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Differences Of Opinion

After my fairly recent awakening from shruggieness  (i.e. a condition in which one is largely unaware of or uninterested in CAM) I decided to discuss my concerns about pseudoscience with my friends. One particular friend is a nationally recognized physician who believes in the importance of accurate health information and the promotion of science. However, he sees no urgent need to warn people against snake oil, and so long as it’s correctly labeled he doesn’t seem to mind it co-existing with scientific alternatives.

My friend and I had dinner a few weeks ago, and our conversation was both animated and disappointing. I somehow felt inadequate in conveying my objections (both ethical and scientific) to the promotion of pseudoscience. My best explanations were met with cheerful rebuttals, and while not intellectually convincing to me, those retorts satisfied my friend just fine. I guess the bottom line was that he was more interested in maintaining his position than reconsidering it… and so it left me feeling rather frustrated and a little sad.

First of all he argued that since he couldn’t rule out the possibility that some alternative therapies could have therapeutic value, he had no problem with them being studied. I asked him if he could name one therapy that proved effective in NCCAM trials, and he could not. I then asked him if he thought it was a good use of tax payer dollars to research practices that had a very low probability of being useful. He asked for an example – I suggested energy healing. He responded that since our bodies do in fact generate electrical currents (which can be detected by EEGs or EKGs for example) it was not inconceivable that a previously undiscovered current measurement could provide important information about disease states. I asked what that had to do with waving hands over the body to realign these hidden energy fields, and he said he didn’t know, but that it wasn’t impossible that the act did something to the body. I responded that so far we’ve found no repeatable, reliable, effect of any medical significance associated with hand waving, and he shrugged.

So then I asked him if he had a problem with practitioners who offered both proven and unproven therapies. He said that was fine, as long as they were described accurately by the practitioner. I asked him if he thought that offering pseudoscience alongside effective therapies presented any credibility issues for the provider. (I likened this to offering a hungry patient a bowl of ripe fruit, some of which are real and some are plastic). No, he didn’t see a problem with credibility – so long as the options were described accurately. “If people want to be entertained or believe in placebos, that’s fine. It’s their choice. It’s the physician’s job to present the facts.”

I then asked my friend if a placebo were disclosed to be a placebo, what use would it have? Isn’t the very effect dependent on the belief in its power? He responded that he thought it was unkind to take hope away from people – and that if they wanted to believe that they might benefit from a certain alternative therapy (especially if they’d exhausted all possible proven options) then they should not be dissuaded of their belief. He said it was the same principle that was operating when a friend of his (diagnosed with a devastating neurological condition for which there is currently no good treatment or cure) asked him if his diagnosis might be incorrect. My friend said there was always a small chance that a diagnosis is incorrect and allowed him to hope that his condition was not what it was.

I changed the subject and asked if my friend was concerned about promoting medical practices that had not evolved in their thinking over hundreds of years. Surely that was a warning sign – since our knowledge of nature, physiology, and basic science is continuing to deepen and expand, surely treatments should also become more sophisticated along with that knowledge. My heart sank as he launched into the Galileo gambit… “Everyone thought Galileo was crazy when he said the world was round, but he was right you know. Sometimes things seem unexplainable, but they turn out to be true.”

I quickly responded – “But how many people do you know who are trying to counter Galileo’s round earth ‘theory’ now?  Is there momentum growing around a flat earth club that you know of?  No. And that’s the same reason why we don’t need to revert back to ancient therapies that have been disproven.”

My friend smiled at me, without comment.

In a final attempt to establish some common ground I suggested that surely he agreed that certain practices like homeopathy had no place in modern medicine. I could tell from his blank expression that he was probably unfamiliar with the theory behind it (that like cures like and water can hold a “memory” of prior exposure to molecules, and that water based treatments are more potent if shaken).

“Well, it’s harmless enough, I guess.” He said, chuckling.

