It is one of the pleasures of travel to read the local newspapers of places I visit. I wholly agree with In a Sunburned Country author Bill Bryson, who observed,
It always amazes me how seldom visitors bother with local papers. Personally I can think of nothing more exciting – certainly nothing you could do in a public place with a cup of coffee – than to read newspapers from a part of the world you know almost nothing about. What a comfort it is to find a nation preoccupied by matters of no possible consequence to oneself. I love reading about scandals involving ministers of whom I have never heard, murder hunts in communities whose name sound dusty and remote, features on revered artists and thinkers whose achievements have never reached my ears, whose talents I must take on faith.
In a Sunburned Country chronicles Bryson’s travels in Australia, which I recently visited, along with New Zealand. Lovely places both – friendly people, jaw-dropping scenery, delicious food and wine. And a welcome vacation from American political wars, American economic wars and American war wars.
It is hard to Sokalize alternative medicine. The closest has been buttock reflexology/acupuncture, but that is a tame example. Given the propensity for projections of the human body to appear on the iris, hand, foot, tongue, and ear, postulating a similar pattern on the buttocks are simple variations on a common SCAM (Supplements, Complementary and Alternative Medicine) theme. The buttocks? Not really different from any of the other focal acupunctures. Most of SCAM does not concern itself with application of reality and physiology, anatomy, biochemistry, etc can all be expected to be ignored with virtually all SCAM modalities.
Every time I think the heights (or depths) of absurdity has been reached, I discover a Braco the Starer or Himalayan Salt Inhalers. This blog is not affiliated with the British Medical Journal in any way, and although this is being published near Christmas, I want no one think that what follows is a hoax. I am not, I repeat not, making up what follows. It is not fiction. Well, it is fiction, but not written by me and believed and practiced by some who really should know better.
I’ve frequently lamented what might happen if the current trend towards quackademic medicine continues unabated, and quackery becomes fully “integrated” with science-based medicine as a co-equal. Interestingly, this concept has provided fodder for several comedians. For example, the first comedy sketch I discovered on this theme was homeopathic e.r. Then a couple of years ago, Mitchell and Webb brought us the British version of essentially the same idea (but done so much better), namely Homeopathic A&E. What I didn’t realize is that predating both of these was…Holistic E.R. (Embedding disabled, unfortunately.)
This sketch comes from an old sketch comedy show known as Almost Live!, which I had never heard of before, but if this sketch is any indication, it was brilliant. Favorite bits from Holistic E.R.: The part about vitamin C, the use of visualization, and, of course, the crystals. Sadly, with the way academic medicine is being infused with quackery such as energy healing, homeopathy, and even anthroposophic medicine at my medical alma mater, I could see this happening within my lifetime.
After spending the first 21 years of life in New Jersey and Philadelphia, I ventured to the University of Florida for graduate school. For those who don’t know, UF is in the north-central Florida city of Gainesville – culturally much more like idyllic south Georgia than flashy south Florida.
It was in Gainesville – “Hogtown” to some – that I first encountered the analgesic powder. I believe it was BC Powder, first manufactured just over 100 years ago within a stone’s throw of the Durham, NC, baseball park made famous by the movie, Bull Durham. I remember sitting with my grad school buddy from Kansas City watching this TV commercial with hardy men possessing strong Southern accents enthusiastically espousing the benefits of BC. I looked at Roger – a registered pharmacist – and asked, “what in the hell is an analgesic powder?”
In 1996, Alan Sokal got a bogus paper published in the journal Social Text. It was a parody full of meaningless statements in the jargon of postmodern philosophy and cultural studies. The editors couldn’t tell the difference between Sokal’s nonsense and the usual articles they publish.
After receiving an invitation to submit papers to an International Conference on Integrative Medicine, he invented a ridiculous story about a new form of reflexology and acupuncture with points represented by a homunculus map on the buttocks. He claimed to have done studies showing that
responses are stronger and of more therapeutic value than those of auricular or conventional reflexology. In some cases, the map can be used for diagnostic purposes.
Life and medicine generate facts and experiences that require conceptual frameworks that aid in understanding. It is no good have a pile of facts if they cannot be understood within a broader understanding.
