Tuesday, September 30, 2014
Science as the Final Authority
This morning there was an interesting interview on NPR with the author of a new book about vaccinations. The interview can be read or heard here: http://www.npr.org/blogs/health/2014/09/30/351242264/vaccine-controversies-are-as-social-as-they-are-medical
The comments on the npr.org website are also very interesting. Below is my contribution to the discussion.
I listened very intently to the interview today with Eula Biss regarding her new book, "On Immunity," regarding vaccination. I, too, am a parent, and I have also had questions about vaccination, on all sides of the question. I agree with Ms. Biss in her borrowed observation that “when you split the difference between information and misinformation, you still end up with disinformation.” However, maybe it is a shortcoming of vocabulary, but the only alternative to “information” is not "disinformation.” Where does “anecdotal evidence” fall in this spectrum? How about “wisdom?” Although I was raised to be a scientist, an intellectual and a skeptic, these approaches alone proved insufficient for fully understanding and managing my life, and I eventually branched out and became a practitioner of breath-centered exercise therapy and an acupuncturist. Some would say this puts me on the side of “disinformation” -- although I would beg to differ, classical Chinese medicine is certainly not scientific medicine, and I'm fine with that.
Ms. Biss blames some of people’s reluctance to vaccinate on a “distrust of the government,” but some people also distrust science, and especially scientific medicine. I myself believe in the scientific method, but scientific medicine is another matter. First of all, when the scientific paradigm shifts, everything that used to be true becomes untrue. This is so patently false that people turn away from, say, the latest scientific advice about a healthy diet, simply because the “truth” is constantly shifting. More aggravating to me, though, as someone whose profession and personal integrity are regularly assailed by people on “scientific” grounds, is the casualness with which even respected and experienced scientists apply the scientific method. As it happens, Ms. Biss employs this same casualness in her own approach to vaccination. In the interview she said, after much rational discussion about the science, economics and politics of vaccinations:
“I would prefer for my son to have as little medical care as possible, as little contact with the medical system as possible. I think vaccination is actually one way to try to help ensure that — making sure that he doesn't get something like pneumonia that might mean a hospital stay, where things will be done to him that will make me uncomfortable or that he will be treated in a way that might feel excessive to me. I think the best way for me to keep him out of that system is to engage in this highly effective preventative medicine.”
I can’t tell you how many people have told me, “I hate pills.” Well, I understand why they feel that way, but it’s an uninformed (or half-formed) and ultimately unconstructive point of view, because sometimes pills will save your life, or make your life better. This is essentially the same thing that Ms. Biss has said regarding her son. Because she fears (or dislikes, or distrusts, or otherwise has a negative opinion of) the “medical system,” she will “only take one” of that system’s strategies in order to avoid using its other recommendations and practices. Never mind that a hospital stay can save her son’s life, she will take this other step, that she can comprehend and that she believes has minimal risk, because she fears the experience of having a child in the hospital. In other words, Ms. Biss’ use of vaccinations for her child is an act of faith, based on her fear of hospitals and the rest of the “medical system.” This is a mother’s prerogative, but it certainly isn’t scientific.
As a body mind spirit practitioner, I have no problem with acts of faith, but I do think you should have some self-awareness, some understanding of how you are living your life and why you are making the choices you make. As a professional whose profession is under frequent attack by proponents of scientific medicine, I don’t feel so generous. If you are going to put all non-scientific points of view on a different and lower level than your own rational, scientific point of view, then have the courage of your convictions and be scientific! And if you are going to occasionally indulge in faith or emotion during a scientific discussion, please understand that this lapse blows your claims of rational, scientific impartiality clean out of the water. You can’t cherry pick the science that appeals to you – you either employ the scientific method in your approach, or you do not.
