Do you mean those decided > upon by someone conducting a systematic review or meta- analysis? The > idea of only using RCTs because of their excellent specificity (I > think of them as like " spotlights " ) is that you feel as if you > understand something, when you have no information on the area outside > your focus (not alternative information or magic - rather important > stuff like the other groups of patients not studied, long term side > effects, the mixtures of drugs commonly prescribed together. > > You need to employ an approach like that of a detective, employing > best available evidence. As Jane Gray said, a RCT is like an > eyewitness in a criminal investigation, pretty good if you can get it, > but if not, you have to intelligently form a picture with the best > evidence you can assemble. Also the eyewitness or RCT is only as > good as its understanding. Much time has been wasted by the dismissal > of the traditional knowledge you so readily dismiss. eg RCTs carried > out using inadequate doses; isolated " active ingredients " that are > inactive without their adjuvant substances, routes of administration > that do not reflect normal practice. (I have recently listened to a > medical education podcast that explained that they are coming to > realise that whole plant extracts and plant combinations are more > effective. This is a case of the traditional view being proved right. > > > > > EBM resolutely rejects tradition and authority as sources of > > justification, and as far as I understand it (from earlier posts), > > you seem committed to tradition. > > I have been astounded by the fact that the critics of herbal medicine > will say this, and then set up authorities of their own , Dawkins, > Singh, Goldacre, etc.......... and the process of peer review > references authority fundamentally references authority.. > > Also Expert opinion is a form of evidence on the Jadad scale. The > Jadad scale when formulated, was intended to be flexible and to be > adapted to the uses it was employed for. Inflexibility implies lack > of understanding and confidence in the system one is using. Science > is all about testing your hypothesis, not clinging to these strange > absolutes you propose. > > Sometimes it seems to me that the antipathy to religion and magical > thinking found in rowdy proponents of science alone is akin to a > religion in itself. There is a view that the human psyche has a need > for belief. Beware the pitfall of filling the vacuum by making > science itself into a religion. (There are signs this may have > already happened ?...... the intolerance to ideas that do not fit, the > rooting out of heresy, the exposition of the one true faith, the high > priests, the high emotion...... > > > As I have found out myself, > > Details please, in what context? And don't forget that the current > interpretation of EBM practice you have encountered may not be the > only or best one. (Sackett, who introduced the concept became very > disillusioned by the way that it developed, and withdrew from > engagement with it) > > > the adoption of EBM will require you to relinquish this commitment. > > One cannot use EBM " as far as it goes " , and then fall back on > > traditional knowledge or intuition when EBM does not come up with > > the goods. > > Actually Sabine, this is exactly what orthodox medicine does, it only > demands evidence for " novel treatments " and for treatments whose > efficacy is in doubt. Research is very expensive, and extremely > competitive. Only areas of high priority, for whatever reason, can > access funding., and views are constantly changing. Science does not > give us " the answer " it just implies the best possible available > answer to a question at the time > > I sometimes think EBM is a bit like a train timetable, if you are > using a route you are familiar with, you don't need to look at the > timetable. If not, or if something has changed, you do. So you keep > up to date with new information on stuff you know about, and if you > encounter something new, you research it thoroughly. > > You seem to be accepting unquestioningly the misconception that herbal > medicine should be treated as wholly " novel " . It is not. Just > because Mainstream medicine and pharmacology may have become > separated from it, and their knowledge of it, it does not need to be > reinvented, as we have kept the careful science and detailed > observation of our forebears in practice continuously since the time > of the physiomedicalists, who incidentally employed evidence based > medicine to abandon the practice of bloodletting at a time when it was > extremely popular with modern medicine. > > Our history is not that of the bloodletting we are sneeringly accused > of wishing to return to, ours is the careful empirical observation and > reflection of the herb doctors who eschewed that debilitating practice > alongside the use of the new wonder drugs calomel lead and antimony. > (And lead ointment was only abandoned in the last century, my > godmother, a wonderful pioneering gynaecologist rather shocked me by > praising its efficacy in pain relief) > > What you dismiss as tradition is the herbalists " clinical expertise " > equally as valid as that of mainstream medicine is in its own