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167 thoughts on “Dr. Amy Tuteur has decided to leave Science-Based Medicine

  1. bluedevilRA says:

    *warning* shameless self promotion to follow…

    just launched my own blog, sort of in the spirit of SBM. not sure if any of you are interested, but if you are:

    http://dfreedm.wordpress.com/

  2. Zoe237 says:

    “I agree with Harriet that posters read a lot into her posts that simply was not there, and I think I demonstrated that with her summary of CAM as useless, particulary in reference to herbal treatments where she readily agreed with all the qualifiers that I offered.”

    What you and she don’t seem to realize is that there is a continuum of belief about anything. Childbirth is from mandatory elective c-section all the way to unattended homebirth. With chiropractic, there is belief all the way from nothing in chiropractic care that is useful to chiropractor can cure cancer With alt med, there is “none of it works” to “all of it works” with many many people in between. That’s why qualifiers matter. Somehow, hundreds of people didn’t feel attacked or simplified by Dr. Hall’s posts on the same subjects. I wonder why that is.

    I don’t believe for a second that I was twisting anything she said, but she could have clarified instead of flying off the handle. And no, I wasn’t kind to her after awhile, but she continually made ad hominem attacks not only on midwives, natural childbirthers, many different researchers in several areas unrelated to her expertise, but also on anybody who dared disagreed with her in the comments section. Many commenters have mentioned how condescending she is, so it’s hardly just me. Eventually, yes, I got sick of it, and I probably should have taken the high road. She also opened herself up to questioning her authority and experience as a doctor when she constantly USED that fact as support of her argument, instead of research or links.

    So it’s kind of an agree to disagree situation. Some people prefer her kind of style and polemic.

  3. Zoe237 says:

    Oh, and the funny thing is that Dr. Tuteur PERSONALLY attacked both plonit and Alex Knapp, despite the fact that neither one ever commented on her authority. And nobody defended them against Dr. Tuteur. It goes both ways. I think most people (not everybody) recognize that the ad hominems went both ways.

    This is not authority based medicine.

  4. mikerattlesnake says:

    @reviewer 3

    That post was incredibly sloppy. She was posting way outside of her area of expertise, misrepresenting statistical and evolutionary plausabilities as outright facts, and making conclusions above and beyond what she had evidence to support and she then ignored and insulted those that pointed that out with contrary evidence. The article would have made an ok opinion piece on another site, but it did not fit in with the content here.

    Again, I have nothing against her really, but you’re unfairly maligning the people who disagreed with her.

  5. StatlerWaldorf says:

    A wish-list of ob-gyn topics (from a balanced, level-headed ob-gyn contributor)

    - Intermittent vs continuous fetal monitoring

    - Umbilical cord clamping

    - Different positions for giving birth

    - Waterbirth

    - Effects of pharmacological pain relief on the mother, baby and birth process

    - Non-pharmacological pain relief in labour

    - Safety of homebirth in the US and other countries

    - Differences in midwifery education worldwide

    - Differences between midwifery and ob-gyn care

    - Episiotomy

    - New birth technology

    - Scams about fertility

    - Scams about treating gynecological issues

    These are general, but would love to see where a new ob-gyn contributor would go with those. Women could really benefit from good discussions of these topics to help make choices in their care.

  6. StatlerWaldorf says:

    And forgot to mention

    - Coached pushing

    - Managed 3rd stage of labour

  7. rork says:

    I second StatlerWaldorf – get a statistician type.

    It can be armor defending you from error – you folks are occasionally missing the important fudges in the science papers, or picking on the wrong problems in the CAM papers. Further it might lead to more bashing of crappy SBM, rather than just more CAM-bashing. CAM’s not a dead horse, but putting the lens on ourselves more often would be good.

    Short list:
    Keith Baggerly and Kevin Coombes. Heroic work. I hope they found the Journal of Forensic Bioinformatics instead though, where fudgers are ruthlessly grilled.
    David Ransohoff is an MD, but kicks ass.
    John Ioannides, also an MD, astonishingly.
    Yes, I’m smoking – they don’t blog, and I know of no good nerd bloggers out there, perhaps because it’s near-suicidal to be too critical about what great scientists write. We just whisper to each other, like cowards do, and permit wickedness to persist.

  8. edgar says:

    Admittedly, I have a clear bias here. You need a good epidemiologist with strong statistical skills.

    As one, I often find myself frustrated by posts because I find that the authors do not seem to understand the nuance of epi and of studies themselves. I often get the impression here, that it have to be RCT or it is not valid, and that is simply not true.

    While this blog as certainly led me to appreciate the difference between SBM and EBM, often what studies themselves show is evidence. It may not be compelling, and it may not be clear, and it may in fact raise more questions that it answers….But that is the essence of the scientific process is it not?
    Epidemiologist.

    stat!

  9. rosemary says:

    Zoe, “I don’t believe for a second that I was twisting anything she said, but she could have clarified instead of flying off the handle.”

    Well, Zoe, you certainly twisted what I said. You accused me of having a hate list. Not only were you very wrong, your accusation was insulting and painful and I think that it revealed more about you and your own prejudices than about me.

    You and most of the people launching personal attacks on Amy are anonymous cyber dwellers. I identify myself, and anyone who has followed my public comments or read my webpage knows that I do not hate nurses, midwives or people with BA degrees. They also know how insulting and painful your accusation was since I am a facially disfigured 67 year old woman who was disfigured by an MD at the age of 15 and has been the target of bigots and prejudiced people all her adult life as in denied jobs and apartments, thrown out of a pension (boarding house), called names by strangers in the street, etc. I have as a result gone out of my way to avoid ever doing that to any other group of people.

