Wednesday, February 22, 2017

Legitimate Questions - A letter to a Young Colleague








"Hey guys I'm a 1st year Chiro student and I have 2 question that I am struggling to find the answer to. Why do we put ourselves into boxes? Mechanistic or Vitalistic! And what do the people in the middle of the spectrum call themselves?"


This question was recently posted on a large (roughly 2,600 member) Facebook page populated by a collection of students, practitioners, researchers and educators. I've been all these at some stage or another in some shape or form. Overall the environment, of this particular forum, is supportive but also supports or promotes objectivity as a fundamental axiom or 'law' considering that we are inside a profession. Professional bodies hold a 'social contract. That assumes that not all ideas are equal and that environment is, in itself, the only one which supports the ethic of professionalism, that despite personal preferences, we all exist primarily for the benefit of others, the public, our patients, and must subject our own opinions and those of the profession to the scrutiny of high intellectual standards - we assume that learning is lifelong and can only proceed if we accept that some ideas will be shown to be forlorn, wrong, and should be discarded, again, for the benefit of society. We accept that the process of being a professional means you may well be wrong, that there are ways to determine this and that we will all follow evidence and good reason above personal belief and speculation.

The query itself is quite possibly the first natural, legitimate, brief and significant question posed by all students as they grapple with what is often a remarkably shallow chiropractic philosophical pool. And the reality is that efforts to expand the profession and truly make it 'Great' are hampered not simply by external pressures (common to all) but the insistence by many that 'Unity' can be achieved by demanding that people 'choose' which un-unified end of a false philosophical spectrum they inhabit.

It's a mouthful. But wait. It is important to understand ourselves if we are to sort out such common (and philosophically falsely based) schisms.

Tribalism

My experience is that most staff members, let alone students, can't exactly define either term (vitalism, mechanism (and a dozen or more others)) and therefore what they mean when those terms are applied to the world around us. Yet many identify strongly with something they appear to understand rather poorly - and that question is a matter of IDENTITY or TRIBALISM. Once a human has identified with a tribal belief it is generally resistant to new or contradictory information. 

We might consider a profession to be a type of tribe but it has quite specific rules and expectations (see above) which are not shared by other ideologies or belief systems.

The minds we have, evolved to be very good at socialisation and re-confirmation for the reason that it seemed to aid our survival if the group 'stuck together'. Sticking together can be enormously beneficial. For professionals, the question should always be - "What exactly are we sticking together for?" That intuitive tribal urge however also means that the beliefs we form are resistant to alteration. Habit's stick whether 'good' or 'bad' and it's also why science (testing hypotheses) has been such a reliable system of knowledge gathering whereas personal faith or revelation is not as neither one can actually be tested beyond opinion.

So tribalism is real and can be very useful. Unfortunately it doesn't necessarily mean that the tribal principles or ethics or information are necessarily sound or true.

Vitalism was a mechanism

A chief (perhaps the only argument) in favour of vitalism is it's assumed difference from mechanism (literally "what makes this 'go' or 'work'? What's it's mechanism?). Something which seems entirely glossed over (by adherents of vitalism) is that Vitalism was a scientific theory ('science' was called natural philosophy back then) over 200 years ago. Most straightforwardly 'Vitalism' was defined as a soul or spirit (later elan vital), basically the quality or process that was thought to make the non-living into living. It was, and here is an irony worth pausing upon, the proposed mechanism that explained why there was 'life' or 'not life'. It was the asserted or claimed mechanism for biology and living systems.

So despite many still believing that something like a soul might exist, no one on the planet has actually found evidence of such a phenomena but, importantly, this is where we need to stop and dissect the issue a little more else we will assume that people are being told that they have to stop believing in something like a spirit, a soul or any of a thousand other forms of supernatural belief.

No middle ground

One responder to the question simply said "What do you call people in the middle of the spectrum between astronomy and astrology? The point being of course that there is no middle between explanations since found to be false (technically superseded) and explanations which actually do work. Imagine measuring the success of Usain Bolt by constantly referring back to the guy who came last, or suggesting 5th place (middle) were both just as 'winning' as first place.

In physics, Newton broke through a conceptual barrier with the theory (the explanation for why his observations worked) that gravity was an attractive force. Einstein came along and leaped out of the conceptual box again and now we understand that a theory which uses a 'magical attractive force' to explain gravity isn't as good an explanation as that mass distorts the geometry of space/time. The FACT is that the explanation is better. The FACT is that vitalism only explained things when the human understanding of biology was 'naive'. To understand 'vitalism' listen to a child explain how living things work - that is as far as we could get when we knew almost nothing about the natural world (circa 1800).

Another way to think of vitalism is that it's one of thousands of labels for our ignorance. Instead of saying "I don't know" we say "that must be what vitalism is" in which case we fool ourselves into believing that we just understood something whereas we have just reinforced a childlike view of the natural world.

Similarly there is no legitimate 'middle' between a flat OR spherical earth, we know it's one and not the other at all. There is no halfway, or 'box', between preformationism and what's really inside a sperm. Preformationism was the theory, plausible at a time when we knew very little about biology, that humans grew from fully formed miniatures housed inside the sperm. If you think about it (and try to strip away what we do know about cellular biology) it actually appears as though a 'miniature' human just 'inflates' inside the mother, pops out and keeps increasing in size. We simply found that this didn't explain anything once we could actually see inside a cell. What clearly happened was that preformationism wasn't anything at all except an idea which was wrong.

Preformation - It seemed perfectly logical to assume that within each sperm was a fully formed human which expanded as it grew. It was never found. So can it still be there but we can't measure it "yet"?


Always "not yet"

I've been in quite a few conversations with vitalists and they will often say "Ok, I know we can't measure it yet" but they appear unaware that there is no 'it' to measure. Perhaps 'it's' something else entirely. On the balance of probabilities we will continue to discover more about how the universe naturally works. (which immediately means it's natural not supernatural (since we can't ever seem to find anything supernatural)).

