Oct 07 2008
ED. NOTE: Circumstances have dictated an unexpected change of plans; so you’re in for a treat. Dr. Val Jones is starting two days earlier than previously announced. Beginning next week, her posts will appear regularly on Thursday mornings. Harriet Hall’s post scheduled for today will appear on Thursday this week. Be ready; it’ll be the return of the cholesterol “skeptics.” Now, Dr. Val…
Greetings, everyone. I am a proud new member of the Science Based Medicine blogging team, and have committed to one post each Thursday morning. As part of my “grand entrance” onto the skeptical blogging stage, I was hoping to introduce a new noun into our lexicon. I’ve asked permission from Steve Novella and David Gorski, and they’ve given me a wink and a nod, so here goes:
Shruggie (noun): a person who doesn’t care about the science versus pseudoscience debate. When presented with descriptions of exaggerated or fraudulent health claims or practices, their response is to shrug. Shruggies are fairly inert, they will not argue the merits (or lack thereof) of complementary and alternative medicine (CAM) or pseudoscience in general. They simply aren’t all that interested in the discussion, and are somewhat puzzled by those who are.
I’m sure you’ve encountered shruggies in your daily life. They are quite common – in fact, they may actually be in the majority among healthcare professionals. And I have a confession to make — I used to be one myself.
If you’ll indulge me, I’d like to tell you the story of how I was awakened from my unhealthy indifference toward pseudoscience.
I grew up on an organic dairy farm in rural Canada, the daughter of Manhattanite intellectuals who turned their backs on the city in search of a “wholesome” environment for raising children. They took pride in learning to live off the land, and (although their cow-herding skills lacked a certain efficiency) we made out all right. My early years were filled with practical problems (escaped animals, weedy gardens, and frozen pipes) with concrete solutions (lasso the cow, remove the weeds, melt snow for water). I ate my share of carob – an unpleasant, chalk-like substance appropriate for children with pica and a vague interest in chocolate – and spent a good deal of time selling fresh yogurt at farmers’ markets and health food stores.
My life took some twists and turns, eventually landing me back in New York City where I attended medical school, graduating from Columbia University College of Physicians and Surgeons. After a short flirtation with Emergency Medicine, I completed a residency in Physical Medicine and Rehabilitation, a specialty that is not dissimilar to farming if you consider that getting people up and moving is 50% of what we do. Whether it’s improving mobility with assistive devices, managing pain, or good old-fashioned cajoling the injured to get out of bed – we PM&R docs are a pragmatic lot, and rather friendly to boot.
Given that background, it’s not entirely surprising that I hadn’t developed any particular antibodies to pseudoscience during the course of my development. In fact, I had a rather “shruggie” attitude about it – in other words, I assumed that frank quackery was a fringe movement that had little influence on medicine, that “natural” products were generally healthy, and that many alternative practices were harmless though probably ineffective. I ended up working in the medical publishing world, engaged in peer review of scientific literature.
I met my first “integrative medicine” enthusiast a few years ago (we’ll call him Dr. John – and I will have to change some of the facts of the case to preserve anonymity, but I’ll retain the spirit of the events). He seemed nice enough, though somewhat fixated on yoga and determined to consume an inordinate amount of spinach. John was exceedingly friendly to coworkers and I noted that he spent most of his time socializing rather than working. Soon he was asked to help me with my editorial and medical review workload, and I gladly handed over a good amount of it since I was putting in 80 hours a week at the time, just to keep my head above water.
Much to my surprise, John did not do a good job of catching inaccuracies and seemed preoccupied with some kind of “bias” that he read into every article. He seemed to feel that articles from sources like the Mayo Clinic were too “narrow” and did not list “all the options available” for the treatment of various diseases and conditions. When I asked him to explain which modalities were being left out – he cited things like acupuncture, traditional Chinese medicine, and herbal supplements. I questioned whether there was evidence that these things were of value, and he explained that of course there was “because they’ve been used for thousands of years.” I responded that shamanism had been used for thousands of years too, but that I wasn’t convinced of its efficacy. Instead of chuckling and agreeing he launched into a diatribe about the persecution of shamans, and at this point I realized that something was terribly wrong.