    I’m sorry. I didn’t want to have to make such a strong emotional statement publicly. I don’t blame Zoe or anyone else who has made personal attacks on me or others because for the most part I don’t think you intended to do it. I think you have all been carried away by your own emotions and personal biases while being completely unaware of it. And Zoe is not the only anonymous person to attack me personally here. Wales, who knows zilch about what a water commissioner does in the US, had claimed that I am incompetent in that job.

    IMO Reviewer 3 stated exactly what has taken place here with Amy and a small group of very vocal, articulate, mostly anonymous commenters.

    To me there are two very sad things here. First, that the people involved in the continuous personal attacks are acting so self righteous, holding themselves up as bastions of reason, science and skepticism instead of admitting even to themselves that they acted like a group of biased bullies. I wouldn’t be surprised if none of them had had the guts to do it without the support of the others. Second, I think that a moderator should censor anyone who makes a personal attack.

    I don’t think this forum is the place to continue this discussion, but if I get angry enough I might do it here. Anyone who wants to speak privately, please contact me: rosemary@rosemaryjacobs.com

    1. David Gorski says:

      Second, I think that a moderator should censor anyone who makes a personal attack.

      Really?

      And how do you define a “personal attack”? It’s not as straightforward as you seem to think. Take it from someone who’s moderated elsewhere.

  10. desta says:

    STATISTICIAN!!!!

    I study statistics (so of course I’m not biased towards it ;) ), but even scientists and medical professionals (and me) need a better understanding of how to interpret results and understand probability.

    No, I don’t have any suggestions for who should do it.

    1. David Gorski says:

      STATISTICIAN!!!!

      I thought of this before and even had someone in mind. Unfortunately that person appears to have given up blogging.

  11. Zoe237 says:

    “Further it might lead to more bashing of crappy SBM, rather than just more CAM-bashing. ”

    Yes, that’s my thing. SBM has btdt with acupuncture, chiro, and homeopathy. I’d like to see more on herbal treatments and supplements (vitamin d or c) (if there are any good ones, I don’t know). But mostly, on the science/evidence behind conventional medicine, because that’s what I’ll be using when I get sick.

  12. Franklin says:

    I fully support this latest development. Dr. Tuteur was the only poster here that I could not respect. I felt she did not accept criticism or respond to it with any sort of decency.

  13. Fifi says:

    zoe – “I’d like to see more on herbal treatments and supplements (vitamin d or c) (if there are any good ones, I don’t know). But mostly, on the science/evidence behind conventional medicine, because that’s what I’ll be using when I get sick.”

    I agree. How about someone who could discuss sports medicine or nutrition from an SBM standpoint instead of an ideological or “common sense fallacy” one? This is one of the biggest crossover woo areas that exists (partly because there’s so much money to be made by pushing woo for so many people – food industry, Big Sup of course, gyms, naturopaths, and even Big Pharma, and partly because it’s part of everyone’s mundane life). It’s also the area that often sucks people into total woo (since neither exercise nor nutrition are actually woo in and of themselves) and where pseudoscience flourishes and starts to encroach on medicine. Stripping away the ideology and woo from these topics would be doing a huge public service and, I’d suspect, gain you a huge audience.

  14. “David Gorskion 25 Feb 2010 at 9:46 am

    STATISTICIAN!!!!

    I thought of this before and even had someone in mind. Unfortunately that person appears to have given up blogging.”

    Are you speaking of EpiWonk?

  15. edgar says:

    Goodness,
    I am in love!..I wandered over to Epiwonk…..

    Maybe he/she would be interested in writing the occasional article, instead of maintaining a whole blog!

  16. lizkat says:

    STATISTICIAN!!!!

    Yes, that’s a good idea! I am always dismayed at how badly statistics and research methods are understood, sometimes even by scientists, and often by medical practitioners. Determining causation can be extremely tricky, often impossible, and yet we’re always seeing confident claims based only on associations.

    I did not get the impression that Amy Tuteur was very competent in this area. When you only look at the surface of data, you can see what you prefer to see. If you are interested in unbiased reality, on the other hand, you have to dig deep and think hard.

    And after all that work, you often find there is no clear answer.

    Dr. T has a particular world view, where modern science and technology and medicine are all-good, and nature is all-bad. I tried to argue that there are pros and cons for each.

    She strongly denied the importance of lifestyle even though we have good evidence that it does matter. But in her worldview, good health depends entirely on modern medicine and luck. How you treat your body is inconsequential.

    As silly as that sounds, I did not imagine her saying it, and I could find the exact quotes. Dr. T could not acknowledge that we have a nature that evolved over eons and that if we want to be healthy, we have to conform to that nature to some extent.

    Dr. T is not alone. She represents an ideological group that is prevalent today.

  17. Zoe237 says:

    I certainly apologize, then Rosemary. I don’t remember the exact circumstances, but I think I said that I had the wrong impression from your post about nurses promoting woo, and that I was mistaken. The last thing I want to do is intentionally hurt anybody.

    I do however see Dr. Tuteur as a blogosphere bully, and it seems everywhere she goes, people pick up on that.

  18. Fifi says:

    bluedevilRA – Nice first blog. Dr Oz and Oprah have certainly been the conduit that’s legitimized a lot of pseudoscience and woo – from promoting the kind of pseudoscience you call Oz out on to Opraph’s promotion of The Secret. It certainly doesn’t help SBM when actual doctors get involved in promoting woo or do unethical things (intentionally or via confirmation bias or ignorance).

