Feb 18 2010
Longing for a past that never existed
There once was a time when all food was organic and no pesticides were used. Health problems were treated with folk wisdom and natural remedies. There was no obesity, and people got lots of exercise. And in that time gone by, the average life expectancy was … 35!
That’s right. For most of human existence, according to fossil and anthropological data, the average human life expectancy was 35 years. As recently as 1900, American average life expectancy was only 48. Today, advocates of alternative health bemoan the current state of American health, the increasing numbers of obese people, the lack of exercise, the use of medications, the medicalization of childbirth. Yet life expectancy has never been longer, currently 77.7 years in the US.
Advocates of alternative health have a romanticized and completely unrealistic notion of purported benefits of a “natural” lifestyle. Far from being a paradise, it was hell. The difference between an average lifespan of 48 and one of 77.7 can be accounted for by modern medicine and increased agricultural production brought about by industrial farming methods (including pesticides). Nothing fundamental has changed about human beings. They are still prey to the same illnesses and accidents, but now they can be effectively treated. Indeed, some diseases can be completely prevented by vaccination.
So why are advocates of alternative health complaining? They are complaining because they long for an imagined past that literally never existed. In that sense, alternative health represents a form of fundamentalism. Obviously, fundamentalism is about religion and the analogy can only go so far, but there are several important characteristics of religious fundamentalism that are shared by alternative health advocacy. These include:
- The desire to return to a “better” lifestyle of the past.
- The longing for a mythical past that never actual existed.
- An opposition to modernism (in daily life and in medicine).
- And the belief that anything produced by evolution (or God, if you prefer) is surely going to be good.
Advocates of alternative health bemoan the incidence of diseases like cancer and heart disease without considering that they are primarily diseases of old age. That both cancer and heart disease are among the primary causes of death today represents a victory, not a defeat. Diseases of old age can become primary causes of death only when diseases of infancy and childhood are vanquished, and that is precisely what has happened.
Alternative health as a form of fundamentalism also makes sense in that it has an almost religious fervor. It is not about scientific evidence. Indeed, it usually ignores scientific evidence entirely. All the existing scientific evidence shows that all of the myriad claims of alternative health are flat out false. None of it works, absolutely none of it. That’s not surprising when you consider that it never worked in times past; advocates of alternative health merely pretend that it did, without any regard for historical reality.
Alternative health is a belief system, a form of fundamentalism, and like most fundamentalisms, it longs for a past never existed. It is not science; it has nothing to do with science; and it merely reflects wishful thinking about the past while ignoring reality.
494 Responses to “Longing for a past that never existed”
Does this criticism of the ‘average lifespan of 100 years ago’ make sense?
http://www.youtube.com/watch?v=qHx1b5MFYkg
My understanding is that the vast majority of that difference in lifespan is accounted for by infant mortality and, to a lesser extent, deaths from other childhood diseases. (As you mention, obliquely, above.) Once you made it to adulthood, life expectancy was basically the same for them as it is for us — most people lived to their seventies, which is why the Bible, for example, gives the average life expectancy (in ancient Israel) as “threescore and ten,” or “if they be strong, fourscore.” Not that the authors of Psalm 90 had access to good statistics, but the numbers seem to give a good indication of what was understood to be a normal lifespan at the time.
So I’m not sure the “they only lived to 35!!!” argument is really useful. There’s nothing wrong with lauding our modern accomplishments, but there’s also nothing wrong with critiquing some new developments as being less conducive to health than things that were done in the past.
And many things are mixed blessings. Modern agriculture — and especially modern agricultural policy — makes food available cheaply, but the cheap stuff is mostly BAD food. We could change that situation, and in the process reduce the risk of diseases like diabetes (NOT a disease of old age these days).
So why not look at human evolution as a guide to what kind of food we likely evolved to eat, and use that understanding as part of a scientific evaluation of nutrition? What’s wrong with pointing to our evolutionary history as an explanation for why vegetables and lean meat are better for you than Twinkies and Froot Loops? The past has a role to play in our understanding of the present — and hence in the shaping of policy.
Also, I’m not sure that lifespan alone is the only valid indicator of where we’re at as a society. You say that the past was “hell” — is that really true? In all times and all places? You can’t imagine someone coming from some past — any past — looking at modern America, and deciding to return to their own time? Really? The past may not have been a golden age, but it doesn’t follow from that that we have nothing to learn from it.
Is it not possible, and reasonable, to say that human lifespan has been greatly increased by childhood vaccination and other useful medical interventions, but also that our average lifespan (not to mention happiness) could be increased still further if, for example, we tried eating and working and living in a manner more in line with our biology? Why are those two things contradictory?
Basically he’s saying life spans haven’t really increased, it’s just that lots of children used to die. Personally, I think children surviving is a pretty good indication that we have a healthier population! Or, as Amy says, we are now able to cure or prevent the things that children used to die from, something that ‘ancienct wisdom’ couldn’t do.
From a completely anthropological point of view – life expectancy in ancient populations isn’t worked out from a mean of the whole population, it’s worked out from the tiny percentage of fossils we find. So the majority of skeletons are in their 30s, giving us an average life expectancy around 35. I’m out of date here, I haven’t done anthropology in several years, but I doubt the method has changed much.
This is not the first instance in history where we see a strong longing for a better, more “natural” world.
The Industrial Revolution saw the rise of the romantic movement, in which the role of man in Nature was evaluated and strongly criticized and an essential ingredient was a strong desire for a way of life that was pure and “natural.”
Quite a number of thinkers – one of them being Alain Finkielkraut – have argued that the roots for various kinds of fundamentalism lie in the idealism of the romantic movement, for example the “Volksgeist” and the “gesundes Volksempfinden,” important principles of the romantic movement in Germany which have inspired national-socialist thinking and can still be seen today in various political circles. I consider the concept of the “mommy instinct” as a branch of this tree.
Ruth Scurr in her book “Fatal Purity” has written about the ideals of the French Revolution, which were inspired considerably by the philosophy of proverbial romantic JJ Rousseau and how these ideals could lead to a reign of terror.
Finkielkraut, Scurr and many others have argued convincingly in my opinion that fervent idealism, i.e. an intense desire for purity – be it religious or otherwise – is often paired with with intolerance and bigotry and carries the seeds of terror.
A quick check of the internet for Infant Mortality Rates in the 1800s threw up these two figures – 3/10 infants died before the age of 1 and 50% of children died before adulthood. Although appalling, this is probably in line with mortality rates in other ape and primate species.
Medicine’s great achievement has been to stop children dying.
But what was the average lifespan of *those that survived to adulthood*?
A quick ‘back of a fag packet’ calculation suggests that to achieve an overall average of 35, the remaining 5 (of 10) adults had to have reached 70 years of age.
The female menopause, which kicks in at 50, is also evidence that our ‘time gone by’ relatives lived well passed 35.
I have not worded my previous comment accurately enough; I don’t mean to say that “mommy instinct” equals national-socialism, but that it is part of the way of thinking that consistently overvalues “natural” vs “scientific”.
“Does this criticism of the ‘average lifespan of 100 years ago’ make sense?
http://www.youtube.com/watch?v=qHx1b5MFYkg”
This video reminds me of a Monty Python skit but in reverse.
You know the one: “What have the Roman’s ever done for us”
As long as you take out all the people who died early, people in the 1900s lived just as long as we do today.
Good one.
It’s very simple to disprove the modern-medicine-does-us-nothing-good-fallacy even by anecdotal evidence. Simply ask yourself: have I ever been seriously ill? If yes, odds are you would already be dead if you had lived in the 19th century.
I’m among those people. I suffered a bad case of mononucleosis when I was six years old, bad enough to put me on IV for several days. It took me months to recover the lost weight. Would I be alive today without SBM? Perhaps. But probably not.
If you have never ever been seriously sick, then congrats: you might have lived on to a ripe old age even in the 1800s. But to extrapolate incredible fortune or genetics to the extent that all medicine is futile is incredibly shortsighted and selfish. Most of us are not that lucky!
My previous comment makes no sense as the original comment is held for moderation. Sorry.
“Today, advocates of alternative health bemoan the current state of American health, the increasing numbers of obese people, the lack of exercise, the use of medications, the medicalization of childbirth. Yet lifespan has never been longer, currently 77.7 years in the US.”
As usual, this post is as overly simplistic as the “all nature is pure” folks’ viewpoint. It might help if you had a specific example.
thehandsomecamel:
” Once you made it to adulthood, life expectancy was basically the same for them as it is for us — most people lived to their seventies”
Although infant and child mortality is responsible for a very substantial proportion of deaths in nature, there is no evidence that most people lived into their seventies. Just consider what we know of historical figures. How many historical figures (generally the best fed and the most well off people in their societies) attained the age of 70?
Consider that while Presidents Adams and Jefferson lived to an advanced age, William Henry Harrison died of pneumonia only 10 days after his inauguration. Queen Elizabeth lived into her 60s, but her brother Edward died of tuberculosis at the age of 16, her uncle Arthur, the Prince of Wales, died in his late teens of an unspecified illness, and her sister Mary died of unknown causes in her early 40s. Some of the ancient philosophers lived to old age, but Alexander the Great died of an infectious disease at age 33.
Medical advances have had the greatest impact on disease of childhood, but the impact on diseases of adulthood has been substantial. Who dies of tuberculosis these days? How about dysentery, smallpox, or even plague?
Malnutrition was endemic, almost always compromising health. For most of human existence, and in some places to this very day, human beings have faced periodic severe food shortages, permanently stunting growth and creating additional health problems. At the simplest level, very few people were able to keep their teeth into middle age, let alone survive that long.
Hobbes was talking about politics when he wrote that life in the state of nature was “solitary, poor, nasty, brutish and short” but his words are equally true of health conditions.
thehandsomecamel:
“So why not look at human evolution as a guide to what kind of food we likely evolved to eat, and use that understanding as part of a scientific evaluation of nutrition?”
Because that’s a naturalistic fallacy. There is no reason to think that what we ate was the ideal diet; it was merely the available diet.
The insights being gained from the field of evolutionary medicine contrast dramatically with the evolutionary claims of “alternative” health advocates. It is axiomatic in “alternative” health that the human body represents evolutionary perfection and that if we only hark back to nature we will be healthier. Evolutionary medicine, in contrast, recognizes that the human body is the result of competing evolutionary pressures and changing pressures of natural selection.
Moreover, the critical driver of evolution, natural selection, does not favor perfection or even health; it favors reproductive success and it tolerates a massive amount of wastage. The most “successful” human beings in evolutionary terms are those that leave the most offspring, not those that live the longest.
This is what I mean when I refer to “longing for a past that never existed.” It is simply a myth that life in the state of nature was “perfect” or even tolerable.
“Quite a number of thinkers – one of them being Alain Finkielkraut – have argued that the roots for various kinds of fundamentalism lie in the idealism of the romantic movement, for example the “Volksgeist” and the “gesundes Volksempfinden,” important principles of the romantic movement in Germany which have inspired national-socialist thinking and can still be seen today in various political circles.”
Karen Armstrong, who has written extensively on religious fundamentalism, has emphasized that religious fundamentalists idealize the past in similar ways and consider themselves to be returning to that past. Of course, that past never existed.
The post would be strengthened by an examination of the evidence that shows ancient life expectancies. The people I know who take this perspective insist that life expectancies in hunter/gatherer societies were 100+ years, and that while medicine has increased them drastically over the past 100 years, that’s only partially making up for the horrible health effects of civilization.
When pressed, they can’t provide any actual EVIDENCE for that proposition, of course. But in my experience the sticking point is precisely what was simply asserted without any detailed discussion – “For most of human existence, according to fossil and anthropological data, the average human lifespan was 35 years.”
Great post. This reminds me of a presentation I attended by a dermatology resident who was into all natural treatments (not sure how she got into derm). She said that using soap daily is unnecessary, claiming that all it does is damage our skin. She pointed to our prehistoric ancestors and said that they were fine without using soap. She ended her presentation with “and how was their health different from ours.” Expecting everyone to say not much, she was a little shocked when I shouted, “They died at 30.” Got a nice laugh from the audience.
Stroh raises a good point. The problem is, most people don’t even realize when they receive treatment for life threatening diseases.
Secondly, the “we evolved to eat only what we could hunt and gather” gambit is a ridiculously romantic portrayal of early humanity. Sure, hunting and gathering sounds fun. Who wouldn’t want to gather food with Racquel Welch in 10,000 BC? But unfortunately, that is not reality. Reality is starvation, scavenging, and scurvy. As Dr. Tuteur aptly states, we evolved to eat what was available. There was no choice involved in the matter.
Furthermore, this argument that we evolved to only eat pre-civilization food is a complete misunderstanding of evolution. We *evolved* the use of tools and the development of agriculture. This has made us fitter as a species. Fitness is about the production of successful offspring and the population boom in the last 100 years has clearly shown that the evolution of agriculture benefited us as a species.
In fact, the development of agriculture is arguably the greatest accomplishment of the human species. It enabled us to create cities and the specialization of labor, which subsequently allowed us to to develop modern science and medicine.
Amy, citing a royal family of Europe as “the most likely to live long” is probably a bad idea, since they were terribly inbred and had many people gunning for their thrones. Medieval medicine being what it was, on some level I’d rather be a peasant without a doctor than nobility with someone who will bleed me repeatedly and make me take gross, unproven remedies.
What a disappointing post in what is overall a wonderful site. When I come to SBM, I’m used to seeing citation to peer-reviewed research and analysis. I’m used to a thoughtful consideration of points. Not just polemic.
This point is particularly bad:
While it’s true that modern medicine has improved life expectancy, particularly for infants and children, the idea that agriculture is an unequivicol good from a medical standpoint simply lacks support. The archaeological evidence suggests, for example, an almost uniform crash in average heights when populations make the transition from hunter-gatherer to agriculture (in Crete, for example, average heights for men went from 5’9″ pre-agriculture to 5’3″ afterwards).
Anyone familiar with contemporary medical literature at the turn of the 20th century also knows that native African and Asian populations suffered very little from diseases such as diabetes, cancer, heart disease and cavities, but saw rapid increases in all of these diseases upon the adoption of the Western “industrial agricultural” diet.
So it’s impossible to state that the difference in life expectancy is due to BOTH modern medicine AND industrial agriculture. Not without a study that compared groups of people with access to modern medicine, but with one living on a traditional diet and the other on a diet of food produced by “industrial farming methods.”
Absent that study, you can have an opinion, but it won’t be a science-based one.
Actually, the movie Avatar could be used as an example in popular culture. Basically, a Native American civilization on another planet are portrayed as the good guys, while the evil technology driven armed forces attempts to exterminate them. As the highest grossest movie of all time, I think it’s relevant to where we’re at as a culture. Historically speaking, nature vs. science is a very interesting push-pull, with people on both extremes. Both sides use life expectancy through history as some sort of “proof” for their false cause associations. In essence though, it’s kind of like nature vs. nurture, or phonics versus whole language.
Something I find as an interesting snapshot of the state of health pre-modern medicine is to open up Wikipedia to a page on someone I find interesting…then to look at what we know of that person’s family. This is hardly rigorous nor is it an impeccable source, but it does, I think, provide some insight.
Take, for example, the Bronte sisters. They were 3 out of 6 children. Their mother died of cancer, age 38. The two oldest children died of tuberculosis age 9 and 10. The one brother died of tuberculosis age 31. Emily Bronte died (TB) age 30, and so did Anne. But hey, Charlotte lived to be 38! She died during pregnancy, either of typhus or a pregnancy-related condition. Their father outlived them all, living to the age of 84.
So sure, yeah. If early childhood illness didn’t get you, and early adulthood illness didn’t get you, and middle age illness didn’t get you, you certainly could live to a ripe old age.
“Fitness is about the production of successful offspring and the population boom in the last 100 years has clearly shown that the evolution of agriculture benefited us as a species.”
I agree that agriculture benefitted us as a species. I would go back even further, to the Neolithic revolution, around 10,000 years ago, (if we’re looking at hunter-gatherer societies versus farming), when population started growing exponentially.
Of course, the advent of agriculture wasn’t all good. Smallpox, for example, became widespread, and the hunter gatherers (along a few groups were farmers, but not of livestock) of North America were decimated by it. Other diseases also became more widespread because people lived closer together in one spot. Tradeoffs.
Jared Diamond’s book “Collapse” talks about some of the “one with nature” myths about traditional societies.
The National Academy of Scienes series Dr. Novella posted about a few weeks ago on evolution has some really cool articles on aging and disease.
While it’s certainly true that declining infant mortality and conquering of childhood diseases were huge factors in increasing life expectancy, adult life expectancy has been increasing as well. For example, John Graunt reported on life expectancy in London in the 1500s and 1600s, one of the earliest examples of vital statistics. In 1662, he published Natural and Political Observations Mentioned in a Following Index and Made Upon the Bills of Mortality. In this book, Graunt was the first to attempt to construct life tables and mortality tables based on the numbers of births and reported deaths in London. As a tercentenary tribute stated:
So what did John Graunt find?
Graunt found that the average life expectancy in London was 27 years, with 65% of people dying before age 16, the vast majority due to childhood infectious diseases, diseases, I note, that have now been largely brought under control by vaccines, antibiotics, and advances in medical care. Steve Rappaport reports in Worlds Within Worlds: Structures of Life in Sixteenth-Century London that, a century earlier in the 1500s, of men who made it to age 25 to 26, the ages at which most men became full citizens, the average further life expectancy was 28 years, meaning that men who made it to adulthood would have had about a 50-50 chance of living to be older than 53 or 54. One-tenth died by their mid-30s, and only around one-third lived to be older than sixty. I’m not quoting these statistics for precision, but merely to show that life expectancy sucked until fairly recently even for adults. Only about 1/3 of people who made it to their 20s made it to age 60, and many fewer still to age 70 or 80, about 12-15% and 2-3% respectively. (I’m guesstimating from looking at a graph in the book.) In all fairness, I note that life expectancy was significantly higher in the countryside, at least as far as the data we have suggest. Still, people who lived to adulthood did not make it to their 70s and 80s at anywhere near the rate that they do now.
Scott, “But in my experience the sticking point is precisely what was simply asserted without any detailed discussion – ‘For most of human existence, according to fossil and anthropological data, the average human lifespan was 35 years.’”
Coming up with solid evidence about what things were like in the past, especially evidence that is meaningful to the general public, is very difficult. The further back you go the more difficult it becomes. However, there is a lot of evidence in our very recent past, even in my experience and that of the generation that preceded me, which is very convincing. Some examples, my maternal grandparents both died in their 40s in the 1930s, one from a stroke probably caused by hypertension, the other from pneumonia. Several other relatives died prematurely from TB. I personally remember the polio epidemics. Before you start shouting ANECDOTES!!!, I’d like to point out that I’m pretty sure you can find very reliable statistics about the number of deaths caused by these diseases in the not so distant past. I had breast cancer in 1984. My cousin has had Type 1 diabetes since childhood. She is now in he 50s. What do you think would be the odds of our being alive today without scientific medicine? How about my dog who has hypothyroidism? Want me to go on? I haven’t gotten to my cats yet.
mxh, referring to a dermatologist, “She pointed to our prehistoric ancestors and said that they were fine without using soap.” She gave a citation right? From the Prehistoric Journal of Dermatology, maybe? Doesn’t anybody read anymore? Off the top of my head I can remember reading about a young Polish girl deported by the Russians along with many other Poles to Siberia during the Second WW where there was no soap, Cambodians living without soap and British nurses held prisoners by the Japanese during WWII who didn’t have any. They weren’t “just fine” and neither was their skin. Of course, they also suffered from other things which could affect their skin, such as, in some cases malnutrition or just very poor diets. While it would take studies to determine, whether or not, or to what degree, the lack of soap was responsible for their skin diseases, if I remember correctly, all really missed soap and were very happy when it was again available. IMO, even that pleasure should account for something that even the prehistoric derm should recognize as valuable.
I think that one of the main reasons that the past is romanticized by so many in the general public is because in addition to having no education in science, they also lack any in history and they seem to do very little reading. In GROWING UP, by Russell Baker, starting on p. 50 he has a few very informative pages about life and death in backwoods America in the 1920s before scientific medicine reached there. Just one quote from p. 52, “In Morrisonville death was a common part of life. It came for the young as relentlessly as it came for the old. To die antiseptically in a hospital was almost unknown. In Morrisonville death still made house calls.”
Alex Knapp, for being so critical of Dr. Tuteur’s lack of citations, you do a poor job yourself. Please include a citation for us to review the Crete archaelogical evidence.
Further, the ability to accurately diagnose coronary artery disease (which is the form of heart disease you seem to be claiming comes from a poor diet) was not developed until the late 1950′s or early 1960′s via use of cardiac catheterization. We cannot retroactively determine the prevalence of CAD from hundreds of years ago.
However, we know that CAD typically affects men over 60 and women over 65. If people died before that age, then of course CAD would be rare. They wouldn’t reach the age to develop clinically significant occlusions in their coronary arteries!
Diagnostic problems apply to cancer as well. How do you know cancer did not exist? We weren’t very good at identifying cancer before the development of modern medicine.
My sources:
http://en.wikipedia.org/wiki/History_of_invasive_and_interventional_cardiology
http://en.wikipedia.org/wiki/Coronary_artery_disease#Risk_factors
“While it’s true that modern medicine has improved life expectancy, particularly for infants and children, the idea that agriculture is an unequivicol good from a medical standpoint simply lacks support. The archaeological evidence suggests, for example, an almost uniform crash in average heights when populations make the transition from hunter-gatherer to agriculture (in Crete, for example, average heights for men went from 5′9″ pre-agriculture to 5′3″ afterwards).”
The best measure of evolutionary success is population growth, and by that measure, agriculture was an extraordinary triumph. Prior to the advent of agriculture, human populations were probably measured in the tens of thousands, dropping as low as 10,000 individuals during certain times of hardship. In contrast, agriculture allowed for a population explosion that has been continuing to this day. Medicine has allowed for an acceleration of that population explosion.
“Anyone familiar with contemporary medical literature at the turn of the 20th century also knows that native African and Asian populations suffered very little from diseases such as diabetes, cancer, heart disease and cavities, but saw rapid increases in all of these diseases upon the adoption of the Western “industrial agricultural” diet.”
Diabetes (type II), cancer and heart disease are predominantly diseases of old age. The rise in incidence of these diseases is a sign of SUCCESS, not failure. When the average life expectancy is low, the rate of chronic diseases of old age is low. When the average life expectancy rises, the incidence of diseases of old age rises too. That’s hardly a bad thing.
As for the incidence of cavities, that’s a bunch of baloney.
“I think that one of the main reasons that the past is romanticized by so many in the general public is because in addition to having no education in science, they also lack any in history and they seem to do very little reading.”
Absolutely. In addition, as a culture we tend to disparage history. The expression “that’s history” means “that’s irrelevant” so people often ignore history. When people know very little history, they tend to imagine that the way things are today is the way that they always were. Nothing could be further from the truth.
@BluedevilIRA -
My mistake – it was Greece and Turkey, not Crete. Citation is from a 1987 article by Jared Diamond. Full copy of the article can be found here:
http://jeffweintraub.blogspot.com/2005/09/jared-diamond-on-why-invention-of.html
No, but you can look at turn of the century comparative research on heart attacks of native v. western populations within the same region. Ditto for cancer. They may not have had the best cancer diagnostics in the 1920s, but they could and did find tumors during autopsy, and they could and did compare the prevalence of tumors in the “native diet” v. “western diet” among the same population in the same region. I have cites in my other office but not on the computer I’m working from now. If I get a chance, I’ll post those citations.
Amy you’re clueless. A reduction in infant mortality is responsible for any increase in average lifespan and that increase had nothing to do with any of your imagined medical miracles – unless you believe not drinking filthy water to be a medical miracle
“A reduction in infant mortality is responsible for any increase in average lifespan and that increase had nothing to do with any of your imagined medical miracles”
Sid, you’re just the kind of person about whom I am writing, those who imagine an idealized past without bothering to acquire any knowledge of what the past was actually like.
How about some scientific evidence in support of your claim? Surely you have something to offer besides your personal opinion.
Alex Knapp, “So it’s impossible to state that the difference in life expectancy is due to BOTH modern medicine AND industrial agriculture. Not without a study that compared groups of people with access to modern medicine, but with one living on a traditional diet and the other on a diet of food produced by ‘industrial farming methods.’”
Absent that study, you can have an opinion, but it won’t be a science-based one.”
I disagree and think this is an example of the problem of using SBM as opposed to EBM to evaluate health interventions. (Yes. I realize that I may not correctly understand what is meant by EBM although from a quick glance I suspect that it isn’t written in stone and that different institutions give it different definitions.) If I understand Alex’s interpretation of SBM, the lack of one very high quality study controlling for all variables, means that there is insufficient evidence to draw any reasonable conclusion. That is where I disagree. I think there are degrees of evidence which provide us with levels of certainty on a continuum with the kind of study he says we need at one end and opinion at the other.
I suspect that there is a lot of evidence that shows that before the introduction of “modern methods” of farming, many people died of starvation because enough food could not be produced the old way. (The Irish Potato famine comes to mind.) If so, the evidence of all those deaths caused by the inability of farmers to feed everyone, is very good evidence that what replaced the old method saved, prolonged and improved a great many human lives. Additionally, countless hours and labor had to be spent growing food the old way prevented people from engaging in other, perhaps more valuable, pursuits.
I suspect, but do not know, that Alex and others are concerned about the dangers of “industrial farming”. However, I believe that is another topic, one for now and the future, not one to use to measure how science, agricultural science and chemistry, benefited past generations.
Sorry if I’m not sounding terribly clear, but it is that kind of topic.
Amy,
I didn’t say that agriculture was unequivocally bad. I said that it wasn’t unequivically good. Until the 20th century, humans in agricultural societies suffered more malnourishment and health problems than humans in agricultural societies. But yes, there were more people in agricultural societies. But is mere numbers of people the only measure of health?
I didn’t dispute that, either. I think that modern medicine is a wonderful thing.
While the indicence of type II diabetes definitely increases with age in the United States, I have a hard time describing a disease that impacts 10.8% of the population between the ages of 40-59 as a “disease of old age.”
(see http://diabetes.niddk.nih.gov/DM/PUBS/statistics/#allages)
Ditto heart disease, which afflicts 7.7% of people between 44 and 65 in the United States. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5606a2.htm)
Additionally, the stuides done between native and westernized populations in the early 20th century were controlled for age and still found lower prevalence of diabetes, cancer, and heart disease in those eating a tradtional diet vs. a western one.
It’s well documented that the incidence of cavities is lower in hunter-gatherer populations vs. agricultural populations. See e.g. Cassidy CM. Nutrition and health in agriculturalists and hunter-gatherers: a case study of two prehistoric populations. in Nutritional Anthropology. Eds Jerome NW et al. 1980 Redgrave Publishing Company, Pleasantville, NY pg 117-145, or just this Archaeology textbook (http://books.google.com/books?id=Nw4eqX0pIt0C&pg=PA246&lpg=PA246&dq=cavities+hunter+gatherers&source=bl&ots=n9GN8fd-B8&sig=bVUFLadeezDNbiHGadeDC-B7cw8&hl=en&ei=A2l9S73hGIb08QanwpXDBQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CAwQ6AEwAg#v=onepage&q=cavities%20hunter%20gatherers&f=false)
I think it’s as dangerous to romanticize the present as it is to romanticize the past. We should take as much knowledge as we can and study it in order to live the best lives we can. To blithely assume that modern life is, in every respect, superior to life in the past based on life expectancy alone is ridiculous. There are trade offs in everything. It may be that aspects of life in the past, coupled with modern advancements, would lead to a healthier life. But we’ll never know it unless we study it instead of just automatically assuming that everything we do now is the best way people have ever lived.
Rosemary,
I think that, given the available evidence, it’s more reasonable to assume that advances in health are almost solely due to modern medicine and not the industrial methods of farming. I say this because modern farming produces food that is less nutrient dense and higher in sugar content than existed even 50 years ago–to say nothing of extensive medical research in the early 20th century comparing the heath effects of native vs. western diets. As a consequence, I’d have to see a highly controlled study that shows the superiority of a modern diet, because the observational evidence goes the other way.
@David
the vast majority due to childhood infectious diseases, diseases, I note, that have now been largely brought under control by vaccines, antibiotics, and advances in medical care.
—————————
except these declines all took place before vaccination, antibiotics or “medical care” See Richard Lewontin’s Triple Helix P104-05
I am glad that science based medicine and agriculture did not really make a difference in longevity, because if they did we would have an overpopulated world.
Lol.
A reduction in infant mortality is responsible for any increase in average lifespan
Let me correct myself. Medicine has increased lifespan but not from the fanciful 35 years Amy imagines. Yet without the Western diet, many wouldn’t need medical interventions to survive.
Alex Knapp:
“But is mere numbers of people the only measure of health?”
Not the only measure, but one of the best. The unhealthy die prematurely. It’s difficult to be less healthy than when you are dead.
“I have a hard time describing a disease that impacts 10.8% of the population between the ages of 40-59 as a “disease of old age.”
But in reproductive terms, age 40 is old age. Consider that childbearing began in the late teens. It is possible to raise several children to their own reproductive age by age 40. Death after that would not be an evolutionary disadvantage.
Remember, evolutionary success is measured by number of living offspring, not by length of life. Natural selection does not select for health, it selects for reproductive outcomes.
“It’s well documented that the incidence of cavities is lower in hunter-gatherer populations vs. agricultural populations.”
Not exactly. Although eating cariogenic carbohydrates is a risk factor for developing cavities, it’s not the only factor.
Sid Offit:
“See Richard Lewontin’s Triple Helix P104-05″
Sorry, but that’s not a scientific citation. Surely you can do better than that when advancing a claim that is absurd on its face.
Sid Offit:
“Medicine has increased lifespan but not from the fanciful 35 years Amy imagines. Yet without the Western diet, many wouldn’t need medical interventions to survive.”
Yes, we know that’s what you believe but you need to provide scientific evidence in order to convince anyone else. Where’s the evidence?
http://www.cepr.org/pubs/bulletin/DPS/DP121.HTM
Mckeown effectively demonstrated that advances in medical science, such as the immuno- and chemotherapies which form the basis of today’s clinical and hospital practices, played only a very minor role in the late nineteenth century mortality decline: most of the important diseases involved had already disappeared in England and Wales before the date at which the relevant medical innovations occurred.
Sid Offit:
“Mckeown effectively demonstrated …”
No, no, no, that’s not how you support a claim with scientific evidence. You need to quote the relevant passages, discuss the limitations of the study or report, and compare it to the larger body of scientific evidence on the topic.
Copy and pasting a link, which might impress lay people, carries no weight here.
Amy,
Okay, but now we’re unjustifiably conflating life expectancy with population size.
I’d highly recommend you read the Cassidy article I cite above, which compared the archaeological evidence of two groups of native Americans in the same region, of which one was a hunter-gatherer society (referred to as “Indian Knoll”) and the other was agricultural (referred to as “Hardin Village”). Here’s the summary of the authors’ findings:
However, it was true that the population of the agricultrual society was higher. However, it came at the price of a lower overall quality of health. Why can’t we learn from that? Why must we blindly disparage “the past” because they had a lower life expectancy? Why doesn’t this merit more study in a modern nutritional context?
Why not? Prior to the invention of writing, people over the age of 40 would serve as a repository of knowledge, customs, culture, and stability. This is why elders are revered cultures without a written language, and it may well be that the survival of that knowledge garners an evolutionary advantage to humans. I’m not saying this is true, I’m saying that given that humans are social animals, there may be evolutionary advantages to longer life spans beyond mere reproductive age and accordingly it’s dangerous to write off over 40 as “old” from an evolutionary perspective. Additionally, when comparative studies have been done of people who do not follow western diets, the prevalence of diabetes and heart disease is diminished even among the elderly compared to those with western diets.
I’m sorry, but this is an incredibly simplistic view of evolution that doesn’t take into account selection among social animals, particularly mammals and primates.
Amy,
While that’s true, it doesn’t change the fact that the archaeological evidence demonstrates that the incidence of cavities is lower in hunter-gatherer societies than in agricultural ones. That doesn’t mean that H-Gs have no cavities. Just that they have fewer.
“Okay, but now we’re unjustifiably conflating life expectancy with population size.”
Unjustifiably? Please explain.
“which compared the archaeological evidence of two groups of native Americans in the same region, of which one was a hunter-gatherer society (referred to as “Indian Knoll”) and the other was agricultural (referred to as “Hardin Village”). Here’s the summary of the authors’ findings:”
And why should we believe that the findings of one study about two native American villages can be extrapolated beyond those two villages?
“this is an incredibly simplistic view of evolution that doesn’t take into account selection among social animals, particularly mammals and primates.”
I’m not sure what you are referring to. Could you elaborate?
“While that’s true, it doesn’t change the fact that the archaeological evidence demonstrates that the incidence of cavities is lower in hunter-gatherer societies than in agricultural ones.”
But not in all of them. For example, research from Asia indicates that the switch to a predominantly cultivated rice diet did not result in a deterioration of dental health.
I would argue that a larger population with a lower life expectancy is indicative of worse health, but that’s the pattern we see time and time againt when socieites move from Hunter-Gatherer to Agriculture. It wasn’t until the adoption of modern medicine and santiation that agricultural societies showed greater and more robust health.
Because the archaeological record is replete with similar stories, as are historical accounts. The Cassidy study I particular recommend because of how comprehensive it is, but it’s far from the only study demonstrating the same result.
True, but when they started refining the rice it did.
Among social animals, the survival of individuals is dependent on the survival of the social group as a whole. Children are helpless for the first decade of life, so the survival of genes is dependent on there being a large support network to ensure the survival of children, even if their parents die. Thus, there’s an evolutionary advantage to long-life in humans, because pre-writing, the knowledge and experience of the elderly allowed for knowledge to be used and passed on to enhance the survival of the group and therefore children. Group dynamics also get selected for from an evolutionary perspective. (Van Der Waal has some interesting insights from a group of chimps where the most aggressive males were killed in an accident, leaving the “beta males” behind to reproduce. The result was a much more cooperative, less aggressive social group that ended up having a larger population than similar chimpanzee groups because there was less violence among the chimps.)
Amy, while I agree with your main points, I have to question one statement you made: “All the existing scientific evidence shows that all of the myriad claims of alternative health are flat out false.”
I think it would be more accurate to say that all the existing scientific evidence is compatible with the hypothesis that no CAM treatment works better than placebo, except for some herbal remedies which would probably work even better if they were approached by the time-tested methods of pharmacology with isolation and purification of the active ingredient.
