The scientific investigation of alternative medicine

British Homoeopathic Journal October 1991, Vol. 80, pp. 201-209

The scientific investigation of alternative medicine P. A. NICHOLLS

May I first of all extend my thanks to the Faculty for asking me to give the Richard Hughes Memorial Lecture. I was honoured to receive the invitation, and very happy indeed to be able to accept it. I should not be doing the lecture at all, of course, if I did not have some connection with homeeopathy, and perhaps I should begin by saying something about how this connection developed, since it helps to explain the perspective which I shall be adopting in today's discussion. This is not meant to provide an excuse for an extended biographical discourse--the easiest thing in the world to do, after all, is to talk for a long time about oneself, but it is not necessarily the best way of entertaining one's audience (especially when it is a captive one!): rather, it is an opportunity to make clear that my own training has been in social science, that the completion of that training involved a doctoral research programme which focussed on the history and sociology of hom0eopathy in Britain, and that this eventually matured into a book, Hom~eopathy and the Medical Profession, which was published in 1988. I Dr Doney was kind enough to give the book a warm reception in his review for the Faculty's journal, not the least adv.antage of which is that it helps to make me feel on hospitable ground in talking to you. One starting point for our discussion today, then, is my own discipline of sociology. Another, of course, must be Richard Hughes himself. These apparently unlikely bedfellows, in fact, lead us to the subject of today's lecture--'the scientific investigation of alternative medicine'. Hughes, after all, was probably Britain's leading exponent in the nineteenth century of a hom0eopathy which had to be consistent with the physics of the day, and which had to be rooted in reliable empirical evidence of drug action as a basis for remedy selection. As Hughes himself said, he always tried to write with 'an allopath looking over his shoulder': if the bridge of reconciliation RichardHughesMemorialLecture,Facultyof Homceopathy, 2 May 1991.

with the regular school was to be crossed-- and Hughes was involved in efforts to do just this in the 1870s--then hom0eopathy had to establish itself in terms acceptable to the scientific outlook which had begun to revolutionize the practice of medicine in general. Hughes, as is well known, did not always win hom0eopathic friends for his low dose, materialist, disease-orientated approach to Hahnemann's system of medicine. Indeed, his perspective failed to survive the Swedenborgian influence of James Tyler Kent in the twentieth century whose views, via Drs Margaret Tyler, John Weir and Gibson Miller, rapidly became the new British orthodoxy. Nevertheless, and whatever one's particular hom0eopathic allegiances, it is reasonably clear that Hughes's general outlook was one which welcomed scientific method as the guarantor of objective, reliable reproducible knowledge about homoeopathy. In short, I feel confident that he would have felt at home with the title of this paper. Whether he would have endorsed its contents, however, is another matter. Perhaps we might speculate about that later on. Let me return, now, to sociology. If the career of Richard Hughes seems, rather naturally, to have suggested the title of this lecture, it is perhaps rather less obvious why sociology should. After all, can sociology have anything at all to say about science? Doesn't sociology deal with people, rather than physical facts, and isn't sociology therefore redundant when it comes to understanding the structure and processes of the natural world? Well, the answer to this is a firm 'no' (one you would no doubt anticipate from a practising sociologist!). Recently, in fact, sociologists, along with philosophers, have begun to say a great deal about science which, I think, is both challenging and provocative, and which I hope you will find worth listening to. 2 My central argument will be--rather irreverently I'm afraid, as far as Hughes himself is concerned--that the notion of scientific procedure as a neutral way of producing objective knowledge is at least overstated; that what is regarded