  19. magra178 says:

    Well, I’m sad to see her go, but I can read her post on her blog. I’m a mother of a young child, and don’t spend much time on the computer, so was thrilled when a skeptical OB/GYN joined the only blog I follow (as throughout my pregnancy I felt bombarded by scam, pseudoscience and all things woo). I didn’t always agree with the perspective or evaluation Dr. Tuteur took of the literature, but felt (semi) educated enough to take her presentation and incorporate it into my own knowledge and go look for more if something was lacking.

    I hope SBM doesn’t get into a he-said-she said, but it seems it already is going that way (although the teenage girl inside me salivates at gossip). Her posts did generate outrageous discussion that anyone with half a life did not have time to read (or maybe it’s just because I’m a slow reader), but I agree with SBM’s stance of little moderation; which leaves people like me usually avoiding the comments because I don’t have time to wade through such negative and often off-topic attacks. Open is better, but it seems to be serving a few of the constant posters to repeat their points endlessly. But that’s the price for free and open. Looking forward to the new addition to the blog! I hope you can continue some parenting/women/childbirth topics.

  20. Harriet Hall says:

    A statistician would be a good addition to SBM, but a research methodologist might be even better. How about R. Barker Bausell, the author of “Snake Oil Science”?

  21. I feel so conflicted.

    I commented a lot, and I challenged Dr Tuteur when I felt her logic didn’t hold together, so I obviously recognise myself when people refer to a small group of bullies who drove her out.

    When she first started, I just thought she was a poor writer. I thought her writing devalued what the brand of SBM meant to me without adding anything, and I said so. When I thought she could improve her writing and strengthen her contribution to SBM, I pointed it out.

    Later someone (Zoe?) posted a link to a Salon thread where Dr Tuteur explained that she used a deliberately provocative style in order to save lives and didn’t care whether she was liked or not. In the Salon thread she named Glenn Beck, Rush Limbaugh and Anne Coulter as model communicators who she aspired to emulate. This made sense of her writing style, though it still didn’t explain why she thought a deliberate poke-the-wasps’-nest approach furthered rational examination of facts. Further, by publicly stating that her goal was to provoke and that she didn’t care whether she was liked — and also when she stated in an SBM thread that she measured the success of a post by the length of the comment thread it generated — she absolved commenters of a certain inhibition. You know how they say that arguing with a teenager is like wrestling with a pig: you both get covered in mud and the pig likes it. Well, I thought she was saying she liked it. If I didn’t mind getting covered in mud, she was game to wrestle. Guess what: I could use the exercise and I took her up on it.

    A lightbulb went off for me in the circumcision thread, where I did a lot of research (for someone who is not in school and has no particular interest in circumcision) and disputed a lot of commenters. (In this thread I was ultimately able to make a link between evidence that circumcision reduced HIV transmission in adult Kenyan and Ugandan men to support for routine neonatal circumcision of Kenyan and Ugandan boys, which was part way to Amy’s link to support for routine neonatal circumcision of US boys. So while I never understood what exactly she wanted from the APA or why, I was not arguing against neonatal circumcision.) At the end of that thread I said the following: “Interestingly, I’ve learned a huge amount following this discussion. I think Amy might have been a great classroom teacher (she was a clinical teacher), throwing out obnoxious, vague, un-nuanced and unsupported statements and motivating angry students to write thoroughly documented research papers. I do think I could have learned as much from a more disciplined discussion following a more complete, nuanced post, however; and I’m quite sure that I don’t want to have to write a term paper to learn something from a blog post.” At that point I decided that her provocative style was a deliberate andragogical strategy. If she was offering study classes on the internet, I was taking them.

    And now she has been driven off the blog by attacks from mean commenters. Which presumably is me. Because I challenged her. But was I really supposed to know that someone who said she wanted to be the Glenn Beck and Rush Limbaugh of SBM didn’t want to be challenged? Was I really supposed to think that when someone who deliberately used a provocative style to educate said something that didn’t make obvious sense, that I wasn’t supposed to notice or ask? And when someone posts on the internet that they deliberately use a provocative strategy to rack up comments, is it really a personal attack on them to observe that they deliberately use a provocative strategy to rack up comments?

    I don’t know what to think. I’m not worried about Amy Tuteur herself, but I feel like I’ve made a mess in an environment I value.

    Obviously for whatever reason, Amy Tuteur and SBM were not a good fit and the collaboration didn’t last. That’s not about me. And some people are completely uncomfortable with any display of conflict, even playful sparring between friends, and these people would presumably feel distressed by commenters challenging Dr Tuteur even if she did like it.

    But I am feeling conflicted.

  22. micheleinmichigan says:

    “Harriet Hall on 24 Feb 2010 at 1:28 pm

    Some of Dr. Tuteur’s critics are guilty of two sins of their own:

    (1) Responding to what they wanted to think she said rather than to what she actually said, and
    (2) Offering personal criticism of the author instead of just criticizing the content and discussing the issues addressed in the post. ”

    Dr H. orginally I agreed with this comment. In fact while Dr. T was posting here I abstained from looking at her blog so as not to skew my opinion of her articles. Out of curiosity, yesterday, I goggled her blog and came across her post and follow-up comments on Down Syndrome Testing. As the parent of a child with a craniofacial and hearing difference, I had a very gut level emotional reaction to the post and particularly her and other’s follow-up comments (apparently approved by her, since she moderates). Best I not say more.