Alex Knapp:
“The archaeological evidence suggests, for example, an almost uniform crash in average heights when populations make the transition from hunter-gatherer to agriculture (in Crete, for example, average heights for men went from 5′9″ pre-agriculture to 5′3″ afterwards).”
Accepting this and the implied causal relationship as fact for the sake of argument: Can you provide any support for the notion that a decrease in average height is detrimental in any way other than it makes it harder to reach the top shelf in the kitchen?
bluedevilRA makes a good point as well: “The problem is, most people don’t even realize when they receive treatment for life threatening diseases.”
You may realize you owe your life to modern medicine if you have/had juvenile diabetes, asthma, certain severe allergies, needed surgery, etc, but…
Let’s put it this way,
Have you ever taken an antibiotic?
Have you ever had a tooth extracted or filled?
Have you ever applied an topical antiseptic or antibiotic to a cut or open wound?
Have you ever had a vaccine?
Had required an injection of epinephrine?
(This list could go on and on…)
If so, foregoing any of these would have increased your risk of, if not led directly to, a potentially fatal outcome
“Reality is starvation, scavenging, and scurvy.”
Yes, reality in the past also favored survival of those physically strong enough to survive and provide for themselves. In modern times, we consider ourselves better off that people like Stephen Hawking are around to think about things.
Amy said “No, no, no, that’s not how you support a claim with scientific evidence. You need to quote the relevant passages, discuss the limitations of the study or report, and compare it to the larger body of scientific evidence on the topic. Copy and pasting a link, which might impress lay people, carries no weight here.”
That is a fine list of requirements, but apparently Amy is exempt from these requirements? Or are we to assume that there is no scientific evidence for her post here, since she has not supported her sweeping claims via: quoting relevant passages, discussing limitations of studies and reports, making comparisons to the larger body of scientific evidence and providing citation links?
Amy’s criticism of Sid is ironic given that his link to an article by Dr. Simon Szreter of Cambridge is relevant, educational and on topic, more so perhaps than the opinions she has generated here. BTW, the emphatic repetition of “no” is best confined to discussions with toddlers.
Karl,
All else being equal, stunted growth is typically symptomatic of malnourishment.
Oh I nearly forgot, here’s the Szreter paper that Sid’s link discusses. For those of you who like to consult primary sources anyway. http://shm.oxfordjournals.org/cgi/pdf_extract/1/1/1
“I think it would be more accurate to say that all the existing scientific evidence is compatible with the hypothesis that no CAM treatment works better than placebo, except for some herbal remedies which would probably work even better if they were approached by the time-tested methods of pharmacology with isolation and purification of the active ingredient.”
Agreed!
Thanks for the citations. I will look into them tonight (I’m at work currently).
Zoe, I didn’t mean to paint the agricultural revolution as one event (I was describing all the agricultural revolutions and advancements that have occurred in human history). Also, I agree that the spread of disease was an unfortunate side effect of the growth of cities, the increase in farm production, and the increase in trade.
I think the EBM vs SBM debate is very relevant here. The theory put forth by Alex and others seems to be that H-G’s were more fit to survive because they lived long and healthy lives. They had fewer diseases compared to modern man and were therefore superior.
I believe this theory is clearly debunked by the growth numbers. H-G’s struggled to survive. If they had lived long, happy and healthy lives their population would have grown. It did not.
Alex Knapp:
“All else being equal, stunted growth is typically symptomatic of malnourishment.”
Accepting this as fact for the sake of argument, can you provide support for the implied assumption that the reduction in average height you mentioned was a result of stunted growth?
One other obvious possibility is an increased survival rate for smaller, weaker, less physically gifted, and shorter individuals (assuming height is an indicator of optimal physique) for one reason or another. This could, perhaps, be due to better, more readily available nourishment, or maybe it was due to a lower probability of being killed by one’s prey if you were tall and strong (assuming tall=strong & fit). Without support, my speculation is as valid as yours.
If you are going to call someone out for not supporting their position with peer-reviewed research and analysis, you’d better make sure your not standing in a glass house when you do it.
There are ways to limit population growth besides having a baby every year and letting half of them die (the agricultural model). My understanding is that in hunter-gatherer societies it is more typical to have a baby every four years. There is no reason to assume that the reason hunter-gatherer groups are smaller than traditional agricultural groups is that their death rates are higher. (Though that might be the case, it is a hypothesis that has to be tested in each group.) They may be using various methods to reduce birth rates to keep group size manageable. This isn’t necessarily a sign of doing things wrong. Even with a lower growth rate, human hunter/gatherer societies managed to cover most of the planet.
I don’t think it’s necessary to assume that everything about hunter-gather societies was perfect to recognize that it drove most of our evolution, and that significant deviations from the lifestyle may need to be compensated for – for instance, through technology. For instance, hunter-gatherers tended to get more exercise than cube-farm dwellers. The cube-farm dwellers suffer health effects from lack of exercise, so they use their agriculture-and-fossil-fuel-enabled technology to build themselves gyms and take sulfonylurea drugs.
Or, hunter-gatherers moved around and didn’t have to worry much about sewage. Agriculture made cities possible and urbanites spent thousands of years suffering from life in various quantities of s*** before flush toilets and rotavirus vaccine were invented. In the meantime, life in crowded medieval and industrial cities could be quite disgusting and unsanitary, killing babies and otherwise-healthy young people. Other animals, such as ants, for instance, can live in large communities without having the same s***-related problems that humans do. Ants evolved to live in large, stationary communities. Humans did not. That doesn’t mean I’m romanticising life as an ant.
While it’s theoretically possible for a particular human community to be hunter-gatherers while having access to modern medicine, modern medicine is dependent on agriculture and fuel. So that will always be a non-option for humans generally. Either we have agriculture and modern medicine and technology; agriculture without modern medicine and technology; or hunting/gathering without modern medicine and technology.
The potato famine is not something that was caused by poor agricultural practices. It was caused by extremely successful agriculture that supported a large (but impoverished) population that could not be supported by anything else. In the absence of potatoes, the Irish either had to leave (like good hunter-gatherers) or use capital (which they didn’t have but the English did) to import food.
We’re going to be facing that again in the coming decades. Fertilizer and pesticides are going to become increasingly expensive and our huge agriculture-supported human population is going to be scrambling.
Amy says:
The difference between an average lifespan of 48 and one of 77.7 can be accounted for by modern medicine
Everybody else says:
Fertility and Mortality in the United States
Michael Haines, Colgate University
http://eh.net/encyclopedia/article/haines.demography
The mortality decline since the late nineteenth century seems to have been the result particularly of improvements in public health and sanitation, especially better water supplies and sewage disposal. The improving diet, clothing, and shelter of the American population over the period since about 1870 also played a role. Specific medical interventions beyond more general environmental public health measures were not statistically important until well into the twentieth century
——————————————————————–
https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/936/WP90-07_Childhood_Mortality.pdf
The two extreme explanations of child mortality decline are on the one hand that the improvements are due to medical science and on the other that they are due to general improvements in economic and social conditions
The first view, giving preeminence to medical advances, was the conventional wisdom until the 1950s, but has, since then, been largely discredited. As has been seen in the previous section, child mortality fell from a number of diseases (e.g., tuberculosis, pneumonia) in the early part of the 20th century for which there was no effective therapy or immunization
“I would argue that a larger population with a lower life expectancy is indicative of worse health”
Where is your evidence that this is what happened during the transition to agriculture? I can’t imagine how a pre-technological society could grow substantially in population without an increase in lifespan. Are you claiming that hunter-gather societies contained small numbers of individuals who lived to old age but had only a few children, all of whom survived to adulthood?
“Because the archaeological record is replete with similar stories, as are historical accounts”
Really? Name 5.
“Children are helpless for the first decade of life, so the survival of genes is dependent on there being a large support network to ensure the survival of children, even if their parents die”
Where’s the evidence that parental longevity leads to increased child survival? How does a support network prevent perinatal death, infectious disease and starvation in time of famine?
Menopause: If I have a baby every four years until I’m 45 and then I die, who is going to look after my younger children and raise them until they’re sixteen? Menopause makes most sense if you assume that it makes at least a small core of women not tied down with infant care available to guide and support a group of younger mothers. My impression is that non-reproductive grandmothers are a prominent feature of the hunter-gatherer societies we know today. Otherwise, if you assume that women contribute to a healthy (=large?) society primarily or solely by the number of infants we generate, there would be no menopause. We would just keep popping them out until we keeled over.
Anecdote: I attended a meeting yesterday about sensory integration in young children. Several attendees expressed disdain for modern civilization and technology because children no longer have to do the “hard sensory work” previously required for survival. In the peacefully idyllic past, evolution actively tuned children to be in harmony with their pre-civilization environment. Today’s technology and urbanism undermines this perfect balance and fails to honor our evolutionary history.
There may be a germ of a point buried in there somewhere, but do we entirely discard 10K+ years of technology to return to nasty, brutish, and short? I live in a very cold climate, and have a great deal of concern about interruption in the supply chain to my local coffee roaster. It’s not as if I could grow my own beans here. Nasty and brutish indeed.
Sid,
Those quotes are meaningless One is from an encyclopedia and the other is someone’s opinion.
Data, Sid, we need data!
Amy
No, no, no, that’s not how you support a claim with scientific evidence. You need to quote the relevant passages, discuss the limitations of the study or report, and compare it to the larger body of scientific evidence on the topic.
Copy and pasting a link, which might impress lay people, carries no weight here.
———————
Let’s simplify things. Show me a infectious disease that you believe would still be an important cause of infant/childhood mortality were it not for modern medicine and I’ll demonstrate you how you’re incorrect
…and I’ll give you lots of data
“Menopause makes most sense if you assume that it makes at least a small core of women not tied down with infant care available to guide and support a group of younger mothers”
Actually, there is another explanation that makes more sense. Ova degrade in quality over the course of a woman’s life making the risk of giving birth to a child with a severe genetic defect (like Down’s Syndrome) increasingly common, particularly over age 40. Since children with genetic defects tend to die very early, and since childbearing is associated with a high risk of death, it makes biologic sense for ovulation to wind down when the quality of ova diminishes.
“Show me a infectious disease that you believe would still be an important cause of infant/childhood mortality were it not for modern medicine and I’ll demonstrate you how you’re incorrect”
Smallpox.
@ Allison – Menopause: If I have a baby every four years until I’m 45 and then I die, who is going to look after my younger children and raise them until they’re sixteen?
I’d assume that there would be remarriage and the stepmothers would take care of the younger children as well as any children she had. I’m also assuming that the father would marry a younger woman. Or the children could be sent to live with relatives who could afford to take care of them.
Amy, I’ve been a reader of SBM for half a year or so and enjoy your articles. I must say though, that you’ve taken quite a condescending and belittling tone with Sid as you demand citations for evidence..
“No, no, no, that’s not how you support a claim with scientific evidence. You need to quote the relevant passages, discuss the limitations of the study or report, and compare it to the larger body of scientific evidence on the topic.
Copy and pasting a link, which might impress lay people, carries no weight here”
In addition to an air of arrogance, you entirely fail to present such evidence in your own article! Thus, you have a very interesting opinion piece, full of fun speculation and plausible inference, but no Level Ia evidence for which you press Sid.
D. Joo, MD
dang typos:
“…you’d better make sure your not standing in a glass house when you do it.”
Corrected: “…you’d better make sure you’re not standing in a glass house when you do it.”
Karl: Stunted growth:
It doesn’t take a lot of food restriction to stunt growth. Children have a lot of demands on the limited amount of food they can consume: physical maturation, exploring, learning, fighting disease, hunting and gathering. They grow with what’s left over. Assuming malnutrition in agricultural societies is what caused people to be shorter is entirely consistent with what we know about nutrition and changes in population heights today. For instance, all those 3rd-generation east-asian immigrants in North America who are so much taller than their grandparents. Or the Dutch army recruits who were conceived after the Hunger Winter of 1946 and who were significantly shorter than the recruits born earlier and later.
Agriculture may lead to:
— More sewage to deal with, more water-borne disease to fight off, therefore less energy available to fuel growth even with the same amount of food.
— More children per mother, leading to earlier weaning of infants and more competition for food among children.
— More dependence on local crops, so a boom-and-bust cycle of feast and famine.
— More dependence on grain and less consumption of meat.
Also:
— More staying at home, better housing, cleared land and fewer (not more) predators.
Even if agriculture can support more people, it wouldn’t be surprising if they were smaller, at least in some circumstances. (Pygmies are hunter-gatherers. They aren’t very big.)
This is actually a testable hypothesis, so someone with anthropological savvy (not me) can probably go and look up the data. In populations with nutrition-related growth restriction, men and women are of similar height because there is not enough surplus food to fuel a complete male adolescent growth spurt. Back in my university days I had a professor who used to talk about that phenomenon being quite visible in Newfoundland, where sex differences in height in the older generation were less pronounced than in the younger generation.
We also haven’t been talking about pastoralists, who are probably the healthiest of the preindustrial groups. They’re tall, mobile and have ready access to animal protein. They can accumulate capital, which offers protection against lean times.
showmedadata:
“no Level Ia evidence”
Are there any empirical claims in the piece for which you would like to see scientific citations? I’d be happy to provide them.
Allison Cummins:
Your family. Humans are social animals, and even in hunter-gatherer groups, children are looked after by more than just their parents. But if you think survival is impossible if people die at 45, consider the fact that in societies without good access to medical care, the maternal death rate can be as high as 10%, so clearly there is a fairly significant risk that a child won’t just become motherless before 16, but may come into the world motherless. Yet our species survived. This is because traits do not survive only if they guarantee survival. They don’t have to be perfect; they just have to improve the odds.
The “grandmother hypothesis” has been floated before to explain menopause, but while I find it plausible, I am not yet convinced. In any case, even if true, it doesn’t mean women usually made it past menopause (nor does it mean that men did). One potential complicator: men and women both care for the children, but although male fertility does decline with age, they don’t really have any equivalent to menopause. Why? Shouldn’t it be just as bad to father a child at 75 and guarantee the child will be fatherless at 16?
There may be another reason why menopause developed. It’s long been known that parental age is associated with the rate of birth defects; as the parents get older, so goes the idea, their gamete-production-systems accumulate genetic defects, some of which will be fatal to the offspring. For a while, it was held that autism was associated with advanced maternal *and* paternal age, but interestingly, a newer study has largely exonerated the fathers; it’s advanced *maternal* age, not paternal, that is associated with an increase. It’s not yet certain that this is causal, but it has me wondering: is menopause adaptive from the perspective of reducing birth defects?
(Mind you, the two explanations are not mutually exclusive.)
I’ve rambled a bit here, but my point is that you can’t point to menopause as evidence that people were generally healthy five thousand years ago. I think it’s safe to say that people *were* generally as healthy then as they are today, as long as they didn’t have any serious accidents, get seriously ill, eat spoiled food, drink tainted water, get snakebit, die in childbirth, get in infection, be unfortunate enough to have a congenital defect, etc. Like most species, we cope with our premature death rate by having enough babies to make up the difference, but it’s probably fair to say our wild life expectancy was in the order of 70 years, barring illness or accident or famine. Our modern life expectancy *is* higher than that (reaching 80 is not considered extraordinary anymore — 90 is the new 80, you might say), but not 35 years higher.
I suspect people romanticize our H-G ancestors because they fancy the idea that if we had to return to those uncivilized times, then they would be the one’s who survive. People like to be counted among the strong. Civilization apparently makes us weak.
I’m guilty too. That’s why I like a good zombie survival story. Everyone likes to imagine they would be the sole survivor during a zombie holocaust.
lillym on motherless infants:
I’d assume that there would be remarriage and the stepmothers would take care of the younger children as well as any children she had. I’m also assuming that the father would marry a younger woman. Or the children could be sent to live with relatives who could afford to take care of them.
In fact, when life is hard, the new young wife is often not at all keen on looking after another woman’s children. Think of all the Evil Stepmother stories from preindustrial Europe. There seems to be an atavistic response that survives today. My sister was taken into care by the children’s aid because it was feared that her stepmother would kill her and her older sister. Sure, that’s unusual and extreme, but stepmothers are unreliable.
When I lived in Africa, children who could not live with their mother (mother died, or mother remarried and new husband was not interested in supporting another man’s child) were sent to live with their maternal grandmother. If this wasn’t possible, they might be adopted by a childless aunt. Otherwise they would be sent to live with someone who needed a small child to fetch wood and carry water. This was definitely a last resort, though. In many cultures a motherless girl can be betrothed and sent to be raised by her future mother-in-law at any time.
“But is mere numbers of people the only measure of health?”
Dr. Tuteur:
“Not the only measure, but one of the best. The unhealthy die prematurely. It’s difficult to be less healthy than when you are dead.”
Hmm, sub-saharan Africa must be the healthiest in the world then!
It would be nice to see one shred of evidence to prove Dr. Tuteur’s assertions, especially that modern agriculture is primarily responsible for an increase in life expectancy. Dr. Gorski and Alex Knapp are the only one who have provided any backup for his statements. Further, it’s rather odd that the claims in the blog are taken as true with no research evidence, but anybody who questions the conclusions must provide iron-clad data (although these commenters are rising to the challenge, even if it’s not reciprocated). There is tons of debate among historians and scientists about the role of agiculture in evolution and population growth and life expectancy, so there’s no shortage of evidence.
I do agree with Dr. Tuteur that there is no evolutionary advantages to having people live past reproductive age.
Alison, I also have read that hunter-gatherers cannot carry their children long distances, so they tend to have less of them (due to lactational ammenorhea, assuming). A transition to urban areas and close quarters made possible by agriculture most certainly INCREASED population at first, but lead to decreased life expectancy. All of Dr. Tuteur’s points apply to post neolithic societies.
The diseases of hunter gatherer societies DON’T tend to be influenza, tuberculosis, smallpox, but things like chagas disease.
There are some skeptic authors (like Michael Shermer) who like to see the EBM approach applied to areas such as history. Obviously there are no RCTs, so the subject of this blog post is different than the usual.
I agree with whoever said that it’s ALSO dangerous to romanticize the present. Before modern sanitation, agriculture most likely lead to increased population, but decreased life expectancy.
Amy on menopause:
“Ova degrade in quality over the course of a woman’s life making the risk of giving birth to a child with a severe genetic defect (like Down’s Syndrome) increasingly common, particularly over age 40. Since children with genetic defects tend to die very early, and since childbearing is associated with a high risk of death, it makes biologic sense for ovulation to wind down when the quality of ova diminishes.”
If a living mother has no value, it makes no difference whether her children are at higher risk of Down syndrome. It only makes sense to reduce childbearing to spare her life if her life has value to the population beyond the infants she can produce.
Calli Arcale:
“Like most species, we cope with our premature death rate by having enough babies to make up the difference, but it’s probably fair to say our wild life expectancy was in the order of 70 years, barring illness or accident or famine. Our modern life expectancy *is* higher than that (reaching 80 is not considered extraordinary anymore — 90 is the new 80, you might say), but not 35 years higher.”
That was my impression as well. Is there a “ceiling” for human lifespan? Why do we die, evolutionarily speaking? I’ve seen lots of debate among scientists about theories of aging- fascinating stuff.
Amy,
Since you offered:
1. Your basic premise is that life expectancy has increased from 35 to 77 due to modern medicine and agricultural advances. Although I don’t doubt this, you give no evidence. Furthermore, there’s haziness in your assertion that “for most of human existence” the life expectancy was 35 years.. How far back does that go? How reliable are the indicators we use to determine that value?
2. Regarding life ‘back then’, you state “It was hell”. Again, likely true because life has always been a battle of survival. Evidence? Presumably there were some pretty decent parts then as there are now.
3. The most flagrant of your assertions, somewhat mitigated by Harriet’s comment with which you agreed:
“All the existing scientific evidence shows that all of the myriad claims of alternative health are flat out false. None of it works, absolutely none of it”
As this is a blanket, absolute statement, a single example to the contrary will suffice. Laser therapy for chronic neck pain (Ia Evidence).
Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009;374(9705):1897-1908.
Medicine and reality are not worlds of absolutes (at least to our current state of understanding). The more black-and-white the opinion, the more I slot it into the “fundamentalist” or “religious fervor” category.
Amy said to Sid “Those quotes are meaningless. One is from an encyclopedia and the other is someone’s opinion.”
1) Referring to the “encyclopedia” comment, which cites a paper by Michael Haines of Colgate University, here is a link to papers by Haines on this topic. http://www.nber.org/authors/michael_haines
(the Economic History Association might quibble with their online encyclopedia being deemed “meaningless”).
2) Amy dismisses the paper “The Decline of Childhood Mortality” by Kenneth Hill of the Johns Hopkins School of Public Health as “someone’s opinion”.
Question: if Dr. Hill’s academic paper, which includes two pages of reference citations, is deemed “mere opinion” then how should we categorize Amy’s undocumented claims? Mere speculation?
Dismissing legitimate academic papers as “meaningless” and “mere opinion” is beyond the pale. What is Amy smoking/imbibing?
So far Sid’s citations are the most educational thing about this post.
Hi bluedevilRNA –
So true. Why is it, though, that a zombie holocaust is fun to imagine, but most other forms don’t romanticize so easily?
And on a related note, what might the zombie apocalypse to do our average lifespan? Does your timeframe as a brain eating zombie count?
- pD
In fact, when life is hard, the new young wife is often not at all keen on looking after another woman’s children. Think of all the Evil Stepmother stories from preindustrial Europe. There seems to be an atavistic response that survives today. My sister was taken into care by the children’s aid because it was feared that her stepmother would kill her and her older sister. Sure, that’s unusual and extreme, but stepmothers are unreliable.
But for every extreme and rare case there are those situations where children were raised by their father’s second (or sometimes third) wives.
I can point to my own famiy history where my grandmother has an older half-sister, my great grandfather’s first wife died, he remarried to my great grandmother and she raised her stepdaughter and her own children.
There’s also a great-great-great (I think I’ve got that right) uncle who had 17 children by three different wives. His second and third wives were actually younger than the oldest children.
Then there’s also the fact that at least one grandparent of mine and both parents were raised with their cousins when the cousins’ parents either died or were unable to afford to care for them. In one case a great aunt died of pnemounia when she went to care of her sister who was dying of breast cancer. As a result all of those children (I believe about eight) were sent to live with various relatives, I don’t think any of the siblings ever lived together after that.
This doesnt’ cover what happens when a father dies, in the case of one of my grandfathers when his father died his older sister married at the age of 14 and he and his younger sister were sent to “schools” because their mother had no money and no desire to try and care for them.
More children per mother, leading to earlier weaning of infants and more competition for food among children.
++++++++++++
Surely it’s the other way round? Earlier weaning of infants leads to more children per mother, all other things being equal.
Amy on parents:
“Where’s the evidence that parental longevity leads to increased child survival? How does a support network prevent perinatal death, infectious disease and starvation in time of famine?”
Ooh, I really wish I could go to the McGill Medical library right now and look it up. (Which I have in the past.)
In times of war and famine, children who are with their mothers are less vulnerable to malnutrition than are children who are with aunts, grandmothers, fathers, stepmothers or some random stranger. Mothers will go further to save a baby’s life than anyone else will.
You can challenge me and I will be helpless before you, but this was part of my senior thesis. (Back in the eighties. There might be better work done now, which I would be glad to hear of.)
From a slightly different angle: One sociological study of an agricultural village looked at all kinds of variables upside down and sideways — family size, father’s family size, mother’s family size, size of land available to family, distribution of land, quality of land — to find variables that would identify children at risk of malnutrition. In that village the only variable they could find was whether the mother had a cash income or not. If she had income she could buy snacks for her children and they would eat twice a day. If a mother didn’t have her own income, her children breakfasted on leftovers from supper — and that was it until they were old enough to stay up and eat supper with the grownups and get two meals a day. Agriculture is a lot of work, and food preparation is a lot of work, and there just isn’t the availability to provide children with food all through the day.
Alison Cummins,
I never maid any claim that food restriction does not result in stunted growth.
In fact, I accepted the statement, “All else being equal, stunted growth is typically symptomatic of malnourishment.” as fact for the sake of argument since its factualness is not relevant to my point.
My point was that Alex Knapp provided no support for the implied claim that reduced average height in the population of the scenario he presented was a result of stunted growth in the same thread in which he criticized Amy for not using citation to peer-reviewed research and analysis.
With regard to diabetes, this world map makes interesting viewing
http://www.worldmapper.org/display.php?selected=239
Plonit on chickens and eggs:
Surely it’s the other way round? Earlier weaning of infants leads to more children per mother, all other things being equal.
One of the means a society can use to space births is a taboo against sex for lactating women which may be a two to four year period. In agricultural societies the taboo is typically shorter, less stringent, and may even be absent.
Hunter-gatherer children don’t eat porrige, so they often can’t be weaned as young as agricultural children. Not weaning them delays mothers’ return to ovulation, absolutely. (However, we all know examples of the imperfection of this method!) If everyone knows they *must* not be weaned then the extended lactation period will be actively protected. (Even to the extreme of infanticide of a child born before the older child is ready to be weaned.)
lillym on stepmothers:
“But for every extreme and rare case there are those situations where children were raised by their father’s second (or sometimes third) wives.”
Yes, and thank you for giving me the chance to agree with you!
Heh — I was menstruating two months after childbirth, both times, and I breastfed both my kids for over a year. It definitely is not reliable as a form of birth control.
There is no reason to kill a child because a new child has been born while the first is still nursing; women can generally support two babies, milk-wise, and by then the older child is not exclusively drinking breastmilk. (If they did, they’d be malnourished; you really do need to start solids prior to age 2. Even the Muslims, who as an article of religious doctrine, are expected to nurse for two years, will introduce solids by six months. There is, after all, nothing saying it has to be the only source of nutrition.) I am doubtful that this happened very often even in ancient hunter-gatherer societies, especially given the paleontological evidence even in Homo erectus of taking care of seriously disabled tribe/clan members, and, more notably, the fact that it isn’t common in modern hunter-gatherer societies (what few still exist).
Amy, you lack imagination.
Let’s start with this:
Infant and child mortality in the past By Alain Bideau, Bertrand Desjardins, Héctor Pérez Brignoli P31 (Google Books)
…one must remember that smallpox had begun to diminish before vaccination. In Sweden smallpox mortality declined by close to half between 1770 and 1800.
…in England the disease was in decline before the end of the century, as was the case in Geneva.
—————–
For actual data see Welch and Miller homage to vaccines, Acute contagious diseases
http://books.google.com/books?id=fOc0TmQsPRkC&printsec=frontcover&dq=acute+contagious+diseases&cd=1#v=onepage&q=&f=false
P109 England – falling mortality and rising population
P 106, 111 Sweden – declining mortality
—————–
Besides for smallpox to live up to its reputation as the speckled monster, we’d need to return the squalorous conditions plaguing the people of the 17 and 1800s.
As to temporal declines occurring after vaccination remember correlation does not equal causation
Finally this is not to say vaccination, when practiced properly with actual vaccine, did not work or have an impact, simply that, as a major cause of mortality, smallpox was on its way out vaccine or not
@Wales
To listen to Amy you’d think this guy was Cliff Clavin spouting off at Cheers
http://faculty.jhsph.edu/default.cfm?faculty_id=310
Sid Offit:
“For actual data see Welch and Miller homage to vaccines, Acute contagious diseases”
No, YOU need to present the data and make the arguments. It is not enough to cite papers and books that you think make your point.
Indeed, I would venture to guess that you keep throwing out citations because constructing an argument to support your claim is literally impossible.
Oh no, Sid, don’t do the “well the diseases were on their way and vaccines had little effect” gambit. This is awful Bill Maher garbage. Vaccines didn’t eradicate polio. Polio eradicated itself!
Modern medicine didn’t get rid of diseases. They all just magically disappeared! The woo alarm in my head is ringing so loud I can barely hear myself think.
I know this is just from a book but I couldn’t resist
The Burdens of Disease
By J. N. Hays P 279
“Government compulsion did not…mean effective administration, and the rapid elimination of smallpox certainly did not result.”
“National administration of a vaccine faced daunting practical problems in the 19th century. For much of the period adequate supplies of the vaccine could not be relied on, and their quality varied widely.”
“Even after the serious epidemics of the early 1870s quality and quantity could not be assumed.”
——————-
bluedevilRA
I don’t want to get into polio, so for now I’ll say you’re right. If however you have another infectious disease eliminated by modern medicine I’d love to hear about it.
Wooo hoooo!
thehandsomecamel on pre-industrial life expectancy:
“Once you made it to adulthood, life expectancy was basically the same for them as it is for us — most people lived to their seventies, which is why the Bible, for example, gives the average life expectancy (in ancient Israel) as “threescore and ten,” or “if they be strong, fourscore.” ”
Israelites were pastoralists. Very clean, very well-nourished. I’m not surprised they thought 70 was a normal lifespan.
David Gorski on pre-industrial life expectancy:
“Only about 1/3 of people who made it to their 20s made it to age 60, and many fewer still to age 70 or 80, about 12-15% and 2-3% respectively. (I’m guesstimating from looking at a graph in the book.)”
This is seventeenth-century London, a filthy place! If 12% of adult Londoners were able to survive to 70, I’m impressed. Really.
David Gorski on pre-industrial life expectancy:
“In all fairness, I note that life expectancy was significantly higher in the countryside, at least as far as the data we have suggest.”
Right, so outside of urban areas, which have their own urban ills, people did much better. And most people did *not* live in cities in the 16th and 17th centuries.
These are three very different modes of life, none of which are hunter-gatherer. The past is a big place.
Amy Tuteur on *all* modes of pre-industrial life:
“Far from being a paradise, it was hell.”
Maybe, maybe not. For some people, clearly yes. For others, clearly no. Kind of like living in a modern industrial city is hell for some people (life expectancy of 57 for DC African-American men) and very nice for some people, thank you very much (life expectancy of 92 for affluent Asian-Americans).
If you want to talk about what is good or bad about something, you need to be able to clearly define what the something is. Once you do that, you’ll probably find both upsides and downsides. (17th century London? Sounds awful to me, but people moved there because they liked it. At least some people apparently thought the risk of disease was worth it.)
Plonit on infanticide:
“There is no reason to kill a child because a new child has been born while the first is still nursing; women can generally support two babies, milk-wise, and by then the older child is not exclusively drinking breastmilk. … I am doubtful that this happened very often even in ancient hunter-gatherer societies.”
You’re right that it probably didn’t happen very often. It depends on the alternatives to breastmilk.
Agriculturalists have access to grain. Grains supply approximately 2-4% of their calories as protein and 1-4% of calories as fat. Legumes are even higher in fat and protein.
Agriculturalists often have access to milk; pastoralists definitely do.
Hunters and gatherers don’t eat much grain. They eat leaves, roots, fruits, tubers, nuts and meat. If you don’t have nuts where you live, the plant material available for your baby is low-protein and low caloric density. Bananas are the highest-protein fruit at about 2% of calories. With a little supplementation, an adult can live on bananas. A baby can’t. A baby with this range of plant food choices needs substantial meat or breastfeeding for the first 30 months, otherwise they are at high risk of kwashiorkor.
In a traditional lifestyle, some people really do face horrible choices. In these circumstances the taboo against sex with a lactating woman is very strong.
Not me! Calli Arcale said that….
Sorry Plonit!
Calli, consider yourself cited.
Point of clarification (sorry if I missed this earlier)
Lifespan is the maximum age an individual may live
Life expectancy is the average age a population lives.
Amy meant “life expectancy” in the article – not lifespan. These two terms have then been used interchangeably in the comments.
So – human lifespan has actually not changed much. But life expectancy has increased – for every age group. If you are 40 now your life expectancy is greater than if you were 40 in 1800. This is not explained by decreased infant mortality.
But it is true that decreasing infant mortality has had a disproportionate effect on life expectancy, since saving one child may add 70-80 years to their life.
However, as someone pointed out, do you know anyone who is literally alive due to modern medicine?
Also – if you look at individual diseases – cancer survival is increasing, heart attack survival is increasing, stroke survival is increasing, etc.
“Also – if you look at individual diseases – cancer survival is increasing, heart attack survival is increasing, stroke survival is increasing, etc.”
But Steven, the naturalists insist those diseases didn’t exist in olden times; they are all a result of our modern, unnatural lifestyles. They will probably counter that, yes, today we are getting better at finding ways of living longer with our unnatural, unhealthy lifestyles.
Apparently there are people who believe that back in the day, ancient man lived a long, strong, and healthy life up to the minute he just dropped dead of old age one day in the middle of running around hunting and gathering nuts.
“Remember, evolutionary success is measured by number of living offspring, not by length of life. Natural selection does not select for health, it selects for reproductive outcomes.”
Natural selection isn’t the only factor. Sexual selection would select for health.
Karl,
re: malnutrition and height, please see the Cassidy et. al. study I cited above, which makes precisely the point in comparing two similar populations, one pre-agriculture and the other post-agriculture.
Amy,
I’ve cited two sources above, one a peer-reviewed paper, the other an article by Jared Diamond synthesizing archaelogical research above. It’s provided. And they’re hardly isolated examples in the literature. For starters, research into !Kung and Masai compared to their agricultural neighbors is eye-opening.
No, I’m saying that those H-Gs that did survive into adulthood had more robust health and longer life expectancies than their agricultural neighbors. But there are definitely advantages and lower infant mortality rates in agricultural socieities, as well as much higher birth rates (1 per year [ag] vs. 1 per 3-4 [H-G]).
The two cited above.
3. I’d also add contemporary accounts of the Mongol invastions into Chinese, Muslim and European terroitories. The nomadic Mongols were, on average, taller and stronger than the peoples they conquered.
4. Angel, Lawrence J. (1984) “Health as a crucial factor in the changes from hunting to developed farming in the eastern Mediterranean.” In: Cohen, Mark N.; Armelagos, George J. (eds.) (1984) Paleopathology at the Origins of Agriculture (proceedings of a conference held in 1982). Orlando: Academic Press. (pp. 51-73)] — which studies populations in the Mediterranean region over time and shows life expectancy dropping after the invention of agriculture, and not rising again for a few thousand years, then dropping again during the Middle Ages, then coming back up again. It also includes studies of nutrition and demonstrates that in terms of minerals and vitamins, people in the region didn’t catch up to hunter-gatherers until relatively recently.
5. Lindeberg S, Cordain L, Eaton SB. Biological and clinical potential of a Paleolithic diet. J Nutr Environ Med. 2003;13;149-160 (compares the health of modern hunter-gatherers in comparison to modern folks in agricultural society and finds a marked absence of hypertension, diabetes, cancer, etc.)
I don’t know if studies have been done with humans. I know they have with other primate groups.
I don’t recall making the argument that it did.
