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Agnotology: The Study of Ignorance

A comment from the blog:

Every single time – bar none – I have had a conversation with someone about CAM and its modalities, they are absolutely astonished when I explain to them what the modality really is. One story I love telling comes from my friend in the year behind me. His parents are professional chemists and he came home one day and saw his mother had a bottle of homeopathic medicine. He asked why and she gave the typical non-committal response of “well, I thought it may help and I saw it on the shelf at the pharmacy.” He explained what homeopathy actually is and they were absolutely dumbfounded. They are well aware of Avogadro’s number, after all. People generally don’t study what the CAM in question actually is – merely the fluff PR garbage that gets touted around and without direct and clear demonstration of harm, give it a pass as a result. After all, the business of real medicine is time consuming and difficult enough.

Participating in activities that have a permanent record gives one the fortunate, or unfortunate, opportunity to revisit the past and see just how you worked early in a career.

It was sobering, as third year resident, to see the notes I had written as an intern. Man. It was amazing how unsophisticated my medical thinking had been a little over two years’ prior. How little I understood about the ins and outs of diagnosis and treatment even after four years of medical school. It is part of the reason I think it is a joke, albeit a cruel joke, that naturopaths and other pseudo-medical providers think they can function as primary care providers after a few years of alternative edjamacation.

I have a similar experience every now and then when I see the notes from early in my Infectious Disease practice, now heading into 24 years. Not quite as painful, but still remarkable in how much I didn’t know then. My ID podcast is an ongoing reminder of how much I still do not know. The last 34 years have been my personal linear acquisition of knowledge from the exponential production in the medical, and non-medical, world. Ignorance isn’t bliss, but an ever-expanding hole that can never be filled.

There is nothing wrong with ignorance per se. It depends on what you do with it. Ignorance can be a condition you can spend a lifetime attempting to overcome.

My early career in the world of SBM was defined by a remarkable naiveté. I thought people who used the various pseudo-medicines were simply ignorant, they lacked basic information about the topic and all I had to do was supply that information. They would read/listen to my explanation and think, ‘Oh. That’s how it works’ and move on. That is partly how medical training works. Once you learn how some therapy or procedure does or does not work, you behave accordingly. Eventually. Change is painful, and I do notice as I age how much harder it is to make an intellectual change. Habit is so comfortable.

There was certainly a large helping of ignorance with a side of hubris on my part. But that is how you increase knowledge. Discover the gaps and fill them.

I have not thought much about ignorance. Most of my time is spent on the hows and whys of the acquisition of knowledge. Part of my job and my hobby is to be an educator. I think of residents, myself, and my readers as an empty glass to be filled with facts and their relationships. A simplistic idea, but how I spend a huge amount of my time. I take in information, organize it, synthesize it, and then pass it to others, hopefully in a clever manner.

Others have thought about ignorance in a more comprehensive way. Robert N. Proctor is such a person and he has coined a term for the cultural production (and study) of ignorance: Agnotology. The author delineates several kinds of ignorance in the paper, and they make for a good conceptual framework for understanding ignorance.

And though distinctions such as these are somewhat arbitrary, I shall make three to begin the discussion: ignorance as native state (or resource), ignorance as lost realm (or selective choice), and ignorance as a deliberately engineered and strategic ploy (or active construct).

And he points out that:

Ignorance has many interesting surrogates and overlaps in myriad ways with—as it is generated by—secrecy, stupidity, apathy, censorship, disinformation, faith, and forgetfulness,

I have tended to think of ignorance only in the first definition: simply lacking knowledge on a topic or having wrong or incomplete knowledge. No one can know everything or anything perfectly. It is the kind of ignorance I thought I was combatting when I started my blogging career and why I spend an inordinate amount of time on Pubmed.

It leads to the second kind of ignorance, that of selective choice. Due to time and interest (not all topics in the universe are equally interesting) there are areas about which I choose to have a minimal knowledge. Diet, I admit, bores me. I pay little attention to the ongoing debates as to the best diet and what is good and mad to eat. I eat for pleasure or fuel and not for health and it is not a part of my professional life.

Other examples of selective ignorance occur in professional education. Medical schools and residency give short shrift to pseudo-medicine and critical thinking, and probably justifiable so. There is just so much time and neuronal space for the jaw-droppingly huge amount of information that becoming a physician requires. I have mentioned before that I was in medical school and training from 1980 to 1990. That decade of my life was spent learning my profession. My kids used to like to watch I Love the 80′s on VH1 and I recognized nothing from the show: the movies, the music, the fashion, the memes were are new to me. Most people lose a decade of life to drugs or alcohol; mine was to medicine. I have a huge selective ignorance concerning the 80′s and if the show is any evidence, it was a good thing.

Even more impressive in their selective ignorance is the training in pseudo-medicines:

Ignorance is a product of inattention, and since we cannot study all things, some by necessity—almost all, in fact—must be left out. “A way of seeing is also a way of not seeing—a focus upon object A involves a neglect of object B.”

And best typified by the curricula at a naturopathic school, but the same is true for any pseudo-medical education. Vast quantities of time are spent on areas divorced from reality: homeopathy, acupuncture, hydrotherapy etc. The effort to absorb these fantasies is, by their nature, going to prevent acquisition of knowledge about reality.

There is a similar process occurring at chiropractic schools, where they like to brag about their education:

According to the American Chiropractic Association, the course of study to become a chiropractor includes 4,200 hours of classroom, laboratory and clinical experience in “orthopedics, neurology, physiology, human anatomy, clinical diagnosis including laboratory procedures, diagnostic imaging, exercise, nutrition rehabilitation and more.”

I am not impressed. That 4,200 hours is 525 eight-hour days, a little under a year and a half. It would be so much more impressive if they said their training was 15,120,000 seconds. The bigger the number the better the education. My internal medicine training was seven years, plus two more for infectious diseases. And what good is all that training if it is being applied to the fantastical ideas of fixing subluxations? It is like learning horse anatomy to take care of unicorns. But it also ensures ignorance in areas of reality-based medicine.

The most interesting form of ignorance is the third:

Ignorance as strategic ploy, or active construct

The focus here is on ignorance-or doubt or uncertainty-as something that is made, maintained, and manipulated by means of certain arts and sciences. The idea is one that easily lends itself to paranoia: namely, that certain people don’t want you to know certain things, or will actively work to organize doubt or uncertainty or misinformation to help maintain (your) ignorance. They know, and may or may not want you to know they know, but you are not to be privy to the secret. This is an idea insufficiently explored by philosophers, that ignorance should not be viewed as a simple omission or gap, but rather as an active production. Ignorance can be actively engineered part of a deliberate plan.

The author uses the tobacco industry as an archetype of an industry that manufactures ignorance and starts the paper with a quote:

Doubt is our product. Brown & Williamson Tobacco Company, internal memo, 1969

The manufacture of doubt is common in the pseudo-medical world. It could not exist without it. I do not know if ignorance is bliss for pseudo-medicine, but it is a requisite.

The false information that underlies all pseudo-medicine, from the popularity of pseudo-medicine in the US, to the efficacy of acupuncture to the safety of chiropractic to the mechanism of reiki relies on the production of massive amounts of ignorance. And so has some aspects of real medical treatments. Pharmaceutical companies have not been hesitant to borrow methods from their tobacco brethren. Although science can be an antidote to the production of ignorance in the real world, the pseudo-medical world is often invulnerable.

Examples of ignorance as strategic ploy in the pseudo-medical world abound and can, for a time be effective, as Megan Sandlin demonstrated, although:

In the end, I couldn’t continue to deny the science. It’s hard to believe now how easily I bought into everything I was hearing from the anti-vaccine crowd. It seems extremely obvious now: doctors aren’t evil, scientists aren’t trying to kill your kids with toxins, and vaccine researchers aren’t just trying to scam you out of your money.

Natural News and the Mercola site are probably the Ford and GM of medical ignorance production, but there are numerous boutique producers. I ran across Why You Never Need A Tetanus Vaccine, Regardless of Your Age or Location by Dave Mihalovic, ND, whose ignorance production I have discussed before

Mr. Mihalovic identifies himself as “a naturopathic medical doctor who specializes in vaccine research.” However, just where the research is published is uncertain as his name yields no publications on Pubmed. BTW. I specialize in beer research. Same credentials.

Tetanus is a rare disease in the US. I have seen one case, years ago as a fellow, in an elderly immigrant who had never received the vaccine. Having every muscle spasm at once is horrible for the victim.

From 1922-1926, there were an estimated 1,314 cases of tetanus per year in the U.S. In the late 1940′s, the tetanus vaccine was introduced, and tetanus became a disease that was officially counted and tracked by public health officials. In 2000, only 41 cases of tetanus were reported in the U.S. … Approximately 20 percent of reported cases end in death.

Tetanus in the U.S. is primarily a disease of adults, but unvaccinated children and infants of unvaccinated mothers are also at risk for tetanus and neonatal tetanus, respectively. From 1995-1997, 33 percent of reported cases of tetanus occurred among persons 60 years of age or older and 60 percent occurred in patients greater than 40 years of age. The National Health Interview Survey found that in 1995, only 36 percent of adults 65 or older had received a tetanus vaccination during the preceding 10 years.
Worldwide, tetanus in newborn infants continues to be a huge problem. Every year tetanus kills 300,000 newborns and 30,000 birth mothers who were not properly vaccinated.

A rare, awful, and mostly preventable disease, it is caused by Clostridium tetani. The bacteria, found in the soil, gets into damaged tissues, releases its toxin and the result is tetanus.

Tetanus toxin, tetanospasmin, is extremely potent and can cause severe disease yet not cause the production of antibody. A curiosity of many toxins made by Clostridia, be it botulism, tetanus or gas gangrene, is the purpose of the toxins in the wild (i.e. the dirt), which remain a mystery. As an anaerobe it can be difficult to grow.

Of course, as is his métier, and no doubt a result of his naturopathic training where his understanding of microbiology and infectious diseases is profoundly ignorant, he says:

The tetanus bacteria may be a factor in tetanus. The toxin may be involved in some way but that these are fundamental causes is nonsense, otherwise the disease would be more common, in view of the fact that the bacteria is so frequently found on and in our bodies.

And:

The real cause of tetanus is not a germ, but dirt and filth. The bacteria are harmless when placed into a surgically clean wound. Tetanus develops when drainage of a wound is checked and dirt is retained in the tissues.

And:

The patient suffering from tetanus should be put to bed, permitted to rest, kept warm and fasting should be immediately instituted. They should receive all the salubrious hygienic influences and the fasting should be continued until all symptoms have disappeared.

Advice and treatment that, if followed, could result a repeat of when parents’ fear of vaccinations nearly killed their son or worse:

Auckland parents Ian and Linda Williams thought they had made an informed choice not to vaccinate their children, but after their son ended up in intensive care with a tetanus infection they realized they had made a terrible mistake.