    This bring me to the question of accountability or consistency of persona or writings in the blog environment. When a blogger is posting on two sites, particularly under the same name ;) Is it realistic to expect that some readers will not take their experience from what they know of the poster’s views on the first site and use it to interpret their reading on another site?

    That is to say if a restaurateur hires a chef with a reputation for serving poor quality meat is it realistic for them to expect their patrons approach the sausage with an open mind?

    As to personal criticism. I generally prefer and try to stick to a critique of the article. But when I see someone who’s behavior is truly out of line, unacceptable or hurtful. I will make a personal criticism. I feel it’s my duty as (you know) a human being. I view it as the blogs editor’s right to moderate or delete that criticism if they see fit.

  23. wales says:

    Rosemary, you’ve put me on the spot, eliciting sympathy and then accusing me of personal attack. I will try to thread the needle here but I suspect someone (and I think I know who) will use my comments as an excuse for further “attack” or criticism. So be it, c’est la vie. The reason I bother to comment at all is to second Dr. G’s cogent point about the subjectivity of personal attack and to reiterate my support for open comments. The perception of personal attack is often (usually?) a subjective one. I know nothing about you (except what you have revealed here) and I do not intend to find your website to learn more. You have disclosed more than I wanted to know. You are twisting my words as well (pot meet kettle, etc.), if you interpret anything I have said to indicate that you are incompetent at your job. How could I possibly make that statement knowing nothing about you or your level of effectiveness at your job? If I recall correctly, I think I have criticized you for minimizing the potential health risks posed by the increasing number and volume of industrial chemicals found in tap water.

    You claim to take the moral high ground by not attacking others, yet do so in this very post. Either you think attack is justified because you believe you have been attacked (vengeance), or you don’t perceive your own comments as attacks (subjectivity). See how quickly the concept of “personal attack” becomes circular and subjective? I try to confine my criticisms to situations of factual error and reflexive dismissal of relevant fact. I have had my head handed to me many times on this site, sometimes justifiably so and often not, especially when it comes to generalized labels. I try not to engage in tit for tat on a personal and emotional level. Tit for tat on in intellectual level is another story.

    As for the benefits of anonymity, what anonymity does is level the playing field. We can all discuss matters as disembodied minds with ideas, without concern for our physical appearance. Why you have intentionally and explicitly brought your physical appearance into one of the few arenas where you could have remained free from that burden is a mystery to me. I do feel sympathy for your unfortunate experience and what must be a difficult life. There are plenty of other websites that serve as venues for those types of discussions. Good luck to you.

  24. David Gorski says:

    Are you speaking of EpiWonk?

    Yep.

  25. Plonit says:

    For the skeptical midwifery or ob/gyn blogger, when you recruit one:

    Diet in pregnancy – ranging from the obviously bogus Brewer diet, through to mainstream govt. endorsed advice on foods to avoid, which could probably do with more scrutiny.

  26. Martin A. Lessem, J.D. says:

    How about a slightly different twist on a member…someone with Regulatory experience who can discuss things such as the FDA, MHRA and EMEA?

    If so, I will gladly volunteer my services and can provide a CV on request.

    Oh, and as an attorney, I have thick skin ;)

  27. lizkat says:

    >she named Glenn Beck, Rush Limbaugh and Anne Coulter as model >communicators who she aspired to emulate.

    If that is true, it explains why I hated her posts. That style of communicating can get you lots of attention and make you rick and famous (if you also happen to be entertaining, which Dr. T is not). But it is exactly the opposite of what we would like to see in scientific research. Actually, it’s the opposite of what I like to see in political discourse, as well as science.

    Basically, I can’t stand to see that kind of over-simplification and distortion. For me, being a skeptic means watching out for that kind of deceptive persuasion.

    If Dr. T really did name those three as her communication role models, then she is exactly what I thought — an aspiring ideological leader. Which is the opposite of a skeptical scientist.

    And it is very strange that some of the bloggers here, such as Harriet Hall, could not see it.

  28. Arnold T Pants says:

    Perhaps one of the Reveres on Effect Measure could add insight regarding statistics, epidemiology, and public health.

  29. David Gorski says:

    Revere would have to be willing to blog under his real name.

  30. bluedevilRA says:

    Thanks Fifi for the kind words! I was glad to see that someone checked it out. I’m always happy to hear from experienced SBMers. Dr. Oz was an easy target, but I didn’t want to make my first post too hard on myself :)

  31. pmoran says:

    Billyjoe: “The bold assertions: “there is not a jot of evidence” and “bogus treatments” are fine because they are true and there is evidence to back them up, but if you have to stick strictly with what the evidence says, it confines you to making statements that run into a long paragraphs of explanations and qualifications. At the end, few are still listening and fewer still will get the message.”
    ====================================
    The Amy episode has been a tragic waste of everyone’s time if no one learns anything from it.

    I think we SHOULD “stick strictly to what the evidence says” although modes of expression will inevitably depend to some extent upon who you are talking to.

    On this very blog many have expressed frustration that people and institutions don’t seem to listen to us. It is also my personal experience that talking down to believers or to those unsure what to believe. using shorthand modes of expression that are commonplace within scientific circles but less readily understood outside them, is the surest way to find an instant argument, a loss of respect, and much heat without light.

    Thus “not one jot of evidence” can simply expand to “no good evidence and a lot of improbability to claims that it does anything beyond placebo”.

