Editorial
Why Medical Hypotheses does not publish papers from the field of Alternative healing
Bruce G Charlton
Medical Hypotheses 2004; 63: 557-559.
Since I became Editor of the journal, it has been the policy of Medical Hypotheses not to publish theories relating to the field of Alternative (or Complementary) systems of healing. However, given that many other medical journals do sometimes publish such papers, that Medical Hypotheses often publishes highly speculative or ‘unorthodox’ ideas, and also that the journal’s radical perspective might be taken to imply that we welcome ideas from Alternative healing, this policy requires clarification and justification. In particular, it is necessary to describe the specific operational criteria by which Alternative healing is demarcated from medical science for editorial purposes.
Discriminating between medicine and Alternative healing
Medical Hypotheses is essentially a journal of theory, and therefore the editorial problem of demarcation boils-down to discriminating between types of theory. In practice, I find that drawing a line between ‘orthodox’ medicine and alternative therapies is usually straightforward. ‘Science’ is the basis for operationally defining what is ‘Alternative’. For editorial purposes a therapy is defined as ‘Alternative’ when it is based on a non-scientific theory. Orthodox medicine has theories that are based on the causal processes of biological science (with elements of other sciences such as chemistry and physics), while alternative therapies do not have such theories. The theories which underlie Alternative healing have many sources – some are ancient, some religious, some are survivals from historical medical systems, some are modern inventions, and some are modern inventions masquerading as ancient historical medicine; but none of these healing systems have their primary roots in the world of modern medical science as-it-is-practiced.
Clearly, this definition implies that a wide range of unorthodox and unconventional therapeutic interventions – e.g., some uses of plants as medicines – are eligible subjects for inclusion in Medical Hypotheses when the therapy is based on scientific theories. Conversely, conventional therapies would be excluded when the theories proposed are non-scientific. In sum, Medical Hypotheses is open to the publication of scientific theories in the field of bio-medicine, but other types of non-scientific theory lie beyond its scope.
Operational definition of science
The operational definition of ‘science’ being used is therefore one which is descriptive, based on the concept of science as a specialized social system characterized by distinctive processes and recognizable methods of evaluation [1], [2], [3], [4] and [5]. Science is, after several hundred years of evolution, a well-defined and differentiated system, typically quite easily recognized by those who have been trained in it. For example, the theoretical basis of both acupuncture and homoeopathy are non-scientific: acupuncture meridians are not a part of biological science, the homoeopathic law of similars (or ‘like cures like’) is not a part of pharmacology, nor is the homoeopathic principle of increasing potency with dilution a part of chemistry. Regardless of the apparent empirical effectiveness (or otherwise) of these therapies (reports concerning which might legitimately appear in empirically orientated bio-medical journals), the fact that they are founded on theories which depend on non-scientific causal mechanisms means that they count as Alternative; so for a journal of theory they are not a part of science and should not be published.
This is not a distinction between truth and falsehood. Although science, as a social system, is based around public evaluations of ‘truth’ [1], [2], [3], [4] and [5], primary science journals are not in the business of publishing truth [6]. Like all ‘pure’ science journals, Medical Hypotheses publishes ideas for further evaluation. The validation of ideas comes only retrospectively, when other scientists have successfully used the ideas in their work [1]. The crucial editorial question that must be answered is therefore whether published ideas are, in principle, amenable to evaluation by the scientific social system. It is their unsuitability for scientific evaluation, and not their falsity or truth, which causes Alternative healing theories to be rejected by science journals.
Of course, there is a grey area of ‘possible’ science but not-yet-science – and in these instances Medical Hypotheses tends to give authors ‘the benefit of the doubt’. Such papers are editorially evaluated in the usual fashion – so long as the ideas are coherent and potentially interesting. But it is usually easy to differentiate between papers from medicine and Alternative healing because they come from different social systems with different functions and different mechanisms of internal evaluation [5]. To be specific, it seems obvious to me that Alternative healing is not based on scientific theories for the simple reason that it is essentially a branch of New Age spirituality [7].