The problem with reality is it doesn’t care if you are ignorant. You can reject and substitute your own where dirt causes tetanus and vaccines are worthless. Get the perfect storm of bad luck and you will get tetanus if not vaccinated.

Pseudo-medicine is producing ignorance at a vastly higher rate than medicine can produce an approximation of the truth. But it will always be that way. It is why I lobbied for Sisyphus to be the emblem of the Society for Science-Based Medicine.

Posted in: Critical Thinking, Naturopathy, Science and Medicine

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119 thoughts on “Agnotology: The Study of Ignorance

  1. goodnightirene says:

    “Every single time – bar none – I have had a conversation with someone about CAM and its modalities, they are absolutely astonished when I explain to them what the modality really is.”

    His parents are professional chemists and he came home one day…”

    I can assure you that you do not get the positive results Andrey speaks of when you are not talking to professional chemists. When I explain homeopathy to most people, they simply tell me that it just has some mysterious way of working and they don’t give a fig whether or not “science” (they always say “science” as though it is in quotes) can “understand” it. Some of the people I deal with are believers in general, but more worrisome are the ones who are health care professionals.

    1. Andrey Pavlov says:

      Yes, it was obviously much easier with the fact that they were professional chemists. But the point was that just because you are a professional or otherwise very scientifically literate, doesn’t mean you are actually literate on material relevant to the question of CAM. In every experience I have had, anyone who gives any CAM any sort of “pass” it is always because they have either a completely wrong or extremely superficial understanding of what it is, which they then retrofit into an otherwise scientific understanding and chalk it up to being unlikely but existing in the realm of genuine scientific ignorance. They are typically flabbergasted when they realize that these CAM’s are not just in the gaps of our knowledge, but very much counter to the knowledge we do have.

      1. Thor says:

        I immediately recognized the quote Dr. Crislip used to open his post with as being yours. So you got to post without intentionally posting—pretty admirable-ha (you should still do a complete guest-post one day, though).

        I must say that I’ve met several scientifically literate professionals who do embrace or use CAM despite knowing exactly what it is. Four come to mind right off the bat: a neurologist who includes acupuncture in his practice but who otherwise is conventional, a podiatrist who recommends acupuncture (“I don’t know why, but in many cases it just works”), an MD with a specialty in oncology who uses facets of naturopathy, and a pharmacist (“what’s the harm”). Granted, they are all in medicine and not other branches of science but it’s quite disconcerting. And also granted, they might indeed have a wrong understanding; if they do, then it’s easy to see how others can as well. But, might there be a group of professionals who subscribe to CAM despite “knowing”— somehow reconciling their cognitive dissonance? Kind of like Francis Collins regarding faith?

        1. WilliamLawrenceUtridge says:

          To be fair, the “complementary” part of CAM means it’s usually at worst a waste of time and money (as long as the practitioner isn’t corrosively badmouthing science and real medicine). And acupuncture is almost guaranteed to have a strong placebo effect, and thus be, for most intents and purposes, “effective”. I have little objection to acupuncture as long as it’s safe (away from lungs, nerves and blood vessels, thanks!), clean, and not accompanied by a whole bunch of nonsense about qi. I’ve tried it myself once (didn’t work), while getting conventional physiotherapy. But my explanation for it (in this hypothetical scenario, I am a doctor with victims/patients – could you imagine me as a doctor? The mind reels…) would emphasize that this is a complement, it does not replace real medicine, and my explanation for how it works would emphasize that it doesn’t affect any disease processes, only the perception of symptoms (true, within a hair of a patronizing lie).

          At which point the placebo effect would probably erode somewhat, thus rendering it truly useless.

          1. Thor says:

            Good points (especially conceding that you as a doctor would be scary…….I kid, I kid). Yes, these seem to mostly consider the “complementary” part of it. But, there still must be quite of bit of justification and rationalization going on. I don’t think those professionals are using the placebo effect as the sole purpose for use, but have actually been duped (or convinced, “in my experience”, “try things”, etc.).

        2. Andrey Pavlov says:

          @Thor:

          Thanks for the compliment. I actually have done 2 posts here in concert with my partner in crime, one (soon-to-be) Dr. Igor Bussel (who will be doing an opthalmology residency at University of Pittsburgh, no small feat). Now that I finally know where I will be spending the next 3 years of my life I will be able to get some things out of the way and, ultimately I hope, become a more regular contributor around these parts. It’s purely on me that I am not.

          As for your experiences… that demonstrates quite clearly why “in my experience” is not a good enough metric! Of course I made it explicit (and assume it was implicitly clear) that my comment was not meant to be an unequivocal statement of fact descriptive of everyone, but to describe a subset of the CAM using population that I have very consistently encountered.

          I absolutely agree that the actual population is varied and I won’t try (nor did I try) to quantify what percentages comprise each subset. But I would argue that the vast bulk is made up of those I described, those who are the “what’s the harm” ilk, and those who just don’t care but like getting paid.

          I think the “what’s the harm” ilk can be broken down even further with those who are still overly paternalistic and use it as an excuse to administer a socially acceptable placebo and those that genuinely have not thought through the potential harms on a large scale. (Plus others).

          Some I believe have a Collins-esque cognitive dissonance, but most I would aver are simply not concerned about looking deeply enough and genuinely feel it can be a good way to get a patient “off your back” in a positive sense. Patients with problems we can’t fix can also be draining on us (we are people too, after all) and it can become very enticing to offer up socially acceptable “alternatives” which at a minimum can keep you sending away your patient with something to try.

          Obviously this is all speculation, but I think there is some evidence to support it along with my own (and others) anecdotes. In any event, it argues to me that CAM should be given less social capital since many of these shruggie types will gladly offer it until they become laughed at for doing so. Ego, after all, still plays a big (often too big) role in medicine.

          There’s also the group that just genuinely don’t understand studies or how science actually works. They take mental shortcuts that work well for the most part but fail when it comes to things like CAM. I had one classmate try and argue that I couldn’t be so staunch in my condemnation of certain practices and studies because “everything we know will be completely different in 300 years anyways.” Seriously.

          When you are a scientist those sorts of ideas are drilled out of your head rather quickly. Or else you become a laughing stock like Rupert Sheldrake. But in medicine, what is king is the mindless regurgitation of facts. Give me a clever person with no skill or knowledge relevant to medicine and a iPad with internet connectivity and I can give you someone who kills all the exams we have to take to succeed. Obviously critical thinking is crucial to good medicine, but the bulk of medical training is refining a very sophisticated mechanic. And as we know, GIGO.

          Anyways, I’m off on a digression again.

          1. Thor says:

            Good to hear. I look forward to more AP!

            Excellent comments, as usual; thanks for expounding a bit more on the subject. Yes, it was clear that you weren’t blanketing everyone. It is certainly the overwhelming majority, if not a tiny minority, of scientifically literate professionals who do somehow fall for the spiel despite being informed. Rare but existent.
            They (scientists/doctors) are all people. I just wanted to add that even they can “legitimately” be fooled. Magic even fools Penn and Teller.

            1. Andrey Pavlov says:

              Thanks again for the kind words.

              BTW – I meant to comment on it sometime in the past when (IIRC) you mentioned that you are a massage therapist. I actually found one myself who I am comfortable with. She has a little bit of woo-ish thoughts from time to time, but it is not prominent at her office or her practice at all and I get the feeling is more a marketing thing for her than anything else since the rare occasion she even brushes up against it in my presence she seems bashful about even saying it (I’ve been seeing her regularly for 18 months now, so she knows quite well who I am and what I do).

              But it took me 4 or 5 tries to find her and I left all the others because there was way too much magical BS and creepy “mysticism” in their offices.

              1. Thor says:

                Thanks for the acknowledgement. I’m glad you found someone who can serve your needs. A good massage therapist can be a rare find, not only concerning degree of wooishness, but capability. There is vast discrepancy in the amount of training they receive. Regulations/requirements differ from state to state. Many states don’t even license practitioners. Basically, you should feel thoroughly satisfied that the massage session was performed according to your standards. You, as a physician might have an advantage in assessing the quality of massage since you are intimately familiar with anatomy. A large portion of quality massage has an almost medical-like component to it, as precise contours of anatomy are followed. No matter the muscle, strokes should start at tendinous attachments and follow the exact course of the muscle until the other attachment point(s) are reached. You, as a recipient knowing the anatomy, can feel/visualize if the strokes are complete. Plus, the pressure needs to be just right. Pressure is never generic as everyone’s body is different. Another important component is the quality of the touch itself. Does it feel nurturing, focused, confident, sensitive?
                Anyway, you had/have that right to be selective.

              2. Andrey Pavlov says:

                My pleasure. I think all facets (well almost all) of life and all professions bring something worthy to the human condition. And as such they can be done better or worse. Just because there are many ways to skin a cat, some equivalent, doesn’t mean that all are equivalent. And it seems to me not only reasonably but useful to acknowledge those that truly do their field a service, whether that is the janitor or the CEO.

                In regards to my masseuse – yes, she is very well trained in the techniques you describe. She does excellent long strokes and applies excellent pressure. I am one of those that likes to get beaten up with a deep tissue massage. I once had a little Thai lady be incredulous that I would tell her to go as hard as she could. She tried to break me in half but the only thing she broke was a sweat. One of the better massages I’ve had. My current masseuse is slim and petite and yet can put pressure on par with any massage I have ever had anywhere in the world. She can hone in on the areas that need work the most (and no, that is not magic or woo – you can feel whether a muscle is tensed or not) and when I really need some extra work will go over our time by a few minutes.

                A rare find indeed and happy to keep her on as my masseuse. Plus she offers excellent rates – the best I’ve ever seen outside of Southeast Asia.

              3. BillyJoe says:

                This discussion reminds me of a woman I met recently. It appears she goes to Bali once every six months where she can get an all over massage for $10. When I teasingly asked her “what do you mean by “ALL OVER”", she replied “oh, yes, ALL OVER”. I would have offered to save her $10, but I think she fancied the young Balinese girls.

          2. PMoran says:

            A: “In every experience I have had, anyone who gives any CAM any sort of “pass” it is always because — – ”
            (My emphasis — PJM)

            – then — (after several have described quite contrary experiences)

            A:” As for your experiences… that demonstrates quite clearly why “in my experience” is not a good enough metric! Of course I made it explicit (and assume it was implicitly clear) that my comment was not meant to be an unequivocal statement of fact descriptive of everyone, but to describe a subset of the CAM using population that I have very consistently encountered. ”

            Still with the bulldust and inconsistencies , Andrey.

            It is not even as if all CAM is as implausible as homeopathy. Herbalism is not, at heart. The science on some use of supplements and some dietary matters is impossible for the lay person to fathom. Some of the claims of mind-body medicine are not implausible.

