Science-Based Medicine

Doug Bremner has a blog. That blog stinks.

Bremner is an apparently well-regarded psychiatrist, and takes a refreshing look at the influence of industry not just on pharmaceuticals but on the conduct of science itself. His outspoken views have led to attempts to squelch his academic freedoms. But his sometimes-heroic record does not excuse dangerous idiocy.

I can understand how wading into the cesspool that is conflict of interest can leave one cynical. But cynicism and suspicion turned up to “11″ is no longer bravery—it’s crankery. It’s not his snarkiness that burns—it’s his inability to separate his biases from the facts.

It’s not like the pharmaceutical industry doesn’t deserve to be taken to the wood shed. Examples of unethical and downright immoral practices abound, such as ghost-writing, fake journals, and a host of other sins. But the industry has also helped develop a most remarkable pharmacopeia which saves and improves countless lives. There is good, and there is bad. And telling the two apart, well, that makes all the difference.

He tends to go for headlines that hit hard, but miss the point entirely. Examples:

• Angioplasty Found to be Useless Waste of Money: he cites a journal article which he says concluded that “not useful for patients with stable coronary artery disease (CAD). ” His title would be accurate if angioplasty were used only in stable CAD—it is not.
• Should I Take Aspirin or Put a Gun To My Head?: here, he sort of gets the difference between primary and secondary prevention, but not really. He also likes to admit that the data contradict his conclusion but he’s nice enough to say, “screw the data”:
  

  Although technically the risk of stomach bleeding is outweighed by the heart benefits of aspirin (which can only be shown when large numbers of patients are studied), in terms of what that means to you the differences are clinically meaningless.

• This Just In: Breast Cancer Screening Essentially Useless: yes, Doug, breast cancer screening doesn’t benefit everyone equally. For example, the prevalence of breast cancers in men is low enough that recommending it for you would be stupid—like your article.

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I realize that I’ve spent a fair amount of verbiage (to put it mildly) expressing my frustration with celebrities whose support for pseudoscience and even outright quackery endanger public health. The two most frequent targets of the wrath, sarcasm, frustration, and puzzlement of me and my partners in crime at SBM have been Jenny McCarthy and her boyfriend Jim Carrey for their having emerged over the last two years as the most vocal celebrity faces of the anti-vaccine movement in general and the anti-vaccine organization Generation Rescue in particular and Oprah Winfrey for her promotion of pseudoscience, quackery, and mysticism on her show. That doesn’t even count Oprah’s inking of a development deal with Jenny McCarthy to do her own weekday talk show, which has poised McCarthy to walk in the footsteps of previous Oprah proteges, such as Dr. Phil McGraw and Dr. Mehmet Oz. I’ve also lamented how celebrity physicians like Dr. Jay Gordon, Robert “Bob” Sears, and the hosts of the daytime TV show The Doctors have promoted, through the mantra of “balance,” anti-vaccine views in particular and pseudoscience about health in general.

As bad as celebrities such as Oprah, Jim Carrey, and Jenny McCarthy are, though, no one views them as skeptics, at least no one I know and no one in the skeptical movement. Even the reporters and newscasters who credulously interview them, I suspect, realize that Oprah, Jim, and Jenny are not exactly the most scientific of people. Unfortunately, if there’s one thing I’ve learned over the years since I became more involved with the skeptical movement, it’s that being an agnostic, atheist, or skeptic is no guarantee against falling for pseudoscience. The problem is that when someone becomes associated with the skeptic movement for another reason, even if that person is a total woo-meister when it comes to medicine, they tend to be given a pass. I don’t give such people a pass because of their anti-religion views because I consider myself a skeptic and don’t really care much about religion, except when it intersects issues of science and health, such as Jehovah’s Witnesses refusing blood transfusions, faith healers offering prayer instead of medicine, and fundamentalists undermining the teaching of evolution. If someone who promotes pseudoscience is a prominent critic of religion, to me that makes it even worse when they spout nonsense.

I’m referring to Bill Maher, comedian and host of the HBO show Real Time With Bill Maher. Thanks to an anti-religion movie (Religulous) and his frequent stance as a “skeptic,” many of my fellow skeptics consider him one of our own, even to the point of giving him an award named after Richard Dawkins. Yet, when it comes to medicine, nothing could be further from the truth. Maher’s own words show that he has anti-vaccine views, flirts with germ theory denialism and HIV/AIDS denialism, buys into extreme conspiracy theories about big pharma, and promotes animal rights pseudoscience. That’s not a skeptic or a supporter of science-based medicine.
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