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202 as 'scientific knowledge' is, in fact, the result of social process, and is therefore (again, at least in significant part) socially contingent, and therefore socially constructed knowledge; and that this claim can be illustrated by looking, among other things, at the research process relating to alternative medicine. These are rather large claims, and it will take me some time to justify them before I am able to show how they apply to medical research on, for example, homoeopathy. Indeed, for many years sociologists themselves refrained from making them, being quite content to uphold and even embellish the unrivalled reputation of the physical sciences as techniques for producing reliable knowledge about the nature of the world which we all inhabit. To see why this was so, we need to examine some of the influential writings of the sociologists who were first interested in developing a 'sociology of knowledge'. Here the work of the German sociologist Karl Mannheim, whose book Ideology and Utopia appeared in 1936, is important. 3 Mannheim, along with other scholars of the time, argued that a firm distinction must be made between the methods and concepts of the natural and social sciences. This distinction followed from the fundamental difference between their respective subject matters. The natural world, as he said, is 'timeless and static', and its system of empirical relationships unchanging and universal. Valid knowledge about such invariant phenomena could be generated by detached observation and careful measurement. The application of these techniques progressively eliminates error, and eventually results in a growing body of permanently established and universally valid truths about the nature of the material world. This happy outcome, however, was not available to the social sciences. Here, in contrast, the subject matter was that of human culture. 'Culture' was not only historically and geographically variable, it also had a subjective dimension, the meaning of which could on!y be studied by developing ways of understanding how subjects themselves understood it. In short, the social sciences could not simply rely on techniques of controlled observation--'meanings', after all, could not be measured or quantified, but only comprehended--and the knowledge which was produced had to be relative to the society, historical epoch or social group under study, as well as the particular cultural characteristics of the investigator. Social scientific knowledge, there-

British HomceopathicJournal fore, could be neither a system of universal nor timeless truths. This did not mean, for Mannheim, that the bid for sociological knowledge was doomed to failure. On the contrary, it opened up the possibility of showing that ideas in society could be analyzed in terms of their social origin, and even in terms of the political, economic or strategic interests which they served. Thus, much of what passed for 'knowledge' in society--political beliefs, religious systems or occupational values for example--could, in fact, upon sociological inspection, be identified as 'ideology', as a way of masking real interests with a more legitimate and acceptable face. Much of what Mannheim goes on to argue in Ideology and Utopia is an elaboration and attempted demonstration of this thesis. The point, however, as far as we are concerned, is that although, according to Mannheim, knowledge of society is context bound, socially contingent and culturally relative, this was not true of science. Scientific knowledge was privileged because it was dependent on a stable, observable and measurable world rather than the subjective flux of history and society. A n d so it came to pass that sociologists left science alone. It was none of their business, because 'society' had no part in determining the content of scientific knowledge. If sociologists had anything at all to say about science in the post-Mannheim world it was to show how the scientific community itself developed norms and values which promoted the growth of knowledge. Here, the contribution of the American sociologist Robert Merton was important. 4 For Merton, adherence to technical norms relating to the validity and reliability of empirical evidence, and to the logical consistency within and among theories, were obviously prerequisites for the development of predictive competence. Additionally, the moral imperatives of universalism (judge scientists by their achievements, and all ttteories according to the same rigorous standards); communism (sharing of knowledge in an open community); disinterestedness (be as dispassionate about examining one's own work as in criticizing that of others); and organized scepticism (take nothing on trust, even if it is proposed by someone of great reputation), were all key elements in the framework of scientific norms and values which ensured accurate knowledge production. Note that, in this account, the normative framework itself does not make science possible. Rather, it is the unchanging, observable regularities of the natu-

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ral world which makes the implementation of these norms of scientific conduct sensible and rational. Merton's catalogue of moral imperatives is probably not exhaustive. Norms such as those of humility, originality, independence, emotional neutrality or even those of tenacity and conviction in the face of the scepticism of others might be added. But, ultimately, this hardly matters as far as Merton's basic assumption is concerned: like Mannheim, he saw science as a system of statements which simply reflected the stable properties and relationships of the physical world whose truth held independently of the culture which expressed them. This position--which I shall call 'the standard view of scientific knowledge'--remained the sociological orthodoxy until the 1980s, when a new sociology of science began to emerge. This programme rejected the position of theoreticians such as Mannheim and Merton, and argued that since knowledge of the physical world was not only mediated by culture, but produced by what was itself a cultural process, it too was socially contingent, and could be brought within the framework of the sociology of knowledge. But I anticipate. I must first say something about the reasons why sociologists began to abandon the notion that scientific knowledge was 'special'. In fact, sociologists were led to revise their thinking in this matter as a result of earlier philosophical work. Now I have no wish to reconstruct the entire history of 20th century considerations of the problem of knowledge-even had I the skill to do so--but I should like, in order to develop my argument, to identify for you. a number of the philosophical considerations which began to weaken confidence in the standard view of science. This is an important point, for only if we are prepared, by force of argument, to relinquish the standard view can a sociological project of the kind I have identif i e d - i . e , one which allows for socio-cultural contingency in the knowledge claims of science--really begin. Let us start with perhaps the most basic principle of them all, which is the principle of the uniformity of nature. How, philosophically, might we justify this proposition? Clearly, it is not selfevidently true: it is not knowable a p r i o r i , as the philosophers would say, but only through an examination of the way the world actually is. But then how could we devise a series of experiments which would establish the proposition one way