As it turns out, we are not capable of being purely rational, nor is it desirable – that’s the comic, ironic and profound point of characters such as Mr. Spock on Star Trek, and Sheldon Cooper on The Big Bang Theory. Again, I don’t have a problem with irrational behavior, but I do have a problem with those who castigate, judge or hold themselves superior to others based on the critics’ self-identification as “rational” or “scientific.” The truth of things is that there are many things we don’t understand, as patients and as practitioners, no matter how rational we are. We have to live with that ignorance, but still make the best, most well-informed and most prudent decisions we can about caring for our health, or helping others care for their health. These are not usually black and white decisions, as scientific medicine would sometimes have us believe, but shades of grey decisions, just like the rest of life’s decisions. How do you choose a spouse? Some of it is rational, and some of it is purely feel, smell, touch, instinct, mythology...
In our society, people don’t want to think about many, many things. They don’t want to think about racial inequality, gender inequality, income inequality, the Middle East, the environment… and they don’t want to think about their health. The truth is that you must engage with the world – disengagement is fatal to life. Where your health is concerned, you must keep your critical mind working at every step of the process, even though you may never arrive at “the answer.” Otherwise, you find yourself with a big surprise, a collapse of the paradigm, if you will, after which the vast majority of us become passive recipients of health care, and the scenario that Ms. Biss most fears plays itself out, like a self-fulfilling prophecy. I think it is more useful, when discussing health matters, to encourage engagement and critical thinking while accepting that some decisions will be made on other grounds – faith in the practitioner, your family’s individual needs, a close friend or family member’s experience, or just a gut feeling. Promoting either/or, black and white thinking is unrealistic in this three dimensional world we inhabit, and is unfair to people making difficult yet conscientious decisions about their or their family members’ health. Putting all your faith in “science” or “reason” is no guarantee that you will dodge the reaper, and like all magical thinking, that faith is bound to come undone at some point, when it conflicts with reality. Better to use all your human faculties, among them reason, when making such an important decision as choosing a spouse or choosing a healthcare strategy or practitioner.
By way of full disclosure, my wife and I decided to vaccinate our three sons with every vaccine that has been on the market for at least 15 years. This should help protect them from many known threats, assuages our consciences on the public health front, and perhaps avoids the dangers that can come from diving into new and as yet unproven scientific paradigms. But I consider our actions in this regard to be as much a matter of faith as of reason.
The comments on the npr.org website are also very interesting. Below is my contribution to the discussion.
I listened very intently to the interview today with Eula Biss regarding her new book, "On Immunity," regarding vaccination. I, too, am a parent, and I have also had questions about vaccination, on all sides of the question. I agree with Ms. Biss in her borrowed observation that “when you split the difference between information and misinformation, you still end up with disinformation.” However, maybe it is a shortcoming of vocabulary, but the only alternative to “information” is not "disinformation.” Where does “anecdotal evidence” fall in this spectrum? How about “wisdom?” Although I was raised to be a scientist, an intellectual and a skeptic, these approaches alone proved insufficient for fully understanding and managing my life, and I eventually branched out and became a practitioner of breath-centered exercise therapy and an acupuncturist. Some would say this puts me on the side of “disinformation” -- although I would beg to differ, classical Chinese medicine is certainly not scientific medicine, and I'm fine with that.
Ms. Biss blames some of people’s reluctance to vaccinate on a “distrust of the government,” but some people also distrust science, and especially scientific medicine. I myself believe in the scientific method, but scientific medicine is another matter. First of all, when the scientific paradigm shifts, everything that used to be true becomes untrue. This is so patently false that people turn away from, say, the latest scientific advice about a healthy diet, simply because the “truth” is constantly shifting. More aggravating to me, though, as someone whose profession and personal integrity are regularly assailed by people on “scientific” grounds, is the casualness with which even respected and experienced scientists apply the scientific method. As it happens, Ms. Biss employs this same casualness in her own approach to vaccination. In the interview she said, after much rational discussion about the science, economics and politics of vaccinations:
“I would prefer for my son to have as little medical care as possible, as little contact with the medical system as possible. I think vaccination is actually one way to try to help ensure that — making sure that he doesn't get something like pneumonia that might mean a hospital stay, where things will be done to him that will make me uncomfortable or that he will be treated in a way that might feel excessive to me. I think the best way for me to keep him out of that system is to engage in this highly effective preventative medicine.”
