ekibastos…

None…

Now, for a suggestion. You may wish to line up a few “guest bloggers” to allow you folks some time off. If the rest of the blogosphre is any measure of the attack dog attitude of the anti-science know-nothings, your regular contributers will need periodic R&R to prevent SBSD (scinece blogging stress disorder).

Congratulations on an excellent start!

My co-authors and I have been vigorously discussing how best to convey the complex relationship among plausibility, basic science, and clinical evidence in the full spectrum of health claims from mainstream science to the absurd fringe. Once we have it tweaked we will likely publish it here as our “mission statement.” Feedback from you and the other commenters will be very helpful in crafting this statement, so thanks.

“Within the practice of medicine there is already a recognition of the need to raise the standards of evidence and the availability of the best evidence to the practitioner and the consumer – formalized in the movement known as evidence-based medicine (EBM). EBM is a vital and positive influence on the practice of medicine, but it has its limitations. Most relevant to this blog is the focus on evidence to the exclusion of scientific plausibility. The focus on evidence has its utility, but fails to properly deal with medical modalities that lie outside the scientific paradigm, or for which the scientific plausibility ranges from very little to nonexistent.”

I agree that the usual model of EBM faces problems when applied outside its native setting of mainstream medicine. It overwhelmingly favours evidence from clinical trials. This is as it should be — it recognises the large gap in reliability between clinical trials and other kinds of evidence such as the personal judgments of medical practitioners. It also normally deals with matters having neutral or positive prior probability (plausibility).

Yet clinical trials are also very easily corrupted or faked and liable to statistical flukes. Positive studies may thus not readily carry the day when applied to matters that have an extremely low prior probability (plausibility). They only work for the mainstream because of the sheer intensity of clinical study, with multiple replications of studies and rigorous re-analyses ensuring that the inevitable occasional wrong judgments don’t endure for long.

But what makes things implausible, or “outside the scientific paradigm”? In the above paragraph you seem to be detaching these concepts from any evidence base. May it not simply be that in considering some matters we are instinctively, almost unconsciously, recruiting types of evidence that don’t normally figure within the medical or scientific mind?

An example: why is homeopathy implausible? Among other matters, its signature proposition is implausible mainly because never in the whole of human experience or research has dilution of solutions been found to enhance their intrinsic physical, chemical or biological properties (Hormesis is a property of a few biological systems, not the consistent behavior of solutions that homeopathy requires). Thus, dilution doesn’t make our coffee taste stronger and we don’t expect otherwise no matter how much we shake or stir it.

It seems many don’t take this kind of evidence into consideration. It is not seen as “science”. It does not involve a laboratory, is not done by scientists, and it is not published anywhere. Yet it is as scientifically valid and consistent an observation as that things always fall down, not up.

This is presumably why so many found “potentisation” implausible well before anyone knew anything about Avogadro’s number.

As you correctly state good science involves taking into account ALL the relevant evidence but we should not be restricitng oursleves as to what kinds of evidence we consider.

Peter Moran