And so we finished our dinner with a clearer understanding of our fundamental disagreements, and no change in our respective opinions of CAM. My friend’s views are probably like those of many other physicians in this country, and I doubt that I’ll be able to do much to change them. And so the two of us will co-exist, him feeling shruggie and me feeling exasperated… until perhaps one day a patient of his will decline curative treatment for a fatal disease in favor of an “alternative therapy,” and he’ll wonder if all these placebos are as harmless as they seem.

Posted in: Science and Medicine

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42 thoughts on “Differences Of Opinion

  1. Joybobington says:

    Send him a copy of “Trick or Treatment”?

  2. adina says:

    I sympathize with both of you, to a certain extent. I agree with you that the pre-test probabilities that many of these homeopathy treatments have any meaningful efficacy are basically zero, and that grant-giving institutions ought to take this into account.

    And I agree with you that, from a moral perspective, treating someone with something that doesn’t work is indefensible. It is important that doctors and other health care professionals work to combat all the claims of people who oppose EBM, as you all do, quite admirably, on this and other blogs.

    The one point where I agree with this physician has more to do with the legal sphere. Consenting adults have the right to do all kinds of crazy behavior, so long as their freedom is appropriately weighed against any non-consentual risk of harm to others. I’m sure the vast majority of people know that main-stream doctors don’t approve of reiki therapy…but most devotees of reiki probably just don’t care. There is only so much we have the right to tell people what to do. If they want to go to a quack, I will try to talk them out of it with evidence and compassion, but I should not be free to stop them.

    Occasionally, some behaviors (vaccination is one good example) do have a potentially marked effect on others, and that is why vaccination is one issue that makes me most angry toward the anti-science folks. But even issues like forced vaccination must be weighed, in terms of its costs and benefits to society. If we require vaccination beyond the amount necessary to virtually guarantee herd immunity, perhaps the headache of the reluctant parents blaming all their kids’ future problems on vaccines will just not be worth any potential benefits.

    I believe that we should focus on addressing issues that are more clear-cut (to me, at least) than “Should a consenting adult be allowed to visit a reiki specialist?” Namely, should we require consent forms to ensure that the patients know that they are not being treated by an EBM-committed doctor? What should be the rules regarding children? And of course, we must always continue to dispel misinformation so people can understand the scientific method, and hopefully make good choices on their own.

  3. David Gorski says:

    I had a similar incident, although not with a shruggie:

    http://www.sciencebasedmedicine.org/?p=306

  4. storkdok says:

    “He said it was the same principle that was operating when a friend of his (diagnosed with a devastating neurological condition for which there is currently no good treatment or cure) asked him if his diagnosis might be incorrect. My friend said there was always a small chance that a diagnosis is incorrect and allowed him to hope that his condition was not what it was.”

    This really disturbs me. I understand getting a second opinion, but to allow someone to believe there is a chance the diagnosis is incorrect could lead to him not getting his affairs in order, or for preparing for the limits the disability would place on him or to prepare for possible death, and to prepare his family for this.

    When my brother’s best friend was diagnosed with CJD, he was already severely debilitated. He lived only 2 more months after the diagnosis. It took a month to get a diagnosis, and then you are really only sure of this diagnosis upon autopsy, if you don’t do a brain biopsy, which is what they finally did. His cognitive ability was lost very quickly, he didn’t have time to get his affairs in order, his wife, luckily, had the help of my brother and all their friends, who took turns flying up to them to help care for him. He had two small children. He never got the chance to write or record messages for them for the future.

    It seems to me that your friend couldn’t face the hard questions from his friend, and took the easy way out. This is what a lot of doctors do with CAM. I would rather have the truth/reality, and if the chances of an incorrect diagnosis were extremely small, I would feel betrayed that my friend had let me think there was hope, and waste precious time.

  5. Dacks says:

    How do you argue persuasively with someone who won’t examine the evidence? This what I come up against with my anti-vaxxer friends: too much counter evidence and they simply stop responding.

    It’s disappointing that this doctor isn’t curious enough to find out whether the alternative methods he hears about have any validity, and thus can give his patients no guidance. This blog does a great service in that respect, with MDs taking the time to research the science behind the claims. If more MDs knew what homeopathy really is and would explain it to their patients, maybe CAM would lose some of its appeal.