            Some give CAM what you deplore as a “sort of pass” because they respect individual rights, some because the expect some non-specific benefits such as placebo responses to accrue from it. These sub-sections may not need much convincing that the science is bunk

            Some CAM methods have even given rise to confusing results form scientific studies — SJW, spinal manipulation in back pain, glucosamine. We cannot expect the laity to be able to understand why many studies into CAM and its theories give positive results. We don’t yet know what it means to report positively to sham acupuncture.

            So your experiences tell us very little of any use.

            It makes much more sense to understand that CAM has a very tenuous connection with science and no strong need for any kind of science (or pseudoscience) to thrive; there are other powerful forces at play. As goodnightirene pointed out the option of retreating into mysticism (or “science doesn’t know everything”) is conveniently close whenever there is serious scientific challenge.

            The only thing that keep CAM in check is a high level of trust in and (sometimes begrudged) respect for science within the general population, despite a lot of what should be seen as posturing — scratch most CAM users/practitioners and you will find a desperate desire for scientific vindication.

            Science is OUR obsession and we like to look at CAM from that rather narrow but simplistic perspective. Let’s think some more about that.

            1. Andrey Pavlov says:

              Still with the bulldust and inconsistencies , Andrey.

              No inconsistency Peter. None. Zip. Zero. Zilch. Nada. But keep grabbing for whatever straws you think you can. My statement stands, as it is a reflection of… wait for it… my experience. That in no way contradicts anything else I have ever said, nor does it contradict the data, nor does it call into question the larger picture. It is merely, by definition and admission, a subset of the larger data.

              But hey, you’ve been using some creationist rhetorical tactics in the past, so quote mining and adding the context of your choice is not terribly surprising to me.

              By the way, have you noticed how you have made some very clear assertions both in general and about Mouse and she has herself demonstrated you wrong on those points, which form part of your platform for your argument? Because it sure doesn’t seem like you’ve noticed. Must be wonderfully convenient to just continue spouting off the same falsities and deepities and conveniently ignore whatever it is you wish to ignore, only focus on the bits you like to, and then add your own context and meaning to them because you “can’t tell what others are actually thinking” so you just assume they are thinking whatever makes your argument seem more sound.

              So your experiences tell us very little of any use.

              Funny, how I actually made that a point. My experience doesn’t tell us much of utility that is generalizable, though it has helped in my own small corner of the world. But the fact that it jibes with the data and the experiences of others seems to lend it a touch more credibility. At least I down have “the laity” saying I am wrong for many of my posts here, unlike you.

              Let’s think some more about that.

              Peter, your points are so repetitive, shallow, and vague there is not much to think about. Despite that, I have, and still come to the same conclusion. You’ve made it abundantly clear in the last few weeks that you think incredibly highly of your own opinions, are convinced you are one of the greatest thinkers on CAM alive, and have taken on the role of the Oracle giving us profound nuggets to chew on, failing to do so at our own peril. Yet I’ve seen very little but deepities coming forth.

              1. Pmoran says:

                Yet Mark Crislip thought you meant to say something profound, and even quoted it up front above. . Those who objected also read it that way.

                You are as unapologetic about this as you were about your gross inconsistencies in that placebo discussion.

                It also did not dawn on you or Mark before presenting such ephemera on a science-based site that your experiences had about the same factual status as the weakest of CAM testimonials?

              2. Sawyer says:

                Peter, every single person here (besides SSR) understands exactly what both Andrey and Dr. Crislip are talking about. They are discussing different types of ignorance. Andrey is referring to the first type outlined by Proctor. Mark is talking about his own experiences, which seem to involve more of the second and third types. The fact that the word “always” does not perfectly convey Dr. Crislip’s narrative is not a big deal, because believe it or not Andrey doesn’t have psychic power to perceive future SBM posts.

                I find the level of irony here absolutely hilarious. You’re complaining about some incredibly minor pedantic point that has nothing to do with actual science, medicine, or communication, in a post that talks about how doubt mongering and distractions are a great way to help people make terrible health decisions.

              3. Andrey Pavlov says:

                Well, I don’t think I need to add much to what Sawyer said. Thanks, Sawyer.

                Funny how quite literally only you and the serious wackaloon types that drop in from time to time are the only ones who find “gross inconsistencies” in my writing and my thoughts. Meanwhile everyone else, including non-medicos and non-scientists, and also including those very new to the blog and comments find your deepities completely impenetrable or utterly trivial.

                And the difference between our experiences and the weakest CAM testimonials is that we know, admit, and understand that they are weak. Doesn’t mean we can’t write about them from time to time, particularly when the rest of the data that is not weak supports them.

                I’ll eagerly await the next deepity from the Oracle of CAM.

    2. yogalady says:

      Homeopathy is based on the idea that water can have structure that can store information. This idea has not been disproven, and interesting research is going on currently.

      People working as chemists would not necessarily be aware of the recent research. They have already made up their minds that water cannot store information, so they are appalled.

      1. Harriet Hall says:

        @ yogalady,
        “Homeopathy is based on the idea that water can have structure that can store information. ”
        No, homeopathy is based on the magical thinking of Hahnemann (“like cures like” etc.)
        The structure of water idea was merely a desperate attempt to rescue homeopathy from unscientific limbo after the meaning of Avogadro’s number was appreciated.

        “This idea has not been disproven, and interesting research is going on currently.”
        It doesn’t have to be “disproven,” it has to be “proven” by its advocates. They haven’t come up with anything even remotely convincing (to anyone but a homeopath). The “interesting” research is terribly flawed.

        “People working as chemists would not necessarily be aware of the recent research. They have already made up their minds that water cannot store information, so they are appalled.”
        We are aware of the recent research and have reviewed some of it on this blog. For instance, here: http://www.sciencebasedmedicine.org/the-montagnier-homeopathy-study/ and here: http://www.sciencebasedmedicine.org/homeopathy-and-nanoparticles/ It’s not that scientists have made up their minds that water can’t store information, it’s that they have no reason to think that it can. Based on what we know about transient water clusters and other aspects of water chemistry and physics, we are justified in thinking that it is astoundingly improbable. But we would not reject it as impossible if they had any credible evidence. They don’t seem to realize that even establishing the ability of water to remember would not begin to explain or validate homeopathy. That’s a far cry from showing that homeopathic remedies have clinical effects, or that those effects increase as the remedy is diluted. It doesn’t explain how the water of the remedy only remembers what the homeopath wants it to remember and forgets all its previous exposures to other substances. It doesn’t explain how the memory can persist after the homeopathic solution is dripped onto a sugar pill and the water has evaporated. They can’t even distinguish a high-dilution homeopathic remedy from plain water. They would have to show that different water memories had different effects on human physiology, and that those effects were somehow therapeutic.

      2. windriven says:

        @yogalady

        Water is, at standard temperature and pressure, simply a volume of dihydrogen oxide molecules. These are dipole molecules and at reduced temperatures where they fall into a crystalline structure, one might be able to mount an argument that that lattice could be manipulated to store information. But that isn’t at all what we’re being asked to believe. And at STP those molecules float around more or less randomly.

        First, you are asking us to believe that science that has bored deeply into the foundations of matter has somehow missed this particular property of water.

        Next, you are asking us to believe that the water only remembers what you want it to remember. For instance why would the water remember a past encounter with a bit of duck heart but not recall passing through Caesar’s urethra as he urinated in the Po?

        Then, you are asking us to believe that water uses this selective energy to seek out some diseased organ in and exert some clinically significant action.

        I’m far too polite to ask if you are drunk or just stupid so I will ask instead why such an improbable set of beliefs should be not just held but acted upon – in the absolute absence of evidence?

        Just wondering…

      3. MadisonMD says:

        Homeopathy is based on the idea that water can have structure that can store information.

        Let’s analyse your statement by three different means:

        Observation. Water that maintains its structure is called ice. Liquid water, on other hand is a fluid that can adopt the shape of any vessel you pour it into within seconds, because it is free to break and make hydrogen bond structures. So, we can, in order everyday observations see that it will be difficult to imagine liquid water maintaining a structure.

        Chemical analysis. Liquid water molecules are linked via hydrogen bonds. The Gibb’s free energy of such a hydrogen bond at 25C is 0.5 kcal/mol per bond (1). Thus breaking these bonds with thermal energy is rapid and so hydrogen bonds live only about 1 picosecond (2, 3). So this could possibly be a useful way to store information for up to 100 femtoseconds, but not much longer. (i.e. Don’t expect to see water-based disk drives soon*)

        The obvious. Homeopathic remedies are dropped onto sugar pills and dried. There is no water to hold the information.

        ——————–
        (1) Silverstein et al. JACS 122: 8037–8041, 2000
        (2) Tay et al. Phys. Chem. Chem. Phys. 11, 409-415, 2009
        (3) Luzar and Chandler. Nature 379, 55 – 57, 1996

        *Wanna buy my new water disk drive for $100? It has a chock full of hydrogen bonds storing information.

      4. Jann Bellamy says:

        I take it you think it is perfectly permissible to sell, or prescribe, a product as a treatment for disease as long as the “idea has not been disproven and interesting research is going on.” An extremely low bar, don’t you think? Perhaps you would favor amending the laws to lower all healthcare products and services to this level of evidence before they can be sold: drugs, medical devices, surgery — all of it.

      5. WilliamLawrenceUtridge says:

        What interesting research?

        How does “information” help health? How is it “stored”? What “reads” the stored “information”? Molecular receptors on the surface of cells are amazingly specific, they’re quite hard to activate or deactivate – that’s why pharmaceutical research is so damned expensive. Why do you think there is, or should exist, some sort of mechanism built into the human body (or presumably) water that translates the molecular structure of certain plant extracts (or homeopathic moonlight, no I am not kidding) into signalling structures of water that somehow survive storage, transport, swallowing, digestion, intravascular and intracellular transport?

        Also, how does your statement reconcile with the fact that most homeopathic remedies are actually lactose pills that have been sprayed with water (i.e. there is no water to “structure”)?

        Also, how does your statement reconcile with the fact that many homeopathic remedies are delivered suspended in alcohol?

        Also, how does your statement reconcile with the fact that mineral homeopathic remedies are also prepared by grinding them in 10:1 or 100:1 ratios of calcium carbonate? Where is the water to structure in that?

        1. CHotel says:

          I see your homeopathic moonlight and raise you homeopathic oxygen: http://webprod5.hc-sc.gc.ca/lnhpd-bdpsnh/info.do?licence=80009302&lang=eng

          (Although I’m ashamed of my country in doing so)

          1. Calli Arcale says:

            Homeopathic oxygen? How do they prevent additional oxygen becoming dissolved into the product, thus ruining its homeopathicness? :-P

  2. Michael says:

    In December 1982 I had epiglottitis. I was not amused by the ET tube so I tried to remove it. The Pediatric Residents stopped me after I got it just past my cords, they then sent me off to a blissful barbiturate induced slumber. My parents cried. the nurses and doctors cried.

    It boggles my mind that people can decry vaccines for side effects too rare to prove causation and in the same breath minimize people such as myself as the “rare few” who get critically ill.