I can’t tell you how many people have told me, “I hate pills.” Well, I understand why they feel that way, but it’s an uninformed (or half-formed) and ultimately unconstructive point of view, because sometimes pills will save your life, or make your life better. This is essentially the same thing that Ms. Biss has said regarding her son. Because she fears (or dislikes, or distrusts, or otherwise has a negative opinion of) the “medical system,” she will “only take one” of that system’s strategies in order to avoid using its other recommendations and practices. Never mind that a hospital stay can save her son’s life, she will take this other step, that she can comprehend and that she believes has minimal risk, because she fears the experience of having a child in the hospital. In other words, Ms. Biss’ use of vaccinations for her child is an act of faith, based on her fear of hospitals and the rest of the “medical system.” This is a mother’s prerogative, but it certainly isn’t scientific.
As a body mind spirit practitioner, I have no problem with acts of faith, but I do think you should have some self-awareness, some understanding of how you are living your life and why you are making the choices you make. As a professional whose profession is under frequent attack by proponents of scientific medicine, I don’t feel so generous. If you are going to put all non-scientific points of view on a different and lower level than your own rational, scientific point of view, then have the courage of your convictions and be scientific! And if you are going to occasionally indulge in faith or emotion during a scientific discussion, please understand that this lapse blows your claims of rational, scientific impartiality clean out of the water. You can’t cherry pick the science that appeals to you – you either employ the scientific method in your approach, or you do not.
As it turns out, we are not capable of being purely rational, nor is it desirable – that’s the comic, ironic and profound point of characters such as Mr. Spock on Star Trek, and Sheldon Cooper on The Big Bang Theory. Again, I don’t have a problem with irrational behavior, but I do have a problem with those who castigate, judge or hold themselves superior to others based on the critics’ self-identification as “rational” or “scientific.” The truth of things is that there are many things we don’t understand, as patients and as practitioners, no matter how rational we are. We have to live with that ignorance, but still make the best, most well-informed and most prudent decisions we can about caring for our health, or helping others care for their health. These are not usually black and white decisions, as scientific medicine would sometimes have us believe, but shades of grey decisions, just like the rest of life’s decisions. How do you choose a spouse? Some of it is rational, and some of it is purely feel, smell, touch, instinct, mythology...
In our society, people don’t want to think about many, many things. They don’t want to think about racial inequality, gender inequality, income inequality, the Middle East, the environment… and they don’t want to think about their health. The truth is that you must engage with the world – disengagement is fatal to life. Where your health is concerned, you must keep your critical mind working at every step of the process, even though you may never arrive at “the answer.” Otherwise, you find yourself with a big surprise, a collapse of the paradigm, if you will, after which the vast majority of us become passive recipients of health care, and the scenario that Ms. Biss most fears plays itself out, like a self-fulfilling prophecy. I think it is more useful, when discussing health matters, to encourage engagement and critical thinking while accepting that some decisions will be made on other grounds – faith in the practitioner, your family’s individual needs, a close friend or family member’s experience, or just a gut feeling. Promoting either/or, black and white thinking is unrealistic in this three dimensional world we inhabit, and is unfair to people making difficult yet conscientious decisions about their or their family members’ health. Putting all your faith in “science” or “reason” is no guarantee that you will dodge the reaper, and like all magical thinking, that faith is bound to come undone at some point, when it conflicts with reality. Better to use all your human faculties, among them reason, when making such an important decision as choosing a spouse or choosing a healthcare strategy or practitioner.
By way of full disclosure, my wife and I decided to vaccinate our three sons with every vaccine that has been on the market for at least 15 years. This should help protect them from many known threats, assuages our consciences on the public health front, and perhaps avoids the dangers that can come from diving into new and as yet unproven scientific paradigms. But I consider our actions in this regard to be as much a matter of faith as of reason.
Tuesday, September 16, 2014
Panic
It's been an alarming time recently. New instability in the Middle East, new confrontations with Russia and new outbreaks of Ebola in Africa. Continued economic hard times, racial injustice and high profile domestic violence here at home. What's an American acupuncturist to do? All the experts say: "Market! Market! Market! Now is the ideal time to take advantage of your patients' fears and worries to sell them on the calming powers of acupuncture!" While it is true that acupuncture can be a great help to people in times of stress, whether extreme trauma (on the battlefield) or quiet desperation (at the dinner table and in the bedroom), it has always seemed despicable to me to take advantage of people when they are at their most vulnerable. Just because I, too, am feeling lots of stress doesn't justify abandoning my principles to take advantage of others.