  6. Beowulff says:

    It seems to me your friend is contradicting himself:

    He said that was fine, as long as they were described accurately by the practitioner.

    which appears to be in direct conflict with this:

    He responded that he thought it was unkind to take hope away from people – and that if they wanted to believe that they might benefit from a certain alternative therapy (especially if they’d exhausted all possible proven options) then they should not be dissuaded of their belief.

    So practitioners need to give accurate information, except where it contradicts their patients beliefs? I guess your sense of frustration is appropriate, your friend really does need to re-examine his beliefs on this matter.

  7. Dr Benway says:

    Why isn’t he using energy healing in his practice? Why no TCM?

    Does he have a rational means of rejecting any therapy from the set of medically reasonable interventions? Where does he draw the line?

    Chiropractors and naturopaths will soon be recognized as primary care physicians, thanks to well-funded PACs and Senator Harkin. Can your friend collaborate with colleagues who tell patients that vaccines are poison?

    Is he cool with the return of polio?

    Does he mind that “doctors” prescribe supplements which they also sell out of their offices and on their web sites?

    Does he have any duty to uphold the integrity of the medical profession, or is that someone else’s job?

  8. Peter Lipson says:

    …and he shrugged.

    Yep.

    The real test, as I always say, is who are you gonna call when you have crushing substernal chest pain?

  9. Calli Arcale says:

    Everyone thought Galileo was crazy when he said the world was round, but he was right you know.

    Oh geez….. That’s the worst version of the Galileo gambit that I’ve ever heard. I’m surprised you didn’t call him on it being so historically wrong.

    Nobody thought Galileo was crazy when he said the world was round, because the Earth’s spherical nature had been a widely accepted scientific fact since ancient times. (Indeed, Galileo was born seventy-two years *after* Columbus landed in the West Indies. Not that Columbus proved the world round either; everybody already knew it was.) It’s more commonly claimed that he got into trouble for heliocentrism, which isn’t entirely accurate either.

    Galileo wasn’t thought crazy in his time. He was thought to be an arrogant prick, which, to be fair, he kinda was. He was one of those sorts who you really shouldn’t put in charge of a diplomatic mission, because he tended to speak his mind regardless of the tactical wisdom of doing so. He ended up pissing off some very important people in the local clergy, mostly for his politics, not his science. When he started talking about Jovian satellites, sunspots, and lunar mountains, they had the chance to get even with him. When the much more diplomatic Johannes Kepler brought his own support to the heliocentric model (as well as resolving the nagging problem of circular orbits not really predicting the motions of the planets), the church had no problem with it. Galileo’s imprisonment was, essentially, political. It wasn’t that his contemporaries thought he was insane or even wrong.

    Sorry for the off-topic rant there, but I’ve never before encountered the belief that Galileo’s big contribution was that the Earth was round. It combines two of my pet peeve misconceptions: that medieval Europeans thought the Earth was flat, and that nobody believed Galileo at the time.

  10. pec says:

    “He responded that since our bodies do in fact generate electrical currents (which can be detected by EEGs or EKGs for example) it was not inconceivable that a previously undiscovered current measurement could provide important information about disease states. I asked what that had to do with waving hands over the body to realign these hidden energy fields, and he said he didn’t know, but that it wasn’t impossible that the act did something to the body.”

    I think your friend sounds very intelligent and open-minded. Too bad there is no one like him at this blog.

  11. pec says:

    “Too bad there is no one like him at this blog.”

    I mean too bad none of the authors at this blog are like him. Some of the visitors are, but they’re always ridiculed and insulted.

  12. hatch_xanadu says:

    Calli Arcale, I salute you.

  13. mr. grieves says:

    Pec:

    “I think your friend sounds very intelligent and open-minded. Too bad there is no one like him at this blog.”