  3. Greg says:

    Good post! And thanks for passing along your acquired knowledge. As you have duly noted – most people are ignorant of CAM modalities. Many are likely taken in by the “sounds good, so it must be plausible” mentality, of which I have regrettably indulged from time to time.

  4. MTDoc says:

    I also have only seen one case of tetanus. It was in a three year old child who presented because she “wouldn’t open her mouth”. No pain, fever, injury or history of injury, but this was in the tropics, and all the kids are barefoot most of the time. Besides the “locked jaw”, she showed abdominal muscle spasms when the skin was lightly stroked. I referred her to the nearby hospital where a U.S. trained pediatrician saw her, made an appointment for her to see an ENT the next day, and sent her home! Fortunately I checked the hospital after I finished my Clinic, sent the police out to fetch her back, and air evacted her out to my home facility on another island, and she did fully recover. The point of all this? First, prevention has been so successful, tetanus is the last thing one is likely to think of. Secondly, I really have to wonder how a diagnosis of “possible peritonsillar abscess” is supported by a finding of trismus alone (no fever, adenopathy,etc.) I am pleased to see some credit given to experience, though I freely admit, the more I learn, the more ignorant I feel.

  5. Sawyer says:

    Since Proctor’s name came up, I’m curious if anyone has ever read Golden Holocaust, his book on tobacco companies manipulating the science on lung cancer. It’s been on my reading list since seeing a reference in Naomi Oreskes’s book on doubt mongering in science, but I can’t find it at my library and want to know if it’s worth looking for. After facepalming at a few absurd suggestions of unlikely conspiracies on Dr. Novella’s recent post, I’d like to learn more about real conspiracies in the world of medicine.

    1. Eldric IV says:

      I have not read Golden Holocaust but I did recently finish a book by Dr. Goldacre called Bad Pharma that includes numerous anecdotes of withheld or manipulated (or is that marketed?) medical trial data that resulted in actual or potential harm. I would recommend it.

    2. BugDoc says:

      Sawyer,
      Yes it is worth finding.
      Easy….get one of the electronic book apps, such as Kindle or iBooks or Nook. Each is free and will work on your smart phone, iPad or MacBook. Then go to one of the ebook sellers…such as Barnes and Nobles or Amazon or Apple store and you will find the book to download.

      1. Sawyer says:

        Thanks BugDoc. For some reason the e-books are almost as expensive as the paper versions, so I think I’ll stick with the old fashioned books. Fortunately I discovered there is one copy at my local library. Of course at 750 pages, I should really just go all out and sign up for a good epidemiology course.

  6. windriven says:

    ” It is like learning horse anatomy to take care of unicorns.”

    Or perhaps more aptly, learning unicorn anatomy to take care of horses. Which suggests the question: can alicorns suffer subluxations?

    One can spend an amusing few moments reading the Wikipedia entry for “unicorn horn.” Really, the alicorn is to quackery pseudo-medicine as the caduceus is to medicine.

    It may amuse you to know that it took several hours after the post appeared before it cleared (I presume) the censors (I’m in China at the moment). I could read the preamble on the home page but when I clicked to read the full entry it ended – repeatedly – in ‘page not available’. Most of the NYT columnists I read have been unavailable throughout my stay this time. A few years ago the entire BBC site was blocked for weeks. I’ve no idea what the problem was with your post but I have discovered that ‘blog’ is a sensitive word.

    1. Except that the caduceus was the staff entwined by two snakes and surmounted by wings which was used by Hermes – the messenger to the gods and also known as a cunning trickster.

      The god of Medicine was Asklepios who used a staff with a single snake (thought never to get ill) and no wings. That is what is used as part of the Coat of Arms and logo of the British Medical Association and imany other institutions who know this.

      I appreciate that in the US the medical orderlies who acted as messengers to doctors out in the field appropriated Hermes’ caduceus as their badge – and that many US medical institutions have followed suit for some strange reason. No doubt the gods will forgive the transgressors.

      Richard Rawlins, on behalf of History-based Medicine.

      1. MTDoc says:

        I learned long ago that our caduceus was “wrong”, but apparently the USAF caught on to the mistake. I just checked my Flight Surgeon badge, issued in 1961, and it is the single serpent. As for the wings, they are appendages to the badge, not part of it. However, the license plate emblem I used back in private practice days was the two snake & wings model. It now is an inlay on my headstone. When I occupy the site beneath it, I will need a messenger more than a doctor.

      2. Andrey Pavlov says:

        My recollection is that the reason the caduceus became confused as the symbol of medicine is because it was used in the earliest mass-print books in the US which happened to be medical texts. It was a symbol the printers used as they were messengers, but it became confused with the content of the books.

      3. weing says:

        I thought it came from the early treatment of dracunculosis. The staff was a twig that the parasite was gently twirled around while pulling it out from under the skin. If you tugged too quickly, part of the parasite would break off and stay under the skin and cause a severe inflammatory response.

      4. Andrey Pavlov says:

        Weing, that is my understanding as to the origin of the Rod of Asclepius as well.

      5. WilliamLawrenceUtridge says:

        Richard Rawlins, on behalf of History-based Medicine.

        I would read that blog.

  7. Angora Rabbit says:

    I am elsewhere caring for my stepmom after a serious lung infection* and today gained a big insight into why people believe Oz et al. He popped up during the afternoon channel surf and she said, “I like his show.”

    Me: “Why? You know that a lot of what he says is nonsense.”

    “I know. But he had some really good exercises and stretches that I like to do.”

    And that’s how it works. If some of it is good, she sees the apple pie and not the moose turd pie (old Utah Phillips story, IIRC). And because one thing he said was good or useful, the rest of it is painted good by association.

    I don’t know how to combat that except to screen continuously and assiduously.

    * She knew to be worried when they pulled out the local equivalent of Dr. Crislip. And no, we don’t know what she has but at least she’s home and on oxygen. I’m not worried about the infection but the continuous daytime tv is going to drive me insane…

    1. Sawyer says:

      I’ve long believed that Oz operates on the 51% rule. If 24:01 of a 48 minute show involves telling the audience to eat right, exercise, and get a yearly checkup, then it qualifies as a success. The 23:59 minutes of nonsense is okay, because hey, it’s not like anyone good produce a show that is entertaining AND true, right?

      And I bet if you could talk to the tobacco executives from the 60′s mentioned in this post, they’d espouse the exact same philosophy.

      1. windriven says:

        I wonder if you might credit the distinguished Mehmet Oz with rather more ethical rigor than he has earned?

        Truth in advertising: I have never actually watched his television show. I base my question on the content of various Youtubes I’ve endured. In these he has consistently made my skin crawl with his smarmy, faux-friendly-approachable-caring persona: sort of our buddy stan in a Marcus Welby costume. Projectile vomiting ensues.

        1. Sawyer says:

          At least Marcus Welby would have had the sense to wear a tie and labcoat instead of those silly scrubs.

        2. brewandferment says:

          to make matters worse, he has debuted a “magazine” that is as appalling a piece of vanity puffery as you could imagine. I have no idea how I ended up on his list of possible marks other than at an address I’ve not lived at for several years, I subscribed to Prevention–back when I was still more credulous of health trickery. It’s called The Good Life and way too many pages give a little tidbit of information about Oz the Great and Powerful.
          Examples:
          An article on ways to boost energy: A Dr. Oz favorite “many Americans are deficient in magnesium, which can result in low energy levels. Cashews are a great source of this important mineral.
          An article about How Well do You Know Your Nose in which the wizard mentions how his Turkish parents used steaming herbal water.
          A sidebar with him sitting in his V-neck sweater (the V-neck t-shirt showing, what’s up with that??) titled How tech helps Dr. Oz
          A teacher wrote in with this question: I …don’t get a lot of bathroom breaks. Will holding my pee for long periods of time hurt me? Ans: I feel your pain [name]. I’ve done plenty of 10 hour heart surgeries when nature had to wait. rest of answer basically technical info.

          Ick. I’m reading it mostly to have some fun with cynicism, thanks to what I’ve learned here and other places like Dr. Gorski’s friend and Quackwatch. But if anyone from the SfSBM wants it for source material/example of awfulness, I’m happy to share if there’s an address to send to.

    2. Renate says:

      To me Dr. Oz works the other way round. If part of what he says can be considered cow pie, I’m doubting everything else he says as well.

    3. mouse says:

      Okay, I’m shallow. Whenever I see Dr Oz all I can think of is his face. He used to have a pleasant, natural looking face, now he looks all, well, not natural.

      And I don’t care what folks say, when it comes to cosmetics, or surgery natural looking is good.

      Now please don’t tell me he had some horrible injury and that’s why his looks changed, because then I’ll feel guilty.

  8. Siobhan says:

    Thanks for the interesting read. I’ve been thinking lately about whether CAM practitioners really believe what they preach, or know that they are selling snake oil. I’m inclined to believe the first theory, mainly because all the CAM practitioners I know seem so full of conviction that they can cure their patient that they convince the patient as well.

    1. windriven says:

      @Siobhan

      1. I have no evidence for what follows,
      2. I suspect that quacks* fall on a more-or-less Gaussian distribution ranging from true believers on one end to crass predators on the other.
      3. I don’t think it much matters; they all seem to sleep well enough and the potential harm they cause is neither ameliorated nor potentiated by their motivations.
      4. Acting on a belief is ethically different from holding that belief.
      5. Acting on a belief is ethically different from acting on evidence.

      *Apologies to Dr. Crislip. I toe the line on ‘pseudo-medicine’ at the wiki but calling it pseudo-medicine doesn’t properly recognize the quacking noise nor the random deposits of watery fowl poop everywhere they pause ;-)

  9. I was hoping to read more about agnotology, but the link in the essay doesn’t work; and when I input the word agnotology in the search window at the site, nothing comes up! What’s that about?

    Any way to direct us to the research?

    1. windriven says:

      I found the link broken as well. Proctor wrote a book titled Agnotology – it is available from Amazon but apparently not in a Kindle version. I suspect that Crislip’s link was to an essay but I wasn’t easily able to find it.

    1. windriven says:

      You da man!

  10. Newcoaster says:

    Agnotology is my word for the day, and I added the link to my reading list for a long flight home later today.

    I think all physicians are comfortable with a certain level of ignorance. It is just impossible to know everything there is to know in medicine. As a family/ER doc I have to know a little bit about almost everything, and am well aware of my lack of in depth knowledge on a whole slew of topics. (I’m sure Dr Crislip would roll his eyes at some of my antibiotic choices in the ER, but I don’t have ready access to an ID specialist). I also am sometimes surprised at specialists lack of knowledge of medical topics outside their area of expertise, so I guess it goes both ways. :)

    I remember struggling as a 2nd year family practice resident to answer all the random questions patients had. Every weird symptom they described, I felt the need to come up with some physiological explanation, and sometimes resorted to making up something plausible. After all, I was “the doctor” and I had spent the last 4-5 years immersed in learning all of this. I was relieved one day when my preceptor said he wanted me to remember 3 words: “I don’t know”. It was very freeing to realize that was ok to say to patients, and generally they were ok with it as well. It made them realize I was just human like they were, not some font of limitless medical knowledge.

