Ann Gauger's latest salvo against Dennis Venema's arguments against an original pair of human beings


(Jon Garvey) #458

Phil

Good try, but you forget the character of English general practice, where the vast majority of my work was done. My partners and I looked after the health of 12,000+ registered patients, including being the NHS gatekeepers for all referrals to secondary or tertiary care.

With the exception of those I killed who couldn’t tell tales, or those so angry that they left the list without explanation, you can be sure I got plenty of feedback from my colleagues, as well as from patients seen in many different contexts. Most of my failures were, naturally enough, referred on by myself on routine review.

Only in the last two years, when I ran the district back clinic, did I lose that continuity, but it was some compensation that I could now refer patients to myself (in order, of course, to access the diagnostic and treatment facilities available via the clinic).

The way that clinic turned out as we developed it, it became mostly a chronic back pain facility (cynically, I would suggest, largely because so many patients had received such inadequate initial care from conventional treatment). But as I think about it, a good number of patients referred from the district ended up with a trial of manipulation first, and many responded to the extent of not needing extra treatment. Naturally they received open appointments to return if necessary for the next step.

Also bear in mind that I was not a one-trick osteopath or chiropractor, but a qualified doctor, using, or referring for, all the conventional treatments as I found appropriate. Anything you say about confirmation bias applies equally to every prescription I ever gave, and every session from my in-house physiotherapist. Evaluation by myself, and my partners, and the patients of the “hands-on” treatment was in that context, as about 15-20% of my workload.

I should add that, coincidentally, another GP in my city had learned the same techniques from the same physicians, though our techniques had evolved interestingly differently over the decades. We ended up running a training course in manipulation together. As it happens he was the guy who organised the academic program for the County Medical Committee.


(Phil) #459

. It is notoriously difficult to access these things, and much has been done that is either worthless or harmful in many aspects of medicine until meaningful objective study was done to show its value, I am sure we can agree.


(Jon Garvey) #460

Sure - but the studies need to be done without prejudging the outcomes, and that has not always been the case.


(GJDS) #461

A couple of points may clarify this discussion.

First, on faith.

Hebrews 11:1-4 (KJV) Now faith is the substance of things hoped for, the evidence of things not seen.
2 For by it the elders obtained a good report.
3 Through faith we understand that the worlds were framed by the word of God, so that things which are seen were not made of things which do appear.
4 By faith Abel offered unto God a more excellent sacrifice than Cain, by which he obtained witness that he was righteous,…

You however present your view on faith as [quote=“T_aquaticus, post:457, topic:36790”]
In my view, faith is a belief held in the absence of evidence. An evidence based conclusion and a faith based belief are opposite things that don’t allow you to move freely from one to the other.
[/quote]

So I suggest that the reason we cannot agree is due to our understanding of faith.

Second point, evidence.

A person may give evidence, and this is common in many areas. The response by others is that of “true” or “false” and such a judgement is based on the available facts.

I think your reason is circular - if a person makes a statement involving faith … than automatically you have judged that statement as absence of evidence.

A scientific experiment is usually based on measurements done by a person, who than reports these with sufficient information for other scientists to repeat the experiment. This excludes a large part of human experience and existence. The evidence for our particular case cannot be reproduced no matter how you argue regarding faith - the person’s medical condition disappeared - you only have the diagnosis of the doctor and the statement of his patient.

I am confining my remarks to the case in hand - you however move from a case to judgements on a general area of “faith must exclude evidence”. I suggest it is because you have decided on an erroneous understanding, or meaning of faith.


(Jon) #462

Absence of proof, I suggest, not necessarily absence of evidence.

‘1 complete trust or confidence. 2 strong belief in a religion, based on spiritual conviction rather than proof.’, Concise Oxford English Dictionary (11th ed. 2004).

Proof is a body of evidence which demonstrates a belief or statement to be conclusively true (typically through testing); evidence is a body of facts which provide rational reason for belief, without being conclusive. Faith is belief on the basis of evidence, where actual proof is absent. It is blind faith which is faith on the basis of no evidence at all (the term was coined for a reason).

Here’s a nineteenth century comment on faith for you, from a conservative Christian.

‘Faith is confidence for a reason. Everyone understands faith in this sense, as applied to ordinary matters. It is the same in divine matters. There is no truth in the popular view that places faith outside the confines of reason.’


(Richard Wright) #463

Hello Phil,

What do you mean by charts?