Alternative medicine as a New Age spirituality
The New Age movement constitutes the largest and most rapidly growing spiritual practice in the contemporary world, having evolved from traditional religion to become especially well-adapted to the conditions of modern societies. The New Age focuses on subjective psychological states such as integration, authenticity and self-expression which are ignored by other social systems including science and medicine [5]. The primary evaluation system of New Age healing is based upon individual subjective feelings and is therefore utterly different from the public ‘objective’ evaluations of social systems such as science [4].
This subjective evaluation system makes New Age healing immune to challenge by science or medicine. New Age validity is a matter of what ‘works for me’; contradiction from other people is re-defined as ‘your truth’ [7]. Individual experience is the ultimate authority, and if an individual claims that they find an Alternative therapy to be effective in achieving subjective spiritual goals such as personal harmony and growth, then there can be no argument from medicine or biology. The wide range of choice, competition and continual innovation in New Age systems of healing ensures that there is little chance of the public becoming habituated or fatigued by the stimuli on offer – there is always something novel to experience [5].
New Age spirituality – including Alternative systems of healing – constitutes a vast resource of ideas and stimuli, and fulfils a range of useful functions. People are free to ‘opt-in’ to the extent that they find ideas helpful, and are free to ignore anything they do not. New Age ideas are published and disseminated widely, for instance in the ‘mind, body and spirit’ sections of bookshops, in the broadcast mass media and on the Internet. But these ideas should not be published in science journals. Medical science and New Age healing systems can coexist quite comfortably and synergistically so long as neither tries to claim supremacy over the other’s proper domain. The parallel growth of modern medicine and the New Age implies that the consumers of Alternative healing use these therapies broadly appropriately: i.e., for the attainment of subjective personal and spiritual goals, and not for the treatment of diseases. The problem seems to arise from a minority of Alternative therapy professionals who attempt to enhance their spiritual expertise with spurious scientific authority publishing derived from their work in the scientific literature.
This analysis implies that ‘orthodox’ medicine and Alternative healing cannot and should not become integrated, for precisely the reason that they are totally different forms of activity with different rules and purposes. To integrate would be to damage what is valuable in each [5]. The gradual separation of science from religion, following the watershed event of the trial of Galileo, was vital to the evolution of effective science – it is also vital to the thriving of modern forms of spirituality which are ever-more-intensely subjective. Consequently there is no point in performing randomized trials of New Age therapies – these will inevitably be inconclusive [8]. When therapeutic ideas are not based on scientific theories, then science cannot legitimately be used to evaluate them, any more than randomized trials can be used to determine the validity of literary criticism or musical appreciation. In such affairs validation is a matter of personal experience.
Of course, spiritual ideas might in principle have empirically beneficial or harmful medical effects – so might reading poetry, playing the guitar, looking at sunsets or watching TV. And if spiritual ideas are harmful, then it might be desirable that this be quantified, in the same way we quantify deaths due to rock climbing or rugby. But ultimately arts and sports, and also Alternative healing using crystals, colours, runes, Feng Shui, homoeopathy, acupuncture, reflexology, flower remedies and so on – should be regarded as self-validating voluntary activities.
New Age spirituality is valuable for some individuals but is obviously not part of the social system of science. Theories of Alternative healing are therefore excluded from Medical Hypotheses, not because of prejudice or hostility, but on the same grounds as papers on literary theory, diplomatic history and plate tectonies are excluded: such theories are beyond the scope of a journal of medical and bio-scientific ideas.
References
[1] D.L. Hull, Science as a process, Chicago University Press, Chicago (1988).
[2] N. Luhmann, Social systems, Harvard University Press, Cambridge, MA, USA (1995).
[3] B. Pokol, Complex society, Co-ordination Office for Higher Education, Budapest (1991).
[4] J. Ziman, Real science, Cambridge University Press, Cambridge (2000).
[5] B. Charlton and P. Andras, The modernization imperative, Imprint Academic, Exeter, UK (2003).
[6] B.G. Charlton, Conflicts of interest in medical science, Med Hypoth 63 (2004), pp. 181–186. SummaryPlus | Full Text + Links | PDF (157 K) | View Record in Scopus | Cited By in Scopus
[7] P. Heelas, The new age movement, Blackwell, Oxford (1996).
[8] B.G. Charlton, Randomized trials in alternative/complementary medicine, QJM 95 (2002), pp. 643–645.