    I also am finally realizing that it isn’t just a knowledge deficit that leads people to CAM. I too thought for a long time all I had to do was let patients know there is no scientific evidence for “X”, and problem solved, the scales would fall from their eyes. Patients reasons for using CAM are far more complicated, and it is usually the emotional investment that is harder to get past. My approach is now more low key, I inquire about CAM beliefs and activities, point out the lack of evidence, but I don’t give a lecture. No, I won’t make a referral to acupuncture so your Blue Cross will pay for it, and no, I won’t order those full body X-rays your chiropractor insists you need, but I say that with a smile and frame it in terms of ethics. “As your physician, you wouldn’t want me to violate my ethical principals, would you?”

    The deliberate ignorance for ideological purposes is the most dangerous and difficult to deal with. This is the type that fuels denialism, and feeds the flame wars on the web. It’s fun to argue with those types, but I just see it as a way to hone my arguments, not thinking there is a chance of changing someone’s mind.

  11. Interesting how gullible the human mind can be.

    You believe that all of ALL of “Science” is the same. FALSE!
    You should not mix the physical with social or life sciences. Numbers on papers and molecules in a tube react differently in the human body.

    You believe all human bodies are identical. FALSE!

    You believe the human body is a machine like a car. FALSE!

    You group all CAMs into one. FALSE!

    You believe the the science of medicine is infallible. FALSE!

    You believe that placebo is a cure or treatment. FALSE!

    You believe that illness will NOT innately and naturally cure without human intervention. FALSE!

    You believe that science is static and a single trial is complete and is forever, no follow up, reproducibility or confirmations are needed. FALSE!

    You do not believe the observations by a colleague are valid and needs further study. FALSE!

    You believe the business and the researchers in science and medicine are ALL altruistic. FALSE!

    1. Andrey Pavlov says:

      I don’t read 99% of your drivel, SSR.

      But this time what is funny is that what is really FALSE! is literally everything you think we think.

      I mean seriously. Literally EVERY. SINGLE. STATEMENT. you have made is absolutely precisely the OPPOSITE of what we here actually believe.

      I find it hard to believe that anyone can be so utterly clueless, particularly someone who claims to be a physician.

      1. WilliamLawrenceUtridge says:

        Yeah, I read every sentence and thought, “I don’t think that at all”.

        I think this is what Stephen thinks other doctors think. Which is weird, since it’s pretty basic stuff that no doctor would ever believe. “You think every body is the same”? Really? Even if doctors weren’t taught the contrary in medical school, an hour’s familiarity with MRI results would quickly disabuse themselves of this notion. In fact, I believe there might be a trend towards recognition of just how variable the human body can be while still remaining functional. I just finished Overdiagnosed by Welch and some other people, and there was an entire chapter basically dedicated to this topic.

        Poe?

        1. Hmmm why are we at odds?? I conclude that you are shocked that I use Acupuncture, CAMs and consider myself a modern naturopath provider.

          Exactly what the dogamatic materialism mechanical scientist dispise.

          There is some truths in Acupuncture , CBT, massage and adjustments.

          Proof is the banter of grouping all CAMs in to the trash bin. A good scientist would sift through the recycle bin looking for clues, bits and pieces of the truth. YOU guys want to burn the bin.

          1. weing says:

            You are full of it. You are the one mixing legitimate treatments like CBT with trash like acupuncture.

            1. @weing. Trash? Please that is a personal belief and you should keep to yourself.

              And if you have a friend or colleague who is suffering in pain and has failed traditional fixes and/or medications, offer them a local seasoned needle practitioner.

              (or be the judge, jury and executioner of their continued pain)

              (don’t assume, I use this paradigm too and if it fails, I offer my patients other vetted, viable options in the needle family )

              1. WilliamLawrenceUtridge says:

                Hi Steve,

                How do we know you are telling the truth and not simply making it up?

                Why doesn’t acupuncture work in controlled studies?

                How long/how many treatments are required for a permanent resolution of the pain?

                How do you “vet” your options? Whatever is convenient and you can charge for?

              2. Hi WilliamLawrenceUtridge,

                How do we know you are being serious?

                Why doesn’t acupuncture work in controlled studies? NO, they have to be “well” controlled studies.

                How long/how many treatments are required for a permanent resolution of the pain? If YOU are the “pain in the neck or butt” there is no cure. YOU will have to leave that particular situation.

                How do you “vet” your options? I scratch my belly and neck, with my hind foot to get a feel for what to do. Using my nose,if it is not warm will help too.

                Whatever is convenient and you can charge for? If I read between the lines, I sense a disdain for providers who have to make a living in the crazy world of healthcare. I can wager that I get about 1% of what it cost to replace a knee, by having to spend a lot time and effort to treat the limb in pain. This therapy actually can return joint function to full capacity.

                If you ask any solo practitioners, many have to write off portions their labor and time. So a lot of the care we give goes into our communities as charity. Hospitals, have a great deal within the schema, can overcharge for cheap items to make up their losses.
                :)

              3. weing says:

                “This therapy actually can return joint function to full capacity.”

                Documentation please. Not anecdotes.

              4. WilliamLawrenceUtridge says:

                How do we know you are being serious?

                What does that have to do with anything, aside from providing a cheap dodge to respond to the substance of my post? I’m quite serious, we have no idea if you are simply making up your anecdotes, and it’s why anecdotes aren’t accepted as proof.

                Why doesn’t acupuncture work in controlled studies? NO, they have to be “well” controlled studies.

                Absolutely, because if you don’t use well controlled studies, it’s absurdly easy to cheat. If acupuncture is only a powerful placebo, a poorly controlled study with single blinding makes it easy to “leak” behavior. Or for that matter, if your control group consists of people simply not getting acupuncture, then there is a massive flaw in your design. This is basic science, particularly when discussing pain and nausea – subjective symptoms with significant placebo components. People can reduce their pain simply by talking to their doctor, which can enhance the apparent efficacy of an effect if not controlled for. That’s why “usual care” is not a good comparison, particularly for something like pain.

                How long/how many treatments are required for a permanent resolution of the pain? If YOU are the “pain in the neck or butt” there is no cure. YOU will have to leave that particular situation.

                So you can’t answer this rather important question, and instead you insult me. I assume because you are frustrated by your continued inability to respond to any of my points in a meaningful fashion?

                How do you “vet” your options? I scratch my belly and neck, with my hind foot to get a feel for what to do. Using my nose,if it is not warm will help too.

                In this context, “vet” means to scrutinize, check or assess, specifically, how do you select a particular option for a particular client out of all possible treatments both proven and unproven.

                Now that I have clarified my intent, could you explain how you select from all possible treatment approaches, and what would make you abandon a particular treatment modality if you thought it useless?

                Whatever is convenient and you can charge for? If I read between the lines, I sense a disdain for providers who have to make a living in the crazy world of healthcare. I can wager that I get about 1% of what it cost to replace a knee, by having to spend a lot time and effort to treat the limb in pain. This therapy actually can return joint function to full capacity.

                Several points:
                1) Yes, my disdain is present.
                2) I have disdain for providers who charge patients for unproven or disproven treatments.
                3) My disdain for you is particularly acute given you seem to prefer such options and you dogmatically believe that your personal experience is adequate to judge whether a medical treatment is effective.
                4) You can’t make any money to replace a knee, you don’t have the training, equipment or support. Your only choice is to deliver medications or services, and I’m guessing you prefer services like dry needling (and presumably marriage counseling). I’m also guessing that you charge a lot more for dry needling than you do to recommend tylenol.

                If you ask any solo practitioners, many have to write off portions their labor and time. So a lot of the care we give goes into our communities as charity. Hospitals, have a great deal within the schema, can overcharge for cheap items to make up their losses.

                Do you write off your labour and time? Do you write off your labour and time for the delivery of unproven treatments?
                How do the alleged failings of hospitals justify you consistently charging for services that are unproven or disproven?

              5. @WilliamLawrenceUtridge
                You have a few issues which should negate your ability to have a reasonable debate that would be beneficial to most.

                I’ve used most CAMs and today I recommend a few that will be a part of healthcare for a while. Most here, have not practiced these modality and have no idea of what is true, an educated opinion or a belief.

                ?? It has taken me a decade to process a case and determine therapy. It is impossible for me or anyone to put in a few paragraphs.

                If you want a case evaluated? ok.
                Trying to discredit me? Keep trying, I’ll be here to defend CAMs for a while.

              6. WilliamLawrenceUtridge says:

                Why do you think the CAM should be used as part of health care at all if, when a group of patients are given the CAM intervention, they do no better, or do worse, than another group not given the intervention?

                Why do drugs need extensive testing, but CAM doesn’t?

                Why do you have a hypocritical double-standard?

                It’s impossible to try out every single medical modality in existence, let alone become proficient in it, but a responsible doctor must still be able to discuss the pros and cons of each intervention – that’s what the scientific literature is for. And the scientific literature says that CAM modalities don’t work, haven’t been proven to work, and in many cases are highly unlikely.

                Also, you seem quite comfortable condemning spinal fusion and knee replacements despite never having done, or experienced one. Again, hypocritical, a double-standard for a set of treatments that stand very little chance of being effective.

                Why the hypocrisy? Why only use science when it supports something you want to believe in the first place? Why not have a single standard?

                I don’t need to discredit you, you do so yourself every time you insist your personal experience trumps well-controlled tests.

          2. WilliamLawrenceUtridge says:

            How is one a “modern” naturopath provider considering naturopathy is comprised of little more than old medical theories discarded decades or centuries in the past?

            Oh, I suppose you also sell high-dose supplements that also aren’t proven to have any benefit.

            “Dogmatic materialism mechanical scientists” don’t despite acupuncture. When it was introduced into the West in the 70s, there was some thought that there might be something to it, and it was considered an intriguing avenue of research. Of course, in the 40 years since then, we have found that needling location doesn’t matter (no acupuncture points), needling depth doesn’t matter (no need to break the skin) and needles don’t matter (use toothpicks!). What most would probably despise are dogmatic CAM practitioners who insist on delivering and charging for disproven and speculative methodologies that at best deliver placebo effects.

            Proof is the banter of grouping all CAMs in to the trash bin. A good scientist would sift through the recycle bin looking for clues, bits and pieces of the truth. YOU guys want to burn the bin.

            Nope. We want to test modalities before they are sold to patients. Those modalities that don’t work (which is most of them since they are inherently unreliable).

            Real medicine asks “does this work better than placebo”, and only delivers it as part of usual care once the answer is determined to be “yes”. The fact that you can’t see the benefit, or the difference between this and what you believe to be happening, is why you are mocked and belittled here.