@bluedevilRA
I’m hypothesizing that, based on the available evidence, prior to the advent of medicine and sanitation, a hunter-gatherer lifestyle appears to produce more robust health outcomes than an agricultural one.
My problem with Amy’s argument is that her hypothesis is that longer modern lifespans is a combination of (1) modern medicine and (2) modern diet. I think that this hypothesis hasn’t been demonstrated (Amy has yet to cite any research).
Personally, I think the difference is almost entirely due to (1) and that (2) introduces problems of disease and malnourishment.
From my personal research to date, I think that the evidence demonstrates that we ought to (a) keep modern medicine, because it’s awesome and (b) emulate to the best of our abilities the traditional diet of hunter-gatherer societies using the tools of modern food production. I would love to see more studies on this to either confirm or deny my hypothesis.
However, I think that it’s a mistake to completely write off the past and romanticize the present as being the best human society, in every aspect, that ever existed.
Karl:
Karl, if you review the literature on modern H-G societies, you will discover that the incidence of cancer, heart disease, and strokes are much lower than in modern agricultural societies.
I personally want the best of both worlds – the benefits of modern medicine combined with the robust health of the H-Gs who were able to survive disease, trauma and other people to have robust health into their 70s. Put the two together and I hypothesize that one could probably increase their lifespan substantially.
I’m not fan of the Garden of Eden fantasy and find the Noble Savage idea that has become popular to be incredibly condescending (not to mention rather colonialist). That said, fantasies about industrialization/technology are equally as silly. (Particularly something as silly as fetishing pesticides.) Technology=good, nature=bad is as dumb and reactionary as nature=good, technology=bad.
I certainly wouldn’t have wanted to live in London in the 1500s, or the 1800s for that matter. All those people crammed in together burning whatever they could get their hands on for fuel was a recipe for disease and early death. Just as contemporary pollution contributes to both disease and death – this is one of the trade-offs of living in a city during any time.
How fabulous and healthy living in nature was or is really depends on where you live. If you live somewhere that’s abundant in healthy food – Tahiti or Hawaii, or a fertile crescent or valley – you probably did pretty well in terms of longevity. People living in a traditional way in Okinawa are a good example of how a good diet, daily exercise (and probably some good genetic material) can play into living a long life. Science and medicine are just tools, it’s what we do with them that determines whether they contribute to longevity or reduce it. Fetishising nature or technology/science and making either into an ideological all-good or all-bad proposition is indulging in fantasy rather than putting on al reality-based thinking cap to figure out what what works in the real world.
Sid Offit:
“The Burdens of Disease”
The type of data we need to see are incidence and mortality rates for smallpox over time.
Alive due to modern medicine:
1) Me: I caught malaria several times when I was in West Africa. Treated with quinine. Alive today. (Note that in a pre-industrial world I would have been highly unlikely to have been in West Africa without having been born there, and if I had been born there I might have been heterozygous for sickle-cell… or, um, homozygous.)
2) My mother: started bleeding in 7th month of pregnancy. Labour was induced.
3) My father: treated with antibiotics for paratyphoid fever caught in Bangladesh.
4) My sister? Burned herself with boiling water while breathing steam to treat a sinus infection. Ten days in the burn unit. Might have survived anyway, might have succumbed to infection. (Pre-industrially she might not have had a pot full of boiling water to spill on herself in the first place, so likely moot.)
5) My beloved? Got an infected toe while mountain climbing. Was eventually able to get off the mountain and get treated. Probably would have been able to fight the infection anyway, but maybe he would have been too weak from low oxygen. (Recreational mountain climbing with very post-industrial equipment. Very unlikely to have been up that high if he had been pre-industrial, so moot wrt benefits of life-saving industrial technology.)
Died from modern technology:
1) My cousin; various acquaintances: car accident.
2) My cousin: altitude sickness. Flew straight into Bolivia.
All well and good. But what does that have to do with, say, whether we evolved to eat a plant-based diet supplemented with leaf-eating herbivores? Or whether extending our day with electric light is good for our neurology? Or why as a society North Americans are getting fatter, though affluent people retain their trim figures?
Evolution isn’t perfect but it is suggestive. It’s possible that termites eat wood because that’s all that’s available to them, but that they would be much healthier as individuals and larger as a population if they were to eat whiskey instead because it has higher caloric density. But if I fed whiskey to a termite colony and they I discovered that they didn’t actually do well, would it really be a naturalistic fallacy to look at what they evolved to eat?
It’s clear that we mostly do better when we don’t get infectious diseases (with the possible exception of helminths in some populations). Absolutely. And it’s clear that a combination of modern birth control, modern infection control and modern obstetrics reduces perinatal mortality. Totally.
But it does not follow that absolutely everything about post-industrial life is better than any imaginable aspect of pre-industrial life.
Alison – “My impression is that non-reproductive grandmothers are a prominent feature of the hunter-gatherer societies we know today.”
Fantastic point about menopause and its evolutionary purpose. The other thing we can do is look at our ape cousins who are hunter-gatherers (both chimps and bonobos). There are old apes that have useful roles in their group. There’s no reason to romanticise humans over other apes. The idea that all life in nature is short and brutish seems to be as much a product of colonial mentality as the notion of the Noble Savage is – neither seem particularly accurate and both seem to look at nature from a rather misinformed and antiquated perspective that’s really not very scientific (at least in contemporary terms).
showmedadata correctly points out that Dr. Tuteur paints with a broad brush, just like Fundies do. Fundies condemn to the lake of fire any sect that varies from their doctrine. Catholics who believe that good works on earth are part of the path toward salvation are condemned to hell because the Fundie maintains that faith alone garners entry through the Pearly Gates. Ecumenicism is anathema to the Fundie.
“Yo, Pot, this is the kettle. Guess what?”
On the other hand, Amy is new to this lil’ corner of the blogosphere, so I expect her commentary to become more measured in the future.
Alex – “However, I think that it’s a mistake to completely write off the past and romanticize the present as being the best human society, in every aspect, that ever existed.”
Well said.
“Heh — I was menstruating two months after childbirth, both times, and I breastfed both my kids for over a year. It definitely is not reliable as a form of birth control.”
Me too. I also nursed two babies at once, and it still didn’t make a difference. Still, in general, lactation is the best bet for birth control if you don’t have access to anything else. And it’s actually 95-98% effective for the first six months as long as you nurse around the clock and don’t have periods (too bad for me- I couldn’t use it!). The failure rate is for that small chance you’ll ovulate before menstruating, but many women have an anovulatory period the first time.
Agriculture enabled people to stop moving around all the time to follow the food source. It also enabled us to have more time for other pursuits. A few people could feed an entire civilization. The H-G diet was plant based, while our diet is more meat based- this probably isn’t the healthiest way to live, not to mention the inactive lifestyle we industrialists follow. Agriculture as the basis of our lifestyle has only been around for the past 10,000 years, probably 1% of our evolutionary history. So, there are advantages and disadvantages and unintended consequences. Not sure why that’s so controversial or romanticizing the past on sciencebasedmedicine.org.
The black and white thinking is just bizarre. Not to mention using an AGRICULTURAL caused disease (smallpox/ cowpox) to prove one’s point that modern agriculuture with pesticides is the main reason (in addition to modern medicine) for increasing human life expectancy.
Nice post, Amy.
I wrote something about a month ago on my blog with similar commentary. It’s not a SBM piece by any stretch, just me commenting on my frustration with the alt med folks and their love of mystifying the past.
I find it strange that anyone would imply that we haven’t seen a huge impact on life expectancy from the effect that medicine has had on so many diseases. And again, I have no numbers in front of me, but the notion that people lived on average to be in their seventies just doesn’t sound right to me.
At any rate, if you’re curious then enjoy! http://www.meddlingkids.org/2010/01/the-real-beautiful-people/
A one in five chance: Me. I had scarlet fever as a child. Antibiotics cured it, but historically scarlet fever had a 15-20% mortality rate before antibiotics. I also will not have the heart valve complications that survivors of untreated scarlet fever often developed later in life.
The US Presidents make a reasonable sample of white males who lived past about 50 years of age. I believe the current life expectancy for a 50 year old white male is about 34 years, more or less. The first ten presidents lived to an average age of 77.4 years. The next ten (omitting those murdered) lived to an average of 66.0 years. The next 10 lived to an average of 69.9 years. Nixon lived to 81 and Ford to 93. It seems to me that the life expectancy of a 50 year old white male is now much better than the average age at death (77.1) of these first 30. So I think the notion that if one survived to 50 or so in 1870 one could have expected to reach about the same age as a 50 year old can expect now is wrong on the facts.
RE Harris
Typo, average age at death of the first 30 71.1, not 77.1
I know two people alive because of modern medicine: My wife is 77. She has a variety of adult onset lupus which has been treated in part with medicines that did not exist 30 years Her stomach got blocked and needed to be reattached to the small bowel, probably something that could not have been done a hundred years ago. My wife’s sister, age 85, has some sort of adult asthma, which nearly killed her 8 years ago.
RE Harris
Alive? Hmmm.
$SELF: Many childhood strep infections — and my paternal grandmother died of rheumatic heart disease. Gangrenous appendix removed w/o drama. Pneumonia survived w/o drama thanks to antibiotics.
$HERSELF: Does typhoid count?
Alive due to modern medicine:
1) My daughter: born 13 weeks premature. She was on a vent for 5 days, CPAP for 5 days, and oxygen for a month. Spent 1 month in an incubator and 2 months being tube fed. I thank modern medicine every day for the mircale baby that she is. She’s 2 years old now, no health problems.
2) My friend: stage 3 ovarian cancer. She had surgery and underwent chemo and just had a clean bill of health at her 6 month check-up. Keep your fingers crossed for her.
3) My mother-in-law: heart attack 2 years ago. Had a stent put in and is doing fine.
And I don’t know if high blood pressure counts, but I went in to the doc two years ago for a check up and he said my BP was so high it was “stroke worthy.” I don’t even know where my salt shaker is, and am a healthy weight and don’t smoke, so I don’t really have any risk factors. Went on HBP meds and BP has been perfect ever since.
[...] hear people wishing for a return to “the good old days.” Study your history and learn the science, is what Dr. Amy Tuteur argues over at Science-Based Medicine. The days of yore were tough, and a [...]
Alive because of science-based medicine – me
1 – Childhood fever of some sort … sulfa drugs saved me. My parents were seriously afraid they would lose a child.
2 – Rocky Mountain Spotted Fever – vaccines saved a whole lot of people in my home town.
3 – The smallpox, whooping cough, polio I didn’t have to worry about because my parents believed in vaccines.
4 – The IV fluids and antibiotics that cured the typhoid I got out of my own stupidity because I forgot to get a booster shot
*****************
Not “alive”, but cured of a chlamydia eye infection that would have left them blind a few months earlier – one entire litter of kittens that got an experimental drug that had been developed in rabbits for use on humans, and proven to work in human babies … for once the “animal research” went the other way.
*****************
My mom was a hobby family historian, and the family tree is full of people who would have been saved today … deaths from childbed fever, pneumonia, and other plagues abound.
My hunch is that hunter-gatherers, agrarians, pastoralists, and civilizationists are all basically equally “healthy”. However, it’s hard to ignore the fact that there are a lot more of one group than the others. So, you’re healthy *if you live to be*, and while I think it’s exaggerating to say few people lived to menopause in the past, it’s also unfair to ignore that a lot of people alive today would be dead if they’d been living a hunter-gatherer lifestyle.
Since we’re sharing lists of who’s alive due to modern medicine:
* Me: meningitis at age 4 (two week hospitalization), umbilical hernia at age 6, chronic cystitis due to a diverticulum, asthma; there is a chance I’d be alive today in a HG society, but I’d likely be sickly
* Eldest brother: life saved by surgery, specifically appendectomy
* Middle brother: hospitalized with nephritis; kidney failure would be a horrible way to go
* Youngest brother: resuscitated after crashing at 4 months of age; two months in ICU, respirator, tracheotomy, naso-gastric feedings, formula since Mom went dry due to the stress, numerous surgeries to repair the trachea…. He’d definitely be dead. Directly owes his life to CPR.
* Husband: his mother had hepatitis while pregnant and had to be hospitalized; it’s very likely the pregnancy would not have been successful without treatment, and as it is, he was born several weeks late and only 7 pounds (in a family where the babies tend to be big).
* Brother-in-law: my mother-in-law lost her second baby, but never delivered it. Had surgical removal of the dead baby not been possible, she could never have become pregnant again (at least not safely).
* a friend’s daughter, who suffered an anoxic brain injury and, among other things, has to be fed through a tube implanted in her stomach (though everybody hopes that will not be permanent)
* godmother, who is now several years cancer-free after treatment for breast cancer
* cousin, who was diagnosed with celiac sprue, a really bad case — the slightest bit of gluten will shut down her digestive tract completely
Hmm, I wonder if I’m the only one lucky enough to have never needed life saving medicine Two broken arms (soccer), torn acl (soccer), flu a few times, that’s it. My mom and brother qualify (two life threatening bone infections), grandmother, type 2 diabetes, but my dad, other siblings, kids, and husband don’t belong in the club either. Of course, I believe that preventative medicine (vaccines) had a lot to do with it.
Just to clarify, does Dr. Tuteur believe that obesity and lack of exercise are not problems
at all? As far as I can tell, there is also a lot of concern among advocates of *conventional* medicine about all of these subjects.
Still waiting for proof of the latter claim.
Please keep in mind that for a significant proportion of the people on this planet, particularly in developing nations, life is STILL a living hell, despite all of our technological advances.
There is also the myth I’ve seen implied in some comments that technologically advanced westerners managed to conquer the “inferior” native people because they were smarter. More likely, they just were lucky.
I love when people try to use “look at all the notable people that lived to…” That is specious on several levels, because the notable people typically had more resources at their disposal. You don’t see people saying, “look at how long that peasant Fishsmeller Barnaby lived” because clearly he wasn’t recorded.
People often examine the famous or notable. Let’s look at, for instance, George Washington. Well, of course, you can’t extrapolate off one person… so widen the net to his family. I just yanked these from a single bio, but I tried to validate the ages.
(Sibling) Able Pontomiac(SP?) Washington – (born & died 1716?)
(Sibling) Mildred – (1739-1740) baby
(Sibling) Jane Washington, II – (1722-1735) 12 ish
(Dad’s 1st Wife) JB died at 30
Married Anne — had several children (at least 4), all died in childhood
(Sibling) Demitrius Lawrence – (1718-1752) 34ish TB
(Sibling) Augustine, Jr. – (1720-1762) 40ish
(Sibling) John Augustine – (1736-1787) 50
(Sibling) Samuel – (1734-1781) 47ish
(Mom) MB – Dad’s second wife, George’s mom, 49
(Dad) Aug lived to 49
(Sibling) Charles – (1738-1799) 50 ish
(Sibling ) George – (1732-1799) almost 70
(Sibling) Betty – (1733-1797) 70ish
So, the mean age would be between 34-40. Of the 17 easily found in the bio, 8 didn’t survive adolescence. Only three of the 17 made it past 50 years old.
So, if you want to ask about famous people, then ask about Mildred Washington, the poet that never was, or Demitrius who died of a disease that we can easily diagnose and CURE! Or ask about Jane Washington, who was three years younger than Anne Frank.
So, the stats that people died younger then seem accurate. It’s clear that many would have lived much longer today, given nutrition, pre-natal care, competent ob-gyn care, anti-biotics, vaccinations and all the things we take for granted.
It’s even HIGHLY probable Washington himself would have lived much longer had he not been “bled” and given quack-therapy of molasses and the like after being diagnosed with the quinsy (LOL).
I enjoyed the article. I am alive today because of modern medicine (adding to the unscientific poll). Perhaps the following can add to the premise of Dr Tuteurs article that abandoning modern medicine for the romantic notion of how we used to be healthier would be disastrous.
Elizabeth Arias, Ph.D., Division of Vital Statistics, CDC published the following article,
“Arias E. United States life tables, 2004.” National vital statistics reports; vol 56 no 9. Hyattsville, MD: National Center for Health Statistics. 2007.,
WWW URL reference
which is an analysis of US Census data, and Medicare data for extraction of Vital Statistics, including survivorship curves, life tables, and simple life expectancy. The advantage of survivorship curves and life tables is the demonstration of mortality as a function of age. The survivor curve that I would call attention to is Figure 3. This is a plot of percent surviving by age, with different curves representing census data from 1900-1902, 1949-1951, and 2004 (which includes medicare data). The following is a quote from the discussion of Figure 3,
“The survival curve for 1900–1902 shows a rapid decline in survival in the first few years of life and a relatively steady decline thereafter. In contrast, the survival curve for 2004 is nearly flat until about age 50 after which the decline in survival becomes more rapid. Improvements in survival between 1900–1902 and 1949–1951 occurred at all ages, although the largest improvements were among the younger population. Between 1949–1951 and 2004, improvements occurred primarily for the older population.”
This population data only covers recent time frames, and only in the United States. However, this would be the time frame and location in which we might expect to see an effect of modern medicine on longevity. The discussion in changes in mortality in this time frame focuses on the effect of rates of smoking, mortality due to HIV and accidents (both of which reached epidemic levels during some of this time frame), and reductions in mortality due to heart disease, malignant neoplasms, stroke, COPD, and pneumonia (primarily in the time frame of 2003 and 2004 in which more data from Medicare sources was available. This data agrees with the assertion by Dr Tuteur that modern medicine accounts for a significant fraction of the improvement in life expectancy. Public health measures may account for a significant fraction in improvement between 1900 and 1950, but modern medicine would still have had an effect. The gradual improvement in longevity in the US population has continued since 2004 (National Center for Health Statistics. Health, United States, 2009: With Special Feature on Medical Technology. Hyattsville, MD. 2009.)
These are population statistics that support the assertion that modern medicine has much to do with increases in longevity. It would be hard to come up with an RCT. The use of survival curves and life tables avoids many of the arguments over the meaning of longevity, and the number of people alive at any given time of a certain age group.
An argument based on logic (another component of scientific method, just ask Einstein) is the following formulation.
If we extrapolate the current measured rate of improvement in longevity backward in time, we would end up with an intuitively ridiculous life expectancy of zero somewhere between 1850 and 1750. Therefore, it is safe to assume that the increase in life expectancy is nonlinear, even though we lack reliable population data before 1900. It is safe to surmise that public health measures and modern medicine (as well as changes in population habits) can take credit for the more recent improvement in longevity. Is this now theoretical SBM?
It seems to me there are two CAM fallacies that Dr Amy is trying to kick out of the way here, the “Natural” fallacy and the “Traditional” fallacy.
Unfortunately she doesn’t do a great job, for a couple of reasons.
First, she doesn’t make adequate distinction between “the past” (in the Traditional fallacy) and “nature” (in the Natural fallacy) – and that has been the cause of a lot of the comment on this thread.
Second, she doesn’t grasp what is actually wrong with these fallacies. You don’t need to demonstrate that the past was hell and nature is a bitch in order to demonstrate the illogic of the Natural fallacy and the Traditional fallacy. If the fallacies stand or fall on the basis of whether Dr Amy has demonstrated her extreme assertions here – then they probably stand. But I’m sure any one of her intellectually nimble and nuanced commentators could explain why the Natural fallacy and the Traditional fallacy utilized by CAM advocates are entirely fallacious. Such an explanation would be independent of the facts about hunter-gatherer societies, etc..that people are arguing about in this thread.
“Hmm, I wonder if I’m the only one lucky enough to have never needed life saving medicine”
The closest I’ve gotten is a couple of stitches in my knee when a car kocked me off my motorcycle.
Plonit – “Second, she doesn’t grasp what is actually wrong with these fallacies. You don’t need to demonstrate that the past was hell and nature is a bitch in order to demonstrate the illogic of the Natural fallacy and the Traditional fallacy.”
Agreed. The use of “heaven” and “hell” tends to indicate Dr Tuteur’s just reacting to what is a fundamentally religious idea with her own religious ideas (and her own opposing brand of all good or all bad fundamentalism/ideological rigidity). Also, conflating medicine with pesticides and commercial farming just doesn’t make any sense. It’s another sign that Dr Tuteur is making an ideological argument that’s simply a reaction to an equally ideological argument rather than actually considering reality. It’s being highly simplistic in the face of complexity in exactly the same way that those who promote the Naturalist fallacy are. There are aspects of technology that both support and destroy human health, just as there are aspects of nature and various cultural traditions that both support and destroy human health. It’s a bit like Dr Tuteur thinks nature is the enemy when everything is part of the natural world, including the tools and technologies that humans create (be they health supporting or destructive to human health and happiness).
As a woman, I’m very glad I live in the time I do and I appreciate our technological advances. Does that mean I need to construct a faith in technology to replace a faith in a god? Or reject and fear the natural world of which I’m a part (if only a little temporary blip)? Of course not. I can simply not adopt a religion at all and accept reality for what it is. Replacing one religion with another isn’t freeing oneself from the fallacies of religion, it’s simply rejecting reality for another form of religion that pretends to be reality and not a religion. Science/medicine/technology aren’t gods, or articles of faith, they’re merely tools that us humans use that can be used constructively or destructively and to support health and happiness or create illness and despair.
Dr Tuteur – “Today, advocates of alternative health bemoan the current state of American health, the increasing numbers of obese people, the lack of exercise, the use of medications, the medicalization of childbirth. Yet life expectancy has never been longer, currently 77.7 years in the US.”
Actually, a great deal of “bemoaning the current state of American health” is being done by medical experts and doctors. Once again Dr Tuteur is making it appear as if medicine doesn’t promote exercise and a healthy diet as basic preventative medicine (and that these are the domain of “alternative health” rather than medicine). Medications are just a tool, used properly they’re life enhancing or even life saving, used improperly they cause issues and even be deadly (the results of overuse of antibiotics is an obvious example of this, the pseudoscience promoted by the pharmaceutical industry is another). Obesity is a public health problem and lack of exercise contributes to obesity – it’s simply a rejection of reality to pretend these aren’t social and public health issues. Certainly we should be using SBM to address these issues but to pretend they don’t exist is a rejection of reality for some kind of fantasy world that’s no more realistic than that proposed by alternative medicine. Not only that, it makes the moderate promoters of alternative medicine seem quite sane and realistic in comparison and their claims that SBM is simply about uncritically promoting industry over public health true. If I wanted religion or some kind of simplistic good/evil fantasy world, I’d be into alternative medicine or technofuturism not science and reality-based thinking.
“It seems to me there are two CAM fallacies that Dr Amy is trying to kick out of the way here, the “Natural” fallacy and the “Traditional” fallacy”
No, that’s not what I am trying to do. I’m aiming for something more straightforward. My claim is an empirical claim: in terms of health and longevity, the past was nothing like advocates of “alternative” health imagine.
I drew the analogy to religious fundamentalism because fundamentalists of all stripes tell themselves and each other that they are recreating the past, when that “past” exists only in their imaginations.
In the case of “alternative” health, this is relatively easy to debunk since we have copious historical evidence on death rates, disease incidence, etc.
JMB,
Thanks for the data and the explanations!
Since JMB’s link to the Arias report was apparently left out, I offer it here:
http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf
At least, this is what I came up with on a google search for the title.
Fifi:
“Actually, a great deal of “bemoaning the current state of American health” is being done by medical experts and doctors”
Yet none of them are advocating returning to some mythical “natural” past where everyone was much healthier.
One of the greatest things about modern medicine is that we don’t rest on our laurels. Even though health has been improved dramatically, we recognize that it can be improved even further.
As JMB described above, the greatest successes in medicine have been achieved in preventing and treating the diseases of childhood, and to a lesser extent, the diseases of early and middle adulthood. That has inevitably led to an older population and an increase in the chronic diseases associated with old age.
As the primary causes of death in childhood and early adulthood have been vanquished, it is only appropriate that we turn our focus to the diseases of old age.
Dr Tuteur – Well, to deal with reality there are some MDs who peddle woo that also peddle naturalist fallacies. The point is that, as usual, you’re being ideological and simplistic and giving the impression that real public health issues are simply being fabricated by alt med types rather than being the domain of medicine and public health concerns also advanced by the medical establishment. You’re simply being reactionary in a sloppy and ill considered way and uncritically promoting industrialization rather than actually presenting reality-based thinking or painting a true picture of reality. Or making a lucid, evidence based argument (which would involve presenting evidence in your initial post) for how medicine has improved public health and longevity.
Dr. Tuteur takes quite a strong stand against something she calls “alternative health”, but fails to define it…leaving me wondering what she’s claiming. Is she trying to tell me that when I give my girlfriend a back massage it doesn’t make her back pain better?
Her blanket claim about “alternative health” that “none of it works, absolutely none of it” leaves me to believe that her definition is quite small, since supporting a claim like this seems difficult, if not impossible.
Dr. Tuteur, could you please explain yourself? I’m very interested in this and want to believe you, but your vagueness is leaving me less than impressed!
“but fails to define it”
“Alternative” health refers to theories and treatments that are invoked and used despite a lack of scientific support, and often in the face of scientific evidence that shows that they are untrue or don’t work.
Dr Tuteur – “As JMB described above, the greatest successes in medicine have been achieved in preventing and treating the diseases of childhood, and to a lesser extent, the diseases of early and middle adulthood. That has inevitably led to an older population and an increase in the chronic diseases associated with old age.”
Obesity, diabetes, asthma are all chronic diseases that have nothing to do with aging. Medicine certainly hasn’t been successful in preventing these diseases and industrialization can very reasonably be argued as a contributing factor. In fact, doctors with attitudes such as the one you repeatedly show here have increasingly made basic preventative medicine the realm of alternative medicine. (Fortunately you don’t speak for all doctors nor do you actually represent medicine, you’re usually simply promoting your personal ideological position and resentments under the guise of standing up for SBM.) Considering that the evidence seems to be pointing to viruses playing a key role in many cancers (as well as lifestyle choices, like smoking, in some), your claims that cancer is a result of aging aren’t actually very scientific. Like the people you’re criticising, you’re simply unthinkingly repeating cliche’s you’ve heard.
While the arguments that people promoting paleolithic diets make regarding evolution are rather silly, it’s just as silly to not consider how we evolved and what we naturally need for optimum health when looking at the best ways to stay healthy and happy. It’s like you believe and indulge in the same technology vs nature exclusionary ideology as the people you criticise, you’re simply uncritically taking an oppositional position.
Amy Tuteur on alternative medicine:
“None of it works, absolutely none of it.”
Amy Tuteur’s definition of alternative medicine:
““Alternative” health refers to theories and treatments that are invoked and used despite a lack of scientific support, and often in the face of scientific evidence that shows that they are untrue or don’t work.”
Yes, by defining alternative medicine as medicine that doesn’t work, you can make the sweeping claim that “None of it works, absolutely none of it.”
Which is simply a tautology and doesn’t advance anything. In that case the post would be made much clearer, simpler, tighter — better writing — by deleting all references to alternative medicine. Or by citing a particular example of a proponent of alternative medicine extolling the long and healthy lives of our ancestors, and then demonstrating the fallacies.
I thought this post was going to be a deconstruction of the currently popular “stone-age diet.” I’d have liked that.
Amy,
Actually, quite a few have examined the peer-reviewed, scientific evidence and noted that, when you control for the problems of infectious disease and infant mortality, people on a H-G diet exhibit more robust health and have fewer incidences of heart disease, cancer, and diabetes.
It’s not “looking to some mythical past”–it’s noting that hey, the modern diet doesn’t promote health, longevity, or a good quality of life.
There are, no doubt, some people who argue that people in the past lived to 90, spoke with the voice of gods and could wipe out armies single-handedly. But most of the commenters here challenging your thesis are not these people.
I am happy to admit that modern medicine saves lives, because there are ample scientific reasons to believe it. I am a big fan of modern medicine. I spend quite a bit of my own time railing against acupuncture, chiropractors, etc. My wife is currently expecting, and believe me, we have a great OB–not a midwife.
But I do oppose your assertion that “modern industrial agriculture” promotes health because the evidence stands very strongly against it. I have offered plenty of evidence to support my position on this, from archaeological sources and peer-reviewed research.
It is a mistake in logic to assume that “progress” is some unilateral arrow, and that as some progress is made, all aspects of the culture progress at the same time. We can move forward in some areas, but not in others. The Enlightenment was followed by religious revival in the United States, but science and technology still progressed and life expectancies still increased. I would not take from this evidence that religious revivals improve life expectancies.
Also, it’s just stupid to say life in the past was “hell”. Life in the past was life. Some people would have had good lives, some would have had crappy ones – just like today. Clearly some people in the past in all kinds of societies and cultures enjoyed their lives very much, there are all kinds of records that show this to be true.
Now, I have no desire to hop into a time machine to live in the past and I appreciate how far medicine and scientific knowledge have advanced even in my own lifetime but to assume that all throughout history before now that life was “hell” is just ridiculous! It’s as stupid as all the Garden of Eden fantasies about the past and just as reactionary, religious and fundemantalist (meaning ideological and a result of black/white or good/evil thinking).
Allison,
Ironically, I got interested in the “stone-age diet” for the purpose of debunking it. However, when you go to its origins I noted that it was begun by medical researchers who took the time and trouble to conduct good studies, and published their work in peer-reviewed journals. The fact of the matter is, those guys have really solid science backing them up. I was surprised, but convinced.
My own definition of “alternative medicine,” by the way, is simply “stuff you can do for yourself that doesn’t involve a gatekeeper.”
The absence of a gatekeeper means that this category can contain a whole heaping pile of utter nonsense. There’s no filter. But this definition also includes things like meditation, massage and exercise for managing stress and pain; cranberry juice for UTIs; honey on wounds; prunes for constipation; whiskey or Celestial Seasonings Sleepytime Tea for insomnia. These remedies may or may not be the best possible, but even when they aren’t they are often good enough.
I personally keep goldenseal capsules at home as a topical antibiotic. It’s not that I think it’s better than anything else. It’s that I can have it handy at 8:00 at night when my beloved (who usually heals very slowly) has a dirty cut on his hand, and it’s not greasy and occlusive like drugstore antibiotic creams.
If your definition of alternative medicine is “anything that doesn’t work” — well, of course it doesn’t work. But you need to be clear about that upfront, because other people have other definitions which can interfere with understanding your point.
To continue, and because I’m not working today, here are a few papers for consideration for further reading:
Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study.
Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. Cardiovasc Diabetol. 2009 Jul 16;8:35.
Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.
Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC Jr, Sebastian A.
Eur J Clin Nutr. 2009 Aug;63(8):947-55. Epub 2009 Feb 11.
Effects of a short-term intervention with a paleolithic diet in healthy volunteers.
Osterdahl M, Kocturk T, Koochek A, Wändell PE.
Eur J Clin Nutr. 2008 May;62(5):682-5. Epub 2007 May 16.15.
(These three above are all short term studies, alas, but all of them note lowered triglycerides, increased insulin sensitivity, and other improvements in measures of health from even a short term stint on a H-G type diet.)
A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease.
Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjöström K, Ahrén B.
Diabetologia. 2007 Sep;50(9):1795-807. Epub 2007 Jun 22.
(This one focuses on glucose tolerance for type 2 diabetes patients with ischaemic heart disease and notes that a paleolithic type diet produced better glucose tolerance than a Mediterranean consensus diet.)
And finally, you can check out a very good review article here:
Loren Cordain, S. Boyd Eaton, Anthony Sebastian, Neil Mann, Staffan Lindeberg, Bruce A. Watkins, James H. O’Keefe, Janette Brand Miller. Origins and evolution of the western diet: Health implications for the 21st century. Am J Clin Nutr 2005;81:341-54.
Obviously both extremes are wrong. There are pros and cons about modern life, and their were pros and cons in the past. It is not romanticizing to admit that we have some problems now, or that some things were better in some previous societies. Using average lifespan as the measure of a society’s health is wrong. For one thing, prehistoric lifespans are hard to estimate. And if you do not consider infant mortality, the distribution is extremely skewed.
Infant mortality has been conquered by modern medicine. Normally, it is very high in all species including humans, because (in my opinion) it is one of nature’s mechanisms for keeping species healthy.
Other triumphs of modern medicine were antibiotics and vaccines, and improved diagnostic and surgical technology.
Yes, the average lifespan has dramatically increased, but that does not mean health has improved.
It is not being fanatical or fundamentalist to say that modern Americans tend to be very unhealthy and dependent on medical treatments. This may be partly because a certain percentage of humans have always been weak and vulnerable to disease, because that’s life. But the modern lifestyle is definitely a big factor.
I didn’t read the previous comments so I might be re-stating the obvious which has already been stated. But I just had to contribute because Dr. T always exaggerates the wonderfulness of modern life, and always said everything was horrible before modern medicine and technology. She is a devout futurist, or something. Definitely a devout fundamentalist.
Lifestyle matters. She says people are getting heart disease and cancer only because modern medicine has given them so many additional years of life. Rubbish. People who survived childhood in pre-modern times were likely to get old, and they were NOT likely to get heart disease or cancer.
Dr. T accuses those of us who advocate a healthy lifestyle of romanticizing the past. Some might, but most probably don’t. We are very aware that the past was no garden of Eden. But Dr. T does the opposite and romanticizes the present. We have lots of serious problems now. Your head must be deep in the sand not to see them.
Alex Knapp,
Yes, the whole stone age diet/lifestyle appears quite sensible to me on many levels, though I have only the briefest of exposures to the theory/ philosophy/ whatever it is. Which is why I would have enjoyed seeing what Amy (or any other skeptic) would do with it.
“here are a few papers for consideration for further reading”
Let’s suppose for the sake of argument that the claims advanced in those papers are true. That would mean that the paleolithic diet was good for preventing heart disease and type II diabetes. That would NOT mean that the diet leads to better health since you first have to survive long enough to get heart disease and type II diabetes.
So the best you could say about that diet is that it prevents heart disease and type II diabetes, but it offers no advantage in terms of infectious disease, common medical problems (appendicitis), injuries or virtually anything else.
And for most people during most of human existence, preventing heart disease was irrelevant, since they died long before they could be afflicted with it.
Alison – “But this definition also includes things like meditation, massage and exercise for managing stress and pain; cranberry juice for UTIs; honey on wounds; prunes for constipation; whiskey or Celestial Seasonings Sleepytime Tea for insomnia. These remedies may or may not be the best possible, but even when they aren’t they are often good enough.”
Taking into account that both you and Dr Tutuer are sharing personal meanings regarding the term “alternative medicine”, I think it’s important to note that there’s increasingly sound scientific evidence for meditation and exercise for managing stress and chronic pain. And that theories about neuroplasticity are grounded in neuroscience, so I don’t see these as being outside of medicine or “alternative medicine” at this point. That said, meditation for pain management certainly started out as “alternative medicine” and was viewed with suspicion (and still is by some reactionary types) and neurplasticity was denied by “modern medicine” for quite a long time. (|The advent of the MRI radically changed our scientific understanding of the brain.) Prunes are certainly a traditional cure for constipation – and generally pretty effective – but they do get prescribed by doctors too!