The most that can be said about the supernatural is that it's a popular word for things no one can seem to verify. Anything we have no evidence for might be called supernatural. Santa is technically supernatural but of course we accept it as myth. Similarly, devoted Muslims don't run about praying to the Greek pantheon of supernatural beings just their own. To them (and every other devotee of another faith) all the other faiths are myth. It all becomes absurd. Confine this to personal belief and not much trouble occurs but inject it into a profession and the sky falls.

The list of discarded or superseded theories is long and full of concepts we didn't see then discard, they were simply wrong, never found, and now populate the history of mistakes. Vitalists can never actually agree on what it is they're talking about except to agree that they'll keep assuming it means something else which can't be measured "yet". It's also why discussing vitalism with someone who doesn't want to understand it's history will prefer to be perplexed, exchanging that natural sense of awe and wonder we all experience for it's facsimile, ignorance itself. They will use awe and wonder (which is our basic human ignorance (not a bad thing)) to reassert their own need to pretend that vitalism is an explanation.

That has quite serious consequences as it simply becomes a reason to stop thinking.

Flogging a Dead Horse

People have invented 'neo-vitalism' more recently in an attempt to reinvigorate or bring back to life something which never worked in the first place. 'Neo' is attached to 'emergence' and even 'quantum mechanics' but in all cases it's assumed to still be there, as yet unmeasured. That sounds slightly plausible and 'open-minded' until we realise that we can't yet measure anything we can't measure but we can claim we can't measure anything! We can make anything up and assert or claim that it's there but we can't measure it yet. Dragons, gods, ghosts, magic teapots, anything, yet!

Mechanisms - Understanding or Incomprehension?

Other complex physical processes (often termed mechanisms or mechanistic) were found but let's remind ourselves again that vitalism WAS a purported mechanism. The most that can be said for vitalism comes from dualism (the very real sense or feeling that 'me' or 'I' is somehow different from 'my body') but even that is explained rather well via the mechanisms of neuroscience and evolution (more on that below). The mind evolved with the quality of imagination. It is possible to imagine being in two places, imagine what might be around the corner or imagine that someone is in your house, but that is a real process inside the brain not the actual ability to project consciousness across a room. Dualism and cognitive neuroscience is a whole other discussion, I mention it here to demonstrate, again, that vitalism as a mechanism never helped explain anything at all.

Epistemology - The thinking behind beliefs.

Having once seriously believed in something like vitalism I understand how compelling the notion is. Just imagine being able to use The Force, because as ridiculous as that sounds the philosophy (the thinking) behind behind every supernatural belief out there is fundamentally the same type of epistemology, that something I can imagine is also felt to be real (that's how the mind works). What we can imagine can be real but a mind does not readily distinguish between real/not real. Intuition only feels that what we imagine is true by default. This is how all beliefs are initially generated and we also know that as far as understanding complex things (like biology (and generally everything really)) intuition is not reliable, it just feels very reliable. it also reminds us that ethics, the sense that we better check our guess (for the benefit of others) against reason and evidence is essential for professionals.

Vitalism simply never explained any part of biology however, the founder, DD Palmer, was a spiritualist who believed that the teachings of chiropractic were given to him from the "other world". His hypothesis was that subluxations interrupted the communication between 'god' and 'soul' (Universal and Innate) via the nervous system. The neurological system is, of course, biology, so vitalism doesn't explain it, evolution via natural selection (which is biological theory) does. In fact if you replace any legitimate theory with 'false explanation' you'll get incomprehension. Again think back to preformationism and ask yourself how that would play out in science and health care today (if all professionals used preference as the chief epistemology in their decision making)?

Creationism

Vitalism shares an uncomfortable relationship with creationism, the move by religious fundamentalism in the USA to inject the teaching of biblical genesis into public education. When early efforts to do this were blocked by the Supreme court, creationists manufactured 'Intelligent Design', called it a 'theory' and popularised an invention by the Tobacco Industry in 1979 to teach 'The Controversy' to combat the "body of fact" within the minds of the public (basically sow confusion when explanation was required in order to avoid the actual explanation and protect the preferred version/sales). We now see this played out in US politics and the re-emergence of fundamentalism and blatant church state boundary crossing into education and politics. Think 'Alternative facts'.

'Mechanism' is never a valid criticism

Mechanism as a philosophical opposite to vitalism is a red herring, a decoy, a non argument. Creationism/Vitalism repeats the same false dichotomy, and error of reasoning, that any issue ONLY has two possible outcomes. In this case it is that you MUST choose either vitalism OR mechanism. The first is generally associated with being open minded, inclusive, loving, kind, etc, while the later is dismissed as 'reductionistic', limiting, dehumanizing, etc. Again, there are valid points if the discussion is well played out but as presented it's worthless rhetoric, as valid as listening to the worst political monologue. 

These days I'm technically an 'atheist' (don't believe in a god concept) however I was a Buddhist for 12 years (which is technically a-theist) so what did it mean? First of all it meant I was remarkably arrogant. I found theistic explanations of the supernatural to be wrong but was quite happy to embrace other explanations which, although more sophisticated, were just as 'not actually there'. These days I'm quite happy to defend the useful aspects of religious traditions as well as criticise the downright dangerous aspects. If you allow your mind to fall victim to a false dilemma/dichotomy you wont be able to think too much about anything just the old 'whose side' do I take schtick.

This is reflected in the first big opposition movements to the teaching of evolution last century when Darwinism was accused of being immoral and dehumanising despite the fact that critics had never bothered to comprehend it in the first place (the same has always occurred when facts clashed with theology). People of all persuasions, used to the supposed sanctity of faith, simply were not used to such an obvious 'assault' on their scripture by basic facts, in this case (natural selection) a fact of astounding philosophical import - that humans were another species of animal and there didn't appear to be any one's version of a god present in the process. Not even Buddha or Vishnu or a thousand other revelations seemed invited either but all faiths fumed in unison and ran about trying to manage the problem. They were all wrong again, no one had asked their permission to have their traditions down graded and by gum the legitimate authorities of a million disparate celestial dictatorships had to be reasserted no matter what.