            Why is it so terrible to ask that a medical intervention be proven to work before you subject patients to it, and more importantly before you charge them for it?

            Seems a bit unethical and greedy if you ask me.

            1. 40 years since then, we have found that needling location doesn’t matter (no acupuncture points)=FALSE!

              The points that are on the models are a guide only, the practitioner chooses the points based on the clinical situation, palpation and feedback from the needles. Also the points are known to overlap modern models of myofascial trigger points. A good practitioner will understand that a “point” can be on the skin, anywhere between the skin and the peritoneum of the bone. So having a wide variety of needles lengths and widths is vital to the clinical outcomes.

              http://en.wikipedia.org/wiki/Trigger_point

              All practitioners of needles realize the futility and stupidity in attempting to sham the effects of real needle with a toothpick.

              1. windriven says:

                You sound like a 10 year old girl with a ouija board. It is all very subjective but you SWEAR it is the truth!!!

                All of the studies showing acupuncture = bullroar would have come out quite differently if only Rodrigues the Magnificent had been the acupuncturist.

                Are you related to Uri Geller?

              2. Harriet Hall says:

                “the peritoneum of the bone”

                And just where might that be? Thanks for the laugh!

              3. Sawyer says:

                @HH

                I think he means periosteum.

                I must admit, I get a big kick out of the fact that half a semester of anatomy at a community college has apparently given me a better understanding of the human body than SSR possesses after decades of training.

              4. Harriet Hall says:

                “I think he means periosteum.”

                I realized that. I still thought it was pretty funny.

              5. Andrey Pavlov says:

                Wait, the bones don’t have a peritoneum? Maybe that’s why I failed my surgery rotation!

                (I kid, I didn’t even come close to failing any of my classes ever. Which is maybe why I would never make such a ridiculous gaff)

              6. WilliamLawrenceUtridge says:

                Several points:

                1) Can you show me any well-controlled studies that indicate points have specific effects? Telling patients “we’re testing this acupuncture point, and this other point which isn’t an acupuncture point” isn’t a well-controlled study. I can explain why if you don’t understand.
                2) If the points are only a guide, why do they matter? Why not emphasize staying away from significant anatomical structures and focus instead on needling safety?
                3) If the point is to needle a trigger point, why do you need a needle? Why not use mechanical pressure? You can call this “acupressure” if you’d like, but it’s basically massage. Safe, non-invasive, low-cost massage.
                4) Do you mean “periosteum” of the bone?
                5) If needling is superior to toothpicks, why did this study find toothpicks to be as effective as needles? Not to mention – no risk of infection, no risk of bruising, no risk of puncturing a lung.

              7. It is very difficult to witness the positive benefits of the therapy day after day on people who have been suffering without it.

                Why would I deny the experience?
                Why would I keep it away from the needy?

                That would actually harm a lot of souls.

              8. Of course periosteum … you guys are good editors.
                No harm done! That was a test to see of you were reading my notes. :)

                How back to how you guys are harming patients in need of alternative.
                1. Open your minds and imaginations.

              9. WilliamLawrenceUtridge says:

                It is very difficult to witness the positive benefits of the therapy day after day on people who have been suffering without it.

                Yes, but you would also see”positive benefits” if you merely spoke calmly to these people and reassured them. If the scientific studies are any guide, you would see positive benefits if you kept your affect the same but needled at random, or didn’t needle, just used toothpicks, and the patients didn’t know. And it would be safer, less infection risk, less risk of cancer. That’s rather the point, your experience is inherently deceptive just starting out, and it gets worse the more patients you treat – because you forget the ones that never come back, or the ones that just say you helped but you didn’t actually help (one aspect of placebo is patients lying to their doctors, to avoid hurting the doctor’s feelings). And you can’t tell the difference.

                Why would I deny the experience?

                Because experience deceives. Again, in bloodletters’ experience, bloodletting helps. Homeopaths, a form of quackery even you find extreme, insist their experience shows that homeopathy helps. Priests of Thoth, and their faithful, insisted prayer helps. The doctors who fuse spines and replace knees insist that there experience shows both these operations help.

                How do you know who is right? You condemn doctors who do spinal surgery – but they insist, just as vehemently as you do, that it helps! Who is right? You can’t both be right, why insist that your experience is somehow magically better or more accurate than anyone else’s?

                Why would I keep it away from the needy?

                Because it wastes time and money. Because your badmouthing of real medicine makes them less likely to go to a real doctor when they are actually sick. Because it’s patronizing. Because it’s lying. Because it’s unethical. Because it reinforces your delusions.

        2. Andrey Pavlov says:

          In fact, I believe there might be a trend towards recognition of just how variable the human body can be while still remaining functional.

          It may be a matter of perspective. It was Dr. Novella who said that we calibrate our meters of who is more or less skeptical vs conspiratorial based on our own ideas on the matter. This may be the same for SSR and others.

          I find that many of my colleagues use the variability of the body as an excuse to do whatever they want. Because idiosyncratic reactions happen (like getting cracked out after taking diphenhydramine instead of being sleepy) then [insert ridiculous woo here] could also possibly work. They ignore the fact that while science may not have given us the answer yet, it has constrained the possible set of answers at any given time.

          SSR may well be of the hyper-variable bent wherein he thinks that there are no commonalities on which to base thoughts and treatments out there. Thus, anyone who claims and constraints must default to thinking everyone is exactly the same. A false dichotomy stemming from a false calibration of the metric in question.

          1. windriven says:

            ” They ignore the fact that while science may not have given us the answer yet, it has constrained the possible set of answers at any given time.”

            Nicely put, Andrey. I’m adding that to my armamentarium.

            1. Andrey Pavlov says:

              Thanks windriven. Arm away!

              1. I’m sure because I understand needles, pain, myofascial tissues and TrPs, as well as what you all have failed to comprehend, you all view my ideas as odd.

                Give it some time and we will all be on a similar page. Having witness these tools in action, they will be a part of healthcare.

                (remember I am just the courier of this data)

                These are the practitioners who will forge the way:
                http://www.medicalacupuncture.org/
                http://aim.bmj.com/
                http://www.medical-acupuncture.co.uk
                http://www.dabma.org/
                http://mcmasteracupuncture.com/
                http://www.icmart.org/links/member-societies/member-societies.html
                http://www.amac.org.au/index.php/about-us/about-amac

              2. WilliamLawrenceUtridge says:

                Steve, if needles, trigger points and myofascial tissues are a real thing, then what is needed is research. Not more of your assertions that you are right and everyone else is too stupid to see your brilliance. And if you’re really that brilliant, you should have no problem developing a brilliant research protocol to test (not prove, mind) your beliefs about trigger points and needling.

          2. “I find that many of my colleagues use the variability of the body as an excuse to do whatever they want.” I have also at disastrous levels on lives and cost. It must end!

            I see some of you as completely delusional! And voluntarily so.

      2. Sastra says:

        The SBM- advocate- that- is, is nowhere near as entertaining, provoking, and self-confirming as the SBM- advocate- in- their- head.

        I bet he wins all the debates, which are epic.

      3. “I mean seriously. Literally EVERY. SINGLE. STATEMENT. you have made is absolutely precisely the OPPOSITE of what we here actually believe.”

        To an outsider or a CAM knowledgeable providers you guys are totally brainwashed by big pharma and big business, stubborn, stupid and on the take.

        1. WilliamLawrenceUtridge says:

          To an outsider or a CAM knowledgeable providers you guys are totally brainwashed by big pharma and big business, stubborn, stupid and on the take.

          Yes, that’s because CAM providers have no scientific evidence to support their modalities, and are forced to justify their existence instead by pointing out the flaws, real or imagined, in real medicine. It’s the same approach taken by creationists and climate change deniers. It’s a combination of ad hominem (real medicine doesn’t work because big pharma is greedy) and false dichotomy (if real medicine doesn’t work, CAM must work).

          Of course, both fallacies are false. Not all research is funded by Big Pharma, the impact of funding source is generally one of emphasis, not outright fraud (i.e. the findings are usually accurate but exaggerated) and the main source of criticism of conflicts of interest are doctors and the medical community. Further, the existence of such conflicts of interest does not mean CAM modalities work, and it does not magically make high-quality research for these modalties appear. It’s a distraction from the fact that there’s very little research supporting CAM, and a fair amount of research showing it is useless.

          And, of course, let’s not forget that CAM practitioners have their own conflicts of interest – they benefit directly and financially from the unwarranted respect CAM gets. CAM practitioners criticize mainstream medicine not out of a sense of fairness or intellectual honesty, but to protect their income streams.

          Every time Steve talks about how evil and greedy doctors are, he’s doing his best to make sure he can pay his mortgage and car loans off.

          1. Frederick says:

            Those believers seem to forget how big the CAM industry is. Homeopathy alone is 4 billions in the US. This is numbers taken from NCCAM : http://nccam.nih.gov/news/2009/073009.htm

            33.9 BILLIONS, so there is money to be made and a lots of money to throw into lobbying, as much as any Drug company. The most evil thing to do is to let people believe in thing that do not work and to lobby for LESS rigour in medicine. Because that is what CAM lobby do, the want the standard to be decrease, science to be deny so they can make they claim look like truth. This is exactly what Climate change deniers do ( like the conservative Party here in Canada, decreases science funding, so there is not fact to oppose their views), creationist do. And that is exactly the way you talk SSR, you want less truth, more fantasy, so you don’t have to feel to need.

            Anyway those standard are already low, if you label you product ‘natural’ or ‘alternative’ there is barely any rule as it is. and you can screw people for their money without feeling guilty.

    2. Newcoaster says:

      You think anything you say has relevance or meaning. FALSE

    3. mouse says:

      Jumping Jehoshaphat, it’s like an army of strawmen.

  12. Kris says:

    I loved this particular turn of phrase:
    “It is like learning horse anatomy to take care of unicorns.”

    I might, however, chose to reverse the roles. Learning unicorn anatomy (a likely fantasmagorical ‘science’) to take care of horses (complex, but reality-based organisms).

    I tripped on your blog when Googling ‘Agnotology’ (a term which fell across my attention and dragged me off in pursuit). I am neither a medico, nor really a scientist of any sort, but was encouraged by my blue-collar father, from an early age, to STOP and THINK about ideas that catch my attention.

    I think I will continue to browse your ideas a bit! Thanks!

  13. PMoran says:

    “Well, I don’t think I need to add much to what Sawyer said. Thanks, Sawyer.”

    If this were an isolated event, yes, I might at a stretch be over-reacting in a pedantic way. But this adds to a lot of other poorly thought -through material (that I have been the main target of — others probably don’t read all Andrey’s long screeds) from one of the most prolific commenters on this is list, also one who has credentials and pretensions that should lead us to have higher expectations of him. The language of good science is very precise.