One reason why I question the highly reactionary positions of someone like Dr Tuteur who rails against some undefined and vague Other such as “alternative medicine” in such a simplistic and ideological way is that grand claims are made about areas where we still don’t have a complete understanding. (And areas where Dr Tuteur is quite obviously not an expert herself, she quite often proposes quite old fashioned and reactionary ideas that aren’t supported by contemporary scientific understandings or that don’t take into account complexity and the limits of current knowledge. The end result is that she very often resembles the very ideologues and promoters of pseudoscience that she’s berating!)
Dr Tuteur – “That would NOT mean that the diet leads to better health since you first have to survive long enough to get heart disease and type II diabetes.”
That’s just silly and once again you’re ignoring reality and scientific consensus that obesity and Type II diabetes are not only diseases of aging but becoming an issue for children and young adults as well. You’re so reactionary and ideological that you’ll even argue against a healthy diet and exercise as important for preventative health! While I have no interest in eating a paleolithic diet personally, I’m quite willing to accept that it may be a healthy diet if it’s scientifically proven to be so. You seem so wrapped up ina an ideological position that you’ll even argue against evidence before you’ve even looked at the evidence!!! This is what makes it clear that you’re using SBM as a soapbox and to try to legitimize a personal agenda and are not actually a champion of SBM and reality-based thinking or trying to educate the public about SBM.
Amy Tuteur on better health:
“That would mean that the paleolithic diet was good for preventing heart disease and type II diabetes. That would NOT mean that the diet leads to better health since you first have to survive long enough to get heart disease and type II diabetes.”
I don’t understand. Are you proposing that a paleolithic diet kills people before they get heart disease and type II diabetes? According to Wikipedia, “the ‘contemporary’ Paleolithic diet consists mainly of meat, fish, vegetables, fruit, roots, and nuts; and excludes grains, legumes, dairy products, salt, refined sugar, and processed oils.” What part of the contemporary paleolithic diet do you believe kills people young?
Or do you have a private definition of “paleolithic diet” that excludes modern medicine and obstetric care?
Fifi on alternative medicine:
“Taking into account that both you and Dr Tutuer are sharing personal meanings regarding the term “alternative medicine”, I think it’s important to note that there’s increasingly sound scientific evidence for meditation and exercise for managing stress and chronic pain.”
Yes, I was assuming we all knew that. Do I need to be more careful? Have I inadvertently stepped into an area of controversy? I’m sorry, I didn’t mean to: my ignorance is showing again.
In any case, the premise of sound scientific evidence was my premise for my two groups of health care without gatekeepers: one that is utter nonsense, and another that is not utter nonsense and that may or may not be the best approach to the problem at hand. The “not utter nonsense” category by definition has at least some degree of scientific support. (Note that it may have a lot of scientific support and that the vague descriptor “may or may not be the best” includes “may be the best.”)
Alison – Oh, I just don’t assume that we all know about the scientific evidence for meditation and exercise (and often find it’s necessary to clarify that these are part of medicine as well as being promoted by “alternative medicine”). Dr Tuteur seems to have a prejudice against non-pharmaceutical or surgical treatments and, for some strange reason exercise and a healthy diet. Plus a lot of people don’t seem to have a very good grasp of neuroplasticity or cognitive science so I tend to leap in to stick up for these as being useful for chronic pain management and some forms of mental disorders since they do get denigrated even by doctors who are stuck in very old fashioned and simplistic understandings of chronic pain and neurobiology. Sorry about that and thanks for clarifying
Dr Tuteur – “And for most people during most of human existence, preventing heart disease was irrelevant, since they died long before they could be afflicted with it.”
That assertion is not only irrelevant but actually works against you because the other poster is talking about contemporary humans eating a paleolithic diet and preventing heart disease is very relevant since we do live longer! He presented contemporary studies and didn’t simply make grand (and often inaccurate) assertions about the past like you’ve been doing. He’s even saying he’s a big supporter of SBM (as am I). Seriously, you’re not even arguing from basic logic, science or interest in contemporay human health anymore but from a purely reactionary and non-evidence based prejudice against a paleolithic diet and all kinds of things you lump in together willynilly.
Amy says:
So the best you could say about that diet is that it prevents heart disease and type II diabetes, but it offers no advantage in terms of infectious disease, common medical problems (appendicitis), injuries or virtually anything else.
—————————————————-
The scientific community says:
http://www.emedmag.com/html/pre/gic/consults/101504.asp
The decline of appendicitis cases in the United States since the 1930s has led some to suggest that dietary fiber or household hygiene is important in the pathogenesis of appendicitis. According to the “fiber hypothesis,” fecaliths develop more readily in people who consume a diet deficient in fiber, because their stools are more tenacious. Societies with high fiber intake (Asia, India, Africa) have less than one-tenth the incidence of appendicitis compared with locations where fiber intake is lower (Europe, North America). A high-fiber diet speeds stool transit times, reduces fecal viscosity, and inhibits fecalith formation.
WIKI
Several studies offer evidence that a low fiber intake is involved in the pathogenesis of appendicitis[14] [15][16]. This is in accordance with the occurrence of a right sided fecal reservoir and the fact that dietary fiber reduces transit time[17].
http://cat.inist.fr/?aModele=afficheN&cpsidt=1424025
This study gives evidence that low fiber intake could play an important role in the pathogenesis of appendicitis
——————————-
Is this science based medicine or make stuff up medicine?
@Alison –
You’re misrepresenting what Dr. Tuteur said, either that or you stopped reading after the sentence you quoted becuase she also said:
So the best you could say about that diet is that it prevents heart disease and type II diabetes, but it offers no advantage in terms of infectious disease, common medical problems (appendicitis), injuries or virtually anything else.
And for most people during most of human existence, preventing heart disease was irrelevant, since they died long before they could be afflicted with it.
I read her comment and I didn’t read it the way you interperted it. I don’t see her as saying that the diet kills people. I see her as saying that , even if the diet eaten in paletolithic time was the ideal diet for no heart disease, etc it didn’t help protect the paleolithic people from sucummbing from non-dietary related illnesses and accidents that shortened the lifespan because of the paleolithic people did not have the medical knowledge and medicine to treat or cure those illnesses and accidents.
Which makes sense for her to point out because there are a lot of people who believe in alternative “natural” healing that argue that not only is the paleolithic diet far superior to our modern diet but the paleolithich and “traditional” treatments and use of herbs, plants, and folk healing is far superior to science-based modern medicine.
I know I’ve seen blogs and websites where people will say they don’t believe in or use allopathic medicine and only use natural herbs, plants and traditional remedies that have been used for 1000s of years because it’s far superior to “allopathic” and modern medicine.
As per Fifi’s point above, if it turns out that
A) there is something that it makes sense to call a “paleolithic diet,” and
B) that it coincidentally is associated with lower rates of heart disease in people who have access to modern medicine, then
C) a plausible hypothesis would be that evolution preferentially selected for paleolithic humans who had lower rates of heart disease when eating the diet available to them.
If evolution selected paleolithic people for lower rates of heart disease, that suggests that enough of them were living long enough that heart disease mattered.
One hypothesis to explain high rates of heart disease in aboriginal Canadians today is that they are not adapted to a grain-based diet. If evolution was able to select for resistance to heart disease in grain-based cultures over the past 10,000 years, it suggests that enough of us were living long enough that selection pressure to resist heart disease was acting very quickly.
These are a lot of ifs — speculative! But it will be interesting to see where the lines of evidence end up pointing, either way.
Amy,
I beg to differ. See the following studies:
Apparent absence of stroke and ischaemic heart disease in a traditional Melanesian island: a clinical study in Kitava. Lindeberg S, Lundh B. J Intern Med. 1993 Mar;233(3):269-75
Age relations of cardiovascular risk factors in a traditional Melanesian society: the Kitava Study. Lindeberg S, Berntorp E, Nilsson-Ehle P, Terént A, Vessby B. Am J Clin Nutr. 1997 Oct;66(4):845-52.
Low serum insulin in traditional Pacific Islanders–the Kitava Study. Lindeberg S, Eliasson M, Lindahl B, Ahrén B. Metabolism. 1999 Oct;48(10):1216-9.
The Kitavans of Paupa New Guinea provide an interesting counterpoint to your claims. There are low rates of infectious disease (because they’re an isolated population) and they follow a hunter-gatherer diet as they are non-agricultural (although, of course, that’s changing.)
Overall life expectancy of the Kitavans is 45 (because like most populations without access to modern obstetrics, infant mortality is high)–which the U.S. did not match about 1900. HOWEVER, life expectancy at age 50 is 75–which the U.S. did not match until 1980– and a signficant portion of the population reaches that age. Among elderly Kitavans, incidence of heart disease, diabetes, and dementia are incredibly low.
That’s without access to modern medicine, obstetrics, etc. Because they’re an isolated population that experiences little infectious disease, they provide a nice control for what a H-G diet looks like when you control for infectious disease. The result are very healthy people who live a long time if they survive childhood.
Now, combine knowledge of this diet with modern medicine and place it in a modern context, and it appears we have an extraordinary way to improve health.
Finally, Amy, one quick question for you. According to my review of the literature, diabetes and heart disease are primarily caused by diet. What is your evidence that they are merely the products of age apart from mere correlation to incidence within age groups in the United States?
Sid,
I’m still waiting for you to provide the statistics that show smallpox disappeared spontaneously and not as a result of vaccination.
“C) a plausible hypothesis would be that evolution preferentially selected for paleolithic humans who had lower rates of heart disease when eating the diet available to them.”
Evolution does not select for anything. Evolution is the result of reproductive success of individuals fittest for the particular environment in which they live. There is no evidence that the Paleolithic diet was the “best” diet; it was the only diet.
I also want to point out that I’ve seen people romanticize the past and how much healthier everyone ate and how much better and simpler life was and they aren’t talking about hunter-gatherer’s they are talking about people living in the US in the 1800s.
I would agree that saying these folks have a “religious-fervor” is a fine metaphor, but this fundamentalist comparison is a bit sloppy. The things you list are elements of some fundamentalists, but are hardly the essential elements of fundamentalism. Fundamentalists really require that infallible source text for them to reinterpret strictly. It’s the only thing the various fundamentalist groups have in common.
I really don’t get the either/or mentality on this post.
Epidemiologists generally agree that communicable diseases were already decreasing when vax were invented. Better living conditions, nutrition, sociable justice and sanitation were instrumental in this. Would this trend have continued without vaccines? Of course not, and to claim so is just folly.
But I am surprised to see the difficulty people have with he concept that good health is multi-factorial and generally can be reduced to s single reason.
lillym,
I take your point, but Amy was responding to Alex. Alex was saying that there’s no evidence that modern agriculture provides a healthier diet. (Amy had pointed to the twin pillars of modern agriculture and modern medicine as being the basis of modern health and longevity.) Agriculture provides concentrated abundance, and therefore can support a larger population, but the grain-based diets of agriculture are not necessarily healthier. (Alex seems to distinguish between modern agriculture producing nutrient-deficient food vs ancient agriculture that produced nutrient-dense food, a distinction I am hesitant to make.) His proposal is that we are healthy and long-lived today because we have access to modern medicine, not because we eat grain.
Amy’s response was that it doesn’t matter if a paleolithic diet prevents chronic disease because nobody eating it could live long enough to get chronic disease anyway.
What Amy may have meant was that even if a paleolithic-style diet protects against chronic disease in post-industrial societies, it did not do so in paleolithic societies because everyone died before chronic disease could have affected them anyway.
Or she possibly was thinking vaguely and conflated “paleolithic diet” with “medicine-free paleolithic lifestyle.” I can’t tell.
However, neither what she said nor what she may have meant make sense as a response to Alex.
In addition, if Alex’s thesis is correct, that would be a strand of evidence in the direction that in fact we did live long enough that resistance to chronic disease would have beneficial. So his thesis is not irrelevant to Amy’s contention that everyone died young before modern agriculture and medicine.
lillym – I agree that romanticising the past and nature is silly. So is romanticising the present or near past and science and industry. Neither is actually dealing with reality or real world complexity, and neither is SBM.
Alison Cummins:
“C) a plausible hypothesis would be that evolution preferentially selected for paleolithic humans who had lower rates of heart disease when eating the diet available to them.”
Amy Tuteur:
Evolution does not select for anything.
Excellent point. Thank you for the correction.
Evolution is the result of reproductive success of individuals fittest for the particular environment in which they live. There is no evidence that the Paleolithic diet was the “best” diet; it was the only diet.
That is absolutely correct, but it does not address what I said.
In a population of humans eating the only diet available to them over the course of, say, 100,000 years, heart disease will exert selection pressure to eliminate genes for susceptibility to heart disease under those particular conditions from the gene pool only if
1) people can live long enough to get heart disease under those conditions anyway, and
2) people who are resistant to heart disease have more grandchildren.
There are various strands of evidence that suggest this could be exactly what happened.
If this is what happened, that suggests that a not-insignificant proportion of the population got old, and that old people were genetically fit — that is, that they contributed to the survival of their relatives and the reproduction of their genes.
Unfortunately Dr Tuteur seems to wantonly ignore whole fields of medical science and likes to make grand proclamations about fields of medicine that are outside of her specialty as an OB/GYN. It’s like epigenetics, sports medicine, cognitive science, pain medicine, evolutionary biology, environmental health and so on simply don’t exist to Dr Tuteur. While I find alt medicine claims about “tradition” as being some form of proof silly, I also find it quite entertaining that Dr Tuteur herself seems unable to move beyond certain traditional medical beliefs that contemporary medical science doesn’t subscribe to and is actually quite reactionary in her beliefs rather than curious about contemporary science and new discoveries.
>I agree that romanticising the past and nature is silly. So is romanticising the present or near past and science and industry. Neither is actually dealing with reality or real world complexity, and neither is SBM.
Dr. T sees everything as either this extreme or that extreme, but life is complicated. She has a religious fervor about the wonders of modern science and medicine. Ok, that’s fine, we all like our modern advantages. But that doesn’t mean we have to be religious zealots about it. We should be able to acknowledge the disadvantages of our technology — for example, the average American doesn’t have the time or energy for physical exercise. This is an extremely serious problem.
Science really does not understand exactly how and why physical exercise helps to keep us healthy. When Dr. T refuses to even consider that our modern lifestyle may have some drawbacks, it becomes obvious that she has little or no interest in reality.
“If this is what happened, that suggests that a not-insignificant proportion of the population got old, and that old people were genetically fit — that is, that they contributed to the survival of their relatives and the reproduction of their genes.”
That’s a giant if. Moreover, it is predicated on the unquestioned assumption that the amount of food available was adequate. Consider that type 2 diabetes is often associated with obesity. HG individuals were not obese. That’s not because their diet was so fabulous. It’s because they barely had enough to eat and sometimes starved.
One of the strawmen often used against a “paleo” or “stone age” diet / lifestyle is that it’s living a fantasy.
That’s exactly true. It’s merely a mythology we employ to in some important ways hopefully fool our genes into keeping us healthy through modeling some of the things we’re evolutionarily adapted to.
Some of us were recently featured in Der Spiegel.
http://www.spiegel.de/international/zeitgeist/0,1518,677121,00.html
I must say that it has worked wonders for me, and here’s the photos:
http://freetheanimal.com/2009/09/interim-progress-update.html
In addition to the weight loss from 235 to 175 so far, I’m off the allergy meds I was on since I was a teenager, GURD meds, and without meds I brought my average BP from 150-160 / 95-105 to normal ranges.
It’s really quite simple:
1. Real Food only (meat, fish, fowl, natural fats, veggies, fruits, nuts). Especially: eliminate flour, sugar, vegetable & seed oils.
2. Go hungry sometimes. I fasted twice per week while losing the weight and now I do it once per week, 18-30 hours, typically.
3. Work out briefly but intensely and explosively, and do it hungry.
4. Play often, and gets lots of sleep.
It has also worked wonders for my parents, my mom getting off insulin as a T2 and my dad getting off about 6 meds now, including BP meds he’d been on for 30 years.
http://freetheanimal.com/2010/02/real-results-dad.html
Lizkat said,
“When Dr. T refuses to even consider that our modern lifestyle may have some drawbacks”
To my knowledge, Dr. Tuteur has NEVER “refused to even consider that our modern lifestyle may have some drawbacks.” What on earth gave lizkat that idea?
Lizkat and certain other commenters persist in distorting Dr. Tuteur’s words and criticizing her for things she never said. I don’t understand why.
Lizkat says one of the “disadvantages of our technology” is that “the average American doesn’t have the time or energy for physical exercise.” I don’t think that is true, and she does not offer any substantiating evidence. Technology has given us more leisure time and I’m not sure how it would affect our “energy.” If Dr. Tuteur had said something like that, she would have been challenged to prove it and accused of merely spouting a personal opinion, having a fundamentalist bias against technology, and not being science-based.
Can you see the double standard? Lizkat and others are doing exactly the kind of thing they criticize Dr. Tuteur for.
To all those who write as if you had some personal vendetta against Dr. Tuteur: it is possible to discuss the content of the writing without saying derogatory things about the writer. Please try. This is not the first time I have asked.
Amy,
In some historical H-G populations, this is true. However, this is not the case among modern-hunter gatherer groups.
See e.g. Cordain L, Brand Miller J, Eaton SB, Mann N, Holt SHA, Speth JD. Plant to animal subsistence ratios and macronutrient energy estimations in world wide hunter-gatherer diets. Am J Clin Nutr 2000, 71:682-92
The study above reviews the food-intake over over 250 modern hunter-gather tribes and examines their macronutrients. The mean intake of calories in these groups is around 2800-3200 calories.
Despite this, incidence of obesity is much less common than among similar population groups eating a modern western diet.
Amy Tuteur on the relationship of evolution and the paleolithic diet:
“That’s a giant if.”
That’s correct, it is. Which is why I framed it as a “plausible hypothesis” and not “paleoanthropological fact.”
I don’t know whether that’s what happened. My point is that if a “paleolithic diet” has benefits to post-industrial folks (a hypothesis you told Alex you were willing to entertain) that is not irrelevant to your thesis that pre-industrial lives were uniformly short, or to your other statement (if I understood correctly) that mothers who survive into the adolescence of their children are no more genetically fit than mothers who die in childbirth, as long as the baby gets born alive.
Harriet Hall: “[I]t is possible to discuss the content of the writing without saying derogatory things about the writer.”
In other words: “Do like I say, not like I do.”
or
“The Kettle and I are mearely a darkish gray.”
Oops
meant to type “merely”
Alex Knapp:
“In some historical H-G populations, this is true. However, this is not the case among modern-hunter gatherer groups.”
So this “healthy” diet that “we evolved to eat” is responsible for the fact that hunter gathers have spread to every corner of the globe and now number in the billions. Oh, wait. That would be the farmers. The hunter gathers only exist in tiny, isolated populations that will soon be extinct.
So much for the evolutionary advantage of the hunter gatherer diet: it has led to the near extinction of the hunter gatherers.
Might I suggest an improvement to sbm’s format? Create a new category entitled “opinion pieces” for posts that contain no reference citations.
wales:
I like that proposal. Very much.
[Lizkat says one of the “disadvantages of our technology” is that “the average American doesn’t have the time or energy for physical exercise.” I don’t think that is true, and she does not offer any substantiating evidence. Technology has given us more leisure time and I’m not sure how it would affect our “energy.”]
Well you’re out of touch with average Americans then. Most work long hours, women with young children often have to work. Americans — many of them — drive everywhere instead of walking or bicycling. Have you tried bicycling on suburban streets lately? I do it, but it’s scary, because drivers do not watch for bicyclists or pedestrians, in general.
Technology freed us from having to walk or do physical labor. I don’t know if we have more free time now. It depends on what culture you are comparing to. And for prehistoric cultures, we really don’t know, and it probably varied greatly.
At least some of the primitive tribes studied in the early 20th century worked much less than we do. But factory workers in the early industrial age (and in some developing nations now) had no free time at all.
Harriet, it is very true that Dr. T consistently minimizes the importance of lifestyle. She repeatedly says that cancer and heart disease are normal diseases of aging. In other words, we will get them regardless of lifestyle. In her opinion, stone age people would have had cancer and heart disease if they didn’t die so young (ad she steadfastly ignores the infant mortality factor).
She always comes down on one side of any controversy she writes about. She is always opposed to people who advocate anything “natural.”
Living in accordance with the nature we evolved with — to some degree anyway — requires conscious effort. After you have spent 8 hours at the office and 2 hours in your car, you have to deliberately and consciously make time for physical exercise. I can understand why most Americans don’t do it.
I exercise every day and it requires discipline and planning. It is no longer a normal part of life, for most of us.
[That both cancer and heart disease are among the primary causes of death today represents a victory, not a defeat. Diseases of old age can become primary causes of death only when diseases of infancy and childhood are vanquished, and that is precisely what has happened.]
She always says this. Cancer and heart disease are a victory! So why are there non-Westernized cultures where these “old age” diseases are rare, even among the old? And why are relatively young people getting these diseases in Westernized cultures?
“So much for the evolutionary advantage of the hunter gatherer diet: it has led to the near extinction of the hunter gatherers.”
As you have said before, there is no such thing as an evolutionary advantage of a hunter-gatherer diet.
I don’t think anyone has disputed that agriculture can support a larger population than hunting and gathering. Food can be cultivated more intensively, grain can be stored, babies can be weaned earlier.
The premise of the paleolithic diet is not that it offered anyone an evolutionary advantage. That’s exactly wrong. The premise is that for… 200,000? years, people who did well on it were more genetically fit because that’s all there was.
And the question RE agriculture is whether the people who are the most genetically fit on a paleolithic diet are the same individuals who are most genetically fit on a grain-based diet.
The suggestion is that they aren’t the same. And that most of us are still stuck with a lot of paleolithic genes.
(Individuals from cultures with 10,000 years of grain-eating are less susceptible to diet-related chronic disease on a grain-based diet than are individuals from cultures who switched to a grain-based diet only recently, so there appears to have been some evolution in grain-eating populations.) (That is, if the whole paleolithic diet thesis is correct.)
“The premise is that for… 200,000? years, people who did well on it were more genetically fit because that’s all there was.”
They can’t be “more genetically fit” if that’s all there was. There’s no selection pressure if there are not at least two choices to select between.
The choice is between being resistant to heart disease on a given diet or not being resistant to heart disease on the same diet.
Might I suggest that you learn what a blog is?
… well, it could be other things as well. Resistant to iron-deficiency anemia on that diet. Resistant to starvation on that diet. Resistant to… whatever. If the diet is the same, people who are healthy when they eat it are more genetically fit than people who are not healthy when they eat it.
I feel the spirit of Dr. T’s post is intact, despite whatever complaints the usual suspects seem to have with whatever it is they complain about. Here’s why:
The claim is that (in regards to paleo diet)
a) People of yesteryear ate “better” as per their reliance on natural foods; and
b) Avoided diseases as a result of that; and
c) We should return to that to gain similar benefits
Fantastic! Which cavemen? Which part of the world? The leaders? The grunts? The women? The children? During ice ages? During warm spells? Within forests? On the plains? In the mountains? During the summer? In conjunction with extreme fasting? Should we all, as a result, abide by some singular cavemen regiment? Relying on the meager evidence of the distant past to guide our actions is a fruitless exercise that is overly romanticized; the “spirit” of the post.
It additionally becomes enormously absurd because all of the things that various charlatans and CAM foodies say are necessary for health would have been exclusive to a particular region and particularly impossible for any one group or individual to acquire anyway. Further, no one could get green tea, acai berry, seaweed, tomatoes, pomegranates, fish, raw cocoa, quinoa and almonds all in the same area.
Shall we discuss what actually *is* the best for a modern human (based on research…maybe) and forget what *may* have benefited any random segment of cavemen? I very much enjoy this blog, it becomes exceedingly tedious to keep up with the good nuggets of info amongst the various squabbles.
Can anyone say, “food low in saturated fat, salt, sugar and high in unsaturated fat, lean protein, fiber, vitamins and minerals?” Have we ever heard/found/seen/read that something to the contrary might be better?
“The choice is between being resistant to heart disease on a given diet or not being resistant to heart disease on the same diet.”
Only if it confers an evolutionary advantage and you’ve not demonstrated that it does.
The thrust of your argument is the naturalistic fallacy: because we ate X in nature, then X must be the best thing to eat.
Human beings and their ancestors have been around for millions of years, and for most of that time, they did not eat meat. At some point, they became skilled hunters and were able to obtain meat. This conferred a tremendous advantage because it provided a more nutrient rich food source. It didn’t matter that the ancestors of the first meat eaters didn’t eat meat. It was beneficial for the new meat eaters anyway.
Similarly, for most of human existence, meat was not cooked. Yet with the ability to master fire came the ability to cook meat and release even more nutrients. It did not matter that the ancestors of those who cooked meat had not done so. The cooked meat was still more nutritious and that nutrition could be accessed by the first people who cooked meat.
The hunter gatherer culture has been a dismal failure compared to the farming culture. It doesn’t matter that we were originally hunter gatherers. Farming conferred a tremendous advantage.
What exists in nature is what exists in nature. It is not the “best” or the “healthiest” or what “we evolved” to eat. It is simply what was available.
For example, if there is a population who lives on nothing but McDonald’s food for the next 10,000 years and then their children suddenly started eating a high-fibre, low-fat diet, I would expect to see a huge crisis in volvulus and diseases related to cholesterol deficiency.
That wouldn’t make McDonald’s “superior.” It would just mean that those people would probably be happier if they dialled back the fibre and made an effort to include more butter in their diets.
Amy,
That’s because, simply put, farming is easier than hunter-gathering. More food can be produced more quickly, thus supporting larger populations. Those populations were then able to drive out H-Gs from their native territories because they had larger armies, even though H-Gs were generally taller and stronger. (for example, Plains Indians were taller than the Western calvarymen who waged war on them — see http://eh.net/XIIICongress/cd/papers/70PrinceSteckel378.pdf).
I have not disputed the fact that agriculture allows larger populations to be supported. That’s pretty much self-evident. Additionally, agriculture allowed the development of cities and technology. Thus, agricultural societies were able to overcome H-G tribes by virtue of superior weaponry and higher populations. See e.g. “Guns, Germs and Steel” by Jared Diamond.
But the individuals within those larger agricultural populations suffered poorer health than individuals within H, and continued to do so until the advent of modern medicine, as the numerous papers I have cited in this comment threat demonstrate.
So once again I say that the available evidence suggests that we could promote better health by keeping the advantages of modern medicine, while at the same time steering our agricultural industry and diet to one that emulates the macronutrient constitution of a paleolithic diet. I have supported this thesis with numerous peer-reviewed research articles in the fields of nutrition and archeology throughout this thread.
And in all this time, you have yet to provide any support for your thesis that modern industrial agriculture produces superior health outcomes, nor have you supported your thesis that diabetes, heart disease, and cancer are primarily diseases of age. I am willing to review any papers that you provide citation for, but you’ve yet to do so.
EricG:
“Fantastic! Which cavemen? Which part of the world?”
Yes, I agree, that is an important and valid criticism of the paleolithic diet hypothesis.
“But the individuals within those larger agricultural populations suffered poorer health than individuals within H, and continued to do so until the advent of modern medicine”
No, those papers don’t demonstrate that, nor could they. They look at contemporary populations living in isolated areas and their diets might not be representative of the “average” paleolithic diet. Moreover, by any parameter you wish to name, modern Americans are healthier and live longer than individuals in hunter gatherer populations.
Could they live longer still if they adhered to the diet of indigenous hunter gatherers? That’s certainly a possibility, but it has yet to be demonstrated.
EricG:
“Shall we discuss what actually *is* the best for a modern human (based on research…maybe) and forget what *may* have benefited any random segment of cavemen?”
Yes, yes, yes!!!
EricG and Alison:
These are excellent questions, and I’d highly suggest you read Cordain L, Brand Miller J, Eaton SB, Mann N, Holt SHA, Speth JD. Plant to animal subsistence ratios and macronutrient energy estimations in world wide hunter-gatherer diets. Am J Clin Nutr 2000, 71:682-92. This shows that while diets vary broadly among modern H-G cultures, the macronutrient compositions are, in fact, quite similar. All I’m saying is, hey, let’s take a look at those macronutrient compositions and emulate that. We are fortunate that through the advances of science and agricultural techniques that this can mean different things for different people.
A successful “paleo diet,” I think, would be predicated on what it eliminates. We may not know precisely what paleolithic humans were eating, but we have a pretty good idea of what they were not:
refined sugar, especially fructose (wild, ancient fruits weren’t bred for hypersweetness)
grains (especially gluten grains) in any appreciable amounts (just try harvesting enough wild grain to bake a loaf of bread)
industrial vegetable oils high in pro-inflammatory Omega 6 fatty acids
Some ate mostly carnivorous (Masai, Inuit), while others thrived on roots, fish, and coconuts (Kitava, Tokelau). Eat whole foods that don’t require industrial processing or intense agriculture, and you’re eating an essentially paleolithic diet.
Alison Cummins:
“The choice is between being resistant to heart disease on a given diet or not being resistant to heart disease on the same diet.”
Amy Tuteur:
Only if it confers an evolutionary advantage and you’ve not demonstrated that it does.
You’re right. I haven’t.
The evidence that doing well on any particular diet conferred an evolutionary advantage to our ancestors would have to come from several sources, but it would include evidence that we do well on that diet compared to other diets, all else being equal. If we do better on a diet that was available to us for 200,000 years than we do on a variety of other diets, that would be part of the evidence that our bodies adapted to make the most of that diet.
Evidence that our bodies adapted to make the most of that diet would be evidence that doing well on that diet conferred an evolutionary advantage — made individuals more genetically fit — otherwise there would be no adaptation.
What I challenge is your statement that any evidence that a “paleolithic diet” is protective against chronic diseases associated with age (compared to a grain-based diet) is irrelevant to discussions of longevity.
The evidence may or may not be there: I can’t evaluate it. What I challenge is your statement that it’s irrelevant.
Amy,
That’s what some of them did. But not the archaeological papers that I cited. Did you even read them?
Once again, I AM NOT DISPUTING THIS.
I’m getting really tired of repeating myself, here.
I think that modern medicine is amazing. I have a degree in biochemistry. I teach MCAT prep courses to get more doctors into the medical school. I do not dispute, for one minute, that modern medicine has enabled modern Americans to live longer and healthier lives.
Once again, what I take issue with is your so far unproved assumption that modern diets create better health. This despite the fact that I’ve cited quite a bit of peer-reviewed research indicating that populations subsisting on H-G diets had life expectancies that many agricultural societies could not match until the 19th and 20th centuries. Moreover, this research also demonstrates that diet-related illnesses such as heart disease, diabetes, and strokes are lower in incidence among the elderly of H-G groups than the elderly in the United States.
Once again, I refer you to:
Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study.
Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. Cardiovasc Diabetol. 2009 Jul 16;8:35.
Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.
Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC Jr, Sebastian A.
Eur J Clin Nutr. 2009 Aug;63(8):947-55. Epub 2009 Feb 11.
Effects of a short-term intervention with a paleolithic diet in healthy volunteers.
Osterdahl M, Kocturk T, Koochek A, Wändell PE.
Eur J Clin Nutr. 2008 May;62(5):682-5. Epub 2007 May 16.15.
A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjöström K, Ahrén B. Diabetologia. 2007 Sep;50(9):1795-807. Epub 2007 Jun 22.
These papers study both diabetics and healthy, modern people, and show health improvements from following a paleolithic style diet.
I don’t understand why your so resistant to this. There is a ton of research that suggests improved health for modern humans who follow a diet that models the macronutrient composition of H-G tribes. What’s wrong with adapting one’s life to suit in order to pursue superior health outcomes?
Alison,
fairly enough, most of what is contained within the paleo diet is roundly accepted as nutritious food. but nutritious food is nutritious food. it doesn’t matter who ate it, when, why, how, what the alternatives may or may not have been or really…anything beyond the question of what nutrition it provides. Likewise, we can easily eat things not available to all cavemen that provide us with an expanded nutrient repertoire.
the inevitable fallacy then becomes “well, if the ‘paleo diet’ was good for them *and* good for us…maybe blood letting, trephining and human sacrifice are as well…” And yes, people are in fact that stupid.
Amy Tuteur:
“Human beings and their ancestors have been around for millions of years, and for most of that time, they did not eat meat. At some point, they became skilled hunters and were able to obtain meat. This conferred a tremendous advantage because it provided a more nutrient rich food source. It didn’t matter that the ancestors of the first meat eaters didn’t eat meat. It was beneficial for the new meat eaters anyway.”
What evidence do you have that our ancestors did not eat meat? Modern chimpanzees hunt, and 2.5 million years ago early hominids were using stone tools to cut the flesh off the bones of large animals (presumably scavenged).
*** *** ***
It’s true that the greatest evolutionary advantage of humans over other species is our behavioural adaptability. We can survive almost anywhere, on a wide variety of diets. This is absolutely true. But that doesn’t mean the reason that I have lived longer than most people born 50,000 years ago is that I eat bread and they ate meat and roots.
“Might I suggest an improvement to sbm’s format? Create a new category entitled “opinion pieces” for posts that contain no reference citations.”
“Might I suggest that you learn what a blog is?”
I don’t think I’ve ever seen a blog here by any of the other SBM posters without a single outside link or source of information. (Especially despite repeated requests for evidence). I’m sure there are a few, but it’s not the norm that the post is nothing more than someone’s opinion. That, in addition to the endless false dichotomies, is problematic. Dr. Tuteur is certainly unique among the bloggers on SBM.
EricG:
“Shall we discuss what actually *is* the best for a modern human (based on research…maybe) and forget what *may* have benefited any random segment of cavemen?”
Historically speaking, the best way to examine the effects of the paleolithic diet are to look at MODERN human hunter-gatherers and their health. There is a great deal of historical/ anthropological research going on in this area… and Dr. Tuteur ignores all of it. Furthermore, research shows that as these people transition to the western diet (like Native pacific Islanders), they have extremely high rates of obesity, diabetes, and heart disease. And no, it’s not just because all of a sudden they are living longer. I am also waiting with bated breath for a science based response to the point that children are now suffering from obesity and type II diabetes… kind of puts a wrench in Dr. Tuteur’s unique theories.
As much as I hate the “noble savage” myth, I also hate the extremely eurocentric belief that the only people who exist on this planet are exactly like you and me. IOW, *those* people are all dead.