203 or another? This is dificult, for every experimental attempt to test the principle that nature is uniform has to assume that the principle is true in the first place in order to make sense of the results, i.e. it must be assumed that every test done under the same conditions will produce the same resutls. 5 But this is the very principle of uniformity which is to be tested! Clearly a significant problem exists here. But maybe only philosophers need worry about it since, in practice, isn't it the case that science is, as a matter of fact, able to state its laws and theories in universal form? This, however, won't do either, and can't be used as proof of the principle, since we do not abandon it When we find evidence that persuades us to replace one law or theory with another. Conflicting evidence is used to revise theories, not to question the principle that nature is everywhere the same. The principle of uniformity, then, cannot be established as an inherent characteristic of the world; rather, it is simply an assumption which science and scientists tend to build into their descriptions or accounts of that world. A second claim which is made in favour of the standard view of science is that a clear distinction exists between 'facts' on the one hand and 'theory' on the other. Here, the argument is that facts are the directly given, unambiguous sensory data which determines the nature of scientific theory. Facts, which 'speak for themselves' on this view, are the neutral arbiters of the success of theoretical explanation and prediction. Again, however, philosophical reflection has shown that this assumption is also problematic. To begin with, it is not possible to use the criterion of 'direct observability' to distinguish a separate realm of empirical facts, because what is observable is a matter of degree. 6 Which sorts of instrumentation allow 'direct observation'? Indeed, can any sort of instrumentation be said to allow direct observation? Clearly, it is absurd to treat the information revealed by microscopic investigation as different in kind to that produced by unaided observation--but this is what the principle of 'direct observability' entails. If the observation requirement runs into difficulty in isolating a separate realm of facts, then the principle of unambiguity is even more fragile. Facts do not speak for themselves, and have no meaning independent of the context in which they are located. Facts, indeed, are constituted by the frameworks of meaning supplied by established theory, assumptions and context: as the philosopher Gilbert Ryle famously put it:

204 empirical observations are 'theory laden'. 7 To use an analogy from the criminal justice system, the meaning of a piece of evidence rather depends on whether the jury chooses to locate it within the case supplied by the prosecution, or the defence. The sound of my car engine ticking over might sound normal to me, but it is turned into a diagnosis of service requirements (usually with an extra nought on the bill!) by my garage. The lunar mountains which Galileo could see through his telescope, his scholastic critics, try as they might, could not. Once the evidence which sustained the theory of witchcraft littered the Christian world for all to see: now all we burn is litter itself (and we are not even terribly conscientious about that). The notion of a 'fact', then, is not as straightforward as the standard view of science suggests. Indeed, we know from the mechanics and psychology of vision itself, that 'seeing' is an active process. It is mediated by language, and involves the construction and interpretation of sense data into comprehensible categories. Scientific observation is no different. As Thomas Kuhn famously argued, most science consists of fitting observations into the theoretical traditions or paradigms given by professional education. 8 In any event, it seems that there are no 'theory neutral observation statements': if facts are themselves theoretically constructed, it follows that the standard view of science, which depends on the existence of a separate, unambiguous realm of empirical data, must be relinquished. It is important, however, to see that what this argument does is simply to reveal 'facts' as provisional and negotiable, rather than non-existent or redundant. It would be absurd to lock ourselves into the scientific relativism which would follow if this latter course were adopted. Rather, by seeing the way in which facts are 'made sense of', it becomes possible to ask interesting questions about the conditions under which scientists begin to make a different sense of the facts than that given by currently dominant paradigms or theories. It is at this point that science, to refer once again to Kuhn, enters a period of revolution. So far we have examined both the principle of uniformity and the fact-theory distinction as part of the standard view of science, and have encountered problems with each. The standard view, however, also depends on the claim that the truth value of knowledge claims or rival theories about the world can be assessed by appeal to unambiguous criteria, or standards, or pro-