There was a horrifying sequence of items on the radio this morning. The first dealt with the rise in the incidence of people's wages being garnished and bank accounts being cleaned out by debt collectors, many times due to medical debt. The next story dealt with 2500 authors who have contracts with Hachette Book Group -- Hachette and Amazon are in some sort of corporate feud, so Amazon is making it hard for people to buy these authors' books. Because sales have dropped for some of these writers by 90%, they have gone to Amazon's Board of Directors to try to get some relief, but the response so far has been to say that the authors are "naive." The final story addressed the horrible and sad killing of John Crawford, a young African-American man who was recently shot and killed by two policemen in a Walmart because he was carrying a BB gun... which he had taken off the shelf at the Walmart in order to buy it. I guess I'm naive, too. All of these things seem so completely unfair, but not only that, they seem to be actively anti-life -- like social Ebola. The debt collectors get their vig, Amazon makes a few more percentage points of profit, and the terrified beneficiaries of slavery get to neutralize another dangerous black man. But when no one has any money left, when no authors will bother writing books, and when the African-American community realizes that non-violent civil disobedience isn't working in the 21st century, where will we be then? The current state of haves and have-nots will seem like a golden age compared to the walled compounds that the haves will need and the criminal societies that the have-nots will create if things keep moving in their current direction.
Since this is a blog about acupuncture and I try to stick to that subject, this period reminds me a bit of the Warring States period in Chinese history. For about 250 years, beginning around 475 B.C., there was almost constant war between the different regions and clans of China. In the end, the strongest clan started the modern era of dynasties, but it was as much a result of the exhaustion of all the other states as it was the superiority of this one group that led, finally, to this extended period of "peace." The main accomplishment of all this fighting was the consolidation of centralized political power, but that centralized power belonged to whoever could seize it. So in a way the wars were just more formalized and ritualized -- less peasant blood was spilled on the battlefield, perhaps, but the same few rich and powerful families continued to scheme over who was going to run China. This is where, hopefully, China's story and America's would diverge. We are a democratic republic, not an aristocratic empire, so feuding between the states followed by scheming for control between a few rich and powerful families shouldn't be how our story plays out... should it? I have to say, I don't know. We all know the names of the families, first in the Gilded Age (Rockefeller, Carnegie, Mellon, Astor, Morgan, Roosevelt), then through the mid-century (Koch, Kennedy, Schwab, Hilton, Vanderbilt) and into the modern day (Gates, Trump, Buffett, Harriman, Duke). Maybe it is a natural law that the wealthy and powerful will rise to a more and more dominant position in any society -- I just don't know. But perhaps this is more heart-breaking in a society that is rooted in idealistic and egalitarian concepts such as liberty, justice and the pursuit of happiness.
In any event, back to the question: What's an American acupuncturist to do? I have been as panicked as anyone, and I don't usually panic. But a combination of stresses reduced me to tearful feelings of despondency and worthlessness last weekend. Where's the money going to come from for my family to survive, never mind thrive? What will become of my children? Will my wife and I ever again get to travel, see or make art or otherwise enjoy ourselves? How will we survive old age if I become unable to work before I quickly, conveniently and painlessly die? And if I, a well-educated son of middle class white American privilege am having it this tough, what about all the people in the country and in the world who don't have my advantages? How can I or anyone else expect the less fortunate to simply lie down and accept their lack of a future and the total lack of any hope for their advancement? Why wouldn't my unhappy neighbors on welfare (or a bunch of destitute refugees from [name your country]) decide to get some weapons and come try to take our homes and belongings from us?
