Friday, March 28, 2014

Blind Faith

"What worries me about religion is that it teaches people to be satisfied with not understanding." - Richard Dawkins

When talking of faith, I would go a step further than Dawkins - it gives people an empty sense of having understood. This sense when seen in others, seems alternately ridicule worthy 
"How could anyone even think of this? Did God miss giving them brains?", or leads to patronization "If only they were educated..."

In a grand gesture of such paternalistic thought, the Government of Maharashtra has even passed an Act outlawing promotion of blind faith. It seems politicians shall have exclusive rights on taking people for a ride in the name of faith. 

Of Gods and Godmen - An Archaeological Trip

Faith, and I am not talking of religion here, has only one criteria to be rational - it should be your own. This was especially rubbed into me the other day, surprisingly, by a pretty diverse group in age, education, vocation, gender - all united only by a love of archaeology and architecture. We were on a long bus ride towards Kolhapur where we planned to visit the temple of Mahalakshmi and also Khidrapur nearby. Our aim was to understand the development of the Goddess, her link to the utterly dynamic world of early medieval India and also, because we were there, to worship her in private for some wealth. No harm in that.

In the 8 hours long journey, we slept, we photographed, we ate and we discussed, with a sprightly enthusiasm, all the irrelevant topics on this planet. Then someone spoke about the gurus and godmen of India which led to a collective lament on the commercialization of religion: on how five star meditation rooms are run, money is measured, devotees are counted for the dough and how people make a fool of themselves, not just the ordinary trusting lay masses, always eager to be taken on a ride but even the educated, professional and successful elite. I was a willing listener and participant. (I also started thinking of the per user valuation of these enterprises, but that's beside the point).

Finally, these I felt were people with a scientific temper, not ready to believe just because they are told. After all, if Satya Sai Baba gets Vibhuti from the air as a cure, equally good would be getting a Justin Bieber haircut or just listening to Himesh Reshammiya crooning. There's no relation between cause and effect here. Godmen just speak in vague generalities and that makes people fell satisfied. Deepities, to use the words of Dan Dennet, give them the false feeling of insight where all they have heard are a couple of homespun metaphors, without even literary merit. The universe is too big to care about you, grow up. God if she exists, would be busy listening to my long list of prayers at Mahalakshmi anyway, so no use trying to bribe Godmen for a way in. 

I was wallowing in the bubble of these self-congratulatory thoughts, when someone asked another to try Homeopathy. Trust me, I could hear the bubble burst. Munching sugar pills is not going to cure any ills, unless it's an issue of low carb. As soon as I said this, it was one against all. They came in from all directions, starting with the traditional defence of anecdotal evidence, the magic (you cannot call it science) of provings, it being very person dependent, very practitioner dependent, the storied history of over a century, the british royal family and many others believing in it, going all the way to a pharmacologist explaining why lack of homeopathic research is a big pharma conspiracy. All these arguments, except admittedly the big pharma conspiracy, could be used in the favour of Godmen - but I didn't tell them that.

In Homeopathy We Trust

This again, is the wrong set of people I thought and so, tarried forth, taking a survey of all types of folk who were professionals, businessmen, colleagues, friends, reasonable, opinionated, modern, ancient, conservative, liberal and I found for myself a trenchant view in support of homeopathy. The most liberating reply that I could get was from some that they had no view on it. Almost, no one though, knew what homeopathy is and why is it supposed to work. To a middle class urban Indian, homeopathy is one of the many falsely equalized '-pathies', with medical science being called 'allopathy'.

This trust on homeopathy is a bit like believing in astrology without knowing what are stars and planets or like trusting your normal medicines without knowing a whit about biology or pharmacology. So let's get into the background. (You can watch or read Ben Goldacre - I would really recommend the read for basics of evidence based medicine. If you do, skip this and the next section.)

