Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine. The lone exception: ginger capsules may help chemotherapy nausea.
Senator Tom Harkin, the driving force behind NCCAM, has long been aware of the problem. From the outset, the center was bedeviled by practitioners of evidence-based medicine. The “unbendable rules of randomized clinical trials”, as he described them, proved unforgiving. Harkin lambasted scientists for their resistance to accepting therapies on faith: “It is not necessary for the scientific community to understand the process before the American public can benefit from these therapies.”
Sadly, his valiant defence of alternative medicine from the Armies of The Enlightenment was all in vain. After being described as ‘Tom Harkin’s folly’ in a New York Times editorial, in 1998, the center was elevated to the status of National Institute of Health center. It was to be run under a mandate of promoting a rigorous and scientific approach to the study of alternative medicine.
The result has been a disappointment to Senator Harkin. He told a Senate hearing in 2009, “One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short.” After all, the center has been “disproving things rather than seeking out and approving things.”
I see the problem, Senator. If only scientists had not adhered so rigidly to RCT standards. If only they had been willing to accept other sources of information. In fact, their willingness to disregard folk wisdom and tradition and their privileging of evidence-based medicine is, well, gosh darn it, it’s almost fascist. Not all the way fascist. Lets say… microfascist.
As someone far more intellectual than I once wrote, “the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge.” The problem? Scientific research operates inside a post-positivist paradigm that excludes alternative forms of knowledge. I would argue that by refusing to contemplate the experiential, the traditional, the imagined and the anecdotal, the evidence-based movement “acts as a fascist structure”. Indeed, credentialed “scientists”, through their “secular priesthood” hold a monopoly on the production of scientific knowledge.
Senator, by privileging ‘regimes of truth’ like evidence-based medicine, the NCCAM has been a good example of microfascism in action. If you want to see your center fulfil its original intention, if you want to see an end to microfascism in the National Institutes of Health, if you want to prevent the elimination of alternative ways of knowing and the reduction of health sciences to the totalitarian ideology of evidence-based medicine, that ‘regimented and institutionalised version of ‘truth”, take back the NCCAM. Alternative medicine can never be integrated with the singular, totalising ideology of evidence-based medicine and its microfascististic worldview.
It is in deconstructivism that the radical singularity of knowledge that is complementary and alternative medicine will find a welcome space of freedom to territorialise and colonise. It is time for CAM to resist the totalitarian program of randomized controlled trials, to decolonise the masculine narratives of large sample sizes and competing hypotheses.
It is time for CAM to embrace postmodernism. And then you can get the results you want.