    Could you tell me where you draw the line? It is ‘possible’ that ANY intervention could do something for a condition. This would include homeopathy, reiki, acupuncture as well as amputation, cyanide poisoning, pouring sulfuric acid onto the eyes, giving one’s children up for adoption, bloodletting and wrapping oneself in saran wrap (among other modalities). Since there is no evidence that there is any kind of energy field present in humans that participates in health or disease states and furthermore no evidence that hand waving around the body can alter this energy field there is no reason to believe energy healing is more effective than any of the other ‘treatments’ I listed above. So, if the mark of intelligence and open-mindedness is encouraging/promoting/condoning practices with no evidence for efficacy, how do you decide which ones are appropriate.

  14. Skeptico says:

    Would he be happy with homeopaths recommending homeopathy, instead of a real anti-malarial, to someone going to a malarial region?

    Would he be happy with a naturopath recommending a patient not vaccinate their children because it’s unnatural?

    Your friend, smart though he may be in some areas, sounds like a fool.

  15. Beowulff says:

    Pec: If you haven’t seen this already, watch this video on open-mindedness.

  16. pec says:

    “it was not inconceivable that a previously undiscovered current measurement could provide important information about disease states.”

    That is a very reasonable statement, and I completely agree with it. Val is sad because he craves certainty, and loves to think that all CAM believers are morons. This is about wanting to belong to a high status group, as well as a need to feel you know the truth. It is NOT about true skepticism.

    The MD who made that statement, about the possible existence of unrecognized biological energies, probably speaks for the majority of physicians. Most intelligent scientific people do not have their minds nailed shut like the organized pseudo-skeptics who write this blog.

  17. Scott says:

    I suspect that pretty much nobody here would *dis*agree with the statement that it’s not inconceivable. The disagreement is with the conclusions that, because it’s not inconceivable, (a) it must necessarily work and (b) it is worth spending (scarce) research funding on.

  18. trrll says:

    “it was not inconceivable that a previously undiscovered current measurement could provide important information about disease states.”
    That is a very reasonable statement, and I completely agree with it. Val is sad because he craves certainty, and loves to think that all CAM believers are morons. This is about wanting to belong to a high status group, as well as a need to feel you know the truth. It is NOT about true skepticism.

    No, it is not reasonable. What is your hypothesis here? What kind of current measurement do you imagine has not been investigated? Every conceivable electrical sensor has been deployed around the body. There is no evidence of anything of the sort. There is no known physical mechanism for any other kind of “field.” There is no evidence that the kind of weak fields generated by the human body can have any kind of effect on another human body, and there are strong physical and physiological reasons for believing it to be impossible.

    So invoking some sort of “undiscovered current” is not really any different from invoking “invisible blue fairies” — less so, in fact, because while we don’t have any knowledge of how to detect for invisible blue fairies if they exist, we know a great deal about currents and fields, how they are generated, and how to detect them.

  19. “Val is sad because he craves certainty, and loves to think that all CAM believers are morons. This is about wanting to belong to a high status group, as well as a need to feel you know the truth. It is NOT about true skepticism.”

    Spoken like a true closed-minded bigot.

    BTW – Val is a woman.

  20. Calli Arcale says:

    No, it is not reasonable. What is your hypothesis here? What kind of current measurement do you imagine has not been investigated? Every conceivable electrical sensor has been deployed around the body. There is no evidence of anything of the sort. There is no known physical mechanism for any other kind of “field.” There is no evidence that the kind of weak fields generated by the human body can have any kind of effect on another human body, and there are strong physical and physiological reasons for believing it to be impossible.

    Respectfully, I must point out that pec is right insofar as we cannot assume that all possible currents or whatever have been discovered. There might even be invisible blue fairies for all we know.

    It’s reasonable to allow that such things might exist, but we presently lack the technology to detect them. What’s unreasonable is then proceeding on the assumption that they *do* exist.

    It stands to reason that there are many possible fields/currents/fairies/whatever that we cannot yet detect. However, it also stands to reason that the vast majority never will be detected because they do not exist.

  21. qetzal says:

    It is not inconveivable that there is a china teapot revolving about the sun in an elliptical orbit between the Earth and Mars. The only way to be sure is to study the possibility! Shall we start a petition to NASA?