field. > > There needs to be an atmosphere of mutual respect. > > Sally Owen MNIMH > > PS I am off now to read " Hidden Histories of Science " edited by > B Silvers, published by Granta, and a copy of which I > fortuitously acquired today. It seems remarkably apposite - " This is > a book about the ways in which science is influenced by culture. It > highlights the misleading images that have distorted our view of the > history of life; it explores the use of darkness and forgetting in > scientific research, and the use of inappropriate mechanistic > metaphors in our understanding of biologic systems; and it considers > the neglect of useful research that does not fit the current > intellectual fashion in science. " > > > best wishes > > > > Sabine (sorry, I had really been determined to say no more on all > > this...) > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2011 Report Share Posted March 30, 2011 Ahhhh... > " [t]estimony-based beliefs are, then, source-dependent though not premise-dependent. As a source of knowledge and justification, testimony depends both epistemically and psychologically on other sources. " (Audi, R. 2003. Epistemology - a contemporary introduction to the theory of knowledge. 2nd Edition, p.148) (see * for plainer English below;-) > Thank you for this Sabine, it is the clarification of something I noticed on studying history of medicines, that seems to me to have interfered with its development. - I called it the " cult of personality " and it's clearly exemplified by the influence of Galen and to some extent Paracelsus. A creative mind creates a system of medicine that works, and then all practice references them, becoming distanced from empiric observation, or in the case of Paracelsus, only focussing on one part of their practice, and the practice stagnates, until another personality emerges. This is one reason I think it is so important that herbalists become truly research savvy, rather than regarding it as something seperate, which requires us to set up new experts and authorities in order to understand it. > > My point was that if herbalism was to subscribe to scientific methodologies (such as EBM) whose epistemic principles require _replication and demonstration of causality_ (regardless of source) for a belief to be justified and true (i.e. knowledge), the _content_ of tradition can still be a candidate for being justified true belief. But you cannot use _tradition as a concept_ as an epistemic principle for justification as part of an EBM approach. Doing so would lead to incoherence, and most importantly inconsistent verdicts ( " I am justified in believing y to be true, and I am not justified in believing y to be true " ). I think part of the problem in these discussions is the different interpretations people have of terms, and the value that they ascribe to them. What a doctor would call clinical experience and expert opinion, has somehow become called traditional knowledge(TK) for herbalists, this makes it easier to dismiss, so is unfortunate. Expert opinion is based on clinical experience and does form part of an EBM approach. Also, our training was very much slanted towards equipping us with the tools to test the veracity of the information we were taught. Eg I was taught that Scuttelaria lat and Stachys officinalis are a good combination in patients with headaches. If they hadn't worked, I would have ceased using them. In the transmission of what we have called T K, this process has been endlessly repeated, so it is based both on authority, and truth/veracity. Also regarding values attached to terms, as these discussions have demonstrated, empiricisism has a negative association for some, as it became a term of abuse during the times when the academic norm was Galenic tradition. This may explain why some people have a negative association with it. > I hope I got this across right - this is stuff I've only explored myself in the last few months, and the conclusions of which didn't really suit me at all... But I better not spend more time on this discussion at the moment, as I'm in the last stages of writing up my thesis... Really interesting, thanks. Hope it goes well, care to share the subject of your thesis, or is it under wraps? > Btw, Godwin's law " does not make any statement about whether any particular reference or comparison to Adolf Hitler or theNazis might be appropriate, but only asserts that the likelihood of such a reference or comparison arising increases as the discussion progresses. It is precisely because such a comparison or reference may sometimes be appropriate, Godwin has argued that overuse of Nazi and Hitler comparisons should be avoided, because it robs the valid comparisons of their impact. " (wiki) > True, but, Bad Science denizens do regard it as a sign that a participant has lost the argument. > Best regards, and thanks again for the stimulating discussion, over and out for me unfortunately.. (btw, I also find Charlotte's contributions very useful) > Sabine > > * " source-dependent though not premise-dependent " means it's the source that counts, not the veracity/falsity of the idea itself. Warm regards, Sally > Quote Link to comment Share on other sites More sharing options...
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