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And bitch all you want about "western medicine", but if you have a heart attack, or need a kidney transplant, or break a bone - you're probably going to choose

And bitch all you want about "western medicine", but if you have a heart attack, or need a kidney transplant, or break a bone - you're probably going to choose the western system. I think western medicine is excellent when it comes to determining specific details about many individual bits are supposed to be working, and fixing those specific things when they're broken or malfunctioning. It's not as successful when it comes to understanding how all of those specific bits fit into place as part of a larger complex system. There are too many variables and interactions, and we've only very recently had the computational power to create models of these systems, let alone understand them. Where western medicine takes a bottom-up approach, from details to system, non-western medicine usually takes a top-down approach, observing how the overall system behaves and reacts. With enough observations, it can become very good at predicting reactions, but still totally fail at being able to explain why the reactions happen. Take acupuncture: in western medicine, we know that the body has pathways and circulatory systems for blood, lymph, and other fluids, and that our cells communicate using electrical, chemical, and hormonal signals that are passed through the pathways and circuits. We know a lot about small details, like how one nerve cell uses ions to pass an electrical charge across a fluid-filled gap to the next nerve cell, but we don't really know how it all works as a whole. But it stands to reason that poking conductive needles into these pathways and using them to cause stimulation could insert signals into the system or interrupt existing signals. Western medicine can't model that, and it can't predict for sure what possible effects it can have. Without a theory, all we can do is perform random experiments in the dark and hope something noticeable happens. Chinese medicine, on the other hand, has done the random experiments over thousands of years, and has determined specific places to put the needles and how to manipulate them to get the desired effect. That's straight-up observational science. But to explain it the Chinese came up with the idea of qi as an energy that flows through the body, which is vaguely right as a very blurry view of western medicine's understanding of our nervous system and other systems, but mostly it's completely fictional. The point I'm trying to make is that different approaches to understanding can both be right and both be wrong, except they tend to be right and wrong about different parts. The top-down, systemic, wholistic approach is good for understanding the big picture and the 'what', while the bottom-up, componentized, analytical approach is good for understanding 'how'.

brownbat 9y ago
I worry we're falling into a false dichotomy, mischaracterizing both Western and Chinese medicine, which I think actually undermines your broader and better point that it's important to embrace the scientific contributions of others, like those in China. First, you describe Western medicine as detail oriented, or bottom-up, but this creates a false contrast. Western medicine studies all sorts of interactions between systems. Yes, there are tons of specialists, but they all have to study how all the different systems interact in early coursework, precisely because the West does value insights gained from how systems are plugged together, and borrowing techniques from some contexts/scales and applying them in others. The real distinguishing feature between "Western" and traditional medicines, and this is really only a very recent phenomenon in the West, is just the recognition that we constantly, unwittingly, lie to ourselves about what is effective. So we design methods to test results, and throw out things that don't work. If there's one dominant feature of "Western" medicine it's RCTs. But note the scare quotes, included for two reasons: First, the roots of Western medicine have nothing to do with scientific rigor. If anything, the West's medical history was so thoroughly unreliable with ramblings about demonic possession and poisonous snake oil that it made the abundance of quackery obvious, making serious practitioners demand proof for everything. This idea isn't "Western," it's just a natural human reaction when you want better information. Make people prove what they claim. Sure, there are specific tools that help, like randomization and extra controls (placebo, blinds, peer review, etc.). But those aren't "Western" anymore than fire or levers or wheels are regional possessions. They're just working tools anyone can use, and China is using them today. And that gets to the bigger problem here, not the mischaracterization of Western medicine, but reducing China's medical research contributions to "traditional Chinese medicine." Most people unfortunately do this, but it completely undermines the brilliant scientific contributions of modern Chinese researchers, who use the best tools available (like RCTs) to contribute to humanity's scientific knowledge. And note, these aren't traditional Chinese practitioners, just dabbling in Western methods, anymore than Watson and Crick were really exorcists who dabbled with chemistry. It's true that some Chinese research may be inspired by traditional medicines, like Tu Youyou's pioneering work on antimalarial drugs. But what's the root of her contribution? It's not merely popularizing an old remedy that makes her brilliant. She's great because of all the thousands of possible old remedies, she conducted rigorous animal studies to identify one useful treatment. She sorted the chaff from the wheat, and she did the hard work to prove her result, and create conditions that could be replicated. (It would be the wrong lesson to conclude her story validates folk remedies generally. Her story validates rigorous scientific testing. There are so so many worthless folk remedies. Rigorous scientific testing was the useful and unique ingredient here that led to a usable result.) More and more often, others like Junjiu Huang, are conducting groundbreaking stem cell research (a field completely unrelated to traditional medicines). Part of this discussion may stem from discomfort at comparing rigorous modern RCTs with Chinese traditional medicine, maybe a fear that this becomes a cheap way to make China look backwards. But the real problem is the comparison. There's no reason to compare those things. Apples to apples would be to compare traditional Chinese medicine to bleeding and trepanning. Or more recently, while we were well past China's stage of economic development, we were using stuff like preorbital lobotomies and insisting schizophrenia was caused by bad parenting. And those were doctors and hospitals. If you include hobbyists and folk remedies, you get people in the West swinging a dead cat over their head in a graveyard to get rid of warts. You get people faith healing on TV by shouting "demons out!" Once you're satisfied that folk remedies have issues in every country, then compare modern with modern. At the worst, you can criticize some Chinese schools as paper mills. But China's sheer number of researchers means its upper ten percentile is already twice the size of the US top ten, and the number of researchers and quality of research in China are both rapidly improving. The sheer potential is staggering throughout Asia, based on population and how rapidly countries are progressing economically (so they can move larger portions of society out of agriculture and basic industry and into more prestige fields like science). Based on demographics alone, the smart money would be that China will develop more "Western" medical advances in the next 50 years than the West itself. That's what we should be celebrating about Chinese medicine. Not stuff from a thousand years ago, a double standard when we consider Western medical advice from a thousand years ago to be laughable nonsense. But all the real stuff they're doing now, today, and what they will inevitably do in the near future, to push forward the frontiers of not Western but human knowledge.