    Of course, it’s going to take a lot of money, and it will take away from other things NASA might do instead. If only there were some way to decide which “not inconceivable” ideas were worth pursuing….

  22. tmac57 says:

    adina-”I will try to talk them out of it with evidence and compassion, but I should not be free to stop them. ”
    Of course Drs are limited in their ability to prevent patients from doing something ignorant, but they shouldn’t play along with unscientific modalities if they want to maintain credibility.
    And to your statement “If we require vaccination beyond the amount necessary to virtually guarantee herd immunity, perhaps the headache of the reluctant parents blaming all their kids’ future problems on vaccines will just not be worth any potential benefits.”
    If 50% of parents decided that they would refuse vaccines what % of those would you be willing to single out to vaccinate to “guarantee” herd immunity? What we really need to be doing is vigorously educating parents to understand that the benefits outweigh the risks, and to show what a bunch of dangerous numbskulls the anti-vax crowd is, and that not protecting children from easily prevented disease is tantamount to child abuse. But I think that requiring vaccinations for public school children is not unreasonable.

  23. Pliny-the-in-Between says:

    I’ve had similar conversations with colleagues. I suppose I shouldn’t be so surprised but I still am. The Galileo example must be a common talking point. But I have always asked them to consider that in light of the enormous scientific advances of the last several centuries and entire disciplines that didn’t exist then, is it likely that a ‘gotcha’ of the magnitude that would be required to support these dubious beliefs is lurking about.

  24. pec says:

    [So invoking some sort of “undiscovered current” is not really any different from invoking “invisible blue fairies”]

    When there is a substantial amount of evidence — both scientific and anecdotal — for a form of energy, then it is only reasonable to consider it might possibly exist. The fact that a medical procedure comes from oriental medicine or traditional medicine does not mean it can’t be scientifically verified.

    Why is there evidence that acupuncture can work, for example, if the oriental medical concepts are all worthless superstition.

    It’s true that interest in CAM is relatively recent and that more research is needed. But I don’t see how you can ignore all that has been done so far, either in American or oriental CAM research.

  25. trrll says:

    When there is a substantial amount of evidence — both scientific and anecdotal — for a form of energy, then it is only reasonable to consider it might possibly exist.

    In fact there is neither scientific nor anecdotal evidence for some other form of energy. There are certainly anecdotal phenomena that have been attributed to some undefined form of energy, but that is not evidence for such energy.

    To put it another way, seeing the sun move across the sky is evidence for some source of light and heat that moves across the sky. It is not evidence, anecdotal or otherwise, for fiery, flying chariots, even though some people have suggested that as an explanation for the sun.

    Why is there evidence that acupuncture can work, for example, if the oriental medical concepts are all worthless superstition.

    When the efficacy of acupuncture is the strongest evidence that you can offer for such “energy,” you know that you are in trouble. In fact, there are multiple mechanisms whereby acupuncture could work that do nor require the interventioin of a novel form of energy. One is obviously the placebo effect, which is another way of saying that acupuncture does not actually “work” at all–indeed, the most careful studies have had difficulty finding any effect of “real” acupuncture over placebo acupuncture. Even if there is a non-placebo effect of acupuncture, there are mechanisms whereby it could work that would not entail any novel energy. After all, the human body has nerves capable of communicating the sensation of needle prick to the brain, and it is the brain that determines which sensations constitute pain. All of this involves forms of energy that are completely conventional and well-understood.

    Here is a related example: Like acupuncture, many martial arts have an oral tradition that invokes the energy of “chi” or “ki”. Aikido and Tai Chi both have an exercise that demonstrates the power of chi/ki, known as the “unbendable arm.” As conventionally performed, one relaxes the arm and visualizes the flow of “energy” through the arm. As readily verified by experiment, the practitioner becomes able to resist the efforts of a stronger opponent attempting to forcibly flex the arm at the elbow, and moreover to do so with little sense of physical effort. So is this evidence for the existence of a mystical “energy” beyond the electrical and chemical energy that mediates the function of nerve and muscle?

