Rival Standards of Testing in Medical Research

There are lots of debates between what is called establishment medicine and alternative medicine. They have very different strategies in conducting research. Their standards of proof are different.


Establishment medicine relies heavily on what are called double-blind tests. These tests are subject to statistical analysis. But there is a fundamental moral problem with these tests. That problem is the placebo.

The tests have randomness as the criterion of truth. If a particular procedure is going to be proven to be both a safe and effective, it has to be compared with something. It does no good to compare it with a procedure known to be dangerous. Nobody is going to be allowed to conduct an experiment based on a dangerous procedure. Anyway, not many experiments will be allowed to be conducted this way.

So, what is the standard? The standard is randomness. Randomness is assumed to be the result of the placebo. The placebo may work in some cases, but if the study is detailed, and in some way is corrected for the famous placebo effect, then the outcome should be random. Some people get better. Some people will say the same. Some people will get worse. There will be no pattern to these three outcomes. In other words, they will be random.

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Because conventional medicine establishes randomness as the criterion of truth, it is forced to conduct large-scale tests in order to demonstrate effectiveness and safety, based on the law of large numbers. A new procedure or drug will have winners and losers, but the people running the experiment want to be able to show that the winners outnumber the losers in a statistically significant way. Statistically significant means compared to randomness.

This means that, in order for conventional medicine to make breakthroughs, at least half of the people who are given access to the experimental procedure will not be helped. Well, maybe because of the placebo effect they will be helped. But they will not be statistically helped. This means that the person who designs the test has sacrificed the health of half the people in the experiment. The person conducting the test knows that some procedure is better than the placebo. If this were true, then all of medicine is a gigantic hoax. But the person running the experiment decides in advance that half the people involved in the experiment will be abandoned to randomness.

Alternative medicine operates differently. Alternative medicine takes in people who generally are at wits end. Everything conventional has failed them, and now they want to get well. So, statistically speaking, alternative medicine does not deal with people who are coming in off the street in a random way. Alternative medicine is conducted by practitioners whose patients are at a dead end. Their concept of proof is that more people are healed than would’ve been the case, had the person never walked in the door. The alternative medicine practitioner can then point to the decisions of conventional practitioners. Conventional practitioners had written off these people.

These people have adopted the line I first heard from Murray Rothbard: “When they tell me I’m terminal, I’ll look for a quack.”

The alternative practitioner does not use randomness as the criterion against which his procedure will be tested. He is using death. For certain kinds of diseases, the outcome of victims at a particular stage is known quite well. For example, people who are in stage IV prostate cancer are dead men walking. In five years, 97% of them will have died. In one year, over half of them will have died. Practitioners are well aware of these statistics. So, the alternative practitioner whose patients come in the door in stage IV is proud of a survival rate above 10% five years later. He sees this as evidence of a successful protocol.

Conventional practitioners deny the legitimacy of this claim. Why? Because it is not justified by a double-blind test. But alternative practitioners do not accept the legitimacy of the double-blind test because it condemns half the people who come in the door to death. Well, not quite, but close to it. It goes to the Hippocratic oath: do no harm. If you give somebody a placebo, and you think that there is a treatment that offers greater chance of recovery than a placebo, then you are doing harm.

If a practitioner thinks the placebo recipients are all terminal, and he tells all the participants that they are terminal, fine. But he must not lie. To conduct the test, he must tell them all that they are terminal, and he must believe this. “Nothing else will save your life.”

There is no way around this conflict of criteria. It will mark the debates that go on in five years, 10 years, or a century.

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