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cedures. But is this the case? Do clear criteria exist? In practice, it certainly seems as though criteria such as 'theoretical simplicity' or 'elegance' or 'accuracy' are flexibly applied. Hooke's Law in elasticity or Ohm's law in electrodynamics are examples where linear formulations are preferred for simplicity's sake, although non-linear expressions would yield greater accuracy. These criteria, then, do not yield the sheet anchors of knowledge which the standard view requires. Moreover, if what counts as 'a fact' is, as we have seen, problematic, then assessing knowledge claims in terms of criteria such as 'agreement with the facts' or 'replicability of the facts/data/experimental results' is also problematic. This is a deep seated problem which has put a severe strain on all attempts to construct clear, universally applicable criteria in terms of which theorectical claims may be evaluated. One such attempt was that of induction, i.e. that scientific knowledge should be accepted as 'true' when it was subject to repeated confirmation by experience. Even accepting facticity as non problematic it is not possible to sustain this position, since no number of empirical confirmations can ever prove a universal statement to be true. That 'all sociologists are weird' cannot be established by the observation of any number of us, since the next one (admittedly, the probability is slight!) might be normal. It was this problem which prompted Sir Karl Popper, one of the most influential of recent philosophers, to suggest what, at first blush, seemed to be an elegant solution to the logical failings of induction as the method for producing objective scientific knowledge. 9 As many of you are no doubt aware, what Sir Karl did was to make a virtue out of the Socratic principle of fallibility, and turn it into a necessary cornerstone for obtaining knowledge about the world. If it was not possible inductively to establish that 'all doctors wear white coats', it was at least possible to know that they don't by searching for one who didn't. This was the method of falsificationism. Scientific propositions were distinct in that they were falsifiable; science grew by a series of bold theoretical conjectures or solutions to problems which could then be tested to destruction experimentally; new theory should explain all that old theory explained, as well as the observations which it did not; and where rival theories were concerned, the theory which was least probable, i.e. explained most, or had greatest content, should be preferred.

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Unfortunately, despite vigorous resistance from Sir Karl, lesions soon appeared within this philosophical tissue.l~ Among the more rampant of the difficulties were: - - t h e problem of testing any theory in isolation (for to test one theory involves suspending disbelief in all the others to which it is connected); - - t h e problem that observation, facts or evidence, as argued above, are theory-impregnated anyway; - - t h e problem that all theories have falsifying instances; - - t h e problem that some of the most useful theories are not strictly falsifiable (e.g. evolutionism); and - - t h e problem that new theories rarely explain all that old ones do, and that therefore to throw them away with falsificationist abandon is to throw away valuable explanatory resources.

What I have tried to do, then, is to show how the process of philosophical critique weakened support for the standard view of scientific knowledge to the point at which it could no longer be seriously sustained. Once the philosophers had broken down this door, as it were, the sociologists rushed in. The c a v e a t which had prevented the inclusion of scientific knowledge within the general framework of the sociology of knowledge had disappeared. Scientific knowledge was revealed as the result of the social activity of scientists in doing science rather than as an unmediated reflection of reality. As such, scientific knowledge, like other forms of knowledge, could be seen as socially constructed, socially contingent. Science, in short, was an enterprise of interpretation, which involved the social construction of the nature of the physical world. It is important to see what this argument does, and what it does not do. It does not establish that scientific knowledge is worthless, or entirely relativistic, or that one theory is as good as another, or that anything will do. What it does establish is that knowledge building in science is simply a social process which invites the use of rules, criteria or standards to assess new findings or theoretical propositions. But this process is one which inherently involves a wide measure of disagreement, since rules and standards always require interpretation. Thus, what comes to be accepted as 'knowledge' is, in fact, the result of negotiations among scientists as to which rules should apply, and how they should be interpreted, in any particular instance. The process of