    Actually, no. If in fact the energy were not that of nerve and muscle, then one would expect the muscles to be flaccid during this exercise. But if you palpate the muscle, you find that this is not the case. Indeed, the triceps muscle that straightens the arm is hard–if the opponent is applying a lot of force, it is hard as a rock. So why is the arm “unbendable?” The answer is found by palpating the muscle of somebody trying consciously to resist having their arm bent. Almost invariably, the triceps is tense–but so is the biceps, the muscle that bends the arm. Without realizing, although he may believe that he is using all of his strength to hold his arm straight, he is actually fighting not merely the opponent, but his own muscles trying to bend the arm. The unbendable arm technique turns out to be merely a way of giving the conscious mind something to focus on, so that it does not interfere with subconscious neural mechanism that are able to control the muscles far more efficiently. And indeed, the “energy” mediation is not even necessary–pretty much any distraction to the conscious mind will work.

    So in the case of the unbendable arm, we have a verifiably real phenomenon being misinterpreted as evidence of some “other” form of energy, when the actual mechanism is normal physiology.

  26. pec says:

    Just go on trying to explain things away trrll. I doubt you have even looked at any of the CAM research, or any of the energy healing research, or anything else that indicates the existence of life energy. As CAM research continues it will become harder and harder for you to explain it all away as mass hysteria and delusions.

  27. Versus says:

    Adina raised a good question: to what extent can we prohibit adults from consenting to crazy treatments? The problem is that the lack of scientific plausibility and good evidence is not disclosed to patients by CAM practitioners. The patients don’t think they are doing crazy things — they think these are legitimate health care practices. Otherwise, why would they use them? Chiropractors tell
    patients they have subluxations, and the patients think that yes, in fact, they do have these subluxations and that they must let the chiropractor adjust them, and that if they don’t, their health will suffer. My view is that it is a violation of patient autonomy to allow these pretenses.

  28. trrll says:

    Just go on trying to explain things away trrll. I doubt you have even looked at any of the CAM research, or any of the energy healing research, or anything else that indicates the existence of life energy. As CAM research continues it will become harder and harder for you to explain it all away as mass hysteria and delusions.

    I would love to see some evidence that any of this is genuine. No scientist could help but be tremendously excited by the discovery of a new form of energy. But one thing that actually doing science teaches you is how easy it is to be led astray by wishful thinking. But I’ve followed the topic for years. You are saying just what advocates were saying 30 years ago–real evidence of these supposed biological energy fields is just around the corner. Yet there has been zero progress. Where are the instruments to measure the fields? What are the physical particles that carry the energy? How is it generated? Where does the energy come from? There has been enormous progress in particle physics over that time, enormous progress in biochemistry, cell biology, and neurobiology, yet no hint of any additional type of energy has been discovered.

    One useful exercise that scientists learn early in their training is to make hypotheses as explicit as possible. It is very easy for vague hypotheses to seem superficially plausible. So let’s think for a moment what needs to be the properties of the hypothesized “energy:”

    1. It supposedly mediates effects on the body, so it must interact with the matter of the body.

    2. From #1, its particles must carry sufficient energy to affect biological systems.

    3. It can’t interact with electrons or electric fields, or it would be detectable by electromagnetic instrumentation.

    4. It can’t be generated by any of the particle interactions studied by physicists in accelerators, as the energy and momentum carried away by its particles would show up in particle physics experiments.

    Now these are some pretty tight constraints. It must interact with matter….and yet its interactions with matter should be undetectable in the many kinds of physical experiments experiments carried out to study interactions of matter and energy.

    To this we can add that even though this energy is supposedly generated by living organisms and capable of having profound effects upon living organisms, it does not play a major role in any of the biochemical or physiological systems studied to date–all of the known functions of the heart, the brain, the biochemistry of cells, are consistent with known types of interactions of matter and energy. Nobody has ever found any kind of simple, reproducible biochemical or physiological experiment in which some additional form of energy is needed to “balance the equation.”

    Does this begin to give you an idea why scientists are skeptical, no matter how enthusiastic we might be about the possibility of a novel form of energy?