It didn't help that people such as HL Mencken (who was 'anti-religion' and probably anti-Semitic as well) spread the dogma that evolution meant we were all just savages who had to forget about the 'weak' in order to prosper - that shit has nothing to do with the theory of evolution or science or mechanism or philosophy at all. It only has to do with human nature and our ability to be selfish, narrow minded, poo flinging apes when there's also an opportunity to create art, literature, science and philosophy. 

It's just true -M'kay?

Basically, both 'Vitalism' and 'Creationism' contend that their explanation is true, M'kay?, and simply don't care that only 0.05% of biologists in the USA accept Creationism as a 'theory' (because they are creationists) while 99.85% do not (and many of those are also religious). But if your self image/identity as a professional is sold as being dependent upon an essentially faith based position we have both philosophical, scientific and significant professional issues because while it's fine for ME to believe whatever, in my own mind, in my own home, I can't just waltz into my office, with the responsibility to others, and claim that science or philosophy proves that my adjustments allow Jesus, or whatever explanation I prefer, to flow about the body chomping up bad things. That's the 'chiropractic philosophy' we can all do without.

Are Vitalists, Vitalists? OR Please shit on my floor OR Silence is Consent.

I find that most who like the idea of vitalism are actually drawn to holism and humanism which have nothing directly to do with faith based beliefs. Humanism (that individuals deserve rights or a 'say') was a response against centralised theocracy (god based governments). That point of confusion (The Incessant 'Controversy') is used by people such as Billy DeMoss, organiser of Caljam 2017 'The Love Tour'. Caljam has hosted some of the planets dizziest conspiracy theorists and they have zero room for anything approaching discussion, scrutiny, disagreement or objectivity. Those who constantly preach the greatest love generally display the worst passive aggressive tendencies (you do get this sort of thing in other industries by the way so don't think it's just chiropractic. I say that as reassurance to you not as an excuse for us or anyone else). Billy's latest offering, posted up on YouTube was titled 'Nazi Vaccine Regime' in Australia. Pure crazy. Apparently vaccination is "Satan's Work" (yes he did say that!) and apparently this demonstrates the level of 'love' held by Principled Vitalistic ChiropracTORs. Something to reflect on. So when anyone insists that everyone, regardless of their behaviour, should be offered a due respect I say bugger off. If a person defecates on your floor you don't say "Oh, goodness, perhaps you'd prefer the living room?"

So note particularly those who say they disapprove (the 'moderate vitalist') of the 'Billy's' but never publicly call for their de-registration. Such types will hold up a banner of 'Individual rights' and never reflect on the fact that they are basically saying 'rights' means sitting on a fence with your 'freedom' banner while people have the right to lie through their teeth and defraud and intellectually disable a population. That is not any right but the right to leverage stupidity and danger. Simple solution - make a stand. Silence is just consent.

The 'innocent bystander' is not a protection for a professional. If you don't want to get involved that's fine but don't expect to be able to 'preach' love or reason while others get run over. That level of dumb will be pointed out pretty quickly. If it does happen then the best approach is to remember that this is why we bother creating these types of groups, because we are responsible for others. I often use the example of teaching children to safely cross a road and another was my younger self learning how to use guns. One day I showed my Aunt how to check the barrel of a rifle by looking down the sharp end (I'd taken 'lessons' from a movie I think, much like an 'education' from Sherman College). My 'freedom' to express myself was met with a slap over the head and "Don't ever do that again!". I was ashamed and hurt (the whole family was watching). My Aunt said "Don't ever check a gun like that!" 

It seems like a ridiculous example but it's ethically very sound. We are responsible to others - Vitalists will argue that the bullet can come out sideways or backwards or invisibly. (Note that 'subluxations' are discussed like this as well because faith never wants to be bothered with facts). They want the freedom to tell the public, that the public has the right to choose whatever their version is, etc. That's how stupid and unethical vitalism has become.

The reason we don't speak up is that most humans avoid trouble, naturally. We are easily indoctrinated into believing that a chiropractor just has to be kind of 'vitalistic', and are told that a strong profession must band together in UNITY. Policing unprofessionalism has fallen directly on those who choose to speak up because, again, our job is to protect the public good, not use this profession or science or philosophy as a personal platform for faith. We are bound by codes of ethics not personal satisfaction.

Here's another irony - vitalists will argue that criticism only comes from 'outside', from medicine, etc and that 'good' chiropractors must always support each other. It's bullshit. Much of our professions problem is that we are not seen to effectively self regulate. When colleagues go 'rogue' we stay silent, the tribe demands wagon circling, and that is professionally disastrous. The public sees us covering up and not acting in a manner they expect from 'experts' so this inward looking stance simply backfires on us.

If you end up swallowing Vitalism as anything like an explanation for biology or clinical reasoning or ethics this is precisely the level of thinking you'll have to adopt. Any supernatural or paranormal explanation as either science or serious philosophy requires you to STOP thinking because none of those claims can be investigated to begin with, therefore any 'evidence' or 'proof' is distortion or just personal opinion, pure conspiracy, not science or philosophy and certainly not professionalism.

If you are religious and have taken immediate offence, or if this all appears rather too 'heavy' then don't worry too much. It's all easy to ignore but I'd offer this. You can ignore it in your personal life just not inside a profession. In that sense the Tribe has spoken. We have no right to mess around with the facts and pretend that 'evidence based' is just a matter of preference, politics or personal faith.

Scientia est potentia - Knowledge is power.

Cheers.

Douglas Scown




Friday, February 10, 2017

Faith. Just Religion?



My profession, as many are aware, has an historical embrace of supernaturalism. The founder, DD Palmer was a spiritualist, very common at the time (early 20th Century), which saw an enormous popularity in the notion that one could communicate with dead people (as well as being particularly good business for charlatans). I say this quite bluntly, not to single our Palmer (plenty of 'respectable' people were fooled) as spiritualism is technically defined as believing that one can communicate with the 'spirits' of the dead, their ghosts. I've been increasingly in agreement with the opinion of Philosopher Peter Boghossian that faith be redefined as 'pretending to know things you don't know' and this is why.