Homeopathy was the brainchild of one Samuel Hanheman from Germany. He woke up one fine day to an epiphany that something which gives you symptoms similar to a disease, when taken in diluted amounts would treat the disease. So 'like cures like' and 'dilution increases potency' of a medicine. 

'Like cures like' : How do you decide what works or the 'remedy' ? It's a process called 'proving'. A bunch of people come together and note the effect of a 'remedy' on them for a couple of days. A homeopath then records this rambling array of 'symptoms'. Your disease is then matched with the list of these symptoms to decided which 'remedy' suits.

'Dilution increases potency': Dilution in homeopathy is repeated to the extent that there are no molecules left of the original 'remedy' in the water solution. A 30C dilution means there is one molecule in a sphere of water with a diameter as large as the distance between the earth and the sun. Again, the process of dilution is not without it's idiosyncrasies. Each dilution needs to be done after striking the vessel against a hard elastic surface 10 times. One can just imagine a vast factory of robots in a homeopathic factory doing this voodoo, striking beakers against wooden boards for 'potency'. To top it all what you are given is not the dilution, which is in effect water, but the dilution coated on sugar pills. 

There is a lot of claptrap about how homeopathic medicine depends on the memory of water, but if you did study through high school, you can see from the potential implications as to why it can't be true. To the extent of those dilutions, all water has been impacted by me, you and everyone else that ever lived, or did not.

Evidence Based Medicine

The only true way you can recognize any medicine to have curative powers, is if it can pass what are called 'Double Blind Randomized Control Trials' or DBRCT. This essentially means you collect, say 200 people with a disease, randomly give them sugar pills or homeopathic pills and then compare the effects on both groups. If your medicine works, it will be more effective than sugar pills. Let's see the importance of each of the terms in DBRCT:

Double Blind: This implies that both the person dispensing medicines (or the doctor) and the patient do not know who gets the medicine and who gets the sugar pill. If they do, then a bias can be introduced - say by giving more homeopathic medicines to the healthy patients. This would defeat the aim of the trial.

Randomized: Randomization again ensures no bias and should be effective, by using a computerized pseudo - random generator. It cannot go, say, by prescribing alternately sugar pills and medicine, because again, there may be a bias introduced in choosing the alternate patients. Good randomization also ensures patients are not being chosen by other factors like age, sex etc.

Control: Control is to primarily establish all other factors, except the medicine, are the same in both groups. Through randomization and a large enough group, we ensure the only factor which could result in the different effects on disease in both groups is the medicine. The biggest reason for having the control group and giving them actual sugar pills though is the 'placebo' effect, one of the mysteries of the natural world. We get cured partly because we think we are taking medicines. If a medicine can work better than sugar pills, it's not just placebo action.

Homeopathy has not passed any DBRCT trials till date, the few it has are ill-designed ones. This is not to say that all DBRCT trials are well - designed. The big and bad things done by big pharma usually involve manipulating these trials. 

Many times, this also involves a positive publication bias. Do an experiment a 100 times, and you are bound to come out with false positives, those flukes where it shows a good result just one time. But what if you don't publish the 99 negative outcomes and publish the one positive outcome. The net published results show a 100% positive impact of the medicine. To counter this, a trial needs to be replicable - something at which homeopathy fails again. 

Faith Based Medicine

I have tried discussing this with friends, family and with those in the bus on the archaeological trip, but what I got in return were responses which are increasingly hardened. All of us like to believe we are open-minded and ready to change our views with slightest of evidence, but in reality for most, nay all of us, the narrative of life is largely fixed, and a reaction to contrary evidence, more often that not is to ignore it or attack it. We form our beliefs first and our reasons later. Look at any investment banker justifying a deal, and you will understand what I am saying.

Science at it's core is falsifiable and to be intellectually honest, it's proclamations are ever-wavering afraid of a better explanation or more evidence. Homeopathy is nothing of these and so it is faith based medicine. The same faith which is reposed in Godmen.

But wait a minute, you say, you were ill. You tried all medicines and what cured you in the end was homeopathy. How can someone say it does not work ? Well it may work in two ways - one is chance and the other is placebo.