  29. tmac57 says:

    trrll- You left off the possibility of ‘magic’ energy ;-)

    By the way, the thing about the unbendable arm was interesting.

  30. pmoran says:

    Yet accessibility of “crazy treatments” may be an inevitable, even somewhat useful, component of a “healthy” society, at least while medical science is barely halfway towards providing affordable, safe and entirely effective solutions to all of mankind’s ills (while expectations have been strongly aroused).

    Consider how much of human life is dominated by make-believe: all the religions and other “spiritualities”, the personal fantasy lives, many recreational activities. Why expect medicine to be different?

    Our understanding of human suggestibility and fairly solid scientific evidence favouring placebo responses, along with other complexities in medical interactions. does leave open the question as to whether many individuals derive significant comforts from fantasy methods that they may not readily find within the mainstream. Some certainly pursue such methods with some determination when there are no mainstream options.

    I am not saying that this phenomenon is an entirely good thing. There are obvious risks. But we judge conventional methods on a risk versus benefit basis while doing our best to minimise the risks. Is a similar approach justified here?

  31. Blue Wode says:

    Val Jones wrote: “My friend’s views are probably like those of many other physicians in this country, and I doubt that I’ll be able to do much to change them. And so the two of us will co-exist, him feeling shruggie and me feeling exasperated…”

    FYI, Edzard Ernst seems to share your exasperation in his blog this week.

    Quote:
    “Today many GPs offer complementary therapies to their patients and many have complementary practitioners on their premises. Sadly, however, I do not have the impression that evidence has anything to do with their decision to do so…why do so many GPs apply double standards?”

    http://www.pulsetoday.co.uk/section.asp?navcode=743

    (Registration is free)

  32. Dr Benway says:

    pmoran, the risk is a return to the pre-Flexner era. I’d prefer for that to happen after I’m long gone.

    See The Road to Wellville.

    Just because something is natural doesn’t mean it’s preferable.

  33. Dr Benway says:

    Blue Wode, marketing departments have discovered that exotica has a certain appeal.

    The for-profit hospitals in my area offer Reiki. The nearest non-profit hospital would never go down that road.

  34. tmac57 says:

    pmoran-”I am not saying that this phenomenon is an entirely good thing. There are obvious risks. But we judge conventional methods on a risk versus benefit basis while doing our best to minimise the risks. Is a similar approach justified here?”
    This, to me, as a consumer of medical services rather that a provider, is a question of how much faith do I have in my health care providers? If my Dr were to try to get me to take a homeopathic remedy, while assuring me that it helps ‘many’ people , I would immediately start looking for another Dr. Wouldn’t you? The harm can extend well beyond lack of confidence though. Any Dr that thinks ‘magic water’ is medicine may also think that shark cartilage can cure my cancer, or that mega doses of some vitamin can help any number of things that more properly should be treated by SBM. When highly educated professionals start to give advice that they ought to know better than to give, I for one, have to question either their intelligence or their competence. If I were a DR I would think twice about that.

  35. Blue Wode says:

    On 16 Apr 2009 at 5:07 pm Dr Benway wrote: “…marketing departments have discovered that exotica has a certain appeal.
    The for-profit hospitals in my area offer Reiki. The nearest non-profit hospital would never go down that road.”

    Well, here in the UK we have reiki practitioners and spiritual healers on the NHS payroll. We also have four NHS homeopathic hospitals and a lobby group, which boasts several dozen GP members, that is intent on railroading more CAM into the NHS:
    http://www.fih.org.uk/what_we_do/join_our_network/integrated_health.html

  36. Dr Benway says:

    It’s that idiot prince of yours, Blue Wode.

  37. trrll says:

    There is another ethical issue in providing doubtful CAM therapies to to patients. I can sympathize with a physician choosing to offer what is effectively a placebo to a patient when there is no effective option, so long as there is no actual dishonesty involved.

    But I cannot see any ethical way in which a physician could charge for services that he does not believe to be effective.