    It’s clumsy, and it actually adds up to “no evidence” depending on the precise claim, but it says precisely what you mean. It has the added benefit of warning others that you are been in this kind of debate before, and are ready to argue out the evidence should they should want to divert debate into whether anecdotal experiences and a few unverified weak studies represent “one jot”, as I am sure BCA lawyers will.

    The thing is that just about everyone knows someone who swears by homeopathic treatments or has heard of studies that supposedly confirm their activity. So what dickhead comes along saying to someone like that, who wouldn’t know a scientific study if it bit them on the ass, baldly saying there is “no evidence”, or “not one jot of it”?

    We cannot force people to think our way merely with the power of our words and definitely not if also seeming to be wielding a delusional sense of having authority over what people should believe. The best we can do is explain why WE think the way we do. Lay it out for them gently and very, very patiently so that they can make up their own minds.

  32. “David Gorski on 25 Feb 2010 at 2:10 pm

    Revere would have to be willing to blog under his real name.”

    Surely no pseudonymous blogger would be willing to do that!

    Maybe some totally different blogger that just happens to have a similar blogging style to Revere would be interested? I swear I’ve seen that done somewhere before.

  33. Daniel M says:

    I don’t have anyone in mind, but I would love to see the next contributor be a clinical geneticist. The field of genetics is interesting and is really starting to work its way into everyday medicine, and I’d love to see more genetics stories here. After all, it is the REAL individualized medicine.

    Another suggestion would be a good science-based DO. I’d love to see how a skeptical Doctor of Osteopathy evaluates the current level of woo in some DO schools, as well as some of the claims of the American Osteopathic Association.

  34. David Gorski says:

    Surely no pseudonymous blogger would be willing to do that!

    Indeed. :-)

  35. dedicated lurker says:

    I second Linda Rosa.

    Jean Mercer (http://www.psychologytoday.com/blog/child-myths) might be a good choice, but she’s a psychologist not a psychiatrist.

  36. Saffron says:

    I’ve read without commenting in the past. But I’ll speak up today to say that Dr. Tuteur’s departure is a relief. It’s a good day for credibility and respect, I think.

    I second the wish list of OB/GYN-related topics for SBM suggested by StatlerWaldorf. When one talks to pregnant women who are actively seeking to educate themselves on (read: make sense of) optimal practices related to birth, these appear to be the big issues that need addressing.

    And if you make a point of not hitting them over the head the moment they land on the site, I’m confident a sizeable proportion of such women will stay and read.

  37. rosemary says:

    David Gorski, “And how do you define a “personal attack”? It’s not as straightforward as you seem to think. Take it from someone who’s moderated elsewhere.”

    I’d suggest you ask Steven Barrett since IMO he seems to have done it very well for a very long time.

    Wales, “As for the benefits of anonymity, what anonymity does is level the playing field. We can all discuss matters as disembodied minds with ideas, without concern for our physical appearance. Why you have intentionally and explicitly brought your physical appearance into one of the few arenas where you could have remained free from that burden is a mystery to me. I do feel sympathy for your unfortunate experience and what must be a difficult life. There are plenty of other websites that serve as venues for those types of discussions. Good luck to you.”

    I did not bring my physical appearance into the arena, if by arena you mean a place in cyberspace intended to combat quackery. It is my physical appearance that brought me into the arena since it is very strong evidence demonstrating the danger of ingesting silver dietary supplements.

    I was disfigured by a drug prescribed by a good, caring, exceedingly naive MD who never would have prescribed it if he had read med. journals instead of fraudulent ads from drug manufacturers in an era when they were not highly regulated. That drug is now fraudulently sold as a “dietary supplement”. When I first learned that in 1995 I went on the warpath predicting that we would soon see more disfigured people. I was and still am viciously attacked by quacks who said I didn’t know what I was talking about. Unfortunately, they were wrong. There are now many victims including children and teenagers almost all of whom are too embarrassed to speak publicly or even talk to a lawyer although many talk to me. I see the victims and their loved ones, not only those injured by silver supplements but others as well. They are real human beings with names and faces. I get exceedingly frustrated when I hear people discussing unscientific medicine with “disembodied minds with ideas” who appear to totally lack any awareness of the human factor, the emotions. IMO, you can all talk and debate with disembodied minds till the cows come home but the situation is not going to change till there are a lot of emotionally involved people screaming as loud as I am, people who actually understand the danger of unscientific medicine and what it does to real live human beings.

    Zoe was gracious enough to contact me off list. I have a great deal of respect for her for doing so. I think she understands what I am trying so hard to get across. This is about people, not intellectual debates. It is about feelings as well as reason. Everyone I’ve spoken to in public health has told me that the laws favoring quackery will not be changed until there are many victims. They say that that has been the way it has been historically and they hope that no one they love is one of the victims.

  38. Composer99 says:

    I’d be more sympathetic to claims that Dr Tuteur was forced out by dedicated bullies if it weren’t for her seeming to have a thin skin when challenged by people with what appeared to be reasonable concerns or who actually backed up their claims with references to topical research.

    I also think someone who aspires to the communication style of Limbaugh, Beck, or Coulter is not likely to be a good fit for the Science-Based Medicine blog, even if she is an ally of science-based medicine generally.

  39. wales says:

    Rosemary, thanks for clarifying your reasons for telling your story. Making others aware of risks is a worthy cause. My point remains that any perceived “personal attack” made upon you had nothing to do with you personally and was about a difference of opinion regarding risks of ingesting industrial chemicals in tap water. I cited a NYT article which cited primary sources and quoted toxicologists expressing concern over contaminated tap water (I think it was Tuteur’s Dec. “toxins” post?). False or exaggerated claims of “personal attack” can be as corrosive as the real thing.