205 knowledge building therefore allows for considerable flexibility, in the sense that the application or interpretation of scientific standards or rules will vary over time, and by social group and context. All of this follows from the recognition that the standard view of science is deeply flawed. It is worthwhile exploring this new, interpretative account of science in a little more detail. Clearly procedures of assessment in science are occurring all the t i m e - - n o t least by the editorial boards and their referees in selecting some papers for publication and rejecting others. What standards are being applied? Consistency of results with established knowledge is clearly one. But the interpretative framework of relevance here (that is, currently accepted theory) is itself in a state of flux, dispute and negotiation. Another standard is represented by various criteria of adequacy, such as precision of results, degree of experimental rigour and quality and quantity of evidence. Here, however, standards of precision and the degree of experimental control possible both vary with the changing basis of technical culture, and the acceptability of observational evidence is often contingent on currently accepted theory. Radio astronomy, for example, had to negotiate for the admissability and meaning of its observational data in the face of standards already established by its optical forerunner. Clearly, too, a tension exists between the standards of consistency and adequacy. Apparently adequate findings may be disregarded because of consistency problems, or consistent findings rejected because of inadequacy. But how adequate, for example, inconsistent findings have to be before the need for a new consistency is recognized is not settled by appeal to some putatively unabiguous rule such as falsification, but by negotiation. A n interesting example of this consistency-adequacy tension, which indicates the necessity for negotiation in arriving at, say, 'the agreed interpretation of experimental work' concerns the issue of gravity waves. Einstein's theory of relativity predicts that these phenomena exist, but nobody has yet (so far as I know) been able to design equipment which has detected them. The basic problem here is that the only test of whether a piece of technology meets the criterion of adequacy which is relevant here, i.e. that it successfully measures gravity waves and nothing else, is that it actually succeeds in doing so. But it can only do this if gravity waves e x i s t - -

206 which is what the equipment is supposed to find out! Hence equipment,which fails to register gravity waves may be judged as inadequate on the basis of criteria of consistency (since so much else of Einstein's theory is so well established), or, if something is measured, criteria of consistency may be suppressed in favour of those of adequacy, i.e. could the equipment be measuring something else besides, or as well as, gravity waves? Clearly, there is considerable room for manoeuvre, flexibility and negotiation here: an unambiguous solution is simply not indicated by the data themselves. H If this general perspective is correct, then we should expect that interpretative initiatives are not merely confined to the rules employed in assessing knowledge claims, but to the broader normative framework, previously identified in Merton's discussion, which forms part of the public rhetoric of science. I have in mind norms such as those proscribing secrecy, and emphasizing the common ownership of knowledge. Edge and Mulkay's sociological study of the group of Cambridge astronomers who published the first paper on pulsars in 1968 clearly shows how different groups of scientists appealed to different normative standards in order to justify their actionsJ 2 The Cambridge group was charged by its scientific competitors with delay in publication, and with secretiveness in general about their work, which could only be detrimental to the advance of science. The response of the Cambridge group to these allegations was that they had a right to prevent anticipation by others of their work through early publication; that delay gave time for further quality checks to be made; that group reputation determined access to research funds and that it was therefore legitimate to claim 'ownership' of high status results; that it was important to prevent the press from misrepresenting results; and finally that the group had a duty to protect the work of research students involved in the project. Incidentally, despite having abrogated the formal norm of communism, two members of the Cambridge group were awarded the Nobel Prize six years later for their work; and though it had originally been so important to protect the work of a young research student, when it came to the prize giving, this particular contribution was apparently less worthy of recognition. What I am trying to demonstrate is that the framework of technical and other norms which scientists employ for assessing and advancing