I’m sure you don’t want this topic to go on, I don’t think the uselessness of these, “studies” was fully fleshed out. I’ll start by repeating that they are designed and performed by those under traditional medical paradigm, attempting to prove (or as Jon said, disprove) the efficacy of treatments outside of the paradigm. They are no more useful than those studies trying to see if prayers could heal John Smith, which are loaded with problems, not the least of which is maybe God didn’t want to heal John! The overriding assumption is that medical doctors know everything about physiology.

Digging deeper, though I don’t read the actual abstracts of the studies and could be proved wrong, they seem to me to treat all causes of back pain the same. But I can tell you that pain coming from muscle, facets, and disc/nerves (I could get a lot more detailed than this) and all require different treatments (this goes for chiropractic as well as acupuncture). Further, in the real world of alternative health care treating, one would never do 12 treatments the same way if they weren’t working after 2, 3, or at most 4. If the acupuncturist was competent at all, he/she would try a different system every 4 treatments, tops, if they weren’t getting the desired results.

And while I’m on my soapbox, to show how the AMA (American Medical Association) controls everything health-related in this country, the CDC finally figured out, after almost literally everyone else in the US, within the last year or so that treating back pain with drugs was not a good first choice. They recommended several options, most if not all under the medical umbrella, but astonishingly not chiropractic. How is that possible? The NIH has studies showing that CMT (chiropractic manipulative therapy) with exercises is a cost-effective, non-intrusive modality to help relieve back pain. Thankfully the average American goes for what works and not what poorly designed and executed studies show.

I think I’ve got it all out of my system now. :smile:


(Jon) #464

The distinctive teachings and beliefs of chiropractic are based on an imaginary energy source, and imaginary disorders (see also here). This has been well recognized by responsible chiropractors.

The actual physical benefits of chiropractic are derived from perfectly normal physical manipulations which are already practiced in standard physiotherapy (this is what self-described “rational chiropractors” confine themselves to). The application of chiropractic to infants is of particular concern.


(Jon Garvey) #465

Ah yes - the lag of theory behind practice is pretty common. I lost count of the number of pain patients I saw who were told by GPs their problem was “muscular”, or by emergency-room doctors that it was “musculo-skeletal”. “Which muscles? Which bones?” I would ask them. Imaginary lesions - buyt they got doses of X-rays anyway, routinely. The problem was their paradigm that such pain was biomechanical, and their lack of any knowledge of the neurophysiological mechanisms involved… but that’s not surprising, because that research is relatively recent. Their ignorance never stopped them slagging off the lay-practitioners’ equally erroneous theoretical framework (and similarly efficaceous treatments!). That’s medicine, unfortunately - problems have to be treated however little practitioners actually understand of them.

If we talk about risk to patients, such mechanistic beliefs were shared by many orthopaedic surgeons, who positively resisted pain-clinic management and dived in with the knife on the simplistic notion that if one can see something abnormal on an MRI scan, it’s the cause of the problem. Failed medication or manipulation is one thing - failed surgery is another.

Still, we’ve discussed this as if all the literature discounts manipulation: I see this 2004 NIH metanalysis appears to show slight to moderate benefit over other therapeutic options for most of the conditions it would actually be used for.

Sadly, the number of good trials on neck pain is low (a shame, because that was where I saw most benefit), and no trials of thoracic pain are mentioned at all - an area where so many cases were confused with cardiac, biliary and renal pathology in my experience, resulting in premature investigations and even ineffective investigative surgery.


(Jon) #466

Are you seriously trying to defend the esoteric mysticism behind chiropractic, and claiming that chiropractic subluxations are real? You also appear to be trying to discredit mainstream medical treatment (in keeping with your general suspicion of science), with little more than vague insinuations.


(Jon Garvey) #467

No - I’m just pointing out, as ever, that science is a provisional enterprise. Being mainstream and wrong seems very little more or less blameworthy to me than being peripheral and wrong. You point out enlightened chiropractors have changed their theoretical models: the same mix of willingness and unwillingness to accept new paradigms exists within the mainstream profession.

Don’t forget that I, unlike you as far as I know, actually practised mainstream medicine for an entire career. My practice was working alongside rheumatologists, pain specialists, neurologists, neurosurgeons, physiotherapists, and - when they were willing to work alongside the others - orthopaedic surgeons. I only encountered non-medics when patients had seen them or, when not infrequently, they contacted me for advice. Some were kooks, and most were excellent.