I recommend Michael Pollan’s book “In Defense of Food.” Basically his diet advice (based on a combination of research on diets from all over the world, not just western high fat, high carbs) is “Eat Food. Not too much. Mostly plants.” (Food as opposed to a collection of ingredients you can’t pronounce… like what’s in green ketchup or twinkies).
EricG
the inevitable fallacy then becomes “well, if the ‘paleo diet’ was good for them *and* good for us…maybe blood letting, trephining and human sacrifice are as well…”
Mmm, that one I don’t follow!
Blood letting mostly* wasn’t good for them and human sacrifice was most definitely not good for them. So there’s no reason to conclude that they would be good for us.
Wikipedia says that trephining was good for them if someone had smashed their heads with a club and they needed to let out the blood that pooled under the skull, and we do in fact do it today for similar reasons except that we call it craniotomy.
*Blood letting:
— Good for hemochromatosis.
— Iron-deficiency anemia can be protective against dysentery, as high levels of transferrin sequester iron and make it unavailable to bacteria.
— Enables longevity as high levels of iron lead to oxidative damage (one reason women live longer than men).
Zoe237,
I’ve written quite a number of “opinion” articles without any links to scientific studies. Here are a few of them:
http://www.sciencebasedmedicine.org/?p=3
http://www.sciencebasedmedicine.org/?p=337
http://www.sciencebasedmedicine.org/?p=126
http://www.sciencebasedmedicine.org/?p=123
http://www.sciencebasedmedicine.org/?p=64 (this one was on home births)
I also wrote a piece about the Michael Pollan book that you recommend. Perhaps you missed it.
http://www.sciencebasedmedicine.org/?p=207
I added “a variety of” to Pollan’s recommendation to eat food, not too much, mostly plants. I did not offer any scientific citations to support my addition, and no one complained.
Why is it that people complain so much about Dr. Tuteur but do not complain equally about me? It seems to me that we are being treated differently, and I don’t understand why.
zoe 237
Maybe I should be clearer, but since I primarily agree with you, I am not going to waste my time trying to come to some perfect agreement. but for fun, *no one* on this planet is the same as the humanoids of 200,000 years ago. ready? set!…disagree!
Alison
Again, I should be clearer. All of those things were picked for their lack of modern utility. trephining, while possibly useful in that capacity, has origins in releasing evil spirits.
The point being, because one ancient method might prove to have some benefit, does not mean that all or any other methods do as well (as we all would probably agree on). People arrive at such conclusions erroneously; the point of this post is in fact rejecting that notion. Raw foodists succumb to this fallacy. The anti-shoe people do this. For goodness sakes, acupuncture falls into this category. For every ancient behavior, i’m sure there is a sect of adherents – “preach on about the saving grace of loincloths, brother!”
HH
its because Tuteur “toots” her own horn! get it!? *slaps knee*
you got me…i like her posts. full of piss and vinegar
or she “tuts” her own horn…witch doesn’t make any cents…d’oh
By the by….
Here’s a couple of decent links concerning the life expectancy of HGs, one in the general and the other, Inuit:
http://donmatesz.blogspot.com/2010/02/paleo-life-expectancy.html
http://wholehealthsource.blogspot.com/2008/07/mortality-and-lifespan-of-inuit.html
is anyone still reading comments at this point?
every single medical discovery started as “alternative.” we decide what’s true based on evidence, randomized controlled trials, etc, not by pigeonholing it into an “alternative” or “mainstream” label.
I have read your post on Michael Pollan in the past, Dr. Hall, and enjoyed it. However, if I was already skeptical of the book, I would have not been convinced by the post. And in fact, I have read posters in the past commenting on the lack of citations in a few of your posts. I also thought the Business of Being Born post was well balanced (unlike Dr. T), but lacking in research to back it up. It really comes down to personal preference, I suppose. I’m not going to take anybody’s word for something on a blog (particularly outside their area of expertise) just because they are a doctor or posting on sbm. However, you also avoid making black and white, absolute statements, and tend to look at both sides of an issue fairly, discussing pros and cons of your positions. Your post on acupuncture about two months ago was one of my favorites to date on this website.
Dr. Tuteur also tends to garner hundreds of comments for the simple reason that she actually responds to people and questions. She also (almost never) takes criticism personally, which I like.
EricG
“Maybe I should be clearer, but since I primarily agree with you, I am not going to waste my time trying to come to some perfect agreement. but for fun, *no one* on this planet is the same as the humanoids of 200,000 years ago. ready? set!…disagree!”
Sorry, should have been more clear. I wasn’t necessarily disagreeing with you, because I wasn’t sure what you meant. The quote just reminded me that some people think all H-G are dead or confined to reservations or something. True, they aren’t the same, but if anthropologists are going to look at human life spans throughout history, looking at (fast disappearing) modern day hunter-gatherers is the next best thing, given the relative paucity of data about people from 200,000 years ago.
Of course, my history background just automatically causes me to cringe when I see people imply that there is nothing of value to be learned from history. Of course, I am very familiar with the naturalistic fallacy as well- romanticizing the past- I don’t like either extreme.
EricG:
“Fantastic! Which cavemen? Which part of the world?”
Alison – “Yes, I agree, that is an important and valid criticism of the paleolithic diet hypothesis.”
Agreed. Different populations in different areas had very different diets and different survival challenges so had very different health outcomes. Living in Tahiti or a fertile valley is quite different than living in the arctic, though people survive and thrive in both environments. (Just like different urban environments throughout history had had different heath issues.)
Not only that, different peoples evolved differently due to different evolutionary pressures. This plays out in contemporary health issues in different populations. For instance, African Americans are vulnerable to sickle cell anemia and sensitivity to salt and are prone to hypertension. The first is theorized to be protective against malaria, the second is generally considered to be a result of who survived the slave ships or the African environment (or the African environment, there’s some debate about this). Also, African Americans are more likely to be lactose intolerant than people of Eastern European descent. Things such as whether your grandparents lived through a famine will also have a genetic repercussion. It’s some pretty fascinate stuff that contemporary research has been uncovering vis a vis nutrition and genes and we’re only starting to understand how environmental pressures shape genetic expression.
Now, none of this actualy validates a paleolithic diet but it does reveal that evolution is not meaningless when it comes to nutrition and health.
Also, agricultural societies have a downside. The rapid expansion and rapid population growth tends to result in environmental destruction, which in turn results in civilizations collapsing. It also tends to result in wars and the fostering and spread of disease. (Humans are animals like any other, you put too many of us in close quarters with poor sanitation and it becomes the perfect environment for diseases to incubate and spread between humans and other animals, as well as having detrimental psychlogical effects.) All modes of living have their advantages and disadvantages, to romanticize any of them is creating fantasies that deny reality. Yes, contemporary medicine is generally a good thing but it also has a dark side for humanity as a whole that few of the faithful like to acknowledge.
Rereading Dr. Hall’s post on Michael Pollan’s book, I can see that the comments are almost all negative comments (9 out 11), and one asked for a citation. My suspicion that many skeptics are anti environmentalists is being strengthened…
I think one of the major things to remember is that we have a bad habit of looking at modern hunter-gatherers as an example of how we must have lived back then. This is false for several reasons: First, most of our major diseases that strike hunter-gatherers today came from domestication of animals and spread by cities and long-distance trade; we don’t really know what our own hunter-gatherer ancestors died of in terms of infectious disease. It’s likely that starvation, death by animal attacks, death in childbirth, malaria in tropical regions, and sepsis in wounds were more common than influenza (from pigs and chickens), smallpox (from cattle), or tuberculosis (also cattle).
Second, humans did not abruptly stop evolving 10,000 years ago. Modern hunter-gatherers have spent the whole time we’ve been developing agriculture evolving to their lifestyle and weeding out bad genes. They have had a strong selective pressure to be faster, stronger, and less prone to local diseases. Of course, their isolation left them susceptible to our diseases, and when they eat stuff like milk and sugary snacks they have health problems. But their health tendencies will naturally be different from ours (meaning descendants of farmers, like myself) since they evolved in a different habitat with a different diet, different ecological pressures, and different founding genes to begin with.
Third, we’ve also evolved. It’s important to remember that the switch from hunting and gathering to agriculture was neither overnight, nor cold-turkey. It was a slow, gradual change over hundreds of generations, as we slowly added small, hardy plots to supplement our gathering diet and eventually transitioned. During that time we were evolving too– gaining things like lactose tolerance and improved grain digestion. The reason I dislike the paleolithic diet is because while it may well be ancestral for a person whose ancestors lived in the Pacific Northwest, anyone whose pre-colonialism ancestors lived in a food-producing region has evolved to consume grain. Everyone’s ancestors diets were different. My ancestors were Celtic and Scandinavian; they had a diet based on milk, domesticated cattle, fish, and farming and it’s stupid to think they stopped evolving to their diet as soon as they got cows.
Now, if you really are a descendant of a hunter-gatherer society that had a fully-formed agricultural system thrust on them suddenly and less than 500 years ago, you should absolutely try out a paleolithic diet. You also probably are lactose-intolerant and prone to obesity because your ancestors never gained the genes needed to tolerate modern food. But I know most of the paleolithic diet supporters did NOT descend from those groups; they are well-evolved to eat whole and stone-ground grains, honey, beer and malted grains, fermented everything, vegetable and seed oils, milk, cheese, and yogurt.
“My suspicion that many skeptics are anti environmentalists is being strengthened…”
Funny, I’m in a college class on conservation biology and community ecology, where we are currently learning about the history of the conservation movement and efforts to save biodiversity. The forerunners of every major discovery or advancement in conservation and REAL environmentalism (ie, out in the field actually fighting for it with science to back them up, not buying “eco-friendly” toilet paper) have all been practical, down-to-earth sorts who abhor fundamentalism and all double as professional skeptics.
The thing is, the most important thing in environmentalism is LAND. The unadulterated kind good for lemurs or buffalo or kangaroos or trees. So anything that reduces the amount of land we use for farming is good, unless it’s dumping more dangerous pesticides and fertilizers (including cow manure– it’s also a burden) into the local ecosystems. This includes massive deaths of humans, which obviously doctors don’t like. It does not include organic farming, which is actually a huge problem as it requires more land than modern farming and is still dumping stuff into the ecosystem that doesn’t belong there, like manure.
Read David Quammen’s The Song of the Dodo. He chronicles the history of conservation biology and interviews the people who have made such leaps and bounds to save biodiversity and save our planet from extinction. My favorite was the guy who collected images of the Virgin Mary on food products and had made a name for himself by debunking bogus science claims.
“Rereading Dr. Hall’s post on Michael Pollan’s book, I can see that the comments are almost all negative comments (9 out 11), and one asked for a citation. My suspicion that many skeptics are anti environmentalists is being strengthened…”
I should take that back before somebody else points it out… it’s more like 3 negative, 3 relatively positive, 2 links, one author response, and one questionable. My general impression of skeptics stands, but I’m still learning.
I’ve read a few of the opinion pieces Dr. Hall links to and I haven’t seen any opinions being touted as fact, which really is the problem in this post.
Zoe, there are plenty of skeptics and advocates of science who are environmentalists and fully able to handle complexity – there are just a subset of people who consider themselves skeptics who are really simply reactionary or conflate being scientific with being uncritical of industry, technology or what they quaintly call “modernity”. Of course, considering that we’re in the post-modern era, the “modernists” are actually simply nostalgic for the past and certain traditional “modern” beliefs and cultural modes from a simpler time where they felt more comfortable. Modernism is really pretty quaint and simplistic with it’s doctors advertising cigarettes and “better living through chemistry”. Not that post-modernism doesn’t have its technofetishists as well and dreams of a post-human future that are just as fantastic as modernism’s promises. From my perspective, it would be nice if humans finally just got over the fantasies and started to figure out how to live on the planet as human animals. Learning from some of our past mistakes and actually living in reality might be a good place to start!
Bariosana -
What’s your evidence to support that populations today have improved health from eating grains? If you check several of the studies I’ve cited here, modern, European-descended populations show improved health on diets modeling that of the macronutrient composition of paleolithic tribes.
I will grant you that some populations are lactose tolerant, but that’s an easier evolutionary leap since all human infants produce lactase, and so selection for individuals who continue to produce lactase isn’t much of a leap. (See the Masai, for example.) However, as far as I can determine, this is not true as far as the consumption of cereal grains go. I will grant you that stone-ground, unsifted flours are healthier than modern refined flowers, but archaeological comparisons of health belie the claim that that cereal grain consumption is health-promoting beyond the mere provision of calories. Not to mention studies of modern populations that show health benefits of removing cereal grains from the diet completely.
Zoe237,
I took a quick look at Dr Hall’s post also.
I noted that 2 of the 11 comments were actually cross-reference comments. It’s hard to call those either negative or positive.
1 of the comments was Dr Hall’s own response to the request for a citation.
Of the remaining 8, about half were what I would call discussion or amplification. In other words, they were not really disagreeing with the theme of the blog, but just trying to clarify or point out something that occurred to them. So, perhaps 4 or 5 of the posts actually disagreed with Dr Hall.
Also, I rather liked Dr Hall’s blog because it advocated for (and she commended Pollan’s book for supporting) a more balanced and practical approach to nutrition than we typically see in most special diets.
Unfortunately, balanced, practical and reasonable don’t typically play well in a blog/comment thread.
I commend Eric G for trying.
Wow what a coincidence. The average age for diaper-wearers is also 35.
Tons of 0 year old diaper wearers + some 80 and 90 year old ones = average age of 35.
Sounds absurd but it’s the same argument used in the article.
After reading more of your comments Amy, I have to question your logic.
You say farmers have been a grand success over hunter-gatherers, but that has happened over such a short period of time (10,000 years or less) how can you consider that an evolutionary process? Our genes evolved over millions of years, not the 10,000 years that power hungry leaders have used farming to control the entire world in a very short time.
That’s like saying if zero-point energy was invented tomorrow and the creators ate mainly Twinkies, and were able to use their resources to take over the world within several decades, that now Twinkies are the ideal food because the zero-pointers have been such a grand success.
“Zoe237,
I took a quick look at Dr Hall’s post also.
I noted that 2 of the 11 comments were actually cross-reference comments. It’s hard to call those either negative or positive.
1 of the comments was Dr Hall’s own response to the request for a citation.”
Squirrelelite, I already took back my post, 3 comments up from yours, after reading more carefully. My bad!
Much of the discussion on this thread (and several of Dr Amy’s other posts) has amounted to disagreements on the relative importance of quantitative factors such as population size, life expectancy, and longevity versus more subjective/evaluative factors such as quality of life and overall population healthiness as a measure of value or success.
Although the statistical basis for these quantitative measures is somewhat limited and uncertain before the last 2 or 3 hundred years, we can at least make an informed estimate for earlier times and compare those.
When we move to measures like quality of life, the data to support those measures becomes more limited and dubious. This may be a bit of an argument from ignorance, but I don’t know how we can repeatably and reliably define the relative quality of sitting around a campfire listening to the tribal elders sing songs and tell stories versus reading a book by candlelight or entertaining (?!) your friends by playing a tune on a piano versus reading a book by electric light and listening to music on or even watching a movie on a digital music player.
However, because we are arguably the most successful species in the last several hundred million years at adapting to and exploiting our environment, we have survived and expanded from a population of only a few thousand living in a small corner of Africa to a population of several billion living or at least surviving in practically every environment on this planet and even off of it.
As a result, we can no longer rely on mere biological or evolutionary pressures to guide us in some “right” direction.
Thus, a major issue for all peoples in all countries for the 21st century is going to be defining and choosing quality of life as well as sheer longevity and trying to find an optimum or at least sustainable balance between quality and quantity.
And, I don’t think that arguments that “that’s the way we’ve been doing it for thousands of years” (the traditional fallacy) or “nature and evolution guided us to do this so it must be best” (the natural fallacy) will be particularly useful in making that choice.
It’s OK, Zoe237.
I’m new to the Science Based Medicine site. For the most part I have found the blogs posted on this site to be extremely informative–I currently work at a Planned Parenthood as a reproductive health assistant but don’t have a “real” medical background; for the most part, I approach the site as a layman skeptic. Normally, I just check-out the blogs to heighten my limited medical knowledge, find good arguments against quackery—which sadly many people I care about deeply engage in—and because I find a lot of comments interesting and fun. I never really thought I would ever ended up posting anything.
However, after reading Dr. Amy Tuteur post, and the numerous comments following it, I feel somewhat obligated to speak up. I think it is very important for those who carry the flag or reason, skepticism, and science to ensure that they don’t fall into the same rhetorical pitfalls and generally confused thinking that we purpose to be against. The post by Dr. Tuteur I found a bit upsetting because it seemed to duplicate many of the things that we are supposing against. Specifically, there are three rhetorical mishaps that weakens her case.
First is the use of generalizations. Dr. Amy Tuteur refers often to alternative health without really describing what she is talking about or who she is addressing. The phrase “alternative health” covers a lot of things—some of them are science-based and some are not. I thought the whole point of saying that we were using science-based medicine is to break out of the false dichotomy of alternative vs conventional health. Working in an abortion clinic, and talking to the doctors there, I find many examples of wide spread “conventional” health practices—like the practice of some doctors of requiring women to have a pap smear before prescribing them birth control or telling women who are over 26 years old that they are “too old” for for the HPV vaccine even though they have only just recently decided to become sexually active—that are not based in science, common sense, or even care. Science based medicine, as I understand it—is not concern who practicing, but what they are practicing. It doesn’t matter if it is conventional wisdom or alternative wisdom—it just matters if it is wise.
Second the use of straw-man arguments. Not everyone who is critical or modern medicine and modern agriculture is a romantic primitivist who thinks we should go back to the stone age. For example, the Union of Concerned Scientists—a very rational, caring, and science-based organization—has been critical of modern agricultural practices, like the use of pesticides, for years. For them the question isn’t has pesticide use increased food production and lead to a higher standard of living (the answer is of course yes), the question is could we still have an even higher standard of living through the use of organic practices with our knowledge of agriculture, ecology, and sustainable development? There conclusions are yes, and people are welcome to check out their website to make-up their own mind on the matter: http://www.ucsusa.org/food_and_agriculture/ Similarly, there are many examples of modern medical practices that were thought to be safe by some that later on turned out to be harmful, or drugs that had immoral and poor testing history. Examples that I am aware of from my work are IUD use in the 1970s, and some of the more tragic elements of the non-consensual testing involving Depo-Provera. As one commenter pointed out a “great deal of ‘bemoaning the current state of American health’ is being done by medical experts and doctors.”
And finally, the use of ad hominem attacks. I know it is easy to for all of us to label many of those who practice alternative medicine as quacks, cranks, irrational buffoons, or–as Dr. Tuteur does in her article–”fundamentalist” but to do so targets are energy on the people and not their ideas. It does us no good to form our arguments in such as way as to read: alternative health advocates claim pesticides are bad and modern diseases are caused by the environment, alternative health advocates are stupid, therefore pesticides are good and modern disease can’t be avoid only cured. I sincerely trust that Dr. Tuteur doesn’t actually believe that argument, but they way she structured her comments it is definitely reasonable to walk-in with that understanding. For example her statement that people living in the modern world “still prey to the same illnesses and accidents, but now they can be effectively treated” just isn’t true. A few weeks ago on the Skeptic Guide to Universe, Steve Novella commented on the dangers of living in an environmental that was too sterile, and how people living in the developing world may have an edge over us because their bodies develop more antibodies and have less examples of incidents of allergies. In some ways, modern industrialize living comes with complications.
Perhaps though, I was so moved to write something because of the comments I read in reply to the post (and in replies to some of those replies), because of the general direction I fear skepticism is going in. I think Carl Sagan was very wise in cautioning skeptics of taking a tone that was too polemic, judgmental, and just plain wrong. At one point in his life, he refused to sign a statement that condemn the influence of astrology on astronomers because he thought the tone of the statement was too harsh and condensing. I think this was a very, and dare I say it—scientific—decision. In my opinion good scientists is passionate about what they know, and ecstatic about what they don’t know. In practical sense, this means defending your position, without putting down those against you, because even if their arguments are not true, there may be some truth to what they are saying.
Personally, this is something I need to practice on a daily basis, so it frustrates me when fellow skeptics take it for granted. I know that most of you probably deal with a lot of people who have some fairly wacky ideas of medicine at a distance—I am not so lucky. Many people I love and care deeply about have chosen to not vaccine their children, go to naturopathic doctors, any use homeopathics. Through experience, I find that trying to beat people over the head with the information never works. Instead, I find the only thing that does work is the really humanist thing—have patience, accept them for where they are at, give people empathy, and most importantly appeal to there reason, not your judgments of them. Telling people that you are concern about some of their healthcare choices, and then give them the reasons why, goes a lot farther than just telling them that their doctor is a quack, their medicine is garbage, and that they are just a backwards looking fundamentalist for thinking so.
I know a certain degree of sarcasm, heckling, and ridicule is unavoidable, necessary, and lets be honest a little fun. But I do think it takes a lot more attention from skeptics then it needs to, or is healthy, and I worry about the environment that it creates for us. As some of the other comments mentioned, it makes no more sense to romanticize the past as it does the present. History travels in veins, often dividing in making directions. Sometimes progress in one area of life, leads to regression in another. By that same token skepticism is just one side of the coin. It does have much value with out certainty in something else. It doesn’t do any could to always be skeptical of fringe ideas and always being accepting of conventional ideas and vice versa.
I think at all cost we should avoid making some to the rhetorical pitfalls I mentioned above, and put more attention on laying out the facts and making reasoned focused arguments. After all, the foundation of science as a philosophy is that people have the potential to be highly rational creatures. It is important for us to put that believe into practice.
Basiorana:
“The thing is, the most important thing in environmentalism is LAND. The unadulterated kind good for lemurs or buffalo or kangaroos or trees. So anything that reduces the amount of land we use for farming is good, unless it’s dumping more dangerous pesticides and fertilizers (including cow manure– it’s also a burden) into the local ecosystems. ”
Well, I know a few people who use cloth toilet paper… but I digress lol. But Dr. Tuteur seems to claim that ALL pesticides have saved lives (indirectly of course), which doesn’t make any sense to me. She doesn’t make disclaimers, even after repeated requests for clarification. From the little I’ve read (which is far more than the average person, but probably not as much as the commenters here), organic farming has pluses and minuses. I like that Michael Pollan (and I did like Dr. Hall’s article on it, but that confirmation bias is very powerful!) points out the disadvantages of organic farming, the big corporate organic farms, and the fact that organic DOES USE potentially dangerous pesticides, just not synthetic ones. But the more I read, the more I conclude that there are not easy answers, despite a few “expert” bloggers who insist there are. In my field (education) this is certainly true, and I find it hard to believe that medicine/diet is a lot different. It does seem to be the more libertarian skeptics who claim to be unconvinced by global warming, DDT/malaria links, recycling, the existence of toxins/ environmental pollutants etc etc etc. Of course, there are liberals on the other side who believe everything they read if it fits in their worldview.
Fifi:
“From my perspective, it would be nice if humans finally just got over the fantasies and started to figure out how to live on the planet as human animals. Learning from some of our past mistakes and actually living in reality might be a good place to start!”
It occured to me as well that the extremist skeptic backlash against *anything* natural was a response to being compared to animals, since, guess what, that’s what we are. Certainly, in the historic nature vs. science/technology debate, people couldn’t stand being compared to animals, and there are certainly some religious undertones there.
I think I mentioned this in a comment that is currently being held in moderation, but as someone with a background in history and education, I have a hard time with the idea that there is nothing we can learn from the past. There is no other time I would like to live in than the present (especially considering sexism and racism!), but modern technology isn’t perfect either. Again, extremists on both sides.
Squirrelelite:
“When we move to measures like quality of life, the data to support those measures becomes more limited and dubious. This may be a bit of an argument from ignorance, but I don’t know how we can repeatably and reliably define the relative quality of sitting around a campfire ”
No, but we can look at the number of people starving and STILL dying of infectious disease around the world. Sheer population may be a measure of success in a limited evolutionary sense, but I think quality of life matters too. I don’t really know what percentage of the 6 plus billion people on this planet have a horrible quality of life, but it would be interesting to find out. I’m sure that somebody will point out that they’d still rather be alive and that’s all that matters, but I’m not sure. At the least, I abhor the Catholic restrictions on birth control (for example).
I’ve also read that agriculture has been around for about 10,000 years, while H. sapiens have been around for 100,000 years, and we branched off from chimps 5 million years ago. So agriculture has been a very small percentage of our history. Is it always a naturalistic fallacy to consider human evolution as a driving factor in medicine? What are some example of fallacy versus logically sound? I’ve also read that evolution can also happen very fast. Is is possible that the human body has adapted already to a grain based or meat based diet, in those 10,000 years? People from around the world have subsisted on varied diets throughout history it seems.
There is a tragic but very interesting genetic disease that supports the statement by Dr Tuteur, “That both cancer and heart disease are among the primary causes of death today represents a victory, not a defeat. Diseases of old age …”
The disease is Werner’s syndrome, premature senescence developing in the 20′s. This reference is to a GeneReviews summary of the disease, authors Dru F Leistritz, MS, et al (I’m not sure of the proper citation)
www URL:
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=werner
The quote from the review I wish to discuss is;
“Disease characteristics. Werner syndrome is characterized by the premature appearance of features associated with normal aging and cancer predisposition. Individuals with Werner syndrome develop normally until the end of the first decade. The first sign is the lack of a growth spurt during the early teen years. Early findings (usually observed in the 20s) include loss and graying of hair, hoarseness, and scleroderma-like skin changes, followed by bilateral ocular cataracts, type 2 diabetes mellitus, hypogonadism, skin ulcers, and osteoporosis in the 30s. Myocardial infarction and cancer are the most common causes of death, typically at about age 48 years. ”
This is a disease in which the natural course of life is altered by a mutation in the Wrn gene (obviously so named because of the investigation into Werner’s syndrome). This gene apparently encodes a protein active in DNA metabolism. Mutations in the gene tend to be associated with loss of integrity of the individual cells’ genome. The loss of integrity is the proposed mechanism of aging.
The higher incidence of cancers and ischemic heart disease in the typically reduced lifespan of Werner’s patients is supporting evidence for Dr Tuteur’s statement that these are diseases of aging. If the genomical aging of an individual is accelerated, then the diseases tend to occur at an earlier chronological age. Of course, the cause and rate of progression of disease such as diabetes, cancer, and atherosclerosis are multifactorial, but the observations of the natural course of Werner’s favors the process of aging as being a significant factor in the development of those diseases. We tend to talk much about the factors of diet, exercise, and smoking, because those are factors we can change. If we could intervene in the 60 year old and give them the genomic integrity of a 20 year old by gene therapy, then maybe we wouldn’t waste so much time trying to convince the patient to eat healthier, get more exercise, and stop smoking. Maybe Woody Allen’s prediction for future medical science in “Sleeper” will yet come to pass.
On a side note, I am well aware of the scientific evidence that severe dietary restriction slows down aging, that is a separate issue.
While we can blame some of the increase in incidence of cancer and heart disease on modern diet and life style, some of the increase must be attributed to the greater longevity we currently enjoy. I can’t estimate the relative strength of the factors, but the study of Werner’s syndrome suggests that aging is a stronger factor than what our beliefs (even after medical training) would suggest.
On another note, there is a difference in CAM using concepts of science (and thus claiming common ground with SBM), and SBM which uses methods of science in addition to scientific concepts. CAM proponents often ignore the issue of scaling when proposing scientific basis for treatment. Here are two examples of issues of scaling in science. How can we scale the concepts of quantum mechanics to predictions of what will we observe in a chemical reaction in a test tube? That is partly addressed by statistical mechanics. How we can scale what happens in the test tube to what happens in an organism is an even more complex problem. This is where we have to back up hypotheses with more evidence. Proponents of CAM often ignore the problems of scaling. I have even seen some explanations of benefit of a homeopathic treatment based on quantum mechanical principles. Sounds great… when I see quantum extinction of an individual, I’ll hurry to see that homeopath.
@Basiorana
“Now, if you really are a descendant of a hunter-gatherer society that had a fully-formed agricultural system thrust on them suddenly and less than 500 years ago, you should absolutely try out a paleolithic diet. You also probably are lactose-intolerant and prone to obesity because your ancestors never gained the genes needed to tolerate modern food. But I know most of the paleolithic diet supporters did NOT descend from those groups; they are well-evolved to eat whole and stone-ground grains, honey, beer and malted grains, fermented everything, vegetable and seed oils, milk, cheese, and yogurt.”
While you display impressive insight from what I typically see as a paleo blogger (the fist part of the para), you seem a bit unconcerned or perhaps ignorant of the possibility of a spectrum.
For instance, are there only celiacs and those perfectly adapted to gluten?
So, I agree that evolution marches on. Everyone feel free to do their part for future generations (where do you hear _that_ all the time?).
While I doubt I’m celiac, and I do seem to tolerate lactose in reasonable quantity, I have a brother with mild chron’s. And me, if I eat grains, I very soon have pretty strong nasal congestion.
Here’s the deal. Paleo is a good baseline starting place. Doesn’t need to be your ending place. I often write that “paleo” is Kitaval to Inutit (70% starchy carb to near 0% carb) and everything in between.
I suspect that a lower carb via starch is probably more suited to most. But eat real food and through self-experimentation, figure out what works for you.
I know peer reviewed research is big around here and good. But I trust my own results far more. For example, I wanted to see about fasting workouts, so I tested BG prior, at 24 hours fast (80s). Then I pushed big weights for 30 minutes and tested again: 105. Gluconeogenesis. It really works.
Moderns eating their 6 tupperware meals a day outta try it someday. One a year, or sumthin’.
JMB,
I’m not sure that a genetic disorder completely supports the hypothesis of heart disease, diabetes and cancer being merely “diseases of age.” I don’t know very much about Werner’s syndrome, but I did find it interesting that part of the recommended course of treatment was diet and exercise.
I think I would have to offer as a counterpoint to your evidence the ample studies indicating that the incidence of heart disease, diabetes, and cancer are very low among population groups that follow a traditional H-G diet compared to similar populations that consume a modern, Western diet.
Still, I’d be interested to see some dietary studies on the sufferer’s of Werner’s syndrome to see if any particular macronutrient compositions help or hinder treatment. I would hypothesize that because Werner’s patients suffer from Type II Diabetes and ischemic heart disease that they would benefit from the diets used in the Lindeberg and Jonsson studies I cite above. I could, of course, be wrong because the nature of the genetic disorder might complicate matters.
I don’t think anyone is suggesting those diseases are “merely” diseases of old age, but they do clearly increase in incidence with age.
Arteriosclerosis has been found in Egyptian mummies. I don’t know how one would classify the ancient Egyptian diet, but it sure wasn’t equivalent to the modern Western diet. I’m guessing that in every society, with every kind of diet, no matter how low the baseline incidence of ischemic heart disease and diabetes, the incidence of both increases with age. I’m guessing that although diet and lifestyle modification can drastically reduce the incidence of those diseases, it can’t entirely eradicate them. Does anyone have evidence that my guesses are wrong?
My evidence suggests that your hunch here is correct. However, as far as I can tell, the incidence among the elderly in populations who eat a modern, Western diet is much higher than those that don’t.
I mean, no matter what we eat, we’re all going to die eventually. But I think there’s powerful evidence to suggest that diet and lifestyle choices make a dramatic difference in longevity and quality of life, all else being equal.
edgar:
“communicable diseases were already decreasing when vax were invented. Better living conditions, nutrition, sociable justice and sanitation were instrumental in this. Would this trend have continued without vaccines? Of course not, and to claim so is just folly.”
Excellent summary – and resolution – of that particular debate!
Amy,
“HG individuals were not obese. That’s not because their diet was so fabulous. It’s because they barely had enough to eat and sometimes starved.”
…and because they had to run around a lot huntering and gathering!
lizkat,
“I exercise every day and it requires discipline and planning.”
Good for you!
Yes, it requires some discipline and planning, but you won’t keep it up unless you enjoy it. And sometimes things happen that you don’t plan for – like injuries. Goddamn, I have patella tendon enthesitis for two months now – and the hills are beckoning and summer is slipping into winter and…
Amy,
“They can’t be “more genetically fit” if that’s all there was.”
Actually I think they can. A HG of 10,000 years ago would be likely to be more adapted to a HG lifestyle that a HG of 100,000 years ago.
Alex
“as the numerous papers I have cited in this comment threat demonstrate.”
Threat? Oh, now your motives are clear, revealed by that little freudian slip.
Hey, are we all forgetting simple evolution? Who cares if the grain and vegan addicts want to stuff their faces with cake and pizza more power to ‘em. “Modern” diseases will handle them and if not they will go the route of the Panda bear (overweight, unable to reproduce with short to non-existent ovulation period, including “my head hurts” syndrome) it may take a few generations but its possible.
Hey what about us being the champions of modern civilization! Pretty arrogant if you ask me. I may live to 70 but my children won’t cause I can set down that last cookie,hoho, and double stuffed oreo. But God help my kids to have the willpower to do it. No amount of gene expression will reverse epic obesity in our population and with the attitude that “drugs” can solve our problems your preempting your own destruction. 35 may become the new average in our “modern” population
Watch Jamie Olivers TED speech for my reference with the kids to parents age examples
We may think were more powerful than our genes but it doesn’t work that way at least not now or for the foreseeable future.
Sorry to veer off topic again…Harriet said “Why is it that people complain so much about Dr. Tuteur but do not complain equally about me? It seems to me that we are being treated differently, and I don’t understand why.”
In light of Harriet’s comments and after mulling over why another commenter’s point about the importance of “finding bloggers you can trust, as long as you don’t trust them absolutely” struck a chord with me I have a comment regarding blogging style and why it’s important for sbm. Harriet’s comment to this post on Feb 18 at 12:49 pm sums up the differences between Harriet and Amy.
“Amy, while I agree with your main points, I have to question one statement you made: “All the existing scientific evidence shows that all of the myriad claims of alternative health are flat out false.” [Harriet omitted Amy’s further emphasis “None of it works, absolutely none of it.”] I think it would be more accurate to say that all the existing scientific evidence is compatible with the hypothesis that no CAM treatment works better than placebo, except for some herbal remedies which would probably work even better if they were approached by the time-tested methods of pharmacology with isolation and purification of the active ingredient.”
I’ve analyzed the two different styles here, though I don’t think Harriet and Amy are saying exactly the same thing as Amy appears to dismiss even the placebo effects of alternative medicine.