Well, tired as it is, the first thing you can do is take a deep breath. And another. Besides the fact that if you survive from one breath to the next cumulatively you are "making it," breathing is mostly associated with the lungs. The lungs are associated with the metal element, which is associated with the autumn. The metal element is also associated with grief, which doesn't sound so great, but wait a minute. The season before autumn is late summer, which we are currently struggling to escape. Late summer is associated with the earth element, which is associated with thought, or pathologically speaking, obsession. Many of us in modern western society, me at the top of the list, tend to over-think things, and to agonize about things over which we have no control. This is not to say that you should just don't worry, be happy, but it is definitely possible to over-think, and indeed, the Chinese made this one of the 5 possible emotional pathogens. So taking a deep breath (or 50) helps to put your mind back in your body, and not let it rattle around alone, isolated and scared inside your head. If you can move around a little, that should help, too. Next, look around and see what is right there in your immediate sphere of influence that you might be able to impact. This can run the gamut from seeking out coupons and sales, to getting a new job, to volunteering or running for office. Finally, acknowledge when your worst fears don't come true. Somehow we have to keep putting one foot in front of the other for 70, 80 or 90 years, and although at times it can seem like there is only quicksand ahead and fire all around, in fact we mostly make it through an entire life. It may not be the life we dreamed of or hoped for, it may not be a life we would recommend to someone else, and it may seem surprising that we were able, at the end, to have survived it all. Yet we do.
In the west we are strivers. That's cool -- I'm a striver, too. But sometimes our efforts to make things better in ourselves, for our families or in the world around us can go over the edge into a frustrated fantasy. Sometimes we don't measure up to the vision we have for ourselves, and sometimes our families and the world around us don't measure up either. This doesn't take away from the miracle of one breath following another, and one foot following another, and one generation following another. Certainly life is sad, terrifying, frustrating, and anxiety-provoking, and certainly it can cause a lot of sleepless nights and worry over what is to come next. But it's still a miracle. And somehow the ancient Chinese figured out that, at this time of year, we are especially likely to obsess about things we can't control.
Me, I've been writing a lot. Emails, blog posts, essays and two novels I'm working on. I don't know if anything will come of it, but it gives me something to do with my mind instead of waiting and worrying for the phone to ring, either with a paying patient or one of my creditors. If any of you have any writing jobs for me to do, I'm open for business. I'll be the guy at this keyboard working on my skills and taking deep breaths. In 2, 3 --- out 6, 7, 8...
There was a horrifying sequence of items on the radio this morning. The first dealt with the rise in the incidence of people's wages being garnished and bank accounts being cleaned out by debt collectors, many times due to medical debt. The next story dealt with 2500 authors who have contracts with Hachette Book Group -- Hachette and Amazon are in some sort of corporate feud, so Amazon is making it hard for people to buy these authors' books. Because sales have dropped for some of these writers by 90%, they have gone to Amazon's Board of Directors to try to get some relief, but the response so far has been to say that the authors are "naive." The final story addressed the horrible and sad killing of John Crawford, a young African-American man who was recently shot and killed by two policemen in a Walmart because he was carrying a BB gun... which he had taken off the shelf at the Walmart in order to buy it. I guess I'm naive, too. All of these things seem so completely unfair, but not only that, they seem to be actively anti-life -- like social Ebola. The debt collectors get their vig, Amazon makes a few more percentage points of profit, and the terrified beneficiaries of slavery get to neutralize another dangerous black man. But when no one has any money left, when no authors will bother writing books, and when the African-American community realizes that non-violent civil disobedience isn't working in the 21st century, where will we be then? The current state of haves and have-nots will seem like a golden age compared to the walled compounds that the haves will need and the criminal societies that the have-nots will create if things keep moving in their current direction.