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scientific knowledge is, in practice, flexible, socially negotiated and interpreted. What drives the interpretation adopted in any particular instance is often the perceptions of material interests held by participants. The above example clearly shows that within the same normative framework two entirely different interpretations of correct conduct can be made; furthermore, it shows that there is no direct connection between the observance of any one interpretation of norms and the distribution of rewards and status. Both secrecy and communism could equally pull the Nobel Prize. Sociologists have been concerned to show that this interpretative view of science is, so far as possible, substantiated by their own research. Of significance here is the work of Collins on the building of the T E A laser, ~3 and his study of research into gravity waves; 14 Wynne's study of how scientists responded to Barkla's theory of a particular set of x-ray emissions (the so called 'J radiations') ;15Frankel's work on nineteenth century research in optical theory; 16and Collins and Pinch's study of parapsychology. 17 I'd like to say just a little more about this last study. Collins and Pinch point out that claimed experimental demonstrations of paranormal phenomena date as far back as the 1930s, but that though the researchers usually advanced their claims in terms of the minimalist position that these phenomena were at least worthy of attention and investigation, most scientists regarded writers in the area as engaged in an attempt to overthrow the very foundations of science itself. Clearly, major interests were at stake here, and from the beginning, new interpretations of technical and other norms appropriate to knowledge assessment were developed in order to undermine the credibility of parapsychological researchers. Their papers, for example, were often rejected by journals. When published, editorial disclaimers were usually inserted, and critics tended either to regard the empirical results as trivial, meaningless or lacking theoretical interpretation. The parapsychologists rejected both views: what was to count as empirical evidence or appropriate theory developed into a hot dispute. One line of thought which was used to contest experimental findings went as follows: although some experiments seem satisfactory and yielded, according to probability theory, significant results, paranormal phenomena cannot as a matter of fact exist, therefore probability theory must be wrong. But if probability theory is

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wrong, then what is widely accepted as a legitimate technique of inference across the whole of science--and the conclusions which it has been used to generate--must be disregarded. Since it is highly unlikely that probability theory could possibly be wrong, it is therefore more likely that experimental results apparently demonstrating the existence of paranormal phenomena were produced by fraud, or error, or that the people producing them were irrational cranks engaged in self-delusion. Claims of this kind, of course, are a very effective way of closing off debate. If parapsychology is just another name for the occult, and if people who believe in the occult are irrational, then there is no need to take their work seriously. The charge of fraud is even more lethal. For it can always be shown that any results could have been produced by fraud. This is a claim which can itself be made without any evidence that fraud actually takes place: it is enough to suggest that it could have, and thereby remove the need for further experimental investigation of the area. Interestingly, Collins and Pinch suggest that parapsychologists, especially in the USA, realizing the difficulty of progress in a scientific community which kept changing the rules about the rules of evidence, resorted to attempts to raise the status of their research by founding their own scientific associations, campaigning for research funds, obtaining university posts and so on. In effect, the tactic adopted here was first to win legitimacy for the researchers in the area as a way of eventually establishing the legitimacy of investigating their knowledge claims. It could be argued, I think, that a similar process has occurred with respect to the investigation of alternative medicine--i.e, that it has only been able to establish itself as something which requires serious experimental investigation by first establishing itself as something which is taken seriously outside the medical laboratory. But that is another story. Let me return to my main theme. It is important to see what is being argued by the examples which I have used. My point has n o t been that scientific knowledge is impossible and scientists unscrupulous. Rather it has been that the standard view of science, resting on the principles of natural uniformity, direct observation, the separation of fact and theory, and procedures such as induction or falsification, cannot be made to hold water; that therefore science is socially constructed knowledge of the physical world; and that the normative frame-