Harriet’s “PBS Newshour” version: educational, mature, reasoned opinion (points for factual, useful information)
balanced, objective, science based opinion
Is this source honest? probably
Can I trust this source? seems likely
Is this source overtly biased or dogmatic? doesn’t appear so
Have I learned anything of value? yes
Have I wasted my time? Probably not
Amy’s “fox news” version: unnecessarily loud and sensationalized (possible points for entertainment value)
Unbalanced, biased, exaggerated personal opinion
Is this source honest? Not sure
Can I trust this source? Don’t know
Is this source overtly biased or dogmatic? possibly
Have I learned anything of value? not really
Have I wasted my time? perhaps
Chalk it up to a matter of personal taste, but in a purportedly science based venue it’s food for thought.
While there are obvious benefits from eating a diet that consists of more fruits, vegetables, whole grains and lean proteins, it does appear that longevity and resistance to cardiovascular disease and dementia have a very strong genetic component to them.
This debate has been very interesting.
Personally, I wouldn’t want to live in any other time, and having followed a very rigorous paleolithic diet numerous times for sport competitions, I must admit, life really isn’t worth living unless you can have Belgian pralines on occasion.
To further clarify: Further downthread from Harriet’s comment Amy agrees with Harriet’s correction of the accuracy of her statements! So is Amy now on the record for changing from “none of it works, absolutely none of it” to admitting that CAM can be as effective as placebo and that some herbal treatments are actually more effective than placebo? To what do we attribute this about-face? Schizophrenia? Confusion? Change of heart? I think I’ve made my point about trustworthiness of source.
wales,
Amy agreed with Harriet’s definition because it is the same as hers. It’s just that her’s is the hyperbolic short version and Harriet’s is the more accurate long version
Amy’s hyperbolic short version:
“All the existing scientific evidence shows that all of the myriad claims of alternative health are flat out false. None of it works, absolutely none of it.”
Harriet’s more accurate long version:
“All the existing scientific evidence is compatible with the hypothesis that no CAM treatment works better than placebo, except for some herbal remedies which would probably work even better if they were approached by the time-tested methods of pharmacology with isolation and purification of the active ingredient.”
They are saying essentially the same thing:
“No better than placebo” means “It doesn’t work”.
But, yeah, some herbs may work, but you wouldn’t use them in preference to pharmacological preparations with their standard and guaranteed amounts of active ingredient, no unnecessary stuff added in, and no potentially harmful contaminants inadvertantly or deliberately added (to be even more accurate)
It’s just a difference in style.
Short and to the point versus long-winded but more accurate.
I think both styles are fine, you just have to recognise each for what it is.
regards,
BillyJoe
wales:
“admitting that CAM can be as effective as placebo”
That’s kind of funny. “As effective as placebo” means “not effective.”
Harriet asks why my posts provoke such a strong reaction. I have been writing on the Internet for 15 years and have evoked similar reactions in certain quarters for much of that time. I’ve had a great deal of time to think about the issue and I consider it to be straight forward: the most vociferous commenters feel threatened.
My provocative posts are provocative because they challenge cherished wisdom. There is a lot of wishful thinking at the heart of conventional wisdom about health. Even some people who believe in SBM insist that they have more control over their health than they could possibly have. They are sure that they can prevent getting cancer and heart disease if they simply eat “right” and exercise. And they are equally convinced that CAD and type 2 diabetes are the modern equivalent of the Black Death.
A lot of what I write challenges those cherished beliefs of control and the comforting illusion that those who are ill have brought it on themselves and for some that is intolerable.
My writing on childbirth challenges a different but equally cherish bit of wishful thinking, the notion that women who make the “right” choices are better mothers and more authentic women than those who choose differently. When I challenge the myths about “natural” chchildbirth, homebirth and breastfeeding, I am threatening some people’s deeply held beliefs about themselves and that is intolerable.
Of course it is possible to disagree with my arguments on the basis of scientific facts and reasoning and some people do. However those who come after me repeatedly, who can’t resist the personal attacks, are fighting to hold on to cherished beliefs about themselves, not for scientific integrity.
Someone commented upthread that I generally don’t take attacks personally and that’s true. It’s because I think that the most vociferous commenters are not attacking me personally; they are fighting to hold onto deeply cherished opinions about themselves.
BillyJoe – The problem is that some of the claims made about specific alternative medicine treatments have been true (not many but some, and they now more or less own the diet and exercise territory in the public eye…and let’s face it, diet and exercise are good treatments for many common ailments). Sure we can play the “once it’s been proven by science it’s not alternative medicine it’s scientific medicine” gambit but there’s quite a bit of intellectual dishonesty in not recognizing that the claims for efficacy were once made by alternative health practitioners. The reason why people keep going back to alternative health practitioners is that bits of it can work – not to cure cancer or AIDS of course, but certainly to help make people feel better or get into shape or make a necessary life change. I, of course, make a distinction between a cure and simply making someone subjectively feel better but it’s worth remembering what the patient is actually seeking…which is often to simply feel better or be supported in some way. I’m also an advocate of people understanding why something is working for them – being cognitively literate and self aware, or aware that something is actually a drug – and not presenting it as magic or harmless because its made from a plant. And obviously people who are simply conning a sick person are charlatans and should be strung up for exploiting the vulnerable.
Also, saying that the placebo effect means “it doesn’t work” isn’t accurate and is overly simplistic – particularly when talking about something as subjective as treatments for pain or depression. (The areas where a placebo effect is the most profound and confounding for studies.) If a placebo is relieving someone’s pain or depression it is working since the end goal of any treatment for pain or depression is to relieve pain or depression. What it indicates is that the actual drug may not work in the way anticipated and be no better than a placebo.
My 11:24 pm post, which was 26 lines long, went straight through, but my 11:26 pm post which was a one liner was held up for moderation !?!? Weird!
Zoe237 (11:39 pm)
I agree with your point about quality of life for as many people as possible being important. I think I was trying to get to that but perhaps I should have been more loquacious. Anyway, evolution may work to select genes that can survive, propagate and reproduce but for humans in the 21st century just generating greater numbers of humans is not going to be good enough. We will need to find a way to provide greater quality of life for a greater fraction of the overall population (mere fairness) under long term stable conditions (environmental concerns).
Also, I woke up this morning listening to two episodes from NPR’s Science Friday podcast which seem pertinent to this discussion.
The first one, from a study of dolphins working with the U.S. Navy in San Diego Bay, discovered that dolphins in a “fasting” state, i.e. just eating a few fish, go into a diabetic-like high blood sugar state to allow the liver to provide the blood sugar needed to support a large brain. Or, as the NPR web site describes it:
“Chimps and mice are the usual test subjects scientists study when they want to learn about the human body. But could we learn something about humans by studying the physiology of marine mammals a such as dolphins? In this segment, live from the annual meeting of the American Association for the Advancement of Science in San Diego, we’ll talk with researchers who are doing just that. Some researchers are studying a sort of natural “on-off switch” for diabetes in dolphins in hopes of learning more about human diabetes. We’ll also talk about how viruses infect humans and dolphins — what happens when a dolphin gets a cold? Could viruses pass between dolphins and humans?
Guests
Hendrik Nollens
Clinical Assistant Professor, Zoological Medicine
University of Florida
San Diego, California
Stephanie Venn-Watson
Veterinary Epidemiologist and Director of Clinical Research
National Marine Mammal Foundation
San Diego, California
”
So, (this is quite preliminary and speculative) our ancestors may have evolved the ability to go into a diabetic state to provide sufficient blood sugar for a large brain despite the vagaries of a paleolithic or even pre-paleolithic diet. What has changed with the modern diet is not the diabetic state itself but something that affects our body’s ability to control when it goes into or comes out of that state.
Here is the link:
http://www.sciencefriday.com/program/archives/201002193
The other segment which you can easily navigate to from the first link is about studying epilepsy in sea lions caused by harmful algal blooms (which affected a large number of people in Canada several years ago when they ate some bad mussels from Prince Edward Island). Evidently, a toxin in the algal blooms can cause seizures in sea lions and humans and even cause a permanent epileptic condition in the brain.
Very interesting!
“Also, saying that the placebo effect means “it doesn’t work” isn’t accurate and is overly simplistic ”
It means that what is “working” is the placebo effect itself, not the drug/herb/whatever. So the drug/herb/whatever should not get the credit. Correct?
Marco – Great post (though I’ll admit to a confirmation bias since I’m a big fan of the Carl Sagans, Ramachandrans and Sacks who are both great scientitsts and great communicators…writers who clearly care much more deeply about people and communication, as well as what they write about, than about their own egos). I really do appreciate the SBM bloggers here who clearly love science for what it is and want to communicate just how cool it is to the general public. Dr Crislip’s posts are funny, incredibly informative and help people to understand how science works. Dr Val Jones is down to earth, easy to read and clearly interested in actually creating understanding and reaching out in a friendly way. Dr Gorski and Dr Novella also do a good job of explaining complex topics and taking on specific advocates of unscientific nonsense. I don’t always agree with them about everything political/social/philosophical but I can respect them as being genuine in their intent and simply having a different perspective. Difference makes the world interesting and it’s worth remaining open to and curious about different perspectives rather than constantly seeking to affirm our own. They can also both openly admit when they’ve made an error of ommision or fact – though Dr Crislip’s recent post is still one of my favorites I’ve read here. It may not have generated much controversy or debate but that’s because it was so well written, humble and non-sensationalist – even though it was dealing with a potentially controversial topic – there was no bullsh*t to call him out on and no sloppy language and vagueness about meaning. What was there to say other than “great post, thanks!”
Bonnie – “It means that what is “working” is the placebo effect itself, not the drug/herb/whatever. So the drug/herb/whatever should not get the credit. Correct?”
Pretty much. We’re still figuring out placebo effects (note the plural
Basically you’re spot on though – the actual substance isn’t causing the effect, the mind/brain or expectation of an effect is.
Dr Tuteur – “My provocative posts are provocative because they challenge cherished wisdom.”
That’s the story you like to tell yourself. However, I find your posts annoying to read because of the reasons Marco outlined above and because you’re a sloppy, sensationalist writer and entirely unreflective about your own biases and clearly have a lot of self worth and ego tied up in this image of yourself as a provocateur and “challenger”.
Dr Tuteur – ” There is a lot of wishful thinking at the heart of conventional wisdom about health. Even some people who believe in SBM insist that they have more control over their health than they could possibly have. They are sure that they can prevent getting cancer and heart disease if they simply eat “right” and exercise. And they are equally convinced that CAD and type 2 diabetes are the modern equivalent of the Black Death.”
Some people may believe this and you certainly believe that others believe this whether they do or not. I don’t believe this at all, diseases happen due to all kinds of reasons outside of our control and we certainly inherit genetic vulnerabilities. However, we simply don’t have conclusive evidence about how much disease genesis is genetic and how much is environmental for many forms of cancer so making grand claims about not having any control is simply not warranted either. Clearly we do have some control over some aspects of our health so it makes sense to practice preventative medicine of various kinds. Not everyone is as absolutist as you are Dr Tuteur, nor do we all see things in the extremely black and white terms you do. That’s you projecting your own absolutist stance onto everyone else that you’re actually seeing when you interact with others!
For my part, if you weren’t blogging at SBM more frequently than any other blogger here, I’d ignore you as another crank on the internet who’s simply being sensationalist and attention seeking, and abusing science to prop up their own ego and personal identity. (I did find it interesting that you seem to make a habit of attacking other bloggers in their comment sections so you seek out adversarial interaction rather than discussion or any form of constructive or positive interaction.) Because this is SBM and because you’re engaged in a form of cargo cult SBM blogging and I find it worth speaking up. Mainly because I used to like to send people here to educate themselves about science and medicine and you’re like the anti-Carl Sagan – you’re guaranteed to turn off the general public and you make SBM look like an ideology that’s uncritically pro-industry and Big Pharma rather than equally critical and looking out for the public good.
Love science Friday! Thanks for the links.
Great post Marco. I’d be interested in knowing what the authors think about the Union of Concerned Scientists, since they seem to both be environmentalists and don’t subscribe to the skeptic label (as far as I know).
Dr. Tuteur, you might want to try writing for a non-internet (print) audience (particularly, actual anthropologists) and see how many of them feel “threatened” by your lack of nuance and black and white/ either-or thinking.
“However, I find your posts annoying to read because of the reasons Marco outlined above and because you’re a sloppy, sensationalist writer and entirely unreflective about your own biases and clearly have a lot of self worth and ego tied up in this image of yourself as a provocateur and “challenger”.”
And yet you can’t stop reading or commenting. Why is that? I’d say it is because you feel threatened by what I write and you are desperately trying to convince yourself and others that you don’t need to heed it.
Amy,
You might want to take a deep breath and retract this, as it makes you sound like an egotistical monster, and I do not believe it’s truly reflective of you.
Dr Tuteur – I started reading and commenting long before you started blogging here. I like this site and many of the bloggers and I’m passionate about science in medicine (and I enjoy discussing things with many of the commenters here too). I care about SBM so I comment when I see it being abused and misrepresented by anyone – advocates of CAM, cargo cult science bloggers such as yourself who use all the same fallacies and techniques as advocates of CAM, and shills for Big Pharma or Big sCAM. I don’t feel threatened by what you write – as much as you want to believe this about yourself all you do when you repeat this is highlight how much your ego is wrapped up in this image of yourself and how you project onto others so much that you can’t hear or see what is being written (and are incapable of being self reflective). Really, your narcissism, grandiosity and outright evangelicism is pretty spectacular! The only person who’s desperate to believe that you’ve got something of substance to offer and are teaching everyone a lesson they “need” to learn is you. You seem pretty proud not to have learned anything in your 15 years of blogging and pretty narcissistically engaged with using SBM as a soapbox to affirm your personal identity. It’s just sad and it’s detrimental to actually getting anyone to respect or trust SBM (not that you actually care about that since it’s all about ego for you).
“an egotistical monster”
What is egotistical about pointing out that people can feel threatened by something that challenges cherished beliefs about themselves, including the belief that they have more control over their health than they actually do?
That’s really at the heart of the disagreement on this thread. You (and others) really, really, really want to believe that if you eat “right” and exercise you will avoid getting ill.
Be honest. You personally practice the diet that you advocate because you think you are protecting yourself. You are defending the paleo diet because you have a personal stake in the argument. If my claims in this piece and the subsequent comment thread are correct, you’re not doing much of anything for your health by following your diet, and you just might get CAD or cancer anyway. That’s what I mean by feeling threatened.
Dr Tuteur, for someone who continually claims not to take things personally you respond exactly like someone who’s ego is threatened and is taking any critiques made personally.
Dr Tuteur – “That’s really at the heart of the disagreement on this thread. You (and others) really, really, really want to believe that if you eat “right” and exercise you will avoid getting ill.
Be honest. You personally practice the diet that you advocate because you think you are protecting yourself. You are defending the paleo diet because you have a personal stake in the argument.”
I don’t follow a paleo diet. I eat a relatively sensible diet and get regular exercise like my GP mom taught me but I also eat cake and icecream (sometimes for breakfast). I eat what I eat because it tastes good and I feel good when I get proper nutrition. I also find exercise has all kinds of benefits but I certainly don’t think it will prevent me from getting cancer or AIDS or being hit by a bus or is magic. You’re continually projecting onto others Dr Tuteur because in your world anyone who disagrees with you must be the black to your self imagined white. You rail on about fundamentalists but continually reveal yourself as being someone who thinks like a fundamentalist in black and white, you’re-either-with-me-or-against-me terms. That’s what you’re being called out on, along with your appeals to emotion and personal biases that you’re so totally blind to but continually reveal because you project so heavily onto anyone who disagrees with you or disrupts your self image as an SBM authority and superior to others even when it’s clear that you don’t really know what the hell you’re talking about and are promoting ideology and personal biases and not SBM!
I did not say that you were an egotistical monster–I said that that that statement made it sound like you were. I was trying to give you a friendly word of advice that you might be a little too heated at the moment. I was giving you a friendly word of advice out of respect.
But I would add that while challenging cherished beliefs is all well and good and something that I’m in favor of, as an advocate of science I believe that such challenges should be backed up with the best available research.
I believe that proper nutrition and lifestyle choices will lead to a decreased risk of illness, yes. I believe this because there are mountains of data to support this opinion.
I believe that by eating a diet that mimics the macronutrient composition of hunter-gatherer groups that yes, I will see lowered risk factors for heart disease, diabetes, and cancer. I believe this because there is a lot of peer-reviewed research that provides data to support this position. Speaking for myself personally, since I adopted this manner of eating, I have lost a significant amount of weight, my LDL levels have gone down, my fasting glucose has gone down, and my blood pressure has gone down.
Sure, but I’m not too worried that they are since you’ve been unable to back up your claims with any peer-reviewed research.
I might die in a car crash even if I wear my seatbelt, but wearing a seatbelt certainly lowers the risk, so I wear one.
I am no more threatened by you than I am threatened by my neighbor who insisted to me that I’m going to Hell because I haven’t been saved. That’s because neither you nor he can provide any evidence to back up their claims.
Dr Tuteur – Perhaps you think everyone else feels threatened because you feel threatened? I certainly don’t feel threatened by science or medicine, it’s what I grew up with and I have a very realistic perspective on it (both medicine and doctors are fallible and our understanding is constantly evolving – think critically here too and know your own body and family history..the basic stuff). However, I do feel that ideologues are a direct threat to science, medicine and reality-based thinking – it’s apparently a perspective that some SBM bloggers share. In a small way, I do feel sort of personally threatened by ideologues in the sense that ideologues that ascend to power may try to impinge upon societal liberties now in place and eventually my personal freedom. This is partly because I’m old enough to remember a time when many people didn’t have social freedoms we now tend to take for granted (and having known some survivors of the Holocaust). I do find fascism – both personal and political something worth speaking up about. That doesn’t mean I’m a libertarian or such, it just means I prefer living in reality and having personal freedom. I do see you as an ideologue and as being very reactionary and unable to be self-critical or take any form of criticism and I do see this as being detrimental to SBM and influencing public opinion. However, you’re not a personal threat in any way and basically serve as a distraction (in the same way Pec used to here when she used to comment, you remind me of a reverse version of her in many ways).
I’d suggest that youmay well feel somewhat threatened by CAM (and particularly by natural birth advocates) since you keep bringing up being threatened and projecting it onto people who obviously aren’t threatened by what you write (though they may disagree). Unlike you, I don’t feel threatened by CAM – even though I don’t agree with most of what is promote under this label and find some of them downright creepy and dangerous. (But then Big Pharma is creepy and dangerous too. That’s about commerce and not medicine.) Why don’t I feel threatened by CAM or science and medicine? Because they don’t threaten my personal or professional identity, nor do they confer status to me or take it away, nor do they influence my income in any way. Nor have I built a 15 year blogging career/hobby on taking sides or presenting myself as an expert. You have a lot invested here vis a vis personal identity and are very often arguing opinion and from an emotional perspective.
Personally I’m much more interested in why CAM is so attractive to people and what they get out of it (as an atheist I feel the same way about religion and faith). I grew up around general medicine, neuroscience and psychology so what interests me is the cognitive aspects and what is actually going on vis a vis placebo effects. And, how people communicate ideas and about medicine. My interest in meditation, nutrition and exercise isn’t because I’m an advocate of CAM. Quite the opposite, I’m interested in the science around these things and sorting out the wheat (the medicine) from the chaff (the made up magical stuff). Quite often the bloggers here touch upon these subjects directly or indirectly, and they also usually do very good breakdowns of the research done in these areas. Not only that, SBM also attracts some interesting commenters and discussions. All of this makes it worth coming back and, well, it’s interesting watching you act and communicate like a CAM promoter and ideologue while claiming to be an SBM advocate. What can I say, I enjoy observing people and seeing what makes them tick (and tock) and how even advocates of SBM fall prey to cognitive traps when they’re unaware or in denial of their own humanity.
I don’t perceive many “threatened” commenters here, just people calling out those who state personal opinion as fact. For what it’s worth, I agree with Fifi that I am reluctant to recommend this site to others (I think that’s what she said anyway), at least not without a large caveat warning about certain bloggers.
Billy Joe, you honestly don’t see a difference between the CAM comments that “none of it works, absolutely none of it” and “except for some herbal remedies”???? If so, then we are speaking different languages. I perceive that as a complete about-face. But I don’t expect we’ll get an explanation from Amy.
Amy said to someone “And yet you can’t stop reading or commenting. Why is that? I’d say it is because you feel threatened by what I write and you are desperately trying to convince yourself and others that you don’t need to heed it.”
I find that I keep commenting hoping that someone (editors perhaps) will get the message that this blog is making a choice between “getting hits” and credibility and that not all readers are happy with that choice. As for reading, I am reading purely for entertainment value now, if at all.
Here is a link to a Science News article about Dr Stephanie Venn Watson’s research:
http://www.sciencenews.org/view/generic/id/56441/title/Dolphins_may_offer_clues_to_treating_diabetes
I’m of the belief that if you don’t like someone’s writing style then you don’t read what they write!
I follow another blog that has multiple writers and there some writers I automatically scroll past, I don’t like their writing style, I don’t agree with them so I just let it go.
I want to point out to Alison that she’s misrepresented a couple of things that Dr. Teteur’s said (I’m late in saying this because I was busy) but Alison is trying to claim that Dr. Teteur said that “nobody” lived to old age.
When in fact what Dr. Teteur said was “most people”.
Another thing that has bugged me is that people started trying to discredit Dr. Teteur’s statement that life expectancy was 35 years old by showing proof that were people who lived to be older than 35.
She never said “and everyone died at age 35″ she said the average life expectancy.
She also said that currently the average life expectancy is 77.7 years. But no one tried to discredit that by proving that people live to be more than 77.7 years old.
It’s the SAME statement the difference is in the tense and yet people seemed to be reading those statements to vastly different ways.
The other thing I can’t understand is people’s refusal to accept diet is not the only indicator of longevity AND that access to food was an issue for hunter gatherers.
Someone lost a lot of weight on a peleo diet which includes times of fasting. That’s great, BUT (and this is a huge BUT) you have the ability to control access to food in a way that was not available in paleolithic times.
H-G had to deal with the fact that their food sources could be unreliable for many reasons beyond their control — plants not bearing enough fruits, vegetables, and nuts. Which could be for any number of reasons: drought, too much rain, too hot, too cold, frost came too early, frost came to late (depending on the climate of where they lived), bad storms damaged fruit as it came ripe, storms damaged plants before they could bear fruit. As for animals they hunted — maybe they over hunted one year, or new predators moved in, or the animals moved on in search of food.
H-G faced the very real threat of malnutrition and hunger do to scarcity of food as mentioned above.
Then there are all the other issues: Infection. Someone has tried to argue that the H-G were really healthy due to their diet being optimal and so they were less prone to infection. I have no idea of that is true, but let’s say it is.
That doesn’t mean that everyone is going to survive an infection (depending on what the infection is). And if there was an issue of food scarcity and the people were suffering from malnutrition (which was a real possibility) they would have been less likely to fight off infections.
And there are all kinds of different ways to get infections — there may have been a contagious infection that sweeps through a population, or maybe someone is bitten by an animal and gets an infection.
Which brings me to — accidents. There all kinds of ways people can die from accidents. There’s immediate death. Or someone could have an accident and there could be internal damage that the H-G couldn’t know about and the person would die later. Someone could have an accident, get wounded, and the wound becomes infected and then they die.
Animal attacks (immediate death or wounds that cause a slow death), animal bites (infections) would also be an issue.
I know that there have been studies on the isolated modern tribes of hunter-gatherers but I can not believe that in all of human history every H-G tribe in every part of the world has always been able to eat the optimal diet.
lillym – “I’m of the belief that if you don’t like someone’s writing style then you don’t read what they write!”
I’m of the belief that it can be healthy to challenge oneself and to read more than just what one likes. However, I don’t think everyone should live by my beliefs or believe or act how I do. The problem with only reading people who’s style you like or who you know you agree and share a perspective with is that it’s just feeding a personal confirmation bias. I purposely read the writing of people who have different perspectives than me and a wide variety of opinions and perspectives other than just those that align with mine. Why? Because it gives me insight into other perspectives, it sometimes gives me an understanding or provokes thought that changes my perspective and even when that’s not the case it means I at least have an understanding of those I disagree with (and just don’t routinely shut out anything that may challenge ideas I already hold). The internet is an interactive medium so I also interact around what I read. That’s not everyone’s cup of tea, of course, and I don’t expect it to be. (Of course, if one isn’t interested in commentary then one should consider publishing in a medium other than an interactive one like the web or have a blog with comments turned off.)
Fifi,
“Sure we can play the “once it’s been proven by science it’s not alternative medicine it’s scientific medicine””
Perhaps we should just stop using all those terms: conventional medicine, alternative medicine, complementary medicine, and integrative medicine, and swap it for evidence-based medicne and non evidence-based medicine.
No this won’t happen. So, in lieu of a change in nomenclature, our best summary is that alternative medicne does not work, none of it. That’s not totally accurate but so close to being true that it doesn’t matter.
“there’s quite a bit of intellectual dishonesty in not recognizing that the claims for efficacy were once made by alternative health practitioners.”
What are claims without evidence though?
They have never had any evidence in support of their claims other than “personal experience”, and it’s only pure luck when they do get things right on the odd occasion.
“The reason why people keep going back to alternative health practitioners is that bits of it can work”
No, you don’t know that unless you have the evidence.
“…but it’s worth remembering what the patient is actually seeking…which is often to simply feel better or be supported in some way.”
But then why use proven ineffective treatments or even unproven treatments to achieve this. Use the thing that’s achieving the effect – understanding, empathy, compassion, psychology etc
“Also, saying that the placebo effect means “it doesn’t work” isn’t accurate and is overly simplistic – If a placebo is relieving someone’s pain or depression it is working since the end goal of any treatment for pain or depression is to relieve pain or depression. What it indicates is that the actual drug may not work in the way anticipated and be no better than a placebo.”
There is no way round it really. If a drug works no better than placebo, that means it doesn’t work. Put it another way: Does placebo work? Yes it does. Does the drug work? No it doesn’t? If you want to deny that, then you will have to show an effect of the drug above placebo.
But do you have to keep making the same criticisms multiple times in every single one of Dr. Teteur’s posts?
You keep making the same general complaints over and over and over and over and over again.
At this point we all know — you don’t like her, you don’t like her writing style, you don’t like her attitude, you don’t trust her judgement or abilities and you don’t think she should be blogging here.
It seems so pointless.
Who the hell is Marco? I can’t find him anywhere?
She never said “and everyone died at age 35″ she said the average life expectancy.
++++++++++++
Actually, she originally used the term lifespan, and only changed that to life expectancy after Steven Novella’s comment on this post.
wales:
“Billy Joe, you honestly don’t see a difference between the CAM comments that “none of it works, absolutely none of it” and “except for some herbal remedies”???? If so, then we are speaking different languages. I perceive that as a complete about-face.”
Because Harriet qualified her comment and, if she had have had even more time to be even more precise, she would have qualified it even more (I know because, unless I’m badly mistaken, I have seen her do so in the past). That would have made her comment almost indistinguishable from Amy’s.
To driver this point home – and both of them can comment if they like (hey, that’ll test me out!) – I think both Amy and Harriet would agree with the following statement about herbs:
There is some evidence – mostly from small trials of short duration and doubtful use of controls – for some potential benefit from herbs in some limited conditions, but further studies using rigourously designed, randomised, double-blind, placebo controlled clinical trials are required to confirm this. In most cases the herb has either not been tested against conventional treatments or has been shown to be less effective than conventional treatments. There is also evidence, on the basis of funnel plots, of publication bias that could account for most of the percieved benefits of herbs. Apart from the question of clinical evidence, the dose of actual active ingredient in the herb has been found to vary greatly from batch to batch and sometimes there is actually no active ingredient. The effect of the “inactive” ingredients is unknown and could be truely neutral and therefore unnecessary, or have presently unknown adverse effects. Herbs are often purposefully supplemented by pharmaceutical drugs to enhance their effect, or inadvertently contaminated by heavy metals and other toxins which make them dangerus to use.
Okay, I don’t expect complete agreement on every single point, but I hiope you see where I am heading.
“But I don’t expect we’ll get an explanation from Amy”
I think Amy has reponded to me on only one occasion. Ironically it was against something I wrote that was in support of something she wrote that others were criticising her for (that made me smile). But I don’t hold it against anyone who doen’t respond let alone Amy who has bigger fish to fry here.
BillyJoe:
“There is some evidence – mostly from small trials of short duration and doubtful use of controls …”
I agree!
“The phrase “alternative health” covers a lot of things—some of them are science-based and some are not. ”
Huh? I beg to disagree.
The Union of Concerned Scientists are not science based from what I have seen. Puhleeze. They are ideologues.
“the question is could we still have an even higher standard of living through the use of organic practices with our knowledge of agriculture, ecology, and sustainable development?”
I’m from Missouri. Show me. They haven’t been able to.
“For example her statement that people living in the modern world “still prey to the same illnesses and accidents, but now they can be effectively treated” just isn’t true. A few weeks ago on the Skeptic Guide to Universe, Steve Novella commented on the dangers of living in an environmental that was too sterile, and how people living in the developing world may have an edge over us because their bodies develop more antibodies and have less examples of incidents of allergies.”
I’m sorry, but that does not show that her statement isn’t true.
“In some ways, modern industrialize living comes with complications.”
Are you trying to straw man Amy here?
We are all susceptible to cognitive biases. The reason some may feel threatened by Amy’s posts may be because she exposes their own biases, making them feel that the perfect image they had of themselves never really existed outside of their own minds.
I am not arguing that diet, exercise, and behavior are not factors in developing diseases we associate with aging, I am just arguing that the aging process based on accumulating errors in our DNA that occur when our DNA repair mechanisms shut down after reproductive years, is a bigger factor than we have realized. Perhaps diet, exercise and behavior combined represent a maximum of 30% predictive power of disease and death, but age (either chronologic, or based on measures of genomic intstability) represents a 50% ppv. The study of Werner’s Syndrome contributes to the argument about the importance of the aging process. We have not yet learned to manipulate the Wrn gene in humans (they have in fruit flies), so treatment of Werner’s focuses on the other factors in the disease. Even though those patients are treated with diet, exercise, and behavior modification, they do not have a normal life expectancy. As applied to American society, focus on diet, exercise, and behavior will result in improvements in longevity, but improvements in longevity are likely to be limited by the phenomenon of aging. I would scale the process of aging of a person to the genetic level of the shutting off of the Wrn gene that is a factor in the rate of repair of damage to DNA (of course, there will be other factors in the aging of the person). Ischemic heart disease or cancer can occur in a patient who is 75 who has eaten the healthiest diet, followed the best exercise regimen, minimized stress, etc. I would argue the incidence of ischemic heart disease and cancer is higher in the 75 year old doing everything right, than in a 25 year old doing everything wrong, but I do not have a citation, just clinical experience. We may achieve greater success in reducing incidence of at least some types of cancer by advances in gene therapy, than by modifications of diet, exercise, and behavior. Lung cancer and melanoma are two obvious exceptions. As we increase the percentage of people living past 100, we may see increasing incidence of leukemia/lymphoma, immune disorders, cardiac valvular disease, osteoporosis, cognitive dysfunction, and metabolic syndrome.
The scientific question that I could understand from the article was how much is the changing incidence of disease between past populations and current populations due to changes in diet, exercise, and other habits, versus the factor of aging of the population, and modern medicine which contributes to the aging of the population. Dr Tuteur represents the mainstream argument (in medicine) as answer to that question. The composition of the article has a central theme about romanticizing the past, other than the scientific argument, that makes it more interesting.
Scientific evidence comes from many different disciplines, with many different methods. Empirical evidence (from current medical experiments) will tell us that diet, exercise, genetic inheritance, and behavioral factors all contribute to diseases that have a higher incidence in a group of people over forty (that does not deny that they may be factors in people under forty). Population statistics gives us accurate measures of disease incidence and mortality as a function of age. Anthropologic studies give us rough estimates of disease incidence and mortality as a function of age, as well as information about how diet, exercise, and behavior has changed across time, or in different cultures. Biochemical studies gives us information about reactions which may cause instability of DNA, or the rate of hydrolysis of simple sugars versus complex sugars.
The analysis of the scientific evidence requires consideration of the different scientific methods, the accuracy and reproducibility of those scientific methods, the scale of the concept (reaction in a test tube, incidence of disease, success or health of a culture, or effects on evolution), and the consideration of the underlying model of disease (individuals are healthier because they are taller, or have lower incidence of metabolic bone disease, or because they live longer). Determination of scientific validity of our answer would ideally be done by an empirical method in a reproducible controlled experiment. The experimental design implies a very simple model of the disease. Since such an experiment is impractical, we must settle on a less reliable method. Since we cannot rely on a simple experiment to test the arguments, then I would argue that we must construct a more complex model of disease. The more complex model of disease allows us to assimilate evidence from different levels of scale (such as chemical reactions in a test tube, and success of different ancient societies). We can apply the model to the observed evidence to see how well it fits. The argument is initially won by the model that explains the greatest amount of evidence, with the evidence weighted by the reliability of the method of collection. The final winner to the argument is based on the ability of the model to predict observations in the future.
The primary contributors to this site may have a difference in opinion about the importance of models in the scientific approach.
Of course, it is more entertaining to argue romanticizing the past versus scientific method, than to construct a model of disease. I will still use romanticized reasons for riding my motorcycle. If you want to use romanticized reasons to eat raw roots and meat, I won’t complain.
“Then there are all the other issues: Infection. Someone has tried to argue that the H-G were really healthy due to their diet being optimal and so they were less prone to infection. I have no idea of that is true, but let’s say it is.”
Well, no. The argument was that there was less infection because one, they were crowded close together in one spot. Population density and settlements dramatically increased with the agricultural revolution, causing unintended consequences of infectious disease. H-G had disease, but they weren’t/aren’t the diseases of agriculture. Second, domesticated animals introduced new disease. The point is that H-G shouldn’t be romanticized, but neither should filthy industrial or agricultural communities.
Alex Knapp is arguing the benefits of paleolithic diets, particularly with regards to the diseases of obesity, I’m assuming those rich in varied plants, seeds, nuts, wild meat, (is whole grains in there…? I don’t think H-G ate much grain at all). I could be convinced either way, but he is the only one providing copious amounts of evidence for his position, while Dr. Tuteur only keeps repeating “But they DIED when they were 35!!!”
I also find it frustrating that she is furthering the myth that conventional medicine does not emphasize diet and exercise, and making it (unintentionally) the domain of “alternative medicine.”
“The Union of Concerned Scientists are not science based from what I have seen. Puhleeze. They are ideologues. ”
I thought someone might say that. Why is that? I’m not super familiar with them, but would like to know more. They seem more in line with my leanings than libertarian skeptics. Particularly those who solely criticise others’ beliefs but never present any new, interesting ideas or solutions of their own.
