Monday, August 8, 2011

A Worldview Informed by Positivism?

Communicating about acupuncture is no simple thing.

I think in part this is a result of how we acupuncturists are trained to think (or perhaps not think) about acupuncture, and in part, patient perception and expectation about something that most know little about- but that's another blog.

First, about acupuncturists…Let me give a couple of examples of contemporary acupuncture thinking.

I read an article recently in Acupuncture Today. It was titled ‘Master Tung’s Five Zang Channel System and Clinical Applications’. In truth, the piece was pretty lacking in substantive content. There were some themes running through the piece though. It spoke of a system based on wisdom inherited from ancestors, the “secret” memorized – passed down by family oral tradition; the effectiveness of which was “confirmed completely” by a large number of undocumented clinical cases; the importance of this work demonstrated clearly by a few anecdotal stories of cases and a couple of self published books by students of the master; and some indication that the true meaning is inevitably to some degree lost in translation to English. Not a lot to go on there…

Another is a piece published in The American Acupuncturist by William Morris, president of AOMA Graduate School of Integrative Medicine – located here in Austin. It is titled ‘Standards for Reporting Acupuncture Research’. In this piece the author outlines current research standards, but the gist really seems to be the author's take on “positivism as a worldview and how it informs the practice of evidence based medicine”. The author states, “While Chinese medicine adopts principles that can be constructed as laws, theories such as 5 Phases and yin-yang do not comport with a contemporary scientific construction of laws.” He concludes with the statement, “There may be a question whether the worldview informed by positivism is a point of view which captures the knowledges of acupuncture and East Asian medicine best.”  


Positivism (I had to look it up) refers to "a theory that theology and metaphysics are earlier imperfect modes of knowledge and that positive knowledge is based on natural phenomena and their properties and relations as verified by the empirical sciences" (Websters).  So a worldview informed by positivism is essentially a worldview informed by scientific inquiry.

So I sort of don’t get it. On the one hand the author outlines standards developed thus far so that acupuncture may be studied more effectively, and on the other he essentially questions whether the scientific method can capture the knowledge of the medicine.

One of these articles reports on a traditional lineage approach to learning, the other a modern scientific approach. Both are more than just a little obscure, and both exemplify the challenges acupuncturists face in moving the field forward, and the challenge of communicating meaningfully about what we do as acupuncturists.

Somehow the field of acupuncture has got to reconcile the disparities between Chinese traditional culture and the modern world. This is a problem not unique to traditional medicine. It is also an acknowledged problem for modern science as China comes to the fore as a global leader. 

I’m not saying everything we do as clinicians needs to be 100% science based or communicated in scientific language, but I do think it is high time we begin to more broadly question the body of knowledge on which acupuncture practice is based. We at least need to come to terms with what we are talking about. Are we talking about philosophy or science? Are we talking about something we know or what we believe? Fundamentally it’s hard to talk about acupuncture because in large part  - if we’re honest with ourselves - we really don't know very much about it at all despite a historical record spanning centuries. Simply claiming metaphysical superiority to reductionist bourgeois methods ain't gonna cut it.

There, I said it.