Chance is when homeopathy and your cure were not related. I was down with an allergic cold for a month which no doctor's medicine could cure. End of the month, my mother insisted on taking me to a homeopath. I refused to go but was cured anyway in a couple of days. If I had gone to a homeopath, I would have been cured in two days by 'homeopathic treatment'. This is why you should not rely on anecdotes but on DBRCT trials. Anecdotes have the special ability of choosing exceptional stories and making them seem more relevant. (To digress, anecdotes are what drive the anti-vaccine movement in the US, another disaster in the making.)

The second reason is this mystery called the placebo effect. It seems if we think we are taking a drug, our body actually responds as if it is. No one really understands this, though it has been dissected threadbare in terms of its visual appearance. So, in a way, what really cures you is your mind. If we could classify placebos as working medicine, shamans and other magic cures would be medically certified.

What we really do not know about faith based medicine, is the quantum of impact through the entire ritualistic rigmarole of going to a doctor, getting yourself examined and getting sugar pills versus just taking some sugar pills. Homeopathic practitioners, anecdotal evidence says, are famous for giving time, showing empathy and drilling their patients for the last traces of symptoms. This entire 'ritual' may serve to strengthen the placebo and needs serious study. Why only 'homeopathy', in bits and pieces this may help in deciphering everything that goes by the name of 'alternative medicine'. Heck, for all we know, modern anti-depressants may all be placebo !

In the same vein, Godmen too work, by chance and by helping your psychology. If Satya Sai Baba conjures vibhuti and you believe it can cure you, maybe it does sometimes. If an astrologer predicts you winning and boosts your willpower, so be it. If the 'inspirational speakers', the neo-Godmen of the materialist world, speak of how your confidence can earn you money, then they too may help your mind. 

Faith, even if it cannot move the proverbial mountains, can definitely move minds and the impact physical reality surrounding them. Given your context, vibhuti from Satya Sai Baba may be more useful as a cure, if it has no medicinal value, compared to getting a Justin Bieber haircut or listening to Himesh Reshammiya crooning. 

What is Faith ?

The responses I received from people around me on homeopathy led me to thinking on faith. The term blind faith may mean faith in what you cannot see or faith which is blind to all the counter arguments - which are present, in howsoever a flawed form, for all arguments. When you move beyond the evidence of what you immediately see and experience (called प्रत्यक्ष प्रमाण in Hindi), you enter the arena of faith. You may know a little bit about physics and may believe in an atomic bomb, but it is at the end of the day, a construct of your faith or your belief for you have never yet seen or experienced one yourself (or you would not be reading this post). It is based on hearsay and to the extent you understand the science, on your capability for inference.

So, to take a logical leap of faith here (pun intended), all of our knowledge is essentially a belief. I know this is a big jump but bear with me. With so much of belief all around, we need a framework to test and bring together these beliefs in our mind. To me the framework of the ultimate belief system of all, religion, can work as a framework for all our diverse set of beliefs - from alternate medicine to science. This is the framework of 'philosophy (or theology for want of a better word), mythology and ritual'. 

Philosophy (or theology for want of a better word) represents a deeper insight, something which you may seek to understand but which is not really necessary to understand or practice. For Islam, this would mean the Shahada, for Vedic Hinduism the Shruti, for Buddhism the four essential truths, each with all the associated dense theology. 

'Like cures like', 'dilution increases potency' and the 'memory of water' may be called the philosophy of homeopathy. 

Position of planets in the astronomical sign of your birth impacts your life is the philosophy driving astrology. 

Many don't know the philosophy behind their beliefs, which leaves them so much the poor for it, but also ironically, more pliable to arguments for the beliefs are yet not rooted. If they don't know the philosophy, though difficult, they can still change their mind.