    I think we’ve exhausted this topic for this particular venue. At least I have.

  40. ZenMonkey says:

    Add my voice to those who would like to see another ob/gyn take Dr. Tuteur’s place, or at least someone who regularly blogs on women’s medical issues.

  41. rosemary says:

    Wales, “You claim to take the moral high ground by not attacking others, yet do so in this very post.”

    If I have personally attacked anyone who hasn’t himself already done that to me or someone else, I apologize. It was not intentional. However, I do not take any “moral high ground”. I very freely state that I respond to others in the tone that they use.

    Wales, “I cited a NYT article which cited primary sources and quoted toxicologists expressing concern over contaminated tap water”

    I understand that you want to end the conversation and would like to respect your wish. However, first I am going to state that I do not believe that you can substantiate the statements in the articles by following the links that followed them. They were resources not citations. I am not trying to be contentious. Neither do I want to engage in an intellectual debate. I have a great deal of experience with silver salesmen who offer hundreds of citations to substantiate their statements. However, I also have and have read almost all of their citations and know that there isn’t one that supports their claim that ingesting silver is safe and beneficial. In fact, many of their citations state the exact opposite, yet by giving scientific citations they deceive many good, intelligent people who can’t imagine that anyone would actually cite articles stating that their claims are false. But there are a lot of brilliant quacks out there who know that very few people will actually bother to pull and read their citations and even fewer will check further to see what they have left out.

    Neither am I calling the NYTs journalists quacks. However, again based on a great deal of experience with the media, neither do I trust them to understand and accurately report what scientists tell them.

    I feel it important to point these things out repeatedly because it is knowledge that can prevent people from being deceived, injured, robbed or killed.

  42. MOI says:

    I’m partial to SBM trying to find another OB/GYN. I was so hopeful when I heard about Dr. Tuteur but was very quickly disappointed with her posts. I learned very little about the issues that are often discussed regarding pregnancy (Statler Waldorf’s list was exactly what I was looking for in regards to subjects). She had an axe to grind and was more interested in demonizing and mocking woo-birth practices than actually educating her audience on the science.

  43. sockpuppet says:

    I am very new to the site, I stumbled across it, found it intriguing. I saw that Dr Steve Novella was a contributor here and being a big fan of SGU and his blog I added it to my RSS feed. Shortly thereafter I clicked on the last article by Dr T and was astounded by the absence of any credible research to her post and scanning through some of the comments surprised by her replies demanding evidence while providing none. Today while surveying my feeds I saw this post and recognized the name, namely because I was so baffled by her post and follow up comments at the time that it stuck in my head. While my opinion carries little weight, having spent little time here and having no vested interest I am happy to see her no longer a contributor and have a renewed respect for the site that was shaken when encountering her posts for the first time while being unsure of what this site represented.

  44. Kylara says:

    I’d like to see another ob/gyn posting on women’s health (to add to the list of suggestions others have had, I’d love an article about breastfeeding after C-sections, because I got told so much utter nonsense about it).

    I’d also love to see a pediatrician. I work (a little tangentially) in elementary education so I see a lot of studies on things that relate to children’s learning in particular — for example, exposure to television. Now that I have a child myself, I’ve become aware that some statements from the AAP citing the same studies I’ve read take their relatively measured conclusions and turn them into “no screen exposure at all until age 2.” Toys that light up when babies press buttons are good, but entertaining them with a cell phone screen lighting up while standing in line, that’s apparently screen exposure and therefore bad. There’s enough parenting hysteria out there as it is; I was surprised to the extent to which the AAP seems to participate in that and even fuel it.

  45. JMB says:

    There is a great potential for misunderstanding of writings in blogs because of the lack of the nonverbal cues in communication. Many arguments may be perceived as personal attacks because we lack those nonverbal cues. We also all have a personal background that provides us with a context in communication that others cannot possibly know. That is why it is difficult for a moderator to judge what is a personal attack beyond blatant name calling or threats. The only effective process is to communicate to those when you think they are attacking you (which the moderator will notice), and then discuss that openly. That appears to have worked well already on this site, but in a few cases it has failed. However, the failure was not due to the site’s moderators.

    There will always be a collision between science and personal beliefs. Science cannot answer all questions. An advocate of science should be careful to explain how science gives us a method to test only a part of our beliefs (that part we can subject to reproducible observation). Science cannot completely replace our personal beliefs, but it can demonstrate what part of our beliefs we can subject to a test, and use the results of tests to reach a consensus, even among those with different personal beliefs. If medicine is to be based on science, then we must be able to recognize when a concept can be subjected to scientific method, and segregate personal beliefs from that which can be objectively tested.

    Scientific rigor is a concept of how close methods of science can bring us to a conclusion of cause and effect. Even the most rigorous methods have weaknesses in proving cause and effect. In medicine, we are very concerned about cause and effect, because we want to know that if we intervene for a patient, the patient will get better. Different fields of study will have different methods of science, and differing degrees of scientific rigor. Medicine is not the most rigorous application of science because of the number of variables that are beyond our control (as well as the ethical limitations of studies in humans or animals). However, we cannot automatically transfer a concept from a different branch in science into medical science without consideration of how rigorous those methods are underlying the concept (which is not a criticism of the other branch of science), and how applicable the concept is to a complex organism. Many arguments on this site arise, because of the difficulty in transferring scientific concepts between different branches of science into medicine.