We will never eradicate faith or we could argue that it would be as successful as disposing of a mind built by evolution and which happens to have gained the quality of being a dualistic processor. This is quite different from the older idea we had concerning dualism. You may have heard of Cartesian Dualism, Descartes notion that the material and immaterial were ontologically distinct but nevertheless somehow interacting. The observation is intuitively sound.

What the hell did that mean?

You've probably heard of the cliche 'mind/matter' or some will add 'spirit/mind/matter'. Ontology is the study of what it means to be or the nature of being. So conversations about reality, which have gone on for thousands of years, sought to make sense of this world around us. Generally, with a few exceptions, these efforts were extraordinary failures, yet they, the idea that when we say 'spirit' or even 'mind/matter', that we are talking about real things or processes or qualities, remained. The short answer here is that we only know of the matter part and that this is most likely because that is what naturalism is, that when we go looking for explanations or things or phenomena, we've found just that, explanations, natural ones, naturally. And at each stage people have simply, quite lazily remarked that just because magical x wasn't found it still might (just you wait!!). What no one has actually found is a spirit or any evidence (apart from opinion) that 'mind' isn't just (and I really should never say 'just', as it infers lesser or not complete)) what happens when the matter does it's thing. Naturalism is cool. Pretending can be amusing but like any old story the assertion is now quite preposterously dogeared.

But here's the really interesting thing - reality feels dual, we feel dual, most humans feel dual. But even that feeling of a separate and distinct quality is, when you sit down and ponder it, what has to happen if we are to have even one thought. When we think we think 'about' something. There's 'me' thinking (another apparent separate stuff) about (more) you (and you're quite different from me). Try to imagine (imagination can't work without a 'dual' processor) anything at all and you'll notice that you simply can't do it and not be dual, or more accurately, process in such a manner that you can't notice a difference in there somewhere.

To the average inhabitant of the planet this will effortlessly play itself out no matter what idea or collection of sensations we come across. The mind (we also know quite well now) will process most information heuristically. It will rapidly throw out solutions to problems (such as get up/out of the way/friend?:)/foe?!/dunno/right/wrong) in such seamless fashion as to leave us unaware of exactly why we made such decisions. Most heuristics are not all accurate, they just 'work' sufficiently well that we don't get killed too frequently or in large enough numbers. So to be able to process at the speeds required to 'work' well enough, it, the mind, the activity of the brain, is largely 'dumb' a great deal of the time. We are covered by, or a collection of, illusions of sensation. We are a city of cells with cities of cells living in us and on us about which we are unaware and they of us or the others, in the sense of 'consciously aware'. Most illusions work to shore up little imperfections so they don't get in the way. Optical illusions are the easiest to comprehend. We cannot 'see', are not conscious of our retinal blind spots. They'd get in the way, so the brain just photoshops it out, covers the error and let's us on our way.

Wow. Isn't that evidence for Intelligent Design, the glory of a god or Vitalism (take your pick)?

Daniel Dennett (philosopher and neuroscientist) offered that faith (pretending you know the answer) was just an opportunity to stop thinking. In philosophy it's called the argument from ignorance or incredulity. You just stop, inject your 'wonder tissue' (the special fix all magic glue) and dust off, none the wiser and probably less so. Certainly that approach never found anything out. If you want that reality go to Afghanistan or 1066 in your holistic wayback machine.

If it ever answered anything other than 'I feel it's true and it works for me' (which is something we all tend to do) then faith would deserve the status it has claimed all these centuries. That's all it is and as you can see it's a robust human quality of the mind. If you can imagine what a city or a flying machine or a gene or a abcdefgh might look like you can easily pretend to know what a god or spirit or ghost or fairy looks like. You can even feel quite strongly that it talks to you and tells you secrets about cosmic consciousness and world peace. This is where art and literature and ISIS come from. Imagine growing up in such environments (where the rule is to never question the 'pretending to know quite ridiculous stuff' and you'll have real trouble NOT imagining that it's real, which quite ironically is more difficult because you know you can't find it anywhere except in your heart or balls or ego or somewhere else special). We can imagine a great deal but what it often imagines is just that, imaginary.

If adults kept this level of reasoning to themselves the world would be pretty good but, well, we're built for it, blame evolution, another irony as it is yet another scientific powerhouse of an idea which failed (once again), to need to invite any ones god to the party. I can just imagine it, a million celestial entities screeching "But what about MEeeee?!"

Can't hear them? No matter, their sycophants are only and always too happy to voice what they regard is it's opinion. Moreover don't get mad with me. The sycophants are usually too busy arguing with each other to care about an atheist. That's another good point (I have many), IF people kept BIG faith to themselves (as opposed to the little faiths we all tend to indulge in) I wouldn't even have the need to write, but more on that below.

Yesterday I was sentenced to have to read yet another metatheory paper regarding why we still need to take magical thinking seriously. It makes no difference that it was about 'vitalism' because it could work as well with 'insert any bloody imaginary thing' which science never found (then claim science found it). The argument was, as usual, incomprehensible from a critical thinking point of view and led off with why vitalists can comprehend complexity without needing to dwell on details, which reminds me of Doug's holistic mechanic video (it's a cracker). That this still gets significant airplay (albeit only in CAM mags) in academia used to make me wonder when it would be over but it wont.

Magic goes down (apparently) and bequeaths upon the person the ability to know all AKA - Pretending to know you know more (Vitalists 'see' emergent global structure' like Palmer saw dead people) means you know more. Ya know? AKA The Arrows Knows Metatheory.

The above 'metatheory' is basically a philosophy 101 ballsup. For any simple argument to be basically sound the assertions (the labels) have to be valid (we gotta have something to support the claim and vitalism has zero except blank assertion - it's always "We found this stuff and we reckon the magic stuff is there as well") and the reasoning (the connections) must be, well, reasonable. It doesn't take much, yet a few highly spurious headings linked by crayon = a metatheory is asinine.

The diagram could be cogent. Rub out the bit on the left. No one ever found it and what we do know came via mechanism. Even the term 'emergence' was invented by scientists grappling with, but never rejecting or downplaying by any stretch, mechanism. Emergence never meant "invite magic" it meant "complex systems are really hard to predict" a feeling which always applied to investigation. It's always been hard. Ignorance always looks to itself to claim knowledge or perhaps we could do with reminding ourselves about the cognitive bias the  'Curse of Knowledge' (it's a mind bender) - think of something you know, now try to know what you knew before you knew that. When we know, we forget how hard it was to learn it. Vitalists are always trying to downplay mechanism by, ironically using it (whilst not understanding it). It's preposterously arrogant. The only argument against reduction which is valid is a comment on people not reduction. It is Dennetts Greedy Reductionism.

But saying that something is just bullshit will never do. Like the dualistic mind, the only possible way to know if you have a good idea is to subject yourself to truly awful ones and, like a small child dissecting any toy or insect, notice why or if it works and how. See if you can put it back together and 'Pump' it for life, for an answer. Is it sound, can you still wind it up and make it mobile or does it break? Yes, all vitalistic propositions are the proverbial house of cards but faith (a thought set upon nothing but pretense) is the toughest interlocutor. Given the precarious nature of it one might wonder why it doesn't fall with a slightest puff, but it wont, Only honest competitors concede the possibility of failure whereas faith is immune to evidence and only honesty (and bravery) can change that. The authors of the paper above will most likely die convinced that vitalism was something but I'd offer this - much more is to be gained by people publishing negative results. Vitalistic articles would serve the world well to say - it's popular but, shit, we aint found nothin.

Vitalism suffers from intellectual cowardice (or if that is too abrupt try a 'lack of intellectual humility' and other valuable suggestions), whilst the history of science and philosophy is populated with figures who came to grief almost exclusively by questioning 'the gods' or inadvertently discovering great ideas that didn't invite them or congratulate them or pat them.

With regular monotony, individuals who like the idea of spirits (vitalisms) will quote various philosophers or scientists in the belief that they support their own conclusions. I've sat in vitalist coaching classes while they waxed lyrical about Socrates and the Socratic Method (I'm a great fan) except Socrates was put to death for questioning the very concept of 'gods' etc. No small irony there. If you want to bring up and suggest you value the philosophical approach of any person you should take care to notice exactly what it was they stood for.

No wonder the comedian Louis CK referred to 'god' as the 'shitty girlfriend' (and no wonder that vitalists and others who grasp onto their faith a little too tightly seem to lack humor. Strong faith builds many safe spaces which eschew serious self reflection. A sense of the ridiculous may well be the only solution to it or the only measure of successful 'deconversion').

Supporters never question, always ask 'why is this still so good again?' not 'why would this not be a good idea? Should I understand the critic?' which would after all mean that one was interested in satisfying curiosity not merely comforting themselves. It would mean they were really thinking about it. Faith warns to avoid any real introspection. The evidence is absent and the arguments atrocious but that is the beauty of truly bad ideas. Without Vitalism or any other example of pretending to know things we don't know, we would not have the sounding board of greatness.


Thursday, February 9, 2017

Chiropractic Spectrophobia - Fear of Ones Own Reflections



Feb 8th 2017

I have two lovely daughters, neither one of whom appears to bare much resemblance to me. I call them 'carriers'. I know that I passed on fifty percent of my genetic material to each of them but, perhaps fortunately, their biology chose not to express it just yet.

Yesterday I reached the altogether insignificant age of fifty four and wished I hadn't been so adamant, upon using the metaphor of a 'view from the mountaintop' when I reached fifty, which felt like quite a milestone, since the only path from the pinnacle was down, another step closer to my own end.

Best not waste any more time.

My two girls (and yes they are both bright and athletic and good looking, their mothers side) go to two separate, and quite different (in many respects), schools. Brisbane State High School is where my youngest and all of her friends alighted to after leaving the local primary school, a 'feeder' for the now prestigious and well populated 'school of excellence'. The other couldn't wait to leave the same large primary school with it's socially dynamic (and for her quite frustrating) culture. "Dad, one day they're all Besties, the next they're fighting. It's exhausting!" So the elder daughter chose a small Catholic girls school and has thrived ever since.

But both schools carry motto's in the classical Latin style inherited from ancient Greek. Moreover, some precepts can be interpreted in a number of ways, allow for discernment or considered judgement. Others are, ironically, quite indiscriminate by virtue of their inability to be considered in any but overtly simplistic terms.

People often regard motto's as nothing more than historical markers but humans need signposts, good ones, not just any empty slogan, lukewarm rhetoric or catchy phrase we feel briefly inspired by but, like any Marvel movie can't manage to recall five minutes later. More still are nothing but dogmatic.

It's no accident that schools still endorse classical motto's which direct our minds towards both a rich classical philosophical past and a future which will be well served by the continued thought provoking use of it. What is important? What is worth a (very brief) lifetimes focus and why is my profession struggling to get it right?

Sherman College has a motto, borrowed from our own tradition or at least the spiritualism of it's founder DD Palmer, which is supposed to inspire in us an awe and wonder of a Universal Intelligence that provides us with life, what he regarded as a god concept. It should be pointed out that spiritualism was a rather more individually narcissistic faith. Not only was there a 'god' and 'souls' but they spoke directly to him, even authoring some his work by some method of celestial dictation. This type of naive solipsism quickly gained a place within the young profession.  It is of course an overtly religious or faith based claim, not only popular in the USA but vocal. American's like you to know how much they pretend to know about a god. However, it's far less than this. Most private schools such as the one I attended were essentially built by religious orders, who have historically had the advantage of financial protection. That they also came to control education, at least initially, was also just historical. Their claim now to knowledge is just that, a claim, the actual production of understanding having passed onto a broader secular education propelled by the discoveries of science. It is now assumed, in most 'progressive' nations (although that appears to be under renewed pressure) that personal faith is an issue quite separate from other pursuits, certainly professional ones, whereas the faith inside chiropractic invites faith healers, crass pretense, piety and ignorance.