My “vague insinuations” are the voice of experience. Sorry if that upsets your worldview, but actually I’ve no reason to even care!


(Phil) #468

Gee, sorry the topic hit a nerve, so to speak. We can quote conflicting studies all day, to no resolution. Trying to bring it back to something somewhat on topic, it is interesting the parallels between the “soft” science in medicine and religious belief. In evangelical Christianity, personal testimony is often considered the primary argument, and for most the basis of belief, whereas with science, it is discounted and may indicate a direction of study but is not accepted as having much weight.
That leads to conflict, not only in the larger societal sense, but also as individuals who struggle internally with discordant validity measures. It seems our task here in part is to help resolve that conflict. It can be a daunting task.


(George Brooks) #469

@T_aquaticus… don’t you Love this sentence?! It describes the barrier between your camp and everyone rlse!


#470

That leads me to the question of what criteria you use to determine if something is evidence. What types of things would you not count as evidence?

I’m not seeing the circle in this line of logic. Could you point it out? I determine if a statement is based on faith using the definition of evidence I used earlier (i.e. demonstrable, independent), so I guess I am not seeing how that is circular.

As I have stated in other posts, any epistemology is going to limit what is and isn’t evidence. If anything and everything can be evidence then your epistemology is worthless, at least in my view. If there is such a thing as true and false then not all conclusions can be true and not all claims can be true. Also, there is nothing in the definition of evidence I am using that says anything pointing to God is not allowed. I don’t see how my definition is inherently biased against your conclusions.[quote=“GJDS, post:461, topic:36790”]
I am confining my remarks to the case in hand - you however move from a case to judgements on a general area of “faith must exclude evidence”. I suggest it is because you have decided on an erroneous understanding, or meaning of faith.
[/quote]

Then correct my errors. What is a better definition of evidence, and how does it work better than the definition I am using? Do you use this definition consistently, or do you change the definition on a case by case basis?


#471

I am firmly IN the camp of “absence of evidence is not evidence of absence”. That is not a barrier separating us. I fully admit that God could exist, it’s just that I have yet to see evidence for God’s existence which is why I currently don’t believe that God exists. Like I have said previously, I am not rejecting faith based claims. I am only withholding acceptance of these claims until there is evidence to back them.


#472

I completely agree. As described in the post above this one, I am not rejecting faith based claims because they lack evidence. I am only withholding acceptance of faith based claims until there is evidence to back them.

[quote=“Jonathan_Burke, post:462, topic:36790”]
Faith is belief on the basis of evidence, where actual proof is absent.[/quote]

At some point, we are just arguing semantics. Let’s call them Camp A and Camp B. Camp A lacks testable evidence for their conclusions. Camp B has testable evidence that supports their conclusions. I am putting claims about God in Camp A. Call it faith or whatever you want to call it, it really doesn’t matter.


(Jon) #473

Yep I am down with that.

I’m ok with that too. But some religious truth claims are testable, and some of them even have testable evidence. Anyway my main point is that faith isn’t simply belief without evidence. Without proof yes, but not necessarily without evidence.


#474

Like I said before, it depends on how you define faith which makes it a semantic argument. It also depends on how you define evidence.


(Jon) #475

These are standard definitions of faith and evidence I’m using; dictionary definitions for example. Legally, there’s a sharp distinction between evidence and proof, and jurors are able to convict on the basis of evidence without proof, as long as it is “beyond reasonable doubt”. In science of course there’s a similar distinction between evidence and proof.


#476

So am I.

“firm belief in something for which there is no proof ·” Merriam Webster

Proof is being used in the “reasonable doubt” sense in this definition which is the same as evidence.[quote=“Jonathan_Burke, post:475, topic:36790”]
Legally, there’s a sharp distinction between evidence and proof, and jurors are able to convict on the basis of evidence without proof, as long as it is “beyond reasonable doubt”.
[/quote]

I was under the impression that defendants are PROVEN guilty beyond a reasonable doubt.


(Jon) #477

That was literally what I said. So that’s the same definition I gave.

Well I’d rather just read the definition for what it says rather than what it doesn’t say. There’s a lengthy Christian tradition of religious faith as a rational assent based on evidence, and that’s within typical definitions found not only in dictionaries but also philosophical works, as opposed to fideism which is all about belief without (or even despite), evidence and rational thought.

Nope, that’s only the highest level of proof. There are varying degrees of proof which can bring a guilty verdict, like “clear and convincing proof”, down to various levels of “preponderance of evidence”.