    With Andrey it is also not only the sloppy language and often starkly conflicting viewpoints in the one post, it is the failure to acknowledge any problem when it is drawn to his attention. So I don’t buy the above retrospective reinterpretation of words which mean something totally different. Then there is the invariable puerile ploy that perceived flaws in the presentation of my views somehow reflects on my right to point out the defects in his. No one lacks flaws and in both science and normal life we are highly dependent upon others to point them out. .

    As a side issue, Sawyer, I think, after a considerable investment of time and thought, that over-emphasising the role of ignorance in CAM works against a complete understanding of the phenomenon, and thus against having rational and realistic strategies in dealing with its dangers.

    1. Andrey Pavlov says:

      You’re the only one around these parts who seems to have that opinion Peter. Something that I used to take seriously in the past. And given how many responses to my “screeds” I get and how many emails I get in regards to them that aren’t on the blog, I’d say a fair number of people actually read them.

      And if anyone should have higher expectations of them it is you moreso than me (of course me as well). Funny how you accuse me of failure to acknowledge such points when it is in fact you that actually fails to acknowledge the many, many, many more times the same charges have been levied against you by numerous others here. Including those with much more credentials and education than I.

      I am in no way trying to argue that the myriad flaws in your writing means you cannot criticize mine. Feel free! Criticize away! But that doesn’t mean I have to agree with you. Not any more than you have to agree with me. But it also doesn’t mean I can’t call to attention the fact that you actually have not addressed the myriad criticisms levied at you by many others, not just myself. And it also doesn’t mean I can’t accurately call you a hypocrite for saying I don’t acknowledge my criticisms whilst yourself being completely oblivious to all the ones in your direction.

      I agree that nobody lacks flaws and I have many. I’ve acknowledged them when necessary, but I am also free to dispute them. You, however, should learn from your own words and actually do the same when yours are pointed out.

      But I am happy to hear from others. Your words have lost weight with me and consistently seem to be the only ones finding fault with me. Independent confirmation would go a long way.

  14. PMoran says:

    Andrey, surely you have observed that bad argument is not often challenged on blogs like this so long as it seems to be supporting prevailing viewpoints. Placing too much store upon the praise of others also means no more than that you are succumbing to an “appeal to popularity” fallacy.

    Accordingly, I am not in the least fazed by the fact that my views are unpopular and also that people are saying they can’t understand them (well, a bit by that). I understand how difficult they are. They present a very subtlety different way of way of looking at things, not in a post-modernist sense, but arising from a critical examination of basic presumptions. I maintain no more than that they may be pointing to an important element in a very complex scenario.

    Making the acceptance of some of my suggestions harder, they cut some of the ground from under notions that bring most satisfaction to the medical sceptical activist. We are engaged in a rewarding pastime here, sometimes more for our own gratification (such as from the praise of others) than for trying to intelligently, thoroughly, understand and change the world for the better. We should understand that. Good science requires that we understand ourselves very well, not only whatever phenomenon it is that we are examining. (Sorry about the “preaching” — it runs in my family.)

    If anyone really wants to learn about CAM and why people resort to it, don’t rely upon experiences of your own selection and initiation. That will definitely merely reinforce prior biases. Don’t rely on the opinions of others, whose “expertise” may derive from little more than that.

    No, go and lurk on its mailing lists and blogs for quite a while. That is where potential CAM users go for their advice before the fact. You will quickly find out what is motivating most of them.

    Before you do, be warned that they are dominated by vocal extremists whose hair-raising views, although rarely ever challenged, do not represent the attitudes of the majority of visitors. Discovering this was one of the matters that convinced me that CAM users may in general be more sensible than we give them credit for — many are simply able to incorporate a bit of make-believe (or gambling on long odds?) into their lives, when faced with unresolved medical needs.

    1. Windriven says:

      “Accordingly, I am not in the least fazed by the fact that my views are unpopular and also that people are saying they can’t understand them (well, a bit by that). I understand how difficult they are. They present a very subtlety different way of way of looking at things, not in a post-modernist sense, but arising from a critical examination of basic presumptions.”

      And that, Peter, is why I wish you would take Dr. Gorski up on his offer of a guest post. I would like to clearly understand the whole of your position. The back and forth between you and David and Andrey debating this point or that paints an incomplete pointillist picture.

      1. Andrey Pavlov says:

        I agree with you Windriven. Peter and I often do lose the forest for the trees.

        I will once again promise unequivocally that I will read any post by Peter with the utmost of intellectual honesty and erring far on the side of the principle of charity. As I am certain all the editors, contributors, and regular commentariat will as well. I am genuinely open to be proven wrong. The only thing I can imagine that is worse than being boorishly wrong for 4 years is to be boorishly wrong for another 4 years.

    2. Andrey Pavlov says:

      Andrey, surely you have observed that bad argument is not often challenged on blogs like this so long as it seems to be supporting prevailing viewpoints. Placing too much store upon the praise of others also means no more than that you are succumbing to an “appeal to popularity” fallacy.

      I’m not appealing to popularity Peter. And if it were just a regular band of the same old cheerleaders and groupies I would be much less inclined to consider that even the small bit of evidence it is. But it is strengthened by the fact that even new commenters and readers, some of whom are lurkers, come to comment in agreement.

      Does it settle the fact? Not at all. So write a guest post (and read my comments to GoodNightIrene and Windriven). But it certainly bolsters my case, and that you cannot reasonably deny.

      And it addresses your indictment that I ignore my own blatantly poor argumentation. Or that I inappropriately cite yours. Once again, new commenters with no obvious “prevailing viewpoint” to fall in line with some perceived dogma of SBM share the same agreement.

      You then go on to play a little persecution complex whilst simultaneously hinting at your amazingly deep understanding of nuance. Bravo! It should be telling that you think your ideas are challenged for nothing more than they undermine the “dogma” of a group of professional critical thinkers, scientists, lay people, and neophytes (just to name a few) from disparate walks of life, who have disagreed with each other when necessary. And for such a subtle nuance we just can’t seem to perceive it, yet so profound it should completely alter our understanding and our rhetoric and tack. Granted, that is possible. Once again, write out a guest post and demonstrate it to us. We’re all eyes.

      If anyone really wants to learn about CAM and why people resort to it, don’t rely upon experiences of your own selection and initiation

      Now seriously, on what planet could it possibly seem that I am “rely[ing] upon experience…” to draw my conclusions? Short of some seriously creationist style quote mining and cherry picking, I can’t fathom that a reasonable conclusion to come to. And Sawyer – a new commenter here who is himself not a medico or a scientist – picked up on that without difficulty.

      Before you do, be warned that they are dominated by vocal extremists whose hair-raising views, although rarely ever challenged, do not represent the attitudes of the majority of visitors.

      So your argument boils down to the notion that we are being mislead by the vocal minority such that we can’t see the silent majority?

      Seriously?

      I really don’t know what to say here. It is painfully obvious we here are all aware of the idea of the vocal minority. It’s, you know, written about from time to time. We also present actual data from peer reviewed studies. We can – and do – disagree on some of that, but overall there seems to be a general direction it is pointing. And your argument is that your experience in the chat rooms and email lists, sleuthing your way past the vocal minority, trumps that?

      Someone once said:

      Don’t rely on the opinions of others, whose “expertise” may derive from little more than that

      Hmmmm……

  15. goodnightirene says:

    Andrey, I stand ny my first comment which is in sharp contrast to your personal experience. I don’t think either of us is wrong (or right?), we simply travel in very differencpnt worlds. You explain CAM to docs and students, I try to explain it to church lady’s and New Agers with BA degrees in various Artsy things. We get very different results because we are dealing with very different populations. The people I often meet are poorly educated ( even if they’ve attended college) and very credulous. Most are religious and already believe in prayer as medicine and think god (or cheery thoughts) can banish a tumor, so when I make my pitch, they simply tell me that there is no need to “understand” how CAM works and that 8 need to “respect” other “ways of knowing”.

    Believe me, I envy you your associations, but I am still seeking better ways to interact with my very different encounters.

    1. Andrey Pavlov says:

      I fully agree with you GNI. If I gave the impression otherwise (which I am not garnering from your comment) then perhaps that is what has Peter so confused. It seems to me you were recognizing that we were merely speaking about different populations and different circumstances. Sawyer recognized that as well.

      And yes, my associations do tend to be rather different. It is simply where I inevitably spend most of my time. However, I am also interested in being able to convey these ideas to the “church ladies” as well. It is an ever improving process, with enough variability that I think 100% success can simply never be guaranteed, but I feel I am managing. I am actually still in contact with Karen, the Christian Scientist. She is still engaged in some magical thinking, but has certainly come to see many of my points as valid. In fact on her own blog she wrote this:

      I think you will find Andrey brilliant, articulate, eloquent, and well-learned – as I have found him. If I ever were in need of a doctor specializing in internal medicine, Andrey would be the kind of doctor I’d try to find for myself.

      Yes, it is anecdotal, but it would be hard to run a proper study on my own individual tactics and encounters. But the point is that I do recognize that there are different people, different groups, and that different tacks are necessary in order to address each of them (which also varies on the context and situation). And I have indeed managed to have some success along the way.

      So when I am speaking of my associations, what their reasons for “giving a pass” to CAM are, and their reactions to my explanations of it that is all I am doing. Talking about a specific group and what I have seen the root problem to be. My comment to the uniformity of that root cause was an indication of how uncommon other root causes are (particularly the one I find the least likely – that they are so well educated they know the limits of medical science and thus give credence to and try CAM). The data, such that there is, supports this but the question is indeed open. But I have yet to see any cause to change my tack with that particular population. You, and Peter, can see for yourselves that my tack with Karen is rather different.

      The one place Peter and I seem to disagree is that he thinks it is not only fair to lump the entire internet in one population but that this also dictates the tone we must always have whenever on the internet, regardless of the context. Or at least that in our particular context here we should “tone it down” since our rhetoric is too strident and off putting.

      1. Karen says:

        Hi, Andrey!

        This church lady has very much enjoyed your presence on my blog. :) Thank you for joining me and my hooligan-friends there.

        Here’s my latest post – I am rather proud of this one – I was nervous about how my fellow CSists would respond to it – and am, frankly, a little surprised, and very appreciative, of the support I’ve felt from the CS community – turns out I’m not alone, after all. :)
        http://madcapchristianscientist.com/2014/03/22/radical-reliance-on-truth/

        And thank you for taking a different “tack” with me – much appreciated! I think you’re right about that – we need to adapt our language to fit the people with whom we’re engaged in dialogue – I can’t expect everyone to understand the language of Christian Science, and you can’t expect everyone to speak the language of medical science. If people from two different perspectives can approach a dialogue with an honest desire to learn from each other, rather than to “win” – that goes a long way to creating a useful bridge of communication.

        Karen

        1. Andrey Pavlov says:

          Thank you again for the kind words. I hope it is obvious that I have not changed my stance nor minced my words with you. But it would be silly to think that I could communicate my ideas to you in the same way I would a fellow medical scientist or even a scientist from a different field. The language, presuppositions, experiences, and knowledge base are simply different.