Take their claims regarding agriculture. They have the money to start farms and growing food to compete with big agra. If they are right, their success will be evident and big agra will be left in the dust. What’s stopping them?
“Take their claims regarding agriculture. They have the money to start farms and growing food to compete with big agra. If they are right, their success will be evident and big agra will be left in the dust. What’s stopping them?”
Who, the Union of Concerned Scientists? Why would they start farms? I don’t really understand this comment.
Has anybody read the Skeptical Environmentalist? Bjorn Lomberg’s claims rather remind me of Dr. Tuteur (minus his thousands of footnotes) and other pseudoscientific skeptics. He has a VERY rosy view of the present and the future and basically dismisses the dangers of global warming, overpopulation, water supplies, overuse of pesticide and nitrogen based fertilizers, and other toxins and pollution. Of course, there is a VERY interesting political, critical history on that book! Typically, pieces in the Wall Street Journal, the Economist, libertarian organizations drool over him, while many scientists think he’s a loon (critiques were published in Scientific American, Skeptic, Nature, and Science, among other publications.)
Union of Concerned Scientists:
http://www.ucsusa.org/global_warming/science_and_impacts/global_warming_contrarians/ucs-examines-the-skeptical.html
Skeptic mag:
http://findarticles.com/p/articles/mi_kmske/is_2_9/ai_n28903009/
Scientific American:
http://www.scientificamerican.com/article.cfm?id=the-skeptical-environment
“The argument was that there was less infection because one, they were crowded close together in one spot.”
Okay, correcting myself here, because obviously this makes no sense. It should be “NOT” crowded together in one spot. I also had a number subject-verb disagreement in my last post, my apologies.
Anyway, IOW, the low population density of H-G, due to lack of agriculture, lead to fewer infections, not their diet. It is possible that agriculture, at least initially, lead to a bigger population, but a lower life expectancy because of infectious disease. At the very least, Dr. Tuteur has certainly not proven her assertion that the increase in average “lifespan” (the wrong word anyway, it’s life expectancy) can be accounted for by industrial farming practices (like pesticides).
Dr. Tuteur:
“The difference between an average lifespan of 48 and one of 77.7 can be accounted for by modern medicine and increased agricultural production brought about by industrial farming methods (including pesticides). “
Zoe237 said “Has anybody read the Skeptical Environmentalist? Bjorn Lomberg’s claims rather remind me of Dr. Tuteur (minus his thousands of footnotes) and other pseudoscientific skeptics. He has a VERY rosy view of the present and the future and basically dismisses the dangers of global warming, overpopulation, water supplies, overuse of pesticide and nitrogen based fertilizers, and other toxins and pollution.”
I have read all 3 of Lomborg’s books. You misrepresent what Lomborg says in the same way that you (and others) misrepresent what Dr. Tuteur says. Lomborg does not “dismiss” the dangers of global warming or other environmental problems.
Harriet Hall, you said that you wonder why people aren’t criticizing your blog articles the same way they are criticizing Amy Tuteur’s. Maybe you can’t see the difference between your contributions to the SBM blog and hers, but I can.
Let’s take an example from your review of the Business of Being Born.
“Normal birth is not a medical problem, but it can turn into a life-threatening medical problem with no advance warning. Published safety statistics for home births are pretty good, but their validity has been questioned. Safety is going to vary with training, patient selection, and circumstances like geographical constraints. Comparisons are problematic. There is undeniably a small risk. The perception of the size of that risk and its acceptability boils down to personal attitudes and risk-taking behaviors.
Highly-paid obstetrical expertise is not needed for most births. There is no reason well-trained, well-equipped midwives could not deliver babies at home for those who prefer it and are willing to accept the small risk. There is also no reason midwives could not deliver most babies within the hospital in a patient-friendly homelike environment with expert emergency backup right next door. That would be the best of both worlds.”
This is quite a fair general assessment of the research and state of affairs for homebirth. It is a dramatic difference to Amy Tuteur’s position that homebirth is not suitable, period, and that anyone who promotes homebirth as a safe option for women is uneducated and/or deceptive.
And you astutely make corrections like this,
“Amy, while I agree with your main points, I have to question one statement you made: “All the existing scientific evidence shows that all of the myriad claims of alternative health are flat out false.”
I think it would be more accurate to say that all the existing scientific evidence is compatible with the hypothesis that no CAM treatment works better than placebo, except for some herbal remedies which would probably work even better if they were approached by the time-tested methods of pharmacology with isolation and purification of the active ingredient.”
Again, a more accurate statement than the sweeping generalization that Amy Tuteur made.
And you represent yourself correctly like this,
“Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices.”
Instead of Amy Tuteur who omits (at least on her SBM profile) that she left the practice of medicine and gives readers the impression that she is currently a practicing ob-gyn.
I can be honest and say that I may not be as intelligent as some of you folks here, and my Masters degree is not in the sciences, but I can plainly see that Amy Tuteur’s blog entries are not of the same quality as the other blog entries by SBM contributors. Her fanatical clinging to the notion that anything natural is not good and everything medical is, classes her in the category of extremist, similar to the “natural” extremists that she rails against. That’s all I want to say on Amy Tuteur, as we should be discussing the content of the blog entry.
———————————————
Maybe people sometimes romanticize about how we lived in the past or at least romanticize elements of how we lived in the past because in their minds the measure isn’t exclusively life expectancy but also the quality of health when people are alive. Poor diet, poor lifestyle, and lack of exercise can contribute to lack of energy, depression and generally feeling unwell. I would argue that a modern fast-paced and stressful life where more junk food is available and cheap, and people aren’t as physically active as they used to be to run their own households and farms/gardens, can mean a lower quality of health for an increasing number of people. Of course it is still possible to live a slower and less stressful life, eat nutritious food, get lots of exercise etc. in our modern world, but it seems like more of an effort for people than those living in the past who had a slower-paced life, no choice but to do physical labour, and the main food available was the nutritious food from their farm/garden. People were living closer to nature and nowadays many people feel so far removed from it. They may be romanticizing and trying to get back to nature in the wrong way, but it certainly can help describe why some people are interested in alternative health therapies.
“Who, the Union of Concerned Scientists? Why would they start farms? I don’t really understand this comment.”
To show us that that their way is as good as they say. It doesn’t even have to be them, it could be some entrepreneurs applying their model of agriculture.
“I would argue that a modern fast-paced and stressful life where more junk food is available and cheap, and people aren’t as physically active as they used to be to run their own households and farms/gardens, can mean a lower quality of health for an increasing number of people.”
How do you measure this “quality of health”?
“no choice but to do physical labour”
That sounds like a lot of fun.
“and the main food available was the nutritious food from their farm/garden”
Really? It may also not have been available due to weather conditions, pests, etc.
“Her fanatical clinging to the notion that anything natural is not good and everything medical is”
Watch out for matches with all that straw around.
statlerwaldorf,
“Harriet Hall…maybe you can’t see the difference between your contributions to the SBM blog and hers, but I can.”
Let’s take an example from your review of the Business of Being Born.
“Normal birth is not a medical problem, but it can turn into a life-threatening medical problem with no advance warning…There is undeniably a small risk [with home birth]. The perception of the size of that risk and its acceptability boils down to personal attitudes and risk-taking behaviors…There is no reason well-trained, well-equipped midwives could not deliver babies at home for those who prefer it and are willing to accept the small risk. There is also no reason midwives could not deliver most babies within the hospital in a patient-friendly homelike environment with expert emergency backup right next door. That would be the best of both worlds.”
But look at all the qualifiers in there? I counted at least eight. Can’t you see that all these qualifiers bring Harriet’s view so close to that of Amy’s that is really only comes down to a matter of emphasis and style?
Again, I don’t think that Amy would disagree with any of this.
What concerns her is that patients do not really truely understand the risk they are taking, even when it is clearly spelled out to them, and will blame the doctor anyway when things do go badly wrong. Her point was that the doctor must make absolutely clear that she really does understand that risk.
“Harriet: “I think it would be more accurate to say that all the existing scientific evidence is compatible with the hypothesis that no CAM treatment works better than placebo, except for some herbal remedies which would probably work even better if they were approached by the time-tested methods of pharmacology with isolation and purification of the active ingredient.””
Firstly, Harriet said “more accurate”, not “wrong”.
And, secondly, Amy readily agreed with my rather long summary of the scientific view of herbal treatment which, as far as I can tell, is just an expansion of Harriet’s summary.
Really, the difference between Amy’s and Harriet’s view regarding herbal treament is probably no greater than the width of a bees…um…whisker.
“Again, a more accurate statement than the sweeping generalization that Amy Tuteur made.”
Yes, Amy: short and to the point; Harriet: more accurate but long winded (not a criticism at all) and both saying essentially the same thing.
“Instead of Amy Tuteur who omits (at least on her SBM profile) that she left the practice of medicine and gives readers the impression that she is currently a practicing ob-gyn.”
I didn’t know Amy was not practising when I first read her articles. I also didn’t know Harriet was practising when I first read her articles (that was elsewhere, not here). Did it make a difference when I found out? Not a cracker.
Of course, Lomborg’s book is so riddled with errors of science that it should not be taken seriously:
http://www.lomborg-errors.dk/skeptical.htm
http://scienceblogs.com/deltoid/2008/02/lomborg_beats_gore_110_to_2.php
http://thingsbreak.wordpress.com/2008/07/22/willful-idocy/
Some appear to be deliberate:
http://www.lomborg-errors.dk/examples.htm
Just to be clear, I’m not advocating for CAM, I’m advocating understanding why people use it, why they believe it works and why the fact that little bits and pieces of it here and there kind of work (or harness certain techniques from behavioral psychology intentionally or accidentally) and can be useful enough to people to lead them to believe the larger CAM narrative and naturalistic fallacies and Garden of Eden fantasies (you know, the kind that sell island vacations too). I also advocate being realistic about SBM and medicine in general. Romanticizing science and “modern medicine” as all good and conflating it with industry is just as romantic and simplistic as doing so about nature.
Fifi – “The reason why people keep going back to alternative health practitioners is that bits of it can work”
Billy Joe – “No, you don’t know that unless you have the evidence.”
If people are just seeking to feel better or get some support making lifestyle changes (I’m not talking about cures here) then going to see someone who pays attention makes them feel better. This “social effect” can also be obtained from seeing a psychotherapist or MD, which I would recommend over a CAM practitioner for many reasons, but if that’s what people are really seeking then they can also get it from many CAM practitioners. Meditation does work to change neuroanatomy and for pain management, exercise has been shown to help alleviate mild to moderate depression, herbs have a biological effect and various other very non-magical things that CAM claims as their treatment territory. Of course, many MDs, pain specialists and psychologists and psychiatrists also promote these kinds of common sense approaches to basic mental and physical health. I just find it unfortunate when an SBM blogger acts as if SBM is merely about surgery and pharmaceuticals and make equally unscientific assertions as those promoting naturalist fallacies. They’re both ideological positions and not reality-based thinking.
BillyJoe – “But then why use proven ineffective treatments or even unproven treatments to achieve this. Use the thing that’s achieving the effect – understanding, empathy, compassion, psychology etc”
Not always – some herbs like St-John’s Wart have evidence behind it, so do meditation, exercise and diet. The problem is that CAM practitioners often take a little bit of science and then exaggerate it greatly (that’s what makes it pseudoscience, whether it’s CAM or Big Pharma doing that kind of thing). Then there’s the issue of dosage and contamination vis a vis herbs, being untrained in psychology and many other issues. I agree it’s preferable for someone to see an MD, psychologist or psychiatrist for a wide variety of reasons – the main one being so that they learn how their own mind works and find healthier ways to get this kind of support and empathy. Of course, there are psychiatrists and psychologists who create dependence in their patients as well or simply prescribe pills inappropriately (as unethical as that is) and not all MDs are capable of providing or arranging the kind of support someone may be seeking or need (due to lack of interpersonal skills, training in psychology or simply time).
Fifi – “Also, saying that the placebo effect means “it doesn’t work” isn’t accurate and is overly simplistic – If a placebo is relieving someone’s pain or depression it is working since the end goal of any treatment for pain or depression is to relieve pain or depression. What it indicates is that the actual drug may not work in the way anticipated and be no better than a placebo.”
BillyJoe – “There is no way round it really. If a drug works no better than placebo, that means it doesn’t work. Put it another way: Does placebo work? Yes it does. Does the drug work? No it doesn’t? If you want to deny that, then you will have to show an effect of the drug above placebo.”
Agreed, if a drug works no better than a placebo then it means the drug doesn’t work. You’re missing my point though – I think probably because you’re thinking about this purely in terms of drug trials and I’m coming at it from the perspective of treating patients. If a placebo works in the sense that it improves the patient’s symptoms that means that a particular condition may well have a viable treatment option that doesn’t involve using a drug. Why would one use a drug when it isn’t necessary and has side effects but no real value for the main effect being tested for? Surely that’s no different than using homeopathy or other forms of CAM (though patients being given pharmaceuticals that are no better than placebos are just as attached and convinced by their experience and “feeling better” as people given CAM treatments that are no better than placebos…it’s human nature
Harriet,
I’m not sure what you’re asking about with respect to the response Amy generates.
My understanding is that her role is to increase traffic at SBM. I don’t know if she has done this, though she does elicit lots of comments from readers. She has stated in the past (on SBM and elsewhere) that the only measures of success in blogging are the number of hits and length of the comment thread and her writing style reflects that. (On another site when readers asked her whether unique hits are also important as a measure, and whether her writing style is effective in driving unique hits as well as total hits, she declined to respond.) While both you and David Gorski have stated that accuracy and effective communication are also important, Amy has never publicly endorsed this view.
Going back to Fifi’s point about Mark Crislip’s post being so perfect there was nothing for a commenter to add, my feeling is that Amy deliberately writes sloppy posts with many indefensible absolutes. People challenge her on them and end up engaging in conversations with one another about topics they care about, often only tangentially related to Amy’s original post.
In this comment thread I mentioned that I had thought that Amy was going to write about the current “stone-age diet” and would have been interested to hear Amy or another SBM blogger deconstruct it. Amy promptly made comments on the stone age diet but they made no sense; she also demonstrated a poor understanding of evolution and made statements about the history of human diet (that our ancestors did not eat meat) that were simply false. That’s fine: an obstetrician is not an anthropologist. But the fact that she didn’t know what she was talking about was no obstacle to her: she made indefensible statements and generated comments. I don’t think this is a problem for Amy. On another thread she taunted a Jew-baiter and deliberately prolonged a discussion of whether Judaism is inherited through the mother without actually bringing any insight to the thread. (Repeated injunctions to “do your research.”) Yes, more comments were added to the thread. They had nothing to do with SBM.
Because Amy shows no restraint in talking about things she doesn’t actually understand, and does not qualify her statements, I can’t trust anything she says. I am willing to believe her when she talks about obstetrics, especially since in this field she is familiar with the literature and is clear about her sources and the bases for her statements. (Even then her statements may bear no obvious relationship to the literature, but at least we are working from common ground and her leaps of illogic are clear.) But for the rest, I follow her blog for the community of argumentative commenters that she builds, many of who understand a particular field much better than Amy does and are able to discuss it intelligently. If building a community of argumentative commenters is her role as an SBM blogger, then she is successful, and I don’t see anything to be concerned about.
weing – “It doesn’t even have to be them, it could be some entrepreneurs applying their model of agriculture.”
I’m not sure about what the particular organization being discussed promotes vis a vis agriculture but there are entrepreneurs and community organizations applying a variety of approaches to small scale and local organic agriculture both in North America and Europe. (We don’t have to go back very far i the history of our own cities to see how a more localized farming system can work.) The success of CSAs (community sponsored agriculture, farms where you buy in a share of that year’s produce) and the resurgence of farmer’s markets are two examples are two examples. Yardshares, rooftop gardens and community plots are another way that more people are growing their own food or using urban and suburban land/spaces to grow food. In my city most Italian immigrant families still grow a great deal of their own fresh fruit and vegetables in their back yard. And, if one still wants a mango in the middle of winter then it’s quite possible to buy fair trade, organic mangoes. And, of course, in Europe there are lots of farmers that have never changed traditional methods (see the Slow Food movement for more info).
The main problem with rah-rah and romantic attitudes to industrial science – be it pharmaceuticals, factory farming and pesticides or technology – is that it generally takes time for us to actually understand what the impact upon human biology and the environment is from these new technologies. It doesn’t mean we shouldn’t develop or use new technologies or products, some are far superior to what we had before. It does mean we should use common sense and some caution rather than putting short term profits for a few over long term effects for the many. Antibiotics and the emergence of superbugs is an obvious area where this applies. As is the increasing evidence that a sparkling clean home and no exposure to dirt and germs isn’t very good for priming a kid’s immune system. What is needed is a reasonable, balanced approach that deals with reality rather than indulging in romantic ideas about science, medicine or nature.
“What is needed is a reasonable, balanced approach that deals with reality rather than indulging in romantic ideas about science, medicine or nature.”
Couldn’t agree more.
lillym,
In her original post, Amy states that for most of human existence the average human life expectancy was 35 years. This could mean a lot of different things, none of which she clarified. But the point that people used to die young at greater rates than they do today was made and taken.
Later on she states that it’s not possible for chronic diseases of aging to have exerted selection pressure during human evolution because people died young.
Over hundreds of thousands – or millions – of years, for chronic diseases of aging to not be able to exert any selection pressure at all, everyone must die young. Not just most people.
Either she doesn’t understand what she is saying, or she understands that she is saying that nobody ever got old before the advent of modern medicine and agriculture.
I don’t believe that the evidence supports the latter conclusion, but I could be wrong. Amy has not produced evidence for her statement, but my evidence for my belief that there were people who lived to old age in the past is pretty skimpy.
“I have read all 3 of Lomborg’s books. You misrepresent what Lomborg says in the same way that you (and others) misrepresent what Dr. Tuteur says. Lomborg does not “dismiss” the dangers of global warming or other environmental problems.”
I only have a second, and I have only read one of his books, but he agrees that AGW may exist, but that it’s really not that big of a deal, in comparison with other problems we face (that he also attempts to diminish however). He completely disagrees with the Kyoto Protocol, for example. The editor of Scientific American in my link said the exact same thing. Dr. Gorski’s links showed the same thing. Lomberg was found innocent in his trial, but his errors remain.
The difference between Dr. Hall and Dr. Tuteur is exactly that of QUALIFIERS. Dr. T’s writing is fine for the back of a cereal box, but I had come to expect more nuance from the bloggers here because of the more knowledgeable readers. I am really really suprised that many can’t see how she overly simplifies complicated medical and science topics.
Amy,
In a previous thread you said it was obvious what my agenda was but you didn’t say what it was. Would you mind telling me? I’m curious.
“My understanding is that her role is to increase traffic at SBM.”
Your understanding? Based on what? Your own personal prejudices? You have absolutely no way of knowing how I came to be writing on SBM. You’re just making it up.
“She has stated in the past (on SBM and elsewhere) that the only measures of success in blogging are the number of hits and length of the comment thread …”
Again, you are simply making this up to satisfy your own prejudices.
Your motivation is obvious. You wish to discredit me personally because you find my writing threatening. You can’t keep yourself from reading it and it frightens you because it casts serious doubts on what you believe.
Unfortunately, and unnecessarily, you view this as an either-or dichotomy. If I’m right, you must be very wrong. Therefore, you wish to censor me. It is not enough merely to stop reading my pieces. You want to make sure that other readers of SBM can’t read what I write.
I have said it before and I will say it again. Feel free to disagree with me; feel free to argue with me; but stop LYING about me and stop trying to censor me.
Dr. Tuteur’s role on SBM is not to increase traffic. It is to provide input from a skeptical OB/GYN and to add the perspective of a specialty that was not previously represented here.
“fanatical clinging to the notion that anything natural is not good and everything medical is” – this is a misrepresentation of what she actually writes, and is typical of the unqualified generalizations that others have accused Dr. Tuteur of making.
You have absolutely no way of knowing how I came to be writing on SBM.
+++++++++++++
You are right, we have no idea. Would you care to enlighten us?
I don’t want to get off-track into a discussion of the very controversial Bjorn Lomborg, but I think it is important to correct one misconception that I have heard repeated over and over. He does not “completely disagree” with the Kyoto protocol: rather, he shows that its actual impact on global temperatures would be positive but very small. His objection to Kyoto is that it accomplishes too little, too late (NOT the argument of a global warming denier!), and that it costs money that could be used to save lives today with simple but effective measures like malaria-preventing bed nets. He advocates a better thought-out, more effective, more economically rational response to global warming. He argues that science ought to be able to come up with more effective remedies than Kyoto, and meanwhile there is much we can do today at little expense to improve human welfare more than Kyoto could. Lomborg’s approach is far more nuanced than his critics claim.
“You have absolutely no way of knowing how I came to be writing on SBM. You’re just making it up.”
That’s about right, though I would use the word “guessing.” You have discussed your writing style openly in the past and stated that your goal is to reach as many people as possible, not to be liked. I guessed (“made up”) that SBM shared your goals and invited you on board at least partly for that reason. The fact that Harriet Hall and David Gorski both referred to traffic as being part of their goals for SBM supported my guess, but I am happy to be corrected. Hope that having you on board would increase traffic played no role in the decision to invite you to blog on SBM.
“Unfortunately, and unnecessarily, you view this as an either-or dichotomy. If I’m right, you must be very wrong.”
I don’t understand. What do I believe?
“Therefore, you wish to censor me. It is not enough merely to stop reading my pieces. You want to make sure that other readers of SBM can’t read what I write.
I have said it before and I will say it again. Feel free to disagree with me; feel free to argue with me; but stop LYING about me and stop trying to censor me.”
I have no power to censor you, so I have no idea where that comes from. If you don’t like my commenting style, feel free not to read what I write or ask to have me put on moderation.
As for lying about you, that’s a very serious accusation. Please be specific about statements that I have made that are lies. I will either demonstrate what led to my misunderstanding so that you can clarify, or gladly retract my statement.
Dr Tuteur – “Your motivation is obvious. You wish to discredit me personally because you find my writing threatening. You can’t keep yourself from reading it and it frightens you because it casts serious doubts on what you believe.”
Simply repeating this over and over again doesn’t make it true. Your writing isn’t threatening, it’s simply not good SBM writing. It’s highly personalize, sensationalist cargo cult blogging. It’s interesting to observe and challenge you because you use so many of exactly the same clichés as CAM advocates and pseudoscience bloggers and writers. (Including the “you can’t handle my super truth” fallacy and narcissistic grandiosity.)
Dr Tuteur – “Unfortunately, and unnecessarily, you view this as an either-or dichotomy. If I’m right, you must be very wrong.”
No, you’re the one who keeps presenting either/or scenarios and extremist and high generalized naturalist vs industrialist fallacies and simplistic nature vs SBM fallacies regarding everything from diet, exercise, psychology and neurobiology and even extending into childbirth and circumcision. You keep making very basic errors of communication (longevity vs lifespan in this particular blog) and then blaming readers for misunderstanding. You keep answering coherent arguments and evidence with personalized attacks and grandiose assertions (“you’re all out to get me because you’re threatened” projection being a big and somewhat obsessive theme with you apparently).
Dr Tuteur – “Therefore, you wish to censor me. It is not enough merely to stop reading my pieces. You want to make sure that other readers of SBM can’t read what I write.”
No, what I was initially after was you actually writing like an SBM blogger and not some sort of cargo cult woo merchant who resorts to the same fallacies as extremist CAM advocates when critiqued. However, that seems highly unlike since you keep resorting to all the same rhetorical tactics as pseudoscientific pseudoskeptics as Big sCAM promoters and climate change deniers. It’s becoming increasingly apparent you’re not an SBM blogger at all – particularly since you’re now resorting to “I’m being oppressed for being a truth speaker” fallacies rather than considering that perhaps your sensationalist and highly personalized style – and choice to present as an expert in all kinds of areas you’re clearly not an expert and make grand ideological claims without presenting evidence – doesn’t actually do anything to promote SBM or further actual understanding of medicine or science as a practice and methodology. On top of that you’re damaging in terms of public perception of SBM since you are an ideologue abusing SBM as a platform to promote an agenda. Since you’re hostile and dismissive of preventative medicine and non-surgical and non-pharmacological treatments, and are uncritically pro-industry, you present as a real life version of the cartoon pro-industry pseudoskeptic/pseudoscientist that CAM advocates and healthfreedomusa types claim scientists and doctors are.
Dr Tuteur – “I have said it before and I will say it again. Feel free to disagree with me; feel free to argue with me; but stop LYING about me and stop trying to censor me.”
Please, once again you’re falling back on the same cries of “I’m being oppressed” as the most ridiculous CAM and antivax bloggers do. You’re unable to own up to your own rather glaring errors in communication or take responsibility for how you communicate (sure you change things after the fact but that’s not actually honestly owning what you originally said, it’s usually just erasing the evidence of your error), you don’t seem to understand or be able to acknowledge how much your project onto people who comment and your own cognitive biases, and you certainly don’t seem aware of just how often you use exactly the same tactics as CAM promoters of pseudoscience or ideologies. On top of that, you keep trying to pass off personal opinion as SBM and claim that you’re not being personal when you’re busy projecting your own motivations onto anyone who critiques you. It’s just sad that you’re doing this as an SBM blogger (but it’s also fascinating in that bug under a microscope way that watching pec implode used to be).
zoe – “The difference between Dr. Hall and Dr. Tuteur is exactly that of QUALIFIERS. Dr. T’s writing is fine for the back of a cereal box, but I had come to expect more nuance from the bloggers here because of the more knowledgeable readers. I am really really suprised that many can’t see how she overly simplifies complicated medical and science topics.”
Agreed. I don’t always agree with Dr Hall’s perspective – and I do think she was unable to acknowledge a personal bias vis a vis circumcision (if you used to do them, there’s bound to be a desire to believe it was and is a good thing) and felt personally attacked in that instance so feels very aligned with Dr Tuteur because of some shared beliefs – but generally speaking she’s at least got a basic respect for science and communicates without resorting to simplistic and ideological black/white distortions. It’s interesting that she seems to be a bit of an apologist for Lomborg who seems to be a pretty classic pseudoskeptic posing as an expert in a field outside of his expertise who romanticizes technology/industry. Of course, none of the SBM bloggers here are climate scientists (and neither am I, nor apparently is Lomborg) so, like Dr Tuteur’s claims of expertize regarding agriculture and anthropology, we’d all really be out of our areas of expertize and mistaking our opinions for fact (if we argued them as fact that is).
You have absolutely no way of knowing how I came to be writing on SBM.
+++++++++++++
You are right, we have no idea. Would you care to enlighten us?
I’d be interested in knowing too since it seems weird that you’re here. Were you recommended by another SBM blogger? Did you promote yourself to Dr Gorski or Dr Novella? Did they seek you out? I find it odd that you’re posting here since, generally speaking, the quality of writing and analysis of other SBM bloggers is so much better that what you post. If you’d started out rocky but gotten better it would be understandable (new to SBM’s style, etc) but you haven’t improved at all and have descended even further into the mire of antivaxer/altmed rhetorical clichés and presenting generalize philosophical or ideological positions as scientific and/or SBM.
Your understanding is in error.
“He does not “completely disagree” with the Kyoto protocol: rather, he shows that its actual impact on global temperatures would be positive but very small. His objection to Kyoto is that it accomplishes too little, too late (NOT the argument of a global warming denier!), and that it costs money that could be used to save lives today with simple but effective measures like malaria-preventing bed nets.”
The Scientific American article points out that Kyoto was NEVER *intended* to be the “solution” to global warming. It’s just a start. Thus, most of his argument is a strawman.
No, Lomberg certainly isn’t a AGW denier. The problem is that his “science” is faulty, used to promote an idealogical agenda, and he romanticizes the present. Pseudoscience. We see this over and over again when a person outside their own field try to make sense of complicated issues for laypeople. Freakonomics is another example, or Steven Milloy, or even Jared Diamond (who I love, but he oversimplifies too). Even Penn and Teller (who I also admire) on passive smoking. Or Randi on AGW. The difference is that somebody intellectually honest will make it VERY clear that this is their opinion, they have biases, and they are not an expert. They also are careful to make qualifiers.
Dr. Tuteur, however, doesn’t even try to research the other side or falsify her own statements or provide evidence. That’s why she hasn’t been able to make it in scientific communication outside the blogging world.
I do however think that some went overboard in their criticism of Lomberg, so we can probably agree there. (Trying to block publication, e.g.)
I do detect a bit of split mind from Amy. She contends that her provocative style threatens others, and that is why she receives the same types of voluminous critical responses in several different blogging venues. Fine, if that is her take she should be proud of her provocative “Fox News” style and stop with the simultaneous persecution complex that readers are trying to “censor” her (tres bizarre).
I also have to say that for a self-described staunch defender of “science” Amy definitely veers far into the realm of “woo” and telepathic/omniscient knowledge with this “Your motivation is obvious. You wish to discredit me personally because you find my writing threatening. You can’t keep yourself from reading it and it frightens you because it casts serious doubts on what you believe.” Woo woo!
As to differences between Harriet’s style and Amy’s, give me long-winded and accurate any day, over short, strident and inaccurate. Qualifiers are an extremely important part of scientific communication, and Billy Joe’s attempt to gloss over and reconcile Harriet’s and Amy’s style differences as a matter of qualifiers just doesn’t cut it for me.
Actually, Milloy is simply a shill for big business, both through ideology and for whom he’s worked in the past. The only times he’s right about science, IMHO, is when the industry position on an issue happens to be closest to the best scientific position, for example, on vaccinations.
Amy,
I’m puzzled about something else. When Harriet Hall wonders why you to elicit more blog participation than she does, your explanation is that you tell the truth and SBM readers can’t handle the truth.
I know you aren’t saying that Harriet Hall does not tell the truth. So what are you saying?
He’s a variety of AGW denialist who concedes that AGW is happening but (1) says it’s not happening as much as claimed and/or (2) denies that AGW is a that bad a thing or claims that it’s a good thing.
To be clear, I don’t think there is anything wrong with having an ideology as long as you can, one, be honest about it, and two, attempt to falsify it. Otherwise, it’s just faith rather than science.
“The Scientific American article points out that Kyoto was NEVER *intended* to be the “solution” to global warming. It’s just a start. Thus, most of his argument is a strawman.”
Again, an oversimplification and a distortion of Lomborg’s position. He recognized that it was intended as just a start, but he described it as a poorly thought out and possibly even counterproductive start whose potential benefits had been over-hyped and he explained why in great detail.
I am amazed at how the emotional reaction to the subject of global warming led readers to react to what they wanted to think Lomborg wrote rather than to what he actually said. His critics have responded to errors he made, but they have not responded to his main points which would still be valid if all those errors were corrected.
“He’s a variety of AGW denialist who concedes that AGW is happening but (1) says it’s not happening as much as claimed and/or (2) denies that AGW is a that bad a thing or claims that it’s a good thing.”
I was operating under the definition that a AGW denialist was someone who completely denied the existence of human caused global warming. Though it definitely seems that there is a huge spectrum of global warming dissidents.
I can respect a libertarian position that simply knowing AGW exists doesn’t necessitate governmental involvement, even if I don’t agree. The problem is misuse of science (or ignoring science) to make your argument.
“I am amazed at how the emotional reaction to the subject of global warming led readers to react to what they wanted to think Lomborg wrote rather than to what he actually said. ”
You know, Rachel Carson also made some errors in “Silent Spring.” And that’s a classic for environmentalists, so who knows.
I am the wrong person to debate this subject. Simply put, he is a political scientist whose environmental conclusions go against most major scientific organizations in the world. As a layperson, I have to decide who is credible and who is not. He seems like a rogue “environmentalist” whose only training is in political science, and has been brought to trial for charges of plagiarism, fabrication of data, deliberate misinterpretation, etc etc etc. So I am skeptical of his skepticism. I suppose it is possible that all of the scientists disagreeing with Lomberg are simply having emotional reactions, but I doubt it.
Off-topic global warming tea party:
No idea who Lomborg is. Doesn’t matter. We’re all borked anyway. (That’s my bias. My personal thing that drives me bonkers? People who actively, deliberately, biologically reproduce themselves, creating new human beings to consume resources on the planet, and then claim to be saving the world by using cloth diapers. Gah. Spare me. Tell yourself that if it makes you feel good about yourself, but don’t put me in the position of having to choose between being rude to you or playing along.) (Conflict of interest disclosure: I have no biological offspring.)
For enjoyment, see the Voluntary Human Extinction Movement:
http://www.vhemt.org/
And indirect commentary on AGW: “It’s interesting to note that an enormous amount of apparently principled argument goes on about relatively tiny movements in where the line is being drawn.”
http://sethgodin.typepad.com/seths_blog/2010/02/moving-the-line-the-power-of-a-zealot.html
“He’s a variety of AGW denialist who concedes that AGW is happening but (1) says it’s not happening as much as claimed and/or (2) denies that AGW is a that bad a thing or claims that it’s a good thing.”
That’s not what I got from his books. I understood him to say that there are various predictions of the extent of global warming and that some of those predictions may be overly alarmist, that it is simplistic to only look at the bad consequences and fail to take into account even the possibility of some good consequences, that there are a lot of other bad things that need to be dealt with (disease, lack of access to clean water, etc.) that have the potential to save many lives and improve human welfare NOW, and that our limited economic resources should be applied judiciously considering where they can do the most good in both the short term and the long term. He also proposes that instead of leaping wholeheartedly into expensive solutions that we “think” will work, we should test proposals to reduce global warming with a scientific approach where something is tried and the results are continuously monitored allowing adaptation of policy in response to the data.
Alison you’ve touched on something I too have been mulling over. If Amy is indeed so threatening, and her basic premise is that medicine should be science based, then wouldn’t all the sbm bloggers be as threatening, for that is their basic premise as well? Yet why don’t they receive the same types of negative commentary?
My perception is that other sbm bloggers give the kind of thoughtful , sometimes long winded (and occasionally arrogant, which is tolerable if accompanied by accuracy) comments that are required of a complex subject. It seems that those critical of Amy’s style are so for the same reason that sbm bloggers (including Amy) criticize the general media inaccuracies when reporting on science and medicine: the brevity and sensationalism of science and medical reporting generally found in the media does not lend itself to the accurate communication (qualifiers and all) of a complex topic.
Regarding the importance of qualifiers in science communication, here’s an extract from a text titled The Hands-On Guide for Science Communicators: A Step-by-Step Approach to Public Outreach by Lars Lindberg Christensen (2007)
The context of this comment from Chapter 21, Credibility in Science Communication, pertains to scientific press releases but is relevant to science bloggers who desire to create or maintain credibility. “Credibility problems in press releases can be caused by…….. omitting qualifiers and diluting the text by using too many superlatives…..”