brownbat 9y ago

I worry we're falling into a false dichotomy, mischaracterizing both Western and Chinese medicine, which I think actually undermines your broader and better point that it's important to embrace the scientific contributions of others, like those in China. First, you describe Western medicine as detail oriented, or bottom-up, but this creates a false contrast. Western medicine studies all sorts of interactions between systems. Yes, there are tons of specialists, but they all have to study how all the different systems interact in early coursework, precisely because the West does value insights gained from how systems are plugged together, and borrowing techniques from some contexts/scales and applying them in others. The real distinguishing feature between "Western" and traditional medicines, and this is really only a very recent phenomenon in the West, is just the recognition that we constantly, unwittingly, lie to ourselves about what is effective. So we design methods to test results, and throw out things that don't work. If there's one dominant feature of "Western" medicine it's RCTs. But note the scare quotes, included for two reasons: First, the roots of Western medicine have nothing to do with scientific rigor. If anything, the West's medical history was so thoroughly unreliable with ramblings about demonic possession and poisonous snake oil that it made the abundance of quackery obvious, making serious practitioners demand proof for everything. This idea isn't "Western," it's just a natural human reaction when you want better information. Make people prove what they claim. Sure, there are specific tools that help, like randomization and extra controls (placebo, blinds, peer review, etc.). But those aren't "Western" anymore than fire or levers or wheels are regional possessions. They're just working tools anyone can use, and China is using them today. And that gets to the bigger problem here, not the mischaracterization of Western medicine, but reducing China's medical research contributions to "traditional Chinese medicine." Most people unfortunately do this, but it completely undermines the brilliant scientific contributions of modern Chinese researchers, who use the best tools available (like RCTs) to contribute to humanity's scientific knowledge. And note, these aren't traditional Chinese practitioners, just dabbling in Western methods, anymore than Watson and Crick were really exorcists who dabbled with chemistry. It's true that some Chinese research may be inspired by traditional medicines, like Tu Youyou's pioneering work on antimalarial drugs. But what's the root of her contribution? It's not merely popularizing an old remedy that makes her brilliant. She's great because of all the thousands of possible old remedies, she conducted rigorous animal studies to identify one useful treatment. She sorted the chaff from the wheat, and she did the hard work to prove her result, and create conditions that could be replicated. (It would be the wrong lesson to conclude her story validates folk remedies generally. Her story validates rigorous scientific testing. There are so so many worthless folk remedies. Rigorous scientific testing was the useful and unique ingredient here that led to a usable result.) More and more often, others like Junjiu Huang, are conducting groundbreaking stem cell research (a field completely unrelated to traditional medicines). Part of this discussion may stem from discomfort at comparing rigorous modern RCTs with Chinese traditional medicine, maybe a fear that this becomes a cheap way to make China look backwards. But the real problem is the comparison. There's no reason to compare those things. Apples to apples would be to compare traditional Chinese medicine to bleeding and trepanning. Or more recently, while we were well past China's stage of economic development, we were using stuff like preorbital lobotomies and insisting schizophrenia was caused by bad parenting. And those were doctors and hospitals. If you include hobbyists and folk remedies, you get people in the West swinging a dead cat over their head in a graveyard to get rid of warts. You get people faith healing on TV by shouting "demons out!" Once you're satisfied that folk remedies have issues in every country, then compare modern with modern. At the worst, you can criticize some Chinese schools as paper mills. But China's sheer number of researchers means its upper ten percentile is already twice the size of the US top ten, and the number of researchers and quality of research in China are both rapidly improving. The sheer potential is staggering throughout Asia, based on population and how rapidly countries are progressing economically (so they can move larger portions of society out of agriculture and basic industry and into more prestige fields like science). Based on demographics alone, the smart money would be that China will develop more "Western" medical advances in the next 50 years than the West itself. That's what we should be celebrating about Chinese medicine. Not stuff from a thousand years ago, a double standard when we consider Western medical advice from a thousand years ago to be laughable nonsense. But all the real stuff they're doing now, today, and what they will inevitably do in the near future, to push forward the frontiers of not Western but human knowledge.