  38. Charon says:

    Go Calli. That version of Galileo’s story is so incredibly messed up I couldn’t believe it… Ptolemy, for example, included several proofs of the round Earth in the Almagest (c. 150 CE), and Copernicus repeated them in De Revolutionibus… (1543 CE). So both sides of the heliocentrism argument agreed on that. Unsurprising.

    More relevant to the discussion, however, is something the cosmologist Sean Carroll once said: “Don’t compare yourself to Galileo. You are not Galileo. Honestly, you’re not. Dude, seriously.”

    The VAST majority of people who are mocked and thought wrong are… wrong. Even the very controversial stuff – Galileo, Darwin, Heisenberg, etc. – doesn’t occur in isolation. At least a few other scientists of the time pick it up, and with a developing theory and accumulating evidence it quickly snowballs into scientific consensus. (Took a little longer for Galileo because the whole “science” thing was just starting.)

  39. trrll says:

    The VAST majority of people who are mocked and thought wrong are… wrong. Even the very controversial stuff – Galileo, Darwin, Heisenberg, etc. – doesn’t occur in isolation. At least a few other scientists of the time pick it up, and with a developing theory and accumulating evidence it quickly snowballs into scientific consensus. (Took a little longer for Galileo because the whole “science” thing was just starting.)

    And it happens fairly rapidly. In just the half-century we have seen hypothesis that were originally controversial–jumping genes, endosymbiont origin of mitochondria, continental drift, chemiosmotic theory–go from “wild ideas” to part of the standard body of knowledge. Even when scientists are skeptical, they look for evidence that bears on a hypothesis, and if there is anything to it, the evidence will begin to accumulate, the details of the theory get fleshed out, more researchers will become interested, and so on.

    What ultimately distinguishes pseudoscience is that it never goes anywhere. Believers in homeopathy, or telepathy, or bioenergetic fields are still trying to sell the same vague theories and ambiguous evidence–small, poorly reproduced “effects”–that they were pushing 50 years ago.

  40. Mojo says:

    @ Blue Wode:

    We also have four NHS homeopathic hospitals…

    Ah, but we used to have five. :)

  41. yeahsurewhatever says:

    “He responded that he thought it was unkind to take hope away from people – and that if they wanted to believe that they might benefit from a certain alternative therapy (especially if they’d exhausted all possible proven options) then they should not be dissuaded of their belief. He said it was the same principle that was operating when a friend of his (diagnosed with a devastating neurological condition for which there is currently no good treatment or cure) asked him if his diagnosis might be incorrect. My friend said there was always a small chance that a diagnosis is incorrect and allowed him to hope that his condition was not what it was.”

    Plato called this the noble lie. It’s a remarkably condescending philosophical position to commit to. It requires one to believe that people other than oneself are intrinsically weaker in constitution, and must be nursemaided by their betters in order to survive. You will also find it as the basis of Rousseau’s social contract.

    Charon:

    It was actually Eratosthenes (circa 240 BC) who is credited as the first European to have experimentally proved the sphericity of our planet. Based on the tools available to him, his calculation of its circumference was actually quite impressive.

    Addressing the infamous “I am a scientific pioneer, not a fraud, and they laughed at {famous scientist} too!” line, Carl Sagan once said: “Sure, they laughed at Columbus, they laughed at Fulton, they laughed at the Wright Brothers. But they also laughed at Bozo the Clown.”

  42. Charon says:

    Just found this thread again on searching for the Sean Carroll quote that it turns out I posted :)

    For the record, to yeahsurewhatever: I said nothing whatsoever about the first observations of a round Earth. This was known well before Eratosthenes (Aristotle, for example, proved it using the shape of the shadow the Earth casts during eclipses, and sailors as early as the Phoenicians knew this from horizon effects). Eratosthenes did get the first good estimate of the size of the Earth, in a very clever way, and was awesome etc., but has nothing to do with the first proof of roundness.

    In any case, my point was at the time of Galileo, the standard works on either side (the Almagest and De Revolutionibus Orbium Coelestium) both agreed on the spherical nature of the Earth, and indeed Copernicus repeated many of Ptolemy’s proofs.

    And yes, I teach a university course on this.

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