    I like the idea of a statistician because they are often familiar with the different experimental designs that predominate in different branches of science. Statistical concepts pretty much dictate the measure of scientific rigor. But any reader should be prepared that even medicine’s most established scientific concepts can be criticized for limitations in scientific rigor. That doesn’t mean that we shouldn’t try to base medical decisions on scientific method. That doesn’t mean that we are incorrect about certain approaches being quackery.

  46. micheleinmichigan says:

    ditto on the pediatrician!

  47. micheleinmichigan says:

    Daniel

    “I don’t have anyone in mind, but I would love to see the next contributor be a clinical geneticist. The field of genetics is interesting and is really starting to work its way into everyday medicine, and I’d love to see more genetics stories here. After all, it is the REAL individualized medicine.”

    I’d also love to hear more science about genetics. A while back I was search for a good informative genetics blog or site that discussed the pros and cons of post-natal genetic testing for chromosomal abnormalities.

    Sadly, I mostly found uninformative discussions about prenatal screening that quickly degenerated into…well people making really unsavory comments.

    Any good links that would be comprehensible to a layman or that one could struggle through would be welcome.

  48. wales says:

    Those requesting pediatricians: sbm already has two pediatricians, Albietz and Snyder. They don’t post much and seem to limit their posts mostly to fighting against “anti-vaxers”.

  49. mikerattlesnake says:

    As nice as having another OB/GYN would be, the suggestion of a geneticist was the first one that really got me excited (though a statistician would be pretty cool too, if he was a good writer). It would be especially cool if the geneticist had a particular interest in evolution. The way that genetics relate to the big picture looking forward and back is always fascinating to read about, and from a medical standpoint we’d get to hear about some cutting edge stuff.

  50. I’ll just add that I am strongly in favor of keeping the open comment system.

    Yes, it can lead to way off topic tangents, but those can be very interesting and sometimes productive.

    Yes, it can lead to vile and vulgar attacks, and persons who can’t keep to a reasonable code of conduct should be banned after sufficient warnings, but their comments should (usually) be retained.

    I feel people should be free to let others know just what kind of person they are and how they think and reason. Plus, it can be very confusing to follow a thread of comments where a moderator has tried to selectively purge certain comments out.

    I understand that a blog is only a quasi-public forum, and since the blog is “owned” by someone, the owner has the right to control what comments the choose to allow, so constitutional free speech does not apply.

    I love that SBM is not afraid to allow open comments from any side, unlike many other blogs.

  51. SomePapa says:

    Interesting to note that, since this announcement, Dr. Tuteur posted a piece (on her own blog) that would fit very nicely at SBM. IMO, it’s a fine, thoughtful critique of a recent study claiming that acupuncture helps depression in pregnant women.

    http://skepticalob.blogspot.com/2010/02/acupuncture-treats-depression-in.html

    If only she had posted such pieces at SBM.

  52. wales says:

    Having been a vociferous critic of Amy’s methods, I would like to comment on what I thought was her best piece “Science by Press Release” on Feb 11. Ironically the topic points out many of the pitfalls of science writing that she herself was prone to. This comment was particularly worthy (note the use of qualifiers and fine tuning) “Publication of a scientific paper is not the end of a process confirming the truth of a paper; it is only the beginning. Publication does not mean that the findings should be accepted uncritically; it merely means that the findings are worthy of being included in the ongoing public discussion that characterizes science. The findings of the paper may ultimately be deemed worthless or wrong.”

  53. Fifi says:

    Karl Withakay – “I love that SBM is not afraid to allow open comments from any side, unlike many other blogs.”

    I agree, and not only because I’m one of the people that some would obviously like to see banned. From my perspective, I was simply returning like for like with Dr Tuteur (after ignoring her initial posts in the hopes that she’d improve). I don’t see standing up to a bully as being bullying and, from my perspective, someone who aspires to be the Anne Coulter of SBM can’t really complain about people treat her in return. No doubt others, particularly those who shared her opinions and are sorry to see her go, see it differently. That’s how it is with subjective perspectives. I have no interest in a grudge match with Dr Tuteur’s supporters, this really was about standing up for SBM for me. Open comments allow everyone to make up their own mind and I see it as very much being in the spirit of skeptical discourse to keep comments open so that people can think for themselves. Censorship is a slippery slope and us ultimately all about subjective calls (though it can be quite appropriate in some forums).

  54. wales says:

    Just noticed JMB’s post at 8:45. Very relevant, thanks.

  55. David Gorski says:

    If only she had posted such pieces at SBM.

    Sigh…too true.

  56. lonnie123 says:

    You’ve got a skeptical RN here if you are looking for an infrequent contributor. I’d love to take suggestions and turn them into articles for you guys about the wide world of nursing. If there is any interest I can email you Dr Gorski or Novella.

  57. SunkenShip says:

    Good riddance to Dr. Tuteur and her one-sided, narrow-minded approach to “scientific” writing. I’ll admit, I only discovered this blog because of her incredibly pro-circumcision article. But I’ve stayed around and found the other bloggers here to be thoughtful and offer interesting viewpoints on health, medicine and science.

    Dr. Tuteur on the other hand was far more interested in smug, put downs. That alone wasn’t the biggest offense. If you’re going to be a rude, insensitive jerk, then fine. But she would throw out verbal land mines and react with denial and shock when people pointed out she was throwing daggers. For example, in the circumcision thread, she titled the post “The case for neonatal circumcision,” closed with the phrase “the AAP should heed the authors’ calls,” and made statements that people opposed to circumcision were somehow obsessed with foreskins. But she balked when people said she was making pro-circ claims! If you’re going to be inflammatory, at least have the guts to stand by what you say and imply.