Sherman College of Chiropractic represents the 20% who view vitalism as just another term for the product of a Universal Intelligence, a doctrine of a pure religious nature akin to Creationism (That Biblical Genesis, not evolution, not science, is the legitimate explanation (theory) for the nature of living things). Many who blindly ascribe to Intelligent Design are not even aware of exactly what the doctrine assumes nor that creationists really care who shares this particularly distorted view of reality. Their only aim is the complete replacement of science with it, with their faith. Sherman's motto is ADIO which stands for 'Above, Down, Inside, Out' as in (the magic comes from up there, and goes this way). That's all the 'science' it contains. At Life University they have a sculpture of a safety pin which is meant to illustrate what happens when the spine is subluxated - the pin is opened and the life force interrupted and closed only by an adjustment and only from a 'principled' or faithful chiropracTOR, when the lights are switched back on.

In the past when I've brought up the observation that faith (pretending to know) cannot be a legitimate replacement for scientific fact it has been met primarily with either nervous dismissal ("I don't want to get into the matter of personal belief") or abject hostility ("How dare you question the truth or you are just one of those materialists" (precisely the same responses, nothing more than reflexive offence, as when one questions any other tightly held, moralistic faith position). The later position - hostile rejection - is, in fact, not the main problem. The chief issue is what Elie Wiesel, survivor of Auschwitz and life long Holocaust 'Rememberer', repeatedly pointed out was sheer indifference, that hatred does not oppose love, ignorance does.

Faith by it's very definition disrupts the later. When a person claims that a mystical life force approaches anything like scientific fact (let alone robust Theory) it is not only wrong it is the duty of professionals to point that uncomfortable fact out. If we do not we cannot blame the more informed for having done so. In these cases it is like blaming the doctor for removing the knife because of the patients objections, the 'caught with one's hands in the cookie jar' analogy, yet still claiming that the hand isn't real or belongs to someone else or got stuck under it's own volition, an 'alternative hand' like an 'alternative fact'.

Our lady's College (where my eldest attends) has inscribed on it's helm - Ad Altiora (go higher, ever higher) which is also shared by numerous other schools both religious and secular. Brisbane State has - Scientia est Potentia (Knowledge (or Understanding) is Power), mine was - Sapere aude (dare to be wise, to know, to think for yourself). In comparison, chiropractic movements which aim or claim to be the 'leaders' in thought and vision can never seem to embrace motto's which would invite both believer and non believer to rise above more than weak consensus. We've had the pleading fiction of 'Unity through diversity' or 'Vitalism and Value' which have the same five minute burn of any postmodern ad campaign and only served as forms of Orwellian doublespeak to give the illusion of placating differences of opinion. Since the profession has a significant minority committed to creationism and educational erosion, unity, via accepting such 'diversity' amounts to the embrace of anything and certainly silence to it. That level of philosophical cogency (and the inspiration it affords) can be applied to any public service portal or fascist movement. It can be read is 'diverse' ways but only invites the dominant factions to press their preferred concept of 'what a true thing' is onto the whole. It turned our association into nothing more than a union, certainly not a receptacle for a public ethic. It turns the public into parishioners, the flock, to be herded and not the central focus of all codes of conduct which place the patients interests quite clearly above ours, clearly above issues of personal practitioner faith. For a professional their raison d'etre IS the ethic - Servire Populo (to serve the people (not ourselves or our brand of religion)) or perhaps ut intellectus (to offer understanding)?

The modern vitalism movement, helped along by the intellectually castrating effects of 'philosophical' relativism (from whence came Unity through Diversity and Value added Vitalisms) has, most unfortunately, fully embraced fundamentalism (Intelligent Design). They now think nothing of awarding and inviting narcissists to spread the credulous and overtly fascist  #CWD (Chiropractic World Domination) #Resistance is Futile, as if this represents anything other than the complete breakdown of civil discourse and the suffocation of rational, ethical critical inquiry, the strangulation of the profession itself.

The great irony is that these groups (representing approximately 20% of the profession) accept the 10% market penetration, that the profession occupies a marginal position. Their explanation of course is Jehovan - the problem isn't ours, it's that everyone else hasn't accepted the correct path to salvation, that being being blocked by 'evil' conspiracies to prevent the 'truth' from getting out, a type of thinking which only inspires the need to redouble evangelical efforts to convert a public, to become even more conspiracy driven, less comprehensible and to eschew responsibility for faults or self reflection or candour. The only things that appear to matter to the organizers of such movements, for example, is faith and personal success. If you just believe you will thrive, or if you are thriving that is the only gauge of success. Such models are achingly self absorbed and adolescent, invite prevarication, base ignorance and low standards. The motto may as well be - submit ac die (submit or die), tuendam fidum (defend the faith) or Me Solum! (Only ME!). All you must do is believe and convert because we already know that we hold the key to life itself. I actually sat in coaching classes with a man (a very politically and, distressingly, educationally influential one) who stated emphatically that the only goal was to get everyone and their family in for lifetime care (at twice a fortnight no less). It didn't matter that you hadn't met them before because you already knew what their only problem was. There was nothing which was not cultish about this behaviour but like 80% I left and like 80% I had no idea what to do about it. Accepting a 'diversity' where one believes that low level education can be effectively repaired by cheap enthusiasm and blind faith, not intellect or knowledge or ethics or professional standards represents that 10% sticking point.

If 80% are prepared to believe that this deserves no criticism, or silent consent, wishful thinking, base stupidity or political protection, then we do not deserve a larger market share. The public like what we do and also generally despise and are afraid of the credulous and purely anti vaccine rhetoric. I'm often asked (by the public or friends outside my profession) as to why this is the case. Most, like myself, accept that vaccines are not perfect and are sometimes harmful (this should be too obvious to ever have to mention) but that life without them (and significantly the science necessary to have developed them and everything else we blindly depend upon and ignorantly assume to have popped into existence) is not a period in human history any rational person would journey back to. The anti vaccine movement, on the other hand, is effectively devoid of any reason whatsoever and I have never encountered such a witheringly ill informed, ill willed and wilfully aggressive group outside of religious fundamentalism. They behave just like any other severely self marginalized collection of fearful humans who can only grapple with reality by grasping onto some version of a utopia (to 'defend' themselves from the dystopia which is out to 'get' them).