Since this is a blog about acupuncture and I try to stick to that subject, this period reminds me a bit of the Warring States period in Chinese history. For about 250 years, beginning around 475 B.C., there was almost constant war between the different regions and clans of China. In the end, the strongest clan started the modern era of dynasties, but it was as much a result of the exhaustion of all the other states as it was the superiority of this one group that led, finally, to this extended period of "peace." The main accomplishment of all this fighting was the consolidation of centralized political power, but that centralized power belonged to whoever could seize it. So in a way the wars were just more formalized and ritualized -- less peasant blood was spilled on the battlefield, perhaps, but the same few rich and powerful families continued to scheme over who was going to run China. This is where, hopefully, China's story and America's would diverge. We are a democratic republic, not an aristocratic empire, so feuding between the states followed by scheming for control between a few rich and powerful families shouldn't be how our story plays out... should it? I have to say, I don't know. We all know the names of the families, first in the Gilded Age (Rockefeller, Carnegie, Mellon, Astor, Morgan, Roosevelt), then through the mid-century (Koch, Kennedy, Schwab, Hilton, Vanderbilt) and into the modern day (Gates, Trump, Buffett, Harriman, Duke). Maybe it is a natural law that the wealthy and powerful will rise to a more and more dominant position in any society -- I just don't know. But perhaps this is more heart-breaking in a society that is rooted in idealistic and egalitarian concepts such as liberty, justice and the pursuit of happiness.
In any event, back to the question: What's an American acupuncturist to do? I have been as panicked as anyone, and I don't usually panic. But a combination of stresses reduced me to tearful feelings of despondency and worthlessness last weekend. Where's the money going to come from for my family to survive, never mind thrive? What will become of my children? Will my wife and I ever again get to travel, see or make art or otherwise enjoy ourselves? How will we survive old age if I become unable to work before I quickly, conveniently and painlessly die? And if I, a well-educated son of middle class white American privilege am having it this tough, what about all the people in the country and in the world who don't have my advantages? How can I or anyone else expect the less fortunate to simply lie down and accept their lack of a future and the total lack of any hope for their advancement? Why wouldn't my unhappy neighbors on welfare (or a bunch of destitute refugees from [name your country]) decide to get some weapons and come try to take our homes and belongings from us?
Well, tired as it is, the first thing you can do is take a deep breath. And another. Besides the fact that if you survive from one breath to the next cumulatively you are "making it," breathing is mostly associated with the lungs. The lungs are associated with the metal element, which is associated with the autumn. The metal element is also associated with grief, which doesn't sound so great, but wait a minute. The season before autumn is late summer, which we are currently struggling to escape. Late summer is associated with the earth element, which is associated with thought, or pathologically speaking, obsession. Many of us in modern western society, me at the top of the list, tend to over-think things, and to agonize about things over which we have no control. This is not to say that you should just don't worry, be happy, but it is definitely possible to over-think, and indeed, the Chinese made this one of the 5 possible emotional pathogens. So taking a deep breath (or 50) helps to put your mind back in your body, and not let it rattle around alone, isolated and scared inside your head. If you can move around a little, that should help, too. Next, look around and see what is right there in your immediate sphere of influence that you might be able to impact. This can run the gamut from seeking out coupons and sales, to getting a new job, to volunteering or running for office. Finally, acknowledge when your worst fears don't come true. Somehow we have to keep putting one foot in front of the other for 70, 80 or 90 years, and although at times it can seem like there is only quicksand ahead and fire all around, in fact we mostly make it through an entire life. It may not be the life we dreamed of or hoped for, it may not be a life we would recommend to someone else, and it may seem surprising that we were able, at the end, to have survived it all. Yet we do.
In the west we are strivers. That's cool -- I'm a striver, too. But sometimes our efforts to make things better in ourselves, for our families or in the world around us can go over the edge into a frustrated fantasy. Sometimes we don't measure up to the vision we have for ourselves, and sometimes our families and the world around us don't measure up either. This doesn't take away from the miracle of one breath following another, and one foot following another, and one generation following another. Certainly life is sad, terrifying, frustrating, and anxiety-provoking, and certainly it can cause a lot of sleepless nights and worry over what is to come next. But it's still a miracle. And somehow the ancient Chinese figured out that, at this time of year, we are especially likely to obsess about things we can't control.
Me, I've been writing a lot. Emails, blog posts, essays and two novels I'm working on. I don't know if anything will come of it, but it gives me something to do with my mind instead of waiting and worrying for the phone to ring, either with a paying patient or one of my creditors. If any of you have any writing jobs for me to do, I'm open for business. I'll be the guy at this keyboard working on my skills and taking deep breaths. In 2, 3 --- out 6, 7, 8...
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