The practice of Infectious Diseases, while certainly aided by understanding anatomy, physiology, microbiology, chemistry and the other sciences that form the core of medicine (referred to in Medical School as the basic sciences), gains a broader appreciation from the concepts of evolution. Infectious Diseases, at its most fundamental level, is applied evolution, and understanding evolution often adds greater insight into infectious diseases. Me find bug, me kill bug, me go home may be my motto, but it is meant in jest.
There have been papers or books that have added conceptual frameworks to my understanding of the natural world and medicine. Besides evolution, there was Observations on Spiraling Empiricism a classic that all health care providers should read, as it outlines the cognitive errors we all make in prescribing medications; I have discussed this article before.
There is The Drunkard’s Walk: How Randomness Rules Our Lives by Leonard Mlodinow. So often the explanation of why something happens is a shrug of the shoulders; feces occurs. The book formalized my understanding that much of what happens is random and without cause. The challenge in medicine is trying find a pattern in the randomness of life upon which to base a diagnosis. It is equally important to recognize when patterns are not there. All too often what is seen as a pattern is our imposing structure on what are random events. Or maybe that really is a bunny in the clouds. Clinical study results often occur by chance and having a significant ‘P’ value may still be due to randomness if the study is measuring nonsense.
A friend of mine at work sent this video to me in great amusement.
I just hope he wasn’t making a comment on my behavior when it comes to dealing with our biostatisticians. I have, of course, seen investigators approach biostatistians this late in the game. Not that I’ve ever flirted with this sort of behavior, of course. At least the researcher in the video above actually consulted the biostatistician before doing the experiment, rather than after doing an experiment with inadequate statistical power to answer the question asked. On the other hand, I guess it doesn’t matter if the researcher doesn’t listen, does it?
We have a saying in medicine that you can’t kill a jerk. Not that we try to kill anyone, but that particularly unpleasant individuals, rife with psychopathology, survive whatever illness comes their way. The corollary is that particularly nice people are prone to having horrible diseases with unpleasant outcomes. We all know intellectually that it is not true, but there is an ongoing feeling in health care providers that somehow patient personality determines the consequences of their diseases. As an aside, I am often left with the explanation for patients that the reason for their odd infection comes down to bad luck. Everyone responds something to the effect that “Typical. I get all the bad luck.” I have never had a patient say, “That’s odd, I am usually so lucky.”
On the question of nurture versus nature, raising two children has convinced me of the relative lack of importance of nurture in the personalities of my children. While abusive/pathologic environments will certainly lead to pathologic personalities, for the average child raised in middle class America I can’t help but think that, to quote Popeye, “I yam what I yam and that’s all what I yam.” I expect to be schooled in the comments on that subject. Yes, I read the Blank Slate and have some understanding of the literature. And yet. My kids, my friends kids. I watch them grow in what is (and isn’t) a similar environment and end up with diverse personalities that often appear present before they can speak. I am well aware of the multiple logical fallacies that lead to that conclusion. Parenthood and medical practice (where people seem to do the same damn stupid things over and over) have lead me to the conclusion that free will is mostly a myth and we are mostly programmed to behave the way we do. Discuss. It is not the main point of the post, but my bias.
OK, I gotta admit that my friend Orac moved me to render this Special 10th Edition of the W^5/2™ (after a brief hiatus) by mentioning it today in the context of an article that used, er, the topic of our venerable game to great advantage! Some of it is brilliant, unprecedented even:
Perhaps most tellingly, the U.S. Internal Revenue Service approved acupuncture as a deductible medical expense in 1973.
My hat is off to whoever came up with that one! Hey, y’gotyer basic logical fallacies, right? Y’gotyer appeal to tradition, yer appeal to popularity (or, as Orac put it, yer argumentum ad populum—sheece, is he a snob er what?), yer appeal to authority, which, I shpoze, an appeal to the IRS is a species of, as it were (hmmm: is that appeal heard in Tax Court?)…but there’s something just a little more special about this than just that. Therefore I propose, in the Tremendous (and Trendy!) Tradition of Trademarked Titles™ long associated with the Wonderful W^5/2™, a bran’, spankin’ new fallacy of its own, presented, of course, in a tasteful Madison Avenue format: