The Science Museum in London is a national shrine to human ingenuity. Its existence is a testament to the value that our society places on inquiry and innovation, its worth paradoxically underscored by the fact that, even in these impecuious times, entry is still free.
The museum sits grandly on Exhibition Road, just around the corner from my laboratory at Imperial College. Some lunchtimes I like to drop in, just to sit among the leviathans in the steam hall or to take a quick peek at some of the brassy instruments. There is a solidity and a magnificence to many of the exhibitions. It is a favourite place.
I was therefore surprised last week to come across a dispute about an exhibition on alternative medicine at the museum. A guest post by Alex Davenport on Marianne Baker’s blog criticised the Living Medical Traditions exhibition for its presentation of practices such as homeopathy and acupuncture without any accompanying evaluation of their worth. Prompted by his critique, the science museum responded on their own blog, defending the exhibition as one that provided “anthropological and sociological perspective on medical practices”. The redoubtable David Colquhoun was also critical of the low level of the scientific content in the exhibition and Marianne and Alex re-visited the argument in The Guardian.
On all these blogs quite a discussion ensued — some of it cantankerous (a ‘firestorm’ according to one participant) — about the proper manner for the science museum to present scientific information to the public. Prominent in support of the museum was Rebekah Higgitt at the Whewell’s Ghost history of science blog, who wrote to defend the anthropological, sociological and historical approach they had taken. She took to task those commenters who claimed the only way for the museum to improve the public understanding of science “is to tell them some science”.
This narrow view of the role of science museums has already been satirised — such is the fearsome speed of the blogosphere — and rightly so, but this response doesn’t address the argument put forward by Davenport, Baker, and Colquhoun or what is for me the most interesting substance of the discussion. The sometimes testy blog conversation had echoes of an earlier exchange on the skeptical approach to astrology. Since I have just read Carl Sagan’s The Demon Haunted World, a wonderful and wise book on the collision of science and non-science, and been wondering about modes of scientific communication, I thought I’d take a closer look.
So yesterday I went to the museum.
The Living Medical Traditions exhibition is just one part of the much larger Science and Art of Medicine Gallery on the 5th floor of the museum. The gallery is a packed maze of glass cabinets — the exhibition relies almost wholly on an amazing and often wonderfully gruesome array of artefacts: scalpels, microscopes, eviscerated models and prosthetics. Starting with Egyptian, Mesopotamian, Greek and Roman practices, the gallery traces the development of modern medicine through the middle ages, into the Enlightenment and right up to the present day. There is a clear narrative about how the development of a scientific and experimental approach to physiology and disease has brought us — not always linearly — to our present understanding. The room may be frustratingly dim but many, many of the exhibits are brilliant. You should go and see it.
In the middle of the gallery, and clearly demarcated from the rest, you will find the Living Medical Traditions exhibition. There are notices at the entrance to explain its purpose. Since this purpose is at the root of the dispute, I will quote them in full. At one entrance there is:
Living Medical Traditions
Medical traditions have developed in all parts of the world. Here we describe different medical traditions. In contrast to scientifically based biomedicine, which is a relatively new approach to medical practice, some of these traditions stretch back over thousands of years.
In this section of the gallery, we have chosen to present four medical traditions: Ayurvdea, Unani Tibb, Traditional Chinese Medicine (TCM) and African medical traditions
Across the world, millions of people use these traditions. For example, 40% of people in China, a country home to nearly a quarter of the world’s population, use TCM clinics as their first choice.
The point is made that this part of the exhibition presents material that is different from “scientifically based biomedicine”. However, that boundary is blurred by the way in which some of the material is presented. For example, part of the display on Traditional Chinese Medicine describes the work of Professor Shi Zaixiang who combines traditional approaches with “cutting edge” biomedicine. How that combination works is not explained. The display on African traditional medicine also describes — but does not explain — joint approaches to treatment by traditional healers and biomedical workers.
Also at the entrance is the following introduction:
Living Medical Traditions
When people fall ill the type of treatment they seek often depends on where they live.
This area of the gallery illustrates healing practices from around the world using objects collected by businessman Henry Wellcome, who died in 1936, and more recent material collected by the Science Museum.
Ayurveda, Unani Tibb, Traditional Chinese Medicine and African medical traditions are all explored. The area also features a number of personal stories from around the world that show how individuals choose medical treatments from different traditions.
A valid strategy in my opinion, but in what sense are these practices being explored?As a further notice explains, the exhibition is structured around the accounts of a small number of individual patients and practitioners:
Around the world, medical traditions coexist, interact, compete and combine.
Here we describe local cases where individuals have chosen treatments from more than one medical tradition. Some visit practitioners who mix knowledge and techniques from different sources.
Individuals choose a practitioner for many reasons. Their choices may be guided by their personal belief systems or limited by geography or cost.
This is a potentially fascinating approach to the subject of traditional medical practices and one that is by no means out of place in a science museum. There is an acknowledgement that traditions intersect in complex ways that depend on local culture with more modern approaches to healthcare. But the material on display is too superficial to do the subject much justice. There are testimonies from individuals — some of them extremely interesting — but that is about all. In my mind each account raised intriguing but unanswered questions. There was no exploration of the individual experiences.
One story from Nepal recounted the case of Pasang, a woman who was injured in a fall and was treated at a nearby hospital. But she also sought out the ministration of a local shaman because she feared the fall may have been caused by a angry deity who needed to be appeased. Why did she choose both treatments rather than one or the other? Did she recover quicker because of the attentions of the priest? On these matters she is silent.
Professor Shi Zaixiang of Beijing University, whom I mentioned above, treated a group of patients who were all suffering nausea, vomiting, hearing problems and bouts of vertigo. Though his modern training suggested they had Ménière’s Disease, his traditional understanding suggested that “their qi energy wasn’t circulating correctly” and so also informed his selection of herbal remedies. But there is no comment from the Professor as to how he melds his modern and traditional outlooks. How, I wondered, does he reconcile the modern understanding of energy with the ancient? How, for him, does qi energy relate to the concept of energy that developed — in a fascinating way — from the studies of physiology and thermodynamics that were done in the 19th Century (explained in some my favourite exhibits elsewhere at the museum)?
These are just two examples but they give the flavour of material on display. What is particularly strange to me is the lack of interaction between the Living Medical Traditions exhibition and the rest of the gallery. Strangely, the approach to the scientific content is deliberately hands-off. In response to Alex Davenport’s blog post, the museum issued a statement explaining its approach (my emphasis in colour):
In our ‘Living Medical Traditions’ section of the Science and Art of Medicine Gallery we take an anthropological and sociological perspective on medical practices. We reflect patient experience in a global setting. We do not evaluate different medical systems, but demonstrate the diversity of medical practices and theoretical frameworks currently thriving across the world.
Our message in this display is that these traditions are not ‘alternative’ systems in most parts of the world. Instead they currently offer the majority of the global population their predominant, sometimes only, choice of medical care. We do not make any claims for the validity of the traditions we present. For example, we include the use of acupuncture but do not say that acupuncture ‘works’. We consider that these ‘alternative’ medical practices are of considerable cultural significance. We also recognise that some may consider the inclusion of these practices in the Science Museum controversial.
As with all Science Museum galleries independent experts were consulted when developing this gallery. In this instance advice was sought from leading academics in the history of non-western medical traditions as well as practitioners and users of these traditions. We maintained editorial control throughout and resisted equating local medical practices with the western medical tradition.
This statement provides a clearer explanation of the aims and limitations of the exhibition than is offered to the public visiting the museum (and might usefully be placed at the entrance to the display). In contrast to some of the commenters who have weighed in on this debate, I agree with the museum — and Rebekah Higgitt — that an anthropological and sociological perspective is a perfectly valid way to look at scientific matters such as the development and practice of medicine in different parts of the world. But why emasculate it by refusing to consider the extant scientific analyses of these practices, particularly when to do so undermines the anthropological and sociological approaches?
The exploration is oddly blinkered.
Why not evaluate the scientific underpinnings of these practices? Wouldn’t that be germane to an understanding of their anthropological and sociological meaning? Why is there no statement anywhere of the known controversial nature of homeopathy or acupuncture? Isn’t that a valid part of the sociology of these methods? Did the patient in the display choose acupuncture because of the weight of the phrase ‘traditional’ or because he had looked at the evidence? How exactly do practitioners combine modern and traditional approaches? That’s an interesting psychological and sociological question; is it a genuine fusion or an approach calculated to seed modern methods in cultures with long-standing traditions?
None of these fairly obvious questions is addressed. Strangely, given the subject matter of the exhibit, the museum has refused to take a holistic approach. And that’s a shame because the end result comes across as intellectually shallow.
The superficiality of the display is all the more surprising because there are healthy doses of a combined scientific, anthropological and sociological approach elsewhere in the Gallery. Anthropological aspects are evident from the historical narrative, which outlines the increasingly mechanistic view of the human body and the causes of its malfunction. And many sociological aspects of healthcare are considered: the pros and cons of abortion are debated; the question of attitudes to vaccination is discussed; the practice of phrenology as a means of assessing mental faculties is described — in this case the museum is not afraid to report that it was ultimately “discredited and became a ‘quack’ subject”. The museum does a good job in places* of critiquing the science: the advantages of X-rays as a diagnostic tool are tempered by the revelation that the penetrating rays also cause cancer; prosthetics for those who suffered the scourge of thalidomide are also on display.
Why the inconsistency? Given the range and robustness of much of the main part of the gallery, the light touch in the Living Medicines Exhibition is puzzling. The museum claims it retained editorial control over the material gathered from practitioners for the display but how much control or judgement did it exercise? Not much it seems to me and as a result it has failed to make much sense — scientific, anthropological or sociological — of traditional medicine. I think the Science Museum could and should do this important topic much greater justice. At a time when public attitudes to medicine remain in such flux, even in the West where scientific approaches are perhaps most deeply embedded, the Living Medical Traditions exhibition is a missed opportunity.
I suspect that despite the ‘firestorm’ there is plenty of common ground between many of the people in the blogosphere who have recently written and commented on this exhibit. Now that the Museum has also joined the discussion, wouldn’t it be interesting to explore whether something positive might emerge?
*In other places it does not — the section in the main part of the Gallery on drugs being a case in point. The introduction contains a panel titled Homeopathic, Allopathic and Herbal Drugs. It begins “During the 20th century, allopathic or scientific drugs have come to dominate medicine in Western countries…” and ends “These cases (S.3-12) show only the development of allopathic drugs and the drug industry.” This is a bizarre take on modern drug development. The museum seems not to know that ‘allopathic’ is a term coined by Samuel Hahnemann, the founding father of homeopathy, and is used almost exclusively by homeopaths to disparage medicines that do not conform to homeopathic ‘principles’. On any objective assessment, the museum should revisit this display. There is little case for presenting the development of homeopathic medicines over the past 200 years since there hasn’t been any. But why is there nowhere to be found a clear explanation of the principles by which homeopathic preparations are prepared and formulated? The Gallery has a sections on biochemistry and drug molecules but nowhere is there an attempt to site homeopathy in relation to science.