Soon thereafter John convinced our supervisor that we needed more diversity in our editorial content. Without my agreement or approval he sealed a business deal to license a large volume of content from an alternative medicine source. Since I was still the primary medical reviewer, I had to sift through this new content to make sure it conformed to our medical review policy. As I read through this new volume of content I found it to be poorly written and journalistically weak – and the subject matter of article after article was unfamiliar to me. Colon cleansing, liver flushes, systemic yeast overgrowth, energy healing – it all sounded far-fetched, and so flawed as to be almost humorous. It was utter pseudoscience – full of silly jargon and implausible “mechanisms of action” that defied what I knew of pathophysiology and even basic chemistry and physics. I looked around to see if I was on Candid Camera – but alas, it was not a joke.
So I began researching these subjects in the medical literature to try to make sense of the content. I sought input from medical experts whom I trusted – I interviewed gastroenterologists, infectious disease specialists and even one of the world’s leading hepatologists. They all confirmed that these treatments and conditions had no scientific basis whatsoever, yet they were being widely promoted in the “natural health” world.
Still reeling from the bizarre nature of this new pseudo-scientific babble, and utterly convinced that promoting false information to patients was unethical, I told John that I simply couldn’t approve any of these articles for publication. John protested that I was “putting a gag order on content” and that he’d do whatever it took to go around me to promote his pro-CAM agenda. He went on to call me “a racist against CAM…a dinosaur, part of a dying breed of physician… and paternalistic and narrow.”
His insults were so clearly out of keeping with who I am (although being accused of being a paternalistic dinosaur was actually quite amusing, considering how young and female I was) that I began wondering where all this vitriol was coming from. Sincerely confused, I began searching the medical blogs for answers. Was John an anomaly or part of some kind of a coordinated, hostile movement against medicine as I knew it?
When I happened upon Respectful Insolence at Science Blogs it was as if a light went on for me. I read post after post about the same illegitimate therapies that were being promoted as treatment options for all kinds of very serious illnesses. I began to realize that these alternative medicine practices were not the innocuous “natural” solutions that I’d once assumed they were. This was modern day snake oil, and it was a 22 billion dollar industry. Patients were being terribly misled about their conditions and the treatments they needed to get better – and some were even dying in the process.
When John approved a chelation therapy article for publication, encouraging parents to seek out DAN practitioners for the treatment of autism, I knew that the line had been crossed. First of all, there is obviously no causal connection between mercury and autism. Secondly, innocent children have died while undergoing this risky and unnecessary procedure. I knew then and there that I had to fight to protect moms and dads from this dangerous and false information. I had gone from feeling “shruggie” about pseudoscience, to lobbying to protect the lives of children.
Meanwhile, John launched an internal campaign among the people at our publishing company. He had spent more time than I had socializing with them, and they were therefore inclined to believe his side of the story. He continued to argue that I was narrow minded and was trying to suppress ideas. He even began to say that I was “a credibility risk to our brand.”
Once I’d realized the insidious nature of the harmful practices packaged under the banner of “integrative medicine,” my peers listened to my concerns with a shruggie attitude. It was that same state of indifference that I had been in when I first met John. Now I saw how dangerous it was, and the natural progression that follows “open-mindedness” about a blend of practices that range from nutrition (which is really part of traditional medicine) to homeopathy (utter snake oil).
I’m afraid that Steve Novella is right when he says,
Very deliberately, modalities which are scientific and mainstream, like the proper use of nutrition, are often included under the CAM umbrella by proponents in order to make it seem like CAM is a bigger phenomenon than it actually is, and as a wedge to open the door for the more pseudoscientific modalities.
I also agree with George Lundberg,
There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is “Eastern” or “Western,” is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest…
The infiltration and whole cloth acceptance of pseudoscience (often being marketed as health and wellness practices) is misleading the public, fleecing our patients, and putting our children at risk. All the shruggies out there should soberly consider whether or not it’s ethical to remain indifferent and/or silent on the matter. Perhaps you don’t realize how high the stakes are (the very foundations of the scientific method and the integrity of our profession are indeed being attacked), or perhaps it will take a personal experience (as it did for me) for you to have an awakening. I sure hope that you’ll join the pro-science movement before lies seep deeper into the public consciousness through an Internet teeming with for-profit fake cures. In fact, Dr. John is out there hoping to open your mind to the notion that your body is full of toxins that only his practitioner friends can detect.
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