207 work within which this process occurs is always and necessarily being actively interpreted. Different interpretations are made by different scientists at different times for different reasons. The Cambridge astronomers ~o whom I have referred were able, quite legitimately, to defend, as it were, protectionism; their critics, free trade. The critics of parapsychological research were able to defend theory consistency by creating new criteria of adequacy--beating 'the fraud squad' and passing 'the character test'! Parapsychologists defended themselves, in part, by concentrating on raising the social status and profile of their work in order to create a climate where the fraud squad could operate with less credibility. This brings me to my closing remarks, and back--after what some of you may have regarded as a rather long p r e a m b l e - - t o the title of my lecture. If what I have said so far makes sense, then it should come as no surprise to find that the reception given to research into alternative medicine proceeds according to the same principles. The interpretative agenda established for assessing this work is again a flexible one, and is fuelled, it may be conjectured, by powerful, personal, occupational and economic interests. Let me remind you of two recent cases with which you are probably familiar. The first involved a report of experimental work conducted by Dr Jacques Benveniste and his associates which showed that certain kinds of white blood cells could be provoked into a release of histamine when exposed to levels of antibody in high hom~eopathic dilution. The paper detailing the work was published in the journal Nature.18 The research had been extensively refereed--a process which apparently failed to identify any crucial weakness in design or control. When published, however, the work appeared with an editorial reservation which expressed 'incredulity', opined that there was ' . . . no physical basis for such an activity', and indicated that arrangements had been made ' . . . for independent investigators to observe repetition of the experiments'.19 This independent team of investigators comprised James Randi, a magician; Walter Stewart, a specialist in the study of misconduct in science; and the third, John Maddox, a scientific journalist. They reported almost exactly a month later. 2~As far as Maddox et al. were concerned, the Benveniste experiments were ' . . . statistically ill-controlled, from which no substantial effort has been made to exclude systematic

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error, including observer bias', and that 'The phenomenon described is not reproducible in the ordinary meaning of that word'.Z1 The implication of these remarks, in conjunction with the composition of the investigating team, was that the results were only reproducible by trickery and self-delusion. Thus the consistency of established scientific theory was preserved, but only by interpreting criteria of adequacy in a novel way--i.e, one which, conveniently, could never be met, since it is always impossible to disprove the claim that results could have been produced by fraud. 'Don't trust the scientists in this area, or their results' becomes a potential part of the interpretative framework for future use in assessing research on hommopathic medicine. On the other hand, where results of research into alternative medicine have produced apparently negative results--i.e, ones which are consistent with established bio-medieal theory-these have b e e n readily published, and given considerable publicity, despite methodological weaknesses. I refer to the recent investigation of treatments used at the Bristol Cancer Help Centre. 22The results of this study, which looked at the survival rate of patients with breast cancer, seemed to suggest that women who attended the centre were actually made worse by the treatment received. Certainly this was how the media reported the findings--and reading the abstract which introduces the research paper in The Lancet, this is indeed a reasonable interpretation for any journalist to make. In fact, no such inference was justified, or should have been implied by the paper itself. There were a number of problems of research design, such as mismatching of experimental and control groups, and lack of control of the varying degrees of patient compliance with the various treatments, which should have signalled a much more cautious wording of the results of the investigation. But what was worse, although the Bristol Centre had itself commissioned 'the research, the hypothesis investigated by the researchers was not an appropriate test of what the Bristol Centre was trying to achieve! Bristol Centre treatment was as much about empowering the patient, and adding life to years, as it was about adding years to life. This is a bit like being judged as having failed to climb a mountain when your intention was only to walk halfway up anyway and spend the rest of the time admiring the view! Clearly, establishing goals of treatment, and ways of assessing their achievement, is contestable terrain.

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A final point. In February of this year, an overview and evaluation of trials of homeeopathic medicine was published by a team of Dutch researchers in the British Medical Journal. 23 Here, a less combative tone seems to be struck. The research team devised seven criteria of adequacy for evaluating the trials, with a numerical scale to measure the relative strength of research design for each variable. One hundred and seven controlled trials were examined. The authors were aware of the problem of publication bias discussed above: possibly low grade work showing positive effect or high grade work showing no effect would be more likely to achieve publication, since in both cases the results could be used to argue that homceopathy does not breach physical laws and that its medicines are really innocuous. Most of the trials in fact were, according to the author's measurements, ' . . . of low methodological quality'. 24 Eighty-four fell into this category. Of these, sixty-six showed positive results. This is in accordance with the publication bias theses, i.e. that these papers could be safely published since design weakness meant that the results could subsequently be dismissed as failing to meet appropriate criteria of adequacy. However, of the remaining twenty-three trials judged to be 'adequate' according to the team' s criteria, fifteen showed positive effect. The authors conclude that, despite the poor methodological record and the influence of publication bias, enough evidence exists to investigate further. Hughes, I'm sure, would have been pleased with this concession, though probably disappointed with the inordinate length of time required to reach it. But the research team end their paper with a pertinent question, which rather sums up what I have been trying to argue. 'The question is', they write, 'how many of such trials would be needed to draw definitive conclusi0ns?'~ For, as the authors again point out, 'Critical people who did not believe in the efficacy of homoeopathy before . . . will still not be convinced.26Quite. To put it provocatively, what counts as adequate evidence is not a simple unambiguous matter of observation, or facts, or replicability, but a matter of socially located point of view. Acknowledgment Grateful acknowledgements are due to Geraldine Nicholls, without whose valuable assistance many of the materials used in the construction of this paper would have remained unlocated. References I Nicholls PA. Homceopathy and the Medical Profession. Beckenham: Croom Helm 1988.