    I look forward to seeing another OB-GYN join SBM. Might I suggest that the next OB-GYN spend more time discussing OB-GYN issues? Dr. Tuteur stepped out of her speciality far too often for my liking. This was also a factor in her poor reception here at SBM, in my opinion.

  58. MomTFH says:

    Dr. Amy’s complaints about moderation are interesting, and typical of her hypocrisy.

    On my site, she complained bitterly when I deleted a few really inappropriate comments of hers, after giving her several chances.

    I have a really forgiving moderation policy. In fact, I think she is one of the two people whose comments I have deleted, and the other one was talking about murdering abortion providers.

    She also accused me of being afraid of having a discussion on a site where not everyone agreed with me, when I insisted on ground rules if she wanted a formal debate with me on evidence based obstetrics.

    Don’t try to logic this one out, folks. She’s just lashing out and saying the most inflammatory thing that comes to mind, as usual. It’s just too easy to catch her in a contradiction. She isn’t interested in science based anything or truth. She is interested in attention.

  59. chimerakitten says:

    I’m sorry that I’m late to all of this to-do about Dr. Tuteur. Normally I wouldn’t comment so tardily on a topic, let alone even comment at all in the first place.

    However, I did feel the need to voice my deep regret that there will no longer be an OB/GYN posting on SBM.

    It’s a realm of medicine (and culture) so clogged up with woo, self-important opinions, and easily manipulated data that it’s entirely too easy for the lay person to lose her (or his) way.

    Since there is a wish list of topics going around, I would like to add that I would love to see more approaches to many of the same topics that Dr. Tuteur already approached. Let’s have some do-overs on topics such as circumcision, home birth, and breastfeeding v. formula feeding , etc. If so many people have felt her scientific work unsatisfactory and lacking that it has concluded with her leaving SBM, I feel as if we the enquiring readers deserve posts on those topics that do meet SBM’s typical editorial style, rationality, and approval.

    I think it would be especially interesting if another author could write with less of a dogmatic, stubborn flair and more along the calm and rational stylings of other SBM authors, yet come to the same or similar conclusions on the subjects as Dr. Tuteur. Is this all matter of personality and style or poor science? Or a combination of both?

    In the end, I feel the most overwhelming thing about women’s health, pregnancy, and parenting issues is how very emotionally involved they seem to be. It yields as lively and vehement of discussions, debates, and arguments as discussing religion, and possibly more so. Which makes sense as giving birth and parenting involve very strong and personal emotions. I feel as if it’s always going to instigate angry comments and arguments, as that sadly appears to be the nature of the beast.

  60. Fifi says:

    chimerakitten – “In the end, I feel the most overwhelming thing about women’s health, pregnancy, and parenting issues is how very emotionally involved they seem to be. It yields as lively and vehement of discussions, debates, and arguments as discussing religion, and possibly more so. Which makes sense as giving birth and parenting involve very strong and personal emotions. I feel as if it’s always going to instigate angry comments and arguments, as that sadly appears to be the nature of the beast.:

    Woah, get a grip on the sexism and gross generalizations about “they” please! Men can be very emotional and irrational about their penises (and their colons or anuses), so much so that some will avoid basic healthcare and/or base their self identity on how small or big their penis is or whether they have anal sex. The emotional responses in the circumcision thread were almost all by men. Men can also be very emotional about women’s bodies and pregnancy (the anti-abortion movement is filled with men who are very emotional about pregnancy and women’s bodies). Not to mention that men can get quite emotional and irrational about their children and parenting too. It’s more accurate to say that some/most people can be very emotional about health issues that involve them personally but tend to think it’s justified when it’s about their own bodies but a hysterical/emotional reaction when the issues someone is emotional about doesn’t effect them directly.

  61. Harriet Hall says:

    chimerakitten said “Let’s have some do-overs on topics such as circumcision, home birth, and breastfeeding v. formula feeding”

    I wrote about circumcision and home birth long before Dr. Tuteur joined SBM. http://www.sciencebasedmedicine.org/?p=64
    http://www.sciencebasedmedicine.org/?p=269

    Did you miss those, or do you think they need do-overs too?

  62. chimerakitten says:

    Fifi – Woah, get a grip on the sexism and gross generalizations about “they” please!

    The word ‘they’ in that sentence was not referring to women, it was referring to the topics of women’s health, pregnancy, and parenting issues. I should have phrased it better, perhaps,

    “In the end, I feel the most overwhelming thing about the topics of women’s health, pregnancy, and parenting issues is how very emotionally involved those very topics seem to be for everyone involved. ”

    I in no way meant for the pronoun ‘they’ to stand in for ‘women.’ All three of those topics: women’s health, pregnancy, and parenting issues typically involve men, too. I say they are incredibly emotionally charged topics regardless of gender identity or sexual orientation.

    Harriet Hall – I wrote about circumcision and home birth long before Dr. Tuteur joined SBM

    I did miss those, and thank you for the links! I look forward to reading them later this evening while I catch on my blog reading.

    I was mostly suggesting (perhaps needlessly) that we revisit some topics from time to time, and mainly that I hope any hullabaloo over a certain topic’s authors or comments does not deter SBM from writing more on that topic in the future.

    But now that I think about it it was perhaps a needless comment, as I think SBM is pretty capable of creating more than one post on a particular topic. ; ) SBM continually posts on a great deal many other topics that are often controversial or emotionally charged in their own right, and that I love.

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