It's like this I now explain - If you have been indoctrinated, either by blind acceptance, peer pressure or supermarket style philosophical 'reasoning', by your professional culture, into believing that it's plausible to vaccinate via adjustments to the spine, you get pure opposition to vaccination, pure opposition to medicine. You get a cult. Such movements preach 'love and acceptance' but require daily injections of fear, superstition, conspiracy and unquestioning agreement to exist. It creates a marginal profession because it's effectively separated from the standards which would lead to expansion and inclusion (and therefore exposure to the very people we claim to want to help). You might not like some of the things your colleagues say but the culture demands a unified approach. It demands that we accept the 'diversity' of opinion even if it includes creationism whilst the profession also claims to be 'evidence based.' In effect it wants the right to claim cogency without having to shoulder the responsibility of demonstrating it. It wants the adulation just not the burden of proof. We simply reserve the right to lie to the public because it suits us.

We have become so afraid of our own reflection that we've taught ourselves to ignore it and cast the blame elsewhere. So practiced are we at this reflexive stance that it's taken years to quietly begin to dismantle the edifice of our own emotional revulsion to simple honesty for fear that candour and critical re-eavaluation would be our end. Quite the contrary. Breaking through that wall of dissonance, having the balls to suffer threats and stupidity and embarrassment from within AND outside the profession has at least begun to present the only real chance we have at legitimacy, maturity and expansion. 20% of this profession do deserve a good life along with other cults and marginal unregistered groups. They have that freedom and deserve it's protection, in this country at least.

But WE are a profession.

We are not a faith.

Tuesday, March 10, 2015

An Open Mind


The following article is borrowed from Matthew Long (Chiropractic Development International)
The twin worlds of health care and education tend to be conservative places. New ideas are treated with scepticism, whilst entrenched dogma often persists without question. Although this culture makes it hard for new and valid ideas to take hold, it also serves to prevent dangerous, costly and unethical practices from gaining traction. However, this situation really only works if we can keep an open mind.
Over the past month I have read two interesting papers that caused me to question some assumptions I had held - specifically about the notion of visceral manipulation. On first glance the concept of moving one’s internal organs for some therapeutic effect seems far-fetched. Indeed, every rationale proposed thus far for visceral manipulation has, for me at least, not satisfied the first hurdle of even being biologically plausible. There are just too many unproven assumptions about the supposed dysfunction occurring, the reliability of palpatory methods, and the efficacy of the treatment. Apparently the goal of such treatment is "to encourage the normal mobility, tone and motion of the viscera and their connective tissues. These gentle manipulations can potentially improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body" (1). While such notions are admirable, they are not backed up by the quality of evidence one would hope might exist to support a revolutionary new treatment.

But does this mean that visceral manipulation is entirely without merit? Perhaps not. A recent study in the 
European Journal of Pain suggests that the use of visceral manipulation might be useful in the long-term management of lower back pain (2). While the short-term benefits weren't obvious, those undergoing visceral techniques did show benefit over a longer duration, prompting the authors to suggest that, "It is possible that, with continuing visceral nociceptive input, control patients experienced greater rates of recurrences of LBP compared with the visceral manipulation group."

This isn't the only study to find clinically meaningful benefits to visceral manipulation. A paper by McSweeney 
et al in 2012 examined the immediate effects of sigmoid colon manipulation on pressure pain thresholds in the lumbar spine (3). In this study,
"Pressure pain thresholds were measured at the L1 paraspinal musculature and 1st dorsal interossei before and after osteopathic visceral mobilisation of the sigmoid colon. The results demonstrated a statistically significant improvement in pressure pain thresholds immediately after the intervention (P < 0.001). This effect was not observed to be systemic, affecting only the L1 paraspinal musculature. This novel study provides new experimental evidence that visceral manual therapy can produce immediate hypoalgesia in somatic structures segmentally related to the organ being mobilised, in asymptomatic subjects."
So it just might be that such techniques are clinically useful. But what of the theories used to guide their application and explain their action? Unfortunately there is a paucity of sound research to underpin the biological construct of 'abnormal visceral motion', or the reliability of methods used to detect this phenomenon. Most of the available literature originates from our osteopathic colleagues, but the explanations given tend to remain abstract in nature and devoid of concrete facts or ideas. Attempts have been made to measure kidney mobility using diagnostic ultrasound (4), but whether the differing patterns of motion represent a true 'abnormality', or just normal human variation remains to be seen. However, is a motion-based model of organ dysfunction actually necessary to support the use of visceral manipulation? Could it be that the existing theories are completely wrong, yet the treatment itself might be useful for some other reason?

This brings me to the second intriguing paper that I reviewed in recent weeks, entitled "
You May Need a Nerve to Treat Pain - The Neurobiological Rationale for Vagal Nerve Activation in Pain Management" (5). In this article De Couck and colleagues reviewed the role of the vagus nerve in modulating pain signals, discussing five distinct mechanisms by which it exerts inhibitory effects upon the pain experience. They wrote,
"The vagus nerve may play an important role in pain modulation by inhibiting inflammation, oxidative stress, and sympathetic activity, and possibly by inducing a brain activation pattern that may be incongruent with the brain matrix of pain. Finally, vagal activation may mediate or work in synergism with the effects of the opioid system in pain modulation. All these mechanisms are thought to influence neuronal hyperexcitability, culminating in the perception of less pain. For all the above neurobiological reasons, it seems justified to increase vagal nerve activity to reduce pain as this targets all 5 mechanisms with 1 intervention. This hypothesis is supported by experimental studies on animals and preliminary intervention trials on humans."
The vagus nerve has been used experimentally to influence pain in a variety of fashions. Simple deep breathing will augment vagal activity and has been shown to reduce pain, while electrical stimulators have been trialled in both implantable and transcutaneous forms (6). In each case, it appears that vagal stimulation influences central pain processing, rather than peripheral nociceptor activity. Could it therefore be that visceral manipulation, as performed by chiropractors and osteopaths, serves as a novel form of vagal stimulation? We might therefore suggest that the established theories of visceral manipulation as a tool for improving organ mobility be revised in light of more biologically plausible mechanisms. Perhaps the true value of visceral manipulation lies in its ability to increase vagal inhibition of pain, leading to widespread suppression of nociception from multiple sources? If this is so, then it would require the active proponents of visceral manipulation to update their understanding and refine their message. But will this happen easily?