Volume 80, Number 4, October 1991 2 The discussion and critique of the standard view of science which follows owes much to the stimulus provided by Michael Mulkay's Science and the Sociology of Knowledge, London: George Allen & Unwin 1979, without which the ideas for this lecture would not have borne fruit. 3 Mannheim Ideology and Utopia. New York: Harcourt, Brace & World 1936. 4 Merton RK. The Sociology of Science. Chicago: University of Chicago Press 1973. 5 This argument is that of Hanson NR, Perception and Discovery, San Franciso: Freeman, Cooper 1969. 6 See Smart JC. 'The Reality of Theoretical Entities' in R. E. Grandy (ed). Theories and Observation in Science, New Jersey: Prentice-Hall, 1973. 7 Ryle, Gilbert. The Concept of Mind, London: Hutchinson 1949. 8 Kuhn TS. The Structure of Scientific Revolutions. Chicago: University of Chicago Press 1962. 9 Of Sir Karl's many defences of falsificationism, see for example Popper, Karl, R. Conjectures and Refutations. London: Routledge & Kegan Paul 1963. 10 Amongst the fiercest of the critics of falsificationism is Paul Fcyerabend. See, for example, his Against Method, London: New Left Books 1975. 11 This example is discussed more fully by Collins HM. 'The Seven Sexes: A Study in the Sociology of a Phenomenon, or the Replication of Experiment in Physics', Sociology. 1975; 9: 205-24. 12 Edge D O & Mulkey MJ. Astronomy Transformed. New

Address for correspondence: D r P. A. Nicholls Department of Sociology Staffordshire Polytechnic Leek Road Stoke on Trent ST4 2DF

209 York: Wiley Interscience 1976. 13 Collins HM. 'The T E A set: Tacit Knowledge and Scientific Networks', Science Studies 1974; 4: 165-85. 14 Collins HM. 1975, op.cit. 15 Wynne B. 'C. G. Barkla and the J Phenomenon: A Case study of the Treatment of Deviance in Physics'. Social Studies of Science 1976 6; 307-47. 16 Frankel E. 'Corpuscular Optics and the Wave Theory of Light: The Science and Politics of a Revolution in Physics' Social Studies of Science 1976; 6: 141-84. 17 Collins HM & Pinch TJ. 'The Construction of the Paranormal: Nothing Unscientific is Happening', in R. Wallis (ed) Rejected Knowledge: Sociological Review Monography. Keele: University of Keele 1978. 18Davenas E, et al. & Benveniste J. ' H u m a n Basophil Degranulation Triggered by Very Dilute Antiserum Against IgE'. Nature 1988; 333: 816-818. 19 Ibid., p. 818. 20 Maddox J, et aL 'High Dilution' Experiments a Delusion', Nature 1988; 334: 287-290. 21 Ibid., p. 287. My emphasis. 22 Bagenal FS, et al. 'Survival of Patients with Breast Cancer Attending Bristol Cancer Help Centre'. The Lancet 1990; 336: 606-610. 23 Kleijnen J, et al. 'Clinical Trials of Homeeopathy'. British Medical Journal. 1991; 302: 316-323. 24 Ibid., p. 316. 25 Ibid., p. 321. 26 Ibid.