          1. Karen says:

            I don’t dialogue with folks on the internet to get them to change their beliefs – honestly. I mean, I don’t have a need for anyone else to believe what I believe, or feel what I feel, or think the way I think. And I guess I’ve never really understood why others DO seem to have that need. I dialogue to learn – to maybe inform, or try to help someone else better understand my perspective – but with no expectation that anyone’s going to change their OWN beliefs or perspective. I guess if I have any mission at all on discussion boards, it’s to try to help end bigotry – bigotry against atheists, bigotry against the religious, bigotry against believers -to try to help get ready of unhelpful stereotypes and generalizations. For instance, there’s a stereotype that all atheists are arrogant, insensitive, emotionless and lacking a sense of morality. That is, of course, a bunch of baloney. There is also a stereotype that all who identify themselves as Christians are ignorant, uneducated, illogical, and unreasonable. That, too, is a bunch of bunk. I do not believe bigotry is a very useful thing in our society. I don’t think we should assume we know what other people think, believe, and feel – or why. Probably far more informative to allow others to tell us themselves what they believe, and to listen. Thank you for taking the time to share your thoughts with me. And thank you for listening, too. Much appreciated. :)

  16. Erik1986 says:

    Aaargh. I have a horse. The tetanus bacilli are rife around horses. I wouldn’t DARE go without a tetanus injection and a booster if a get puncture or other semi-closed wound. And the horse has a yearly tetanus injection too!! I keep in mind re how long since I’ve had a shot (they’re good for about 10 years) and when I will need another. I can’t imagine NOT using the tetanus vaccine. Weren’t we all warned as children about “rusty nails?” and given our tetanus shots/boosters? Perhaps it’s because I’m older. Is it that younger people (ah, the younger generation(s)) have been so influenced by these homeopaths/naturopaths/anti-vaxers. Heck, I grew up in the Haight-Ashbury, surround by people who wanted to be “natural,” but I was still given all my vaccines/shots as a baby/child/young adult.

  17. Mal Adapted says:

    I lurk here often, but seldom comment. I also frequent blogs on Evolution and on Climate Science. It seems that ignorance, in the categories enumerated by Mr. Proctor and in its innumerable surrogates, is the default condition of humanity.

    We are challenged every day by an indifferent Universe, and we want desperately to know the answers to our problems. It’s so easy to fool ourselves that we have them, so hard to be content not to know. I think the reason so few adopt the scientific worldview is that one must accept how little we can know with confidence, and so often all we can know is that our hopes have been dashed.

    Science’s greatest value is as a way of trying not to fool ourselves. Empiricism and inter-subjective verifiability may be limited tools, but without them there is no way to know whether we’re fooling ourselves or not. Science can’t give us all the answers we’d like, but at least we can have confidence (even if not complete) in those it does give us.

    IMO, Mr. Rodriques, Mr. Moran and their fellow CAM promoters are blinded by both hope and pride. They would rather fool themselves and their patients than accept that the Universe is indifferent to their hopes. They pay lip service to Science but are casual in their empiricism and will gladly dispense with verification by more disciplined observers, as long as they can hold on to hope. They lack the humility to see what’s perfectly clear to the rest of us. Understandable perhaps, but still vain, foolish, and self-defeating in the end. A cautionary tale!

    1. Windriven says:

      @Mal Adapted

      “IMO, Mr. Rodriques, Mr. Moran and their fellow CAM promoters are blinded by both hope and pride.”

      You insult Dr. Moran and do yourself some disservice by lumping him with Rodrigues and his ilk. Many of us do not agree with Peter in each and every instance but his positions are nuanced and interesting. Compare and contrast with the vacuous babblings of Dr. Rodrigues and the other quacks and charlatans. Dr. Moran hardly qualifies as a CAM promoter.

      1. WilliamLawrenceUtridge says:

        I’ve found it extremely hard to be anything but disappointed with Pete for years now. All his great work in delineating exactly why cancer quackery is harmful and wrong, and now he’s here, defending the right to lie to patients so long as they get an endorphin burst? How the mighty have fallen.

        1. Andrey Pavlov says:

          WLU, I genuinely think that his position is actually more nuanced and worthwhile than that. However, I also think that it is not as nuanced and worthwhile as he perceives it to be.

          Once again, a well thought out guest post would go a long way to achieving some clarity.

          1. WilliamLawrenceUtridge says:

            I exaggerate for comedic effect, but his willingness to prescribe placebos under the guise of them being effective is, in essence, what I describe.

            In my opinion :)

      2. weing says:

        I haven’t been following the back and forth with Dr. Moran too closely. My impression is that he’s willing to give a pass to the CAM use of placebos and calling it something else. I can understand it but disagree, as I feel this opens the door too much to paternalism.

        1. WilliamLawrenceUtridge says:

          And far too much credibility to CAM in general. While “slippery slope” is a logical fallacy, we must recognize that CAM is actively wedging itself into patient practice, and is actively (or inactively) killing people through its guise of effective treatment. CAM is not proven to work. Either it is an ineffective waste of money that is given to parasites rather than useful portions of the economy like, say, garbage collection, or effective treatments are not distributed widely (in the rare and unusual case where a CAM treatment actually does anything).

          “It can’t hurt” could be a rallying cry of antivaccinationists who claim that their decision to not vaccinate doesn’t impact herd immunity. Well, sure, your decision might not bite someone on the ass – but there are millions of you, and that is a direct erosion of herd immunity thank you very much. Similarly, CAM “might not hurt” in individual cases (or, it might, just like the occasional antivaccinationist might kill their kid with pertussis) but collectively it is harmful.

      3. Windriven says:

        @WLU and weing

        I have long held out hope that Dr. Moran would use a guest post to thorough lay out his position. I feel as if I have bits of it but not a clear understanding of the uniting philosophy.

        I believe the bottom line is that Peter believes that placebo can deliver sociological and, to perhaps a lesser degree, clinical benefits. I think he is generally OK with allowing patients to believe more than science supports if that is their choice and if it does not interfere with science based care.

        But as I’ve observed elsewhere, the pissing matches between he and David and Andrey generate more heat than light.

        There is a reasonable discussion that can and needs to be had about health care objectives where technological cure isn’t achievable. Chronic pain, terminal conditions, chronic conditions. At some point the objective isn’t which study has the best p value, it is the patient’s perceived quality of life.

        1. Andrey Pavlov says:

          I have long held out hope that Dr. Moran would use a guest post to thorough lay out his position.

          I still hold out that hope and welcome it.

          I feel as if I have bits of it but not a clear understanding of the uniting philosophy.

          Agreed, though with his most recent posts I feel as if his united philosophy is that there is some benefit to placebo medicine (which I agree with, at least in principle) but also that we are fighting an insurmountable battle which can only end in Pyrrhic victory at best (which I disagree with) and that the battle itself will lead to worse outcomes than just ignoring it (which I also disagree with). He may be trying to have some nuance in that it is a “pick your battles” sort of advice, but I have yet to see any consistent rationale as to how to pick the battles, but some evidence that this may stem from his perception that he himself has failed in the past and is thus over correcting now.

          But as I’ve observed elsewhere, the pissing matches between he and David and Andrey generate more heat than light

          I wish I could disagree. And I can say that for the most part I have genuinely attempted to generate some light. But I have also failed in many cases myself.

      4. Mal Adapted says:

        If I was wrong to judge Dr. Moran’s position by his comments on this thread, I’ll readily defer to those who’ve engaged him over time, and beg his pardon. My comment wasn’t intended as a personal attack, in any case, but as an analysis of the motivations of CAM promoters as a class. Mr. Rodrigues appears to represent them quite well enough for my purposes.

        To be honest, my own position is close to that which Windriven ascribes to Dr. Moran: I’m “OK with allowing patients to believe more than science supports if that is their choice and if it does not interfere with science based care.” I especially agree with this:

        There is a reasonable discussion that can and needs to be had about health care objectives where technological cure isn’t achievable. Chronic pain, terminal conditions, chronic conditions. At some point the objective isn’t which study has the best p value, it is the patient’s perceived quality of life.

        IANAD, but I know the best MDs are motivated by compassion for their patients’ suffering above all. Pure Science may demand asceticism from its practitioners, but even Science-based Medicine must place the needs of the patient first. As I noted, too often Science can only dash our hopes. If a comforting illusion is truly all that an MD can offer, it is compassionate to do so.

      5. Mal Adapted says:

        If I was wrong to judge Dr. Moran’s position by his comments on this thread, I’ll readily defer to those who’ve engaged him over time, and beg his pardon. My comment wasn’t intended as a personal attack, in any case, but as an analysis of the motivations of CAM promoters as a class. Mr. Rodrigues appears to represent them quite well enough for my purposes.

        To be honest, my own position is close to that which Windriven ascribes to Dr. Moran: I’m “OK with allowing patients to believe more than science supports if that is their choice and if it does not interfere with science based care.” I especially agree with this:

        There is a reasonable discussion that can and needs to be had about health care objectives where technological cure isn’t achievable. Chronic pain, terminal conditions, chronic conditions. At some point the objective isn’t which study has the best p value, it is the patient’s perceived quality of life.

        IANAD, but I know the best MDs are motivated by compassion for their patients’ suffering above all. Pure Science may demand asceticism from its practitioners, but even Science-based Medicine must place the needs of the patient first. As I noted, too often Science can only dash our hopes. If a comforting illusion is truly all that an MD can offer, it is compassionate to do so.

        1. Mal Adapted says:

          Sorry for the double post. I got an error on my first try, so I tried again and got another error. Good think I was late for work, or I’d have posted the same comment a third time 8^(.

    2. MadisonMD says:

      I second windriven’s comment that Dr. Moran clearly is not a CAM promoter. He is a bit of an apologist. His position seems to be that the strong anti-CAM tone here can do a disservice to the ultimate cause of SBM.

      But, Mal, I agree with much else you say. And with all the Dr. Pavlov-versus-Dr. Moran text on this blog it would easily seem that Dr. Moran was siding with CAM. (I would additionally say that some personal animosity has crept into the arguments, unfortunately. This seems to have polarized Dr. Moran into an apparently more pro-CAM stance.)

      Dr. Moran, has, by the way, accurately pointed out the flaws in Rodrigues’ arguments.

      1. Andrey Pavlov says:

        I second windriven’s comment that Dr. Moran clearly is not a CAM promoter

        For what it is worth, I’ll third that.

        I would additionally say that some personal animosity has crept into the arguments, unfortunately.

        Indeed, and I am not blameless in that myself.

      2. mriddel@wowway.com says:

        Very good summary of the situation.

      3. WilliamLawrenceUtridge says:

        This seems to have polarized Dr. Moran into an apparently more pro-CAM stance.)

        …as would be predicted by some extremely well-validated cognitive psychology. It’s why civil wars are the worst kind of wars – when you’re separated by only the narrowest of margins, the feelings of betrayal are that much the worse.

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