At this point I should point out that I am not trying to single out the supporters of visceral manipulation for criticism. Indeed, the pretext of this article is to 
maintain an open mind, and I have found the topic to be one that lends itself to this exercise very well. So often the field of biological science is challenged to redefine its theories when new evidence comes to light, and we must learn to walk a balanced line of judgment. Unfortunately, this can be difficult once we have become emotionally invested in a practice or an idea. When presented with new information that conflicts with our long-held beliefs it is both easy and natural to dismiss it out of hand. Cognitive change can be costly, both in terms of mental effort and the possible impact upon our established patterns of practice. According to Chris Mooney in "The Science of Why We Don’t Believe Science” (7), it can be extremely hard to convince others of new ideas simply by presenting them with evidence and argument. Indeed, often this can have the opposite effect.
"...an array of new discoveries in psychology and neuroscience has further demonstrated how our preexisting beliefs, far more than any new facts, can skew our thoughts and even color what we consider our most dispassionate and logical conclusions. This tendency toward so-called “motivated reasoning” helps explain why we find groups so polarized over matters where the evidence is so unequivocal...

The theory of motivated reasoning builds on a key insight of modern neuroscience: Reasoning is actually suffused with emotion (or what researchers often call “affect”). Not only are the two inseparable, but our positive or negative feelings about people, things, and ideas arise much more rapidly than our conscious thoughts, in a matter of milliseconds - fast enough to detect with an EEG device, but long before we’re aware of it. That shouldn’t be surprising: Evolution required us to react very quickly to stimuli in our environment. It’s a “basic human survival skill,” explains political scientist Arthur Lupia of the University of Michigan. We push threatening information away; we pull friendly information close. We apply fight-or-flight reflexes not only to predators, but to data itself..."
retina
'We apply fight-or-flight reflexes not only to predators, but to data itself.'
retina
"In other words, when we think we’re reasoning, we may instead be rationalizing. Or to use an analogy offered by University of Virginia psychologist Jonathan Haidt: We may think we’re being scientists, but we’re actually being lawyers. Our “reasoning” is a means to a predetermined end - winning our “case” - and is shot through with biases. They include “confirmation bias,” in which we give greater heed to evidence and arguments that bolster our beliefs, and “disconfirmation bias,” in which we expend disproportionate energy trying to debunk or refute views and arguments that we find uncongenial."
So faced with new ideas it seems very 'human' to resist the cognitive burden of change. However, change we must if we wish to remain up-to-date and relevant as a profession. I would suggest that there are two distinct personality types that we need to consider when reflecting upon the subject of keeping an open mind.
1. The traditional 'scientist' type, who remains cynical until there is an overwhelming body of accepted evidence. These individuals use their faith in science to resist change.

2. The front-line clinican, who may view the greater scientific community with scepticism and as having an overly pessimistic view of the realities of clinical practice. These individuals use their lack of faith in science to resist change.
Obviously there are many other personality types who lie in between these polar opposites, but it is these two stereotypes who probably have the most difficult time keeping an open mind. To quote George Bernard Shaw, "The reasonable man adapts himself to the conditions that surround him... The unreasonable man adapts surrounding conditions to himself... All progress depends on the unreasonable man."

But why should we even care? Does it really matter if clinicians still explain their treatment rationales using ideas that are somewhat outdated?

I would suggest that it 
does matter, because in health care at least, truth is preferable to fiction. As our understanding improves, so does our capacity to target our treatment better. Furthermore, the long-term future of the chiropractic profession is one that will increasingly become intertwined with other health professionals and third-party payers, all of whom need to understand chiropractic through contemporary neuroscience theory. It is my contention that much of the clinical practice of chiropractors is uniquely helpful to our patients, but it just might not work for the reasons that we've traditionally thought. As long as we maintain an open mind we can retain the practical usefulness of our techniques, while upgrading the theories supporting their application.
Something to think about...
Dr Matthew D. Long
BSc (Syd) M.Chiro (Macq)

References:
1. http://www.barralinstitute.com/about/vm.php
2. Panagopoulos, J., Hancock, M. J., Ferreira, P., Hush, J., & Petocz, P. (2014). 
Does the addition of visceral manipulation alter outcomes for patients with low back pain? A randomized placebo controlled trial. European Journal of Pain, n/a–n/a. doi:10.1002/ejp.614
3. McSweeney, T. P., Thomson, O. P., & Johnston, R. (2012). 
The immediate effects of sigmoid colon manipulation on pressure pain thresholds in the lumbar spine. Journal of Bodywork and Movement Therapies, 16 (4), 416–423. doi:10.1016/j.jbmt.2012.02.004
4.Tozzi, P., Bongiorno, D., & Vitturini, C. (2012). 
Low back pain and kidney mobility: local osteopathic fascial manipulation decreases pain perception and improves renal mobility. Journal of Bodywork and Movement Therapies, 16(3), 381–391. doi:10.1016/j.jbmt.2012.02.001
5. De Couck, M., Nijs, J., & Gidron, Y. (2014). 
You May Need a Nerve to Treat Pain. The Clinical Journal of Pain, 30 (12), 1099–1105. doi:10.1097/AJP.0000000000000071
6. Busch, V., Zeman, F., Heckel, A., Menne, F., Ellrich, J., & Eichhammer, P. (2013). 
The effect of transcutaneous vagus nerve stimulation on pain perception – An experimental study. Brain Stimulation, 6 (2), 202–209. doi:10.1016/j.brs.2012.04.006
7. Mooney, Chris. 
The Science of Why We Don’t Believe Science. https://medium.com/mother-jones/the-science-of-why-we-dont-believe-science-adfa0d026a7e?goal=0_9f67e23487-a5da358f4e-97580213