Mythology is what connects in a very coffee - shop argument way, the dense philosophy to everyday life. It's not an accurate mapping exercise, but it captures the essence. The Mahabharata and the Puranic tales bring the Shruti directly to us. This is where anecdotal evidence comes together in a homespun fashion through lively tales and riveting stories which tie our own personal narrative with the narrative of the larger philosophy. 

While we may or may not visit the philosophy of our beliefs, we interact with it daily through our mythology. The anecdotes of people being cured by homeopathy are part of this mythology. The tales of Godmen bringing relief, of Christian saints performing miracles (a compulsory requirement for sainthood) is all a mythology that buttresses our particular belief. Mythology is the vicarious experience that fills the voids of our stories, by the collective experiences of the beliefs we associate with. It provides our minds with enough dots to make a picture. This makes our belief an important part of our identity.

Ritual is when we put our money behind our mouth, practice what we preach and so on. This is the holy grail of practice. Of praying in temples, reciting the namaz five times a day, going on pilgrimages and visiting doctors for medicines when ill. Ritual is what brings our belief alive for us. Where mythology reminds and reinforces, rituals in their myriad form lead us to do what we say.

It is the core repeatable essential of any belief system. Without this a system cannot exist. This is not the dreamy world of philosophy or the semi-real engagement of mythology. This is the touchstone of practice nurtured by mythology. What you keep doing becomes a habit and the essence of your belief, reinforced every time you repeat it.

Science as a Belief System

It is in this context of belief systems, that we can begin to empathize with the thinking of others. Science and rationality are but other variations of a belief system which can be viewed through the lens of philosophy, mythology and ritual.

In the paradigm of science - god is replaced by evidence.

'Everything is to be examined by the touchstones of peer review and proof' is the philosophy of science. We dig into its arcane roots with textbooks and papers to the extent we understand them.

When we hear of the inspiration of Einstein, Raman or Hawking or the story the relative who was cured of cancer or of new communication gadgets, we hear the mythology of science.

When we perform lab experiments, use our mobile phones, or read this blog, we enact the ritual of science.

The Roots of Faith - Mythology and Ritual

We often know our answers and frame our questions accordingly. So it is with belief systems. If there is one thing that shines through, say in political debates, it is that the participants believe firmly in their ideology - there is no search for the truth. We know the answers and all questions shall be twisted to fit our answers. No whys, hows or patient thoughts. While the leadership core may be spinning the philosophies, adopting their mythology and enacting the ritual of the party is the grass route membership. This is where we see the everyday power of mythology and ritual. They, and not the obscure and arcane reasoning, link our roots and our identity with the larger faith.

While we may not know the philosophy or the driving reasons, we are acquainted with and trust the narrative and the practice. We may not know much about the common cold and it's particular medical reasons, but we do believe in going to a doctor and taking a medicine which will cure us. We face a problem however, when another belief system tries to adopt this particular mythology and ritual.

While the core philosophy of homeopathy and medical science is poles apart, their mythology and ritual are the same. You just need to add a few words like quantum, nano, meta, energy fields and such extended faff to guide someone following the 'scientific' mythology into following the 'homeopathic' or 'alternative medicine' mythology. People really do not care about the underlying philosophy. It looks scientific and ties with the scientific narrative or mythology they identify with. The ritual is also almost the same. So in their minds, the '-pathies' of allopathy and homeopathy are comparable.

That this happens so regularly with all kinds of people and in all kinds of situations, makes me a bit aware that I may have beliefs, say political, which would not easily budge. They are pre-decided, not necessarily on evidence. As everywhere, what fits my personal narrative, my mythology and reinforces my ritual would be my truth. It would be very difficult to shake that belief system. This stands true for religion, for Godmen, for homeopathy and I like to think, for rational science.

So be careful, be very careful when you lampoon another's faith. Many a times, you will use the same argument as being perfectly reasonable for your belief. Much like the missionaries teaching the civilizing virgin birth to a tribe following magic. One set of beliefs traded for another.

Disclaimer:
All of this, is of course, coloured by my vision and beliefs.

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