Bring on the qualifiers. I like accuracy.
Dr Hall, it’s interesting that you’re an advocate for Lomborg’s political/ideological position even though he’s been called out by climate scientists as promoting bad science (either willingly or purely by virtual of ignorance). Nothing wrong with having a personal or political position, of course. Pretending that it’s evidence or science based when it’s not, however, is problematic whether we’re discussing medicine or climate change. It’s leaving the realm of reality-based thinking to enter the land of ideology where the great woobeast flourishes. Accusing others of being emotional and irrational or not science-based in the context of someone being critiqued for promoting bad or pseudo science is just weird on an SBM blog (and pretty much a fall back tactic of dishonest pseudoskeptics of all stripes, whether they’re applying pseudoskepticism to medicine or anything else). Just because it sounds “common sense” to you or aligns with your beliefs doesn’t mean his approach is actually evidence or science based – even if he makes a ritual showing of presenting science. You’re making the same kind of error involving confirmation biases that believers of woo do about “traditional” cures and so on.
Really? How so?
Fifi,
You are reading more into my words than I intended. I’m not an advocate for any ideology Lomborg may support; I’m an advocate for trying to understand what his position is.
He is clearly evidence- and science-based, although he has made mistakes about what the evidence shows. The percentage of his mistakes is small compared to the percent of facts he got right, and correcting those mistakes would not be enough to change his arguments. Anyway, it is inaccurate to say that such mistakes constitute “promoting bad or pseudo science.” It is more accurate to say that he is promoting good science but made some mistakes in a field that he is not an expert in.
His whole thrust is not to support any particular ideology but to encourage skeptical critical thinking based on scientific evidence and uncontaminated by emotions and beliefs. His discussion of how money should be spent is not a prescription but a recognition of the practical reality that the money is finite and that we have some hard choices to make. In all the criticisms I have read about him, no one has addressed his main points or even shown that they understood them.
Dr. Hall:
“His critics have responded to errors he made, but they have not responded to his main points which would still be valid if all those errors were corrected.”
Does this make sense? If the premises of your argument are incorrect, what does it say about your conclusion? It doesn’t prove said conclusion false, but it doesn’t prove it true either.
How would the main point be valid if the premises are in error?
The same logic has been a defense of Dr. Tuteur- that her premises may be wrong, but her main point remains intact. For example, she disagrees with a targeted c-section rate of 15% proposed by the WHO. One of her premises is that c-sections DO NOT lead to higher maternal mortality (perhaps morbidity). Yet ACOG and WHO say that maternal mortality, while difficult to measure because of confounders, is 3 to 7 times larger with cesarean section. They have loads of research to back that up. Factual errors matter, if left uncorrected by the author. Yes, these are small differences, but small differences matter in the messy world of science. (Look at the tree ring debate in AGW).
Lomberg was brought up on charges with the Danish Committee on Scientific Dishonesty. The finding was that while the book was scientifically dishonest, it wasn’t fraud because Lomberg wasn’t an expert. I think the ruling was later said aside… I read the book almost ten years ago. The Skeptical Environmentalist and the resulting uproar is really instructive for skeptics of any stripe. (And I really disagree with the witchhunt aspect to silencing opposition in this case). What the lesson is, I have no idea! But the line between a skeptic and a denialist is pretty darn thin.
David,
I explained what I understood Lomborg’s main points to be in my comment at 3:03. They are mostly common sense points about how to think about the subject, rather than specific arguments that depend on the facts his critics say he got wrong.
“One of her premises is that c-sections DO NOT lead to higher maternal mortality (perhaps morbidity)”
No, that’s not my premise; that’s your misrepresentation of my claims because you’d rather argue against that instead of what I really said.
You have a curious disregard for the truth.
Dr. Hall:
” I understood him to say that there are various predictions of the extent of global warming and that some of those predictions may be overly alarmist, that it is simplistic to only look at the bad consequences and fail to take into account even the possibility of some good consequences, ”
This point, for example, must be backed up by correct science. 1. That GW predictions may be overly alarming. 2. That GW may have some good consequences.
Especially because they go against mainstream scientific thought.
It’s also worth noting that someone communicating in an emotional or passionate manner doesn’t automatically mean they’re being irrational or that what they’re communicating isn’t evidence or science based. Passionately held positions can be based on very solid evidence or science (and remain evidence based if one is willing to consider new evidence when it appears and/or if one’s passion is for an outcome rather than an attachment to a certain process or belief). Entirely irrational positions or beliefs, when one considers the evidence, can also be presenting in a very unemotional way. A lot of pseudoscience and pseudoskepticism does this – that’s the ritual or cargo cult aspect of it, how it presents as being scientific or rational but doesn’t actually conform to scientific or skeptical processes or results (it does things like cherry pick evidence, misrepresent the actual science, be unreasonably skeptical in the face of reasonable evidence, etc).
For instance, while most of us who support SBM probably have very rational reasons for doing so, my guess is that quite a few of us are also passionate about science, medicine and SBM and that contributes to why we participate here.
Granted, my interest in cognitive science, neurobiology, psychology and emotions – and people, art and how we communicate and perceive the world – probably means I’m biased towards seeing emotions as being as important as reason, and emotions and logic as not being mutually exclusive. Within cognitive science it’s understood that reason and decision making is rarely (barring a neurobiological problem) a purely logical process. When people do have neurological damage that removes emotion entirely from the decision making process it causes all kinds of real world problems. Trying to pretend that one is never swayed by emotion or subject to cognitive biases is really pretty deluded and, not surprisingly, makes one even more prone to being swayed by emotion or unaware of cognitive and confirmation biases.
And this post will be buried. But—
You can look at “Little House on the Prairie”
Narrowly escaped death by malaria (thanks to quinine!), Carrie was always weak and sickly (hookworm?), Mary blinded by measles, Laura healthy, grace healthy, and a son (not in the books) dead in infancy. Milk, butter, and salt pork were the proteins of the diet; other meat was salted and smoked. Crops were lost from locusts, winter, and drought (twice for laura and almanzo’s case, forcing them to move to arkansas). The whole family almost died during the dakota winter when the trains stopped running.
Additional info– numerous property losses forcing moves through debt that they could not repay for both pa and almanzo. Truely– everything you need to know is in that series.
Good news on the obstetrical front: Ma made it through 5 pregnancies.
Dr Hall – “You are reading more into my words than I intended. I’m not an advocate for any ideology Lomborg may support; I’m an advocate for trying to understand what his position is.”
Ah but you keep acting like an apologist and making excuses for why his bad science is okay because you think he’s promoting “common sense” so maybe you’re actually communicating something other than you intend via these shaky kinds of arguments that scream “confirmation bias at work”. You support his “common sense” opinion despite the fact that neither you nor he are climate scientists and the people you’ve denigrated as being “emotional” for critiquing him are actually climate scientists. Sounds pretty much like a confirmation bias and, consequently, as if you’re being an apologist for someone you agree with.
His arguments about how money should be spent have been cut down over and over again. For instance, why not take money away from bankrolling wars to spend on medicine? (You’d have the added benefit of not maiming and killing people in wars and polluting the environment and drinking water, sounds like a win win situation. Of course, it’s not a pro-industry approach, it’s a pro-human one instead. ) He’s creating a false (and emotional!) choice by making it medicine vs environment and you’ve bought into it wholesale!
Me: One of her premises is that c-sections DO NOT lead to higher maternal mortality (perhaps morbidity)”
Dr. T: “No, that’s not my premise; that’s your misrepresentation of my claims because you’d rather argue against that instead of what I really said.”
Really? So you do believe that unnecessary c-sections can possibly kill mothers? If so, I apologize. You have stated on numerous occasions that there is no good data to think that c-sections increase maternal mortality, but I certainly may be misinterpreting. You do acknowledge that unnecessary c-sections can increase maternal morbidity.
My understanding is that you think the data showing an increase is maternal mortality is flawed by confounding factors, but I haven’t seen any independent corroboration of that opinion.
Dr. Tuteur: “There’s actually no good data to show that C-sections increase the risk of maternal death, despite a number of studies that make that claim.”
http://www.sciencebasedmedicine.org/?p=2507
I’m afraid not, Harriet. Lomborg’s mistakes were so glaring, both in quantity and quality, that they easily bring into question his entire thesis, the “common sense” aspects of it notwithstanding, and, more importantly, his mistakes are consistent with allowing an ideological agenda override science. They were not random mistakes, as one might expect if he were just getting it wrong without an agenda. They were all in the direction of either downplaying or denying the severity of AGW. Such a pattern of error always sets my skeptical antennae a’twitchin’, as I like to say. Lomborg also seems to fall into the “either or” fallacy; i.e., the fallacy of the false dilemma. Either we try to reduce malaria or we try to reduce carbon emissions, not both. Yet there is no reason why we can’t do both.
“There’s actually no good data to show that C-sections increase the risk of maternal death, despite a number of studies that make that claim.”
Yes, that’s what I wrote. I did not say “c-sections do not lead to higher maternal mortality.” They are not the same thing.
“Either we try to reduce malaria or we try to reduce carbon emissions, not both. Yet there is no reason why we can’t do both.”
Lomborg doesn’t say we can’t do both.
Reading a book is an interaction between the reader and the text. People interpret what they read in the light of their personal knowledge, experience, and prior opinions. When I read Lomborg, I got one impression; when others read the books, they got a very different impression. That says more about the readers than about the text. I won’t argue about Lomborg any more: I think it is obvious that all his readers are biased in one way or another, myself included, and further discussion would be as fruitless as the protracted debate about Dr. Tuteur.
David,
Am I an AGW denialist if I like global warming and want more of it?
I always looked upon myself as a global warming proponent.
Dr Hall – Certainly bowing out of discussing Lomborg is up to you but pretending that his misrepresentation of climate science is no big deal and just a matter of subjective opinion is kind of strange on an SBM blog. Simply owning up to your own bias and claiming that all readers (do you include critical experts here?) are biased has absolutely no bearing on whether he was actually presenting objective science or presenting manipulated pseudoscience with an ulterior motive. Do you apply the same rationalizations vis a vis the accuracy of medical science when you blog and post here? I’d hope not but if this is your general attitude towards scientific accuracy and honesty then it is somewhat disturbing vis a vis SBM too!
weing – Maybe you’re a warm monger? Sorry, couldn’t resist the bad pun.
Amy Tuteur on premises:
“There’s actually no good data to show that C-sections increase the risk of maternal death, despite a number of studies that make that claim.”
Yes, that’s what I wrote. I did not say “c-sections do not lead to higher maternal mortality.” They are not the same thing.
I admit it: I don’t see the difference. So this is probably a good opportunity to do some education. Perhaps a post on how to read and talk about science?
It would be interesting to have SBM examine some of the purported health effects of Global Warming in the IPCC reports.
“pretending that his misrepresentation of climate science is no big deal and just a matter of subjective opinion”
I’m pretending no such thing. This comment is just one more illustration of why further discussion would be fruitless.
“There’s actually no good data to show that C-sections increase the risk of maternal death, despite a number of studies that make that claim.”
Yes, that’s what I wrote. I did not say “c-sections do not lead to higher maternal mortality.” They are not the same thing.
Fair enough, I apologize. I agree, there is a difference between “studies don’t show” and “there is no.” Let me rephrase my original statement, changes in brackets.
The same logic has been a defense of Dr. Tuteur- that her premises may be wrong, but her main point remains intact. For example, she disagrees [or there is no good data to show] with a targeted c-section rate of 15% proposed by the WHO. One of her premises is that [[there are no good studies that show]] c-sections lead to higher maternal mortality (perhaps morbidity). Yet ACOG and WHO say that maternal mortality, while difficult to measure because of confounders, is 3 to 7 times larger with cesarean section. They have loads of [not without errors, but still valid] research to back that up. Factual errors matter, if left uncorrected by the author. Yes, these are small differences, but small differences matter in the messy world of science. (Look at the tree ring debate in AGW).”
Btw, the 3-7 range takes into account the presence of confounders.
Obviously Dr. Tuteur thinks the research is flawed in this area, and that’s fine. Lomberg believes AGW research is flawed. But you still have to back up your assertions with evidence.
Dr Hall – Okay, you just asserted that the science he got wrong was no big deal and didn’t change anything he wrote in any meaningful way and any critiques of his science or ideas were “emotional”. Then Dr Gorski corrected you regarding the science part. Then you said you didn’t want to talk about it anymore without acknowledging that Lomborg was actually promoting pseudoscience or misrepresenting science. Whether he was presenting science or using pseudoscience to advance an agenda seems pretty relevant on an SBM blog! Science isn’t just a matter of subjective opinion, that’s why it’s science!
” I don’t see the difference”
Saying there is no evidence for x is not the same as saying there is evidence for not-x.
I think Dr. Hall admitted that some of Lomberg’s data was wrong, just that it didn’t make any difference to his “common sense” positions. I’m sure he was right on a few things in the book. The trouble is figuring out what since most of it was so riddled with errors.
There certainly is a lot of subjective opinion that goes into environmental solutions, so I agree with Dr. Hall there. THAT’S WHY the ***data*** is so important, to take the subjectivity out. I can’t stress that enough. If the premises are wrong…
Zoe,
Let’s be honest. You really want to believe that the ideal C-section rate is 15% or less. I pointed out that there is NO evidence to support that contention. Even Marsden Wagner, the WHO official who pushed through the recommendation acknowledges that there was never any evidence. YOU have been unable to provide any evidence for it. Nonetheless you persist in insisting that it must be true and resort to personal attacks to divert attention from the fact that you have no evidence for what you prefer to believe.
No one is fooled. You attack because you disagree and you lack any other ground to stand on.
Amy Tuteur on evidence:
“Saying there is no evidence for x is not the same as saying there is evidence for not-x.”
Good point. I confess to taking mental shortcuts. Since it is never possible to prove a negative, when people say “There is no good evidence for the effectiveness of homeopathy” or “There is no evidence at all for the existence of Russell’s teapot” I interpret that as being the same as “There is no reason to think that… ” or more pragmatically, “Homeopathy doesn’t work/ Russell’s teapot doesn’t exist.” But as you repeat so often, one must always read the entire source to understand whether that is the appropriate interpretation in that individual case.
There just seems to be no recognition by Dr Hall that he got his facts wrong…
Dr Hall – “He is clearly evidence- and science-based, although he has made mistakes about what the evidence shows. The percentage of his mistakes is small compared to the percent of facts he got right, and correcting those mistakes would not be enough to change his arguments. Anyway, it is inaccurate to say that such mistakes constitute “promoting bad or pseudo science.” It is more accurate to say that he is promoting good science but made some mistakes in a field that he is not an expert in.”
Here Dr Hall dismisses his mistakes regarding the science and claims that there’s no ulterior motive and isn’t promoting pseudoscience. Dr Gorski shows that it wasn’t just getting one or two small things wrong and that there’s a bias (as did the many climate scientists that Dr Hall dismissed as being “emotional”).
Dr Hall – “They are mostly common sense points about how to think about the subject, rather than specific arguments that depend on the facts his critics say he got wrong.”
No admission that he got facts wrong here, just that “his critics” said he got it wrong. Of course, his critics were actual climate scientists! Would Dr Hall frame medical scientists’ expertise in this same way in a discussion of medicine when the scientific consensus was being challenged by someone not versed in medical science?
Really, Dr Hall is being an apologist and claiming on the one hand that his ideas are “clearly science and evidence based” and then claims they’re just common sense so the bad science doesn’t matter because really he’s telling us how to think…um, using bad science and confirmation bias apparently. In this case, “common sense” seems to be code for “agrees with what I already believe”. When a CAM promoter makes these same claims about “common sense” or presents distorted science as evidence we question them – rightly so. The same should apply to all of our own ideas, no matter how much we emotionally feel they’re “common sense” or how sciency they look even if we can’t expertly dissect the science ourselves.
“There just seems to be no recognition by Dr Hall that he got his facts wrong…”
Let me correct that…
There just seems to be no recognition by Dr Hall that the fact that he got his facts wrong is problematic if she believes his position is science/evidence based and that he’s not promoting pseudoscience in service of an ideological position…
“It would be interesting to have SBM examine some of the purported health effects of Global Warming in the IPCC reports.”
Thanks, I was going to write about bees for Friday, but I have a ton of info and a lecture on weather, climate and infections. Maybe I will do that instead.
“Zoe,
Let’s be honest. You really want to believe that the ideal C-section rate is 15% or less. I pointed out that there is NO evidence to support that contention.”
Again with the absolutes. I’m not sure what the right number is. I do know there are active worldwide and national efforts to lower the c-section rate because of possible increased neonatal and maternal mortality and morbidity from elective cesareans. ACOG along with he US Healthy People guidelines also set some numerical goals. Once again, I can believe you or every medical organization in the world.
Of course I believe cesareans are necessary sometimes. What I don’t believe is that the 80% being done in Latin America (for example) are, or the 45% rate in some U.S. hospitals. I could say the same about the hysterectomy rate- too many unnecessary surgeries.
“. I do know there are active worldwide and national efforts to lower the c-section rate because of possible increased neonatal and maternal mortality and morbidity from elective cesareans.”
Now you’re trying to change the subject. I made a claim; you’ve provided no evidence to contradict it. What any organization says or does not say is irrelevant. My claim is true, you misrepresented it and now you are dismissing it.
You don’t have a problem with my “style,” you have a problem with the substance, but lacking the ability to challenge the science, you resort to personal attacks.
I’ve been following SBM for a few months now. So far I’ve observed that there are a few people here who seem to have a lot invested in attacking both Dr Tuteur and anything she says. I agree with Dr Hall that she is being treated unfairly. The hypothesis that the average life expectancy has more than doubled due to science-based medicine is hardly controversial. There are other writers on SBM who also publish opinion pieces. We get it people, you don’t like her. Move on.
Exactly. His books discussing AGW are so riddled with errors of science that it’s really quite impossible to figure out when what he is arguing is science-based and when it isn’t if you don’t already know quite a bit about the science. That’s what makes him so problematic. Intelligent and even skeptical people like Harriet can find his arguments compelling because they don’t know the background science.
A few years ago, I used to be a lot more “skeptical” of AGW. However, then I took the time to learn a bit more about the science, and it rapidly became clear to me that most of my objections were based on a lack of understanding and, in essence, arguments from incredulity and ignorance.
Dr. Tuteur:
“What any organization says or does not say is irrelevant.”
I didn’t say any organization, I said every organization. And scientific consensus may be irrevelant to you. But it is relevant to me, whether it be global warming, targeted cesarean section rates, vaccinations, or anthropological claims about longevity throughout history.
BillyJoe, I completely disagree with your opinion about Harriet Hall vs. Amy Tuteur’s writings and ways of portraying themselves on this blog. Harriet Hall is generally more well-balanced in her views and considers issues beyond a mere black and white viewpoint. Amy is completely focused on discrediting natural childbirth and its practices. (Still waiting for a definition of natural childbirth though…).
weing, you can be sarcastic and flex your intellectual muscles – I’m easy prey for you. Enjoy
Hjordis, you haven’t been reading carefully if that is your conclusion. And you might want to also read for a few months on Amy Tuteurs own blog and you will get a better picture of what she is all about.
I have been quite puzzled how SBM editors could read Amy Tuteurs own blog and view her Ask Dr. Amy website and still accept her as a contributor here. (Unless maybe they do want more controversy and readership for this site…)
In any case, she is here, and her writing is constantly critiqued even by those who have not encountered her before. Her writing and the responses generated will have to speak for themselves when it comes to quality and bias. I just hope it won’t be to the detriment of the purpose of a SBM blog in the first place.
The hypothesis that the average life expectancy has more than doubled due to science-based medicine is hardly controversial.
++++++++++
That’s not Dr Amy’s hypothesis – the post was mainly about modern agriculture.
David,
I am not skeptical of AGW and neither is Lomborg. We all agree that the problem is serious and that action is needed. The devil is in the details.
In “Cool It,”Lomborg calls for cooling the earth but also cooling the emotional heat of the debate about what actions to take. He advocates a cool-headed scientific approach instead of rushing prematurely into the most radical, expensive procedures based on panic and emotion a la Al Gore (whose movie also contained a lot of errors).
You may not agree with the ordering of priorities in the Copenhagen Consensus but I hope that you can agree with the general principles. As a doctor, you weigh the risks and benefits of every treatment, and you don’t rush to adopt every proposed new experimental treatment before its value is demonstrated. You don’t get so fixated on treating a patient’s cancer that you neglect to treat his other medical conditions like diabetes and hypertension, some of which might kill him before the cancer does. As a research grant competitor, you understand that funds are limited and priorities must be set somehow.
That’s what I hear Lomborg saying. I don’t hear his critics responding to any of that. Something is wrong.
Maybe it’s me. I didn’t go into his books with any conscious bias, but I’m willing to admit that my reading comprehension could be unconsciously impaired by a tendency to optimism and a distrust of alarmism. By the same token, others might be equally and oppositely biased by a tendency to pessimism and catastrophism. The sober, unbiased truth is hard to get at. And even the most accurate scientific data can’t tell us what is the “right” thing to do. That’s a human judgment call.
StatlerWaldorf, how can you say “Amy is completely focused on discrediting natural childbirth and its practices” when so many of her posts have addressed other subjects? You have made a general statement that is black and white and is clearly inaccurate and is based on your unsubstantiated opinion – the same sins that Amy has been accused of.
zoe,
“The difference between Dr. Hall and Dr. Tuteur is exactly that of QUALIFIERS.”
So then why are we arguing?
There were posters here saying that Amy’s opinions on what the science says (regarding herbal treatments) was different from Harriet’s opinon of what the science says. I responded that their views were pretty much the same. For the sake of brevity and impact, Amy assumes the qualifiers. For completeness and clarity, Harriet spells them out.
With Amy, you have to read between the lines.
With Harriet, ypou have it all laid out for you.
“Dr. T’s writing is fine for the back of a cereal box, but I had come to expect more nuance from the bloggers here because of the more knowledgeable readers. I am really really suprised that many can’t see how she overly simplifies complicated medical and science topics.”
She simplifies for impact.
Herbal treatments are useless. That is a good take home message. Of course there is a long list of qualifiers but, as long as you are aware of them (as Amy is as she has demonstrated), I have no problem with that take home message. After all, those qualifiers do not alter the basic conclusion that herbal treatments are useless.
———————-
wales,
“As to differences between Harriet’s style and Amy’s, give me long-winded and accurate any day, over short, strident and inaccurate. Qualifiers are an extremely important part of scientific communication, and Billy Joe’s attempt to gloss over and reconcile Harriet’s and Amy’s style differences as a matter of qualifiers just doesn’t cut it for me.”
You’ve lost sight of what I was responding to. The point was that Harriet and Amy have the same views on what the science says (regarding herbal remedies), they just have a different way of communicting that view.
I haven’t anywhere stated which style or method I prefer.
As to the qualifiers: that is exactly the difference between them – Amy implies them, Harriet spells them out.
———————————
weing,
“Am I an AGW denialist if I like global warming and want more of it? I always looked upon myself as a global warming proponent.”
You are a very naughty boy is what you are!
(A denialist is one who, when presented with facts contrary to his position, instead of confronting them, ignores them and continues on expounding his original position completely unfazed by those contrary facts)
—————————–
StatlerWaldorf
“BillyJoe, I completely disagree with your opinion about Harriet Hall vs. Amy Tuteur’s writings and ways of portraying themselves on this blog. Harriet Hall is generally more well-balanced in her views and considers issues beyond a mere black and white viewpoint.”
If you are entitled to make that differentiation than perhaps we should also allow that the difference is that Harriet is wishy washy and Amy is direct.
I prefer to say that their styles are different.
“Amy is completely focused on discrediting natural childbirth and its practices.
I don’t think so.
Either that, or we have been reading different blogs.
BillyJoe on the necessity of qualifiers:
“For the sake of brevity and impact, Amy assumes the qualifiers. For completeness and clarity, Harriet spells them out. With Amy, you have to read between the lines. With Harriet, you have it all laid out for you.”
To rephrase: “Harriet says what she means. Amy sometimes (often?) says something different from what she means. Readers must either already know what she means in order to interpolate the qualifiers she omitted (in which case there’s no point in reading anything she writes, because they already know it) or guess (meaning they might guess wrong) or challenge her statements (in which case they are accused of not liking her).”
I actually prefer the idea that she is deliberately using a pedagogical technique of withholding crucial elements or including distractors to get her readers to think for themselves. If so, it works and I (mostly) appreciate it. (Yes, yes, I know, I am “making this up” on the basis of no evidence.)
BillyJoe on herbal treatments:
“Herbal treatments are useless.”
Neither Amy nor Harriet said that.
Amy said that alternative medicine is useless, and later defined alternative medicine as that which is useless. By that definition, any herbal treatments which are not useless (eg foxglove for dropsy, white willow bark for fever and pain) are not alternative.
Harriet said that some herbal treatments are (or could be) an exception to the general statement that alternative medicine as useless, though they are inferior to their pharmaceutical counterparts.
If you’re going to tally up errors, then actually I would reiterate that Lomborg had way more errors and flaws in science in just one chapter on AGW in The Skeptical Environmentalist than Al Gore had in his movie and book combined. It’s not even close.
http://www.lomborg-errors.dk/GoreversusLomborg.htm
Not that errors alone are the measure, given that both Lomborg and Gore are making political arguments. After all, one huge error can trump a dozen piddling minor errors. However, Lomborg’s errors are not minor. They are also far more numerous and nearly all skew in one direction.
Alison,
Your post changes nothing of what I said.
Okay, Amy said CAM was useless (which means that herbal treatments are useless, no?). But herbal treatment was singled out by Harriet as an exception and she posted the beginnings of a list of qualifiers which I expanded to a large paragraph.
“Amy said that alternative medicine is useless, and later defined alternative medicine as that which is useless. By that definition, any herbal treatments which are not useless (eg foxglove for dropsy, white willow bark for fever and pain) are not alternative.”
No, foxglove and willow bark ARE alternative.
But digoxin, acetyl salicylic acid are not.
They are herb-based pharmaceuticals.
“Harriet said that some herbal treatments are (or could be) an exception to the general statement that alternative medicine as useless, though they are inferior to their pharmaceutical counterparts.”
Yes those qualifiers again.
They may not be strictly “useless”, but as an alternative to the herb-based pharmaceuticals, would you “use” them?
Of course not.
Apart for the active ingredient, they contain other substances which may be neutral and therefore unnecessary, but may have unknown detrimental effects. The active ingredients are present in variable amounts depending on the souce and season, and sometimes not present at all. They may contain unintended contaminants such as arsenic, lead or mercury or deliberately laced with actual pharmaceuticals.
“I actually prefer the idea that she is deliberately using a pedagogical technique of withholding crucial elements or including distractors to get her readers to think for themselves. If so, it works and I (mostly) appreciate it.”
Fair enough.
I think she paints with a broad brush for impact.
I think her broad brush “CAM is useless” is pretty good in achieving that result. And, with the unstated qualifiers – which don’t add up to much – it is basically the truth of the matter.
StatlerWaldorf:
“In any case, she is here, and her writing is constantly critiqued even by those who have not encountered her before.”
Constantly critiqued by the same 5 people, all of whom are lay people, most (? all) who formed their personal opinions without reading the scientific papers and can’t even be bothered to read them even after it is clear that they have misinterpreted them.
Alex Knapp (not one of the 5) had the virtue of at least being honest about his motivations. He has a personal stake in whether I am right or wrong. He has adopted the paleo diet because he is sure it will keep him healthy, and if I’m right, he has been wasting his time. Even more importantly, if I’m right, he has a lot less control over his health than he’d like to think.
Plonit is a British midwife and she can reliably be counted upon to support the British midwifery line, regardless of whether it is based on scientific evidence. She chimes in periodically on other topics in the hope of discrediting me, and evidently doesn’t even bother to actually read my posts (e.g: ” [this] post was mainly about modern agriculture.”)
You, SW, have come from my personal blog where you have submitted more than a hundred comments all glorifying your personal birth choices and demeaning women who make different choices.
Zoe has not only betrayed her prejudices, but she has demonstrated a fine disregard for the truth by constantly misrepresenting what I write. When confronted she keeps digging herself in deeper: It is laughable when she claims: “And scientific consensus may be irrevelant to you. But it is relevant to me” at the exact same moment she is ignoring the scientific (as opposed to the political) consensus on the C-section rate, not to mention VBAC, breech and just about any obstetric intervention you care to name.
I’d be concerned if I were being repeatedly criticized by doctors and scientists who provided relevant quotes from appropriate papers. And I’d be concerned if I were being criticized by lay people who provided relevant quotes from appropriate papers. It’s difficult to take seriously the obviously biased criticism from lay people who are so invested in what I critique that they can’t be bothered to read the scientific papers and are virtually impervious to scientific evidence.
Plonit is a British midwife and she can reliably be counted upon to support the British midwifery line, regardless of whether it is based on scientific evidence. She chimes in periodically on other topics in the hope of discrediting me, and evidently doesn’t even bother to actually read my posts (e.g: ” [this] post was mainly about modern agriculture.”)
+++++++++++
This is an unfair characterisation.
I’m not sure what the “British midwifery line” is. Perhaps you can explain?
I certainly do care about whether claims are based on scientific evidence.
I chime in on non-midwifery topics on this blog as the fancy takes me, and certainly not restricted to your posts (although perhaps you don’t read the other comment threads, and why would you?).
I have no need to ‘discredit’ you – everyone can read for themselves and form their own judgments.
My comment that this “post was mainly about modern agriculture” was a direct response to Hjordis’s comment that “The hypothesis that the average life expectancy has more than doubled due to science-based medicine is hardly controversial” and should be read in that context. Agreed, it would have been more accurate to say that the post was about the advantages of modernity in toto, in particular citing modern agriculture and not at all restricted to SBM, in contrast to the hellishness of the past/nature.
BillyJoe on alternative medicine:
“No, foxglove and willow bark ARE alternative.”
Amy Tuteur on alternative health:
““Alternative” health refers to theories and treatments that are invoked and used despite a lack of scientific support, and often in the face of scientific evidence that shows that they are untrue or don’t work.”
That’s why it’s important to define terms. My personal definition of alternative medicine is stuff that I can access without a gatekeeper. So foxglove is in there.
Amy’s definition is that there’s no scientific support for the treatment or its mode of action. By that definition foxglove might or might not be alternative. It works and its mode of action is explained by science (therefore not alternative) but pharmaceuticals are more predictable (therefore science doesn’t support using foxglove over pharmaceuticals if pharmaceuticals are available, therefore alternative in most modern contexts). (My grandfather’s black bag contains, among other things, a standardized digitalis preparation: that is, a herbal preparation that a pharmaceutical company standardized to a certain strength.)
I’m not saying one definition is better than another (there are a lot of problems with my personal definition); just that defining terms is important.
[...] brings up a sticky situation in that, if “all-natural” is better for us, why are we living longer now than ever? It’s a very contentious issue: as of the time I wrote this there were over 330 comments on [...]
Regarding the errors in Lomborg’s and Gore’s books. There are many types of errors, some egregious, some not. Wouldn’t a better measure be a ratio of errors to claims? Say, if Lomborg makes a 1000 claims and 500 are shown to be errors the ratio would be 0.5. If Al makes 4 claims and 2 are shown to be errors the ratio would also be 0.5. This would obviate the biasing by “look at all the freaking errors in that book!”
“My personal definition of alternative medicine is stuff that I can access without a gatekeeper.”
But that’s not a definition shared by anyone else.
By your definition, Prilosec is alternative medicine because you can buy it over the counter.
Amy Tuteur said, “You, SW, have come from my personal blog where you have submitted more than a hundred comments ALL glorifying your personal birth choices and demeaning women who make different choices.” (Bold added by me, because it is too funny!)
Yes, I’ve been reading your blog for quite some time and it is very easy to rack up many comments with the heated discussion there. Please explain how I have glorified my birth choices and point to where I have ever demeaned other women who make different choices. It is a sad world when people can say they had manageable labours with non-pharmacological methods of pain management, uncomplicated births, and were able to breastfeed successfully and that is considered as “glorification” or “demeaning” to those who had other experiences. The choices made for my births were based on me and my partner’s wishes and the circumstances of each pregnancy. I have never commented on your site that all low-risk pregnant women should be homebirthing. Anyone can view my comments in context and decide for themselves.
If you want to talk about demeaning other women, maybe you should retract your blog entries where you characterize women who don’t birth in hospitals, choose non-pharmacological pain relief, and are pro-breastfeeding as “uneducated”, “egocentric” “sanctimommies”, “stunt-birthers” etc.
Harriet Hall, you are right, Amy Tuteur has written on a few other topics on SBM, but on her own blog you can see that she clearly loves to rail against pretty much everything natural.
Hmm, more ad hominem attacks by Dr. Tuteur. How characteristic.
The reasons that scientists don’t criticize you is that you DON’T ***PUBLISH*** in peer reviewed journals! LOL. It’s very convenient for you to sit around debating laypeople all day. If you didn’t, you might be forced to actually have some evidence behind your claims.
Amy Tuteur on alternative medicine:
“[Alison Cummins said]“My personal definition of alternative medicine is stuff that I can access without a gatekeeper.”
But that’s not a definition shared by anyone else.”
I don’t know. I haven’t asked. Maybe, maybe not. Which is why if I were to discuss “alternative medicine,” I would define it first. But if you were to go up to someone on the street and ask them to define alternative medicine, I don’t know how many would say “anything that doesn’t work,” either. Promoters of CAM include diet and exercise as CAM treatments to prove that CAM is very popular and even scientific. I suspect (but don’t know) that most people think there are some alternative remedies that work, in which case they don’t share your definition either.
“By your definition, Prilosec is alternative medicine because you can buy it over the counter.”
Yup, as I said, there are problems with my definition and I don’t promote it over anyone else’s. Perhaps I could say “OTC drugs if used off-label; anything else that doesn’t require a gatekeeper.”
“The reasons that scientists don’t criticize you is that you DON’T ***PUBLISH*** in peer reviewed journals!”
The reason that the doctors and scientists who read SBM don’t criticize my posts is because the aren’t published in peer reviewed journals?
Since commentators do not submit a CV, I’m not sure how you can know whether or not they are doctors or scientists.
In any case, is David Gorski not a doctor? He has made criticisms on a number of occasions.
Billy joe, I disagree that the appropriate use of qualifiers in science communication is merely a personal style choice. It is necessary for the sake of clarity, accuracy and credibility. I didn’t begin reading sbm over a year ago because of a desire for Fox News type journalism, but for the opposite. You appear to be a champion of brevity and your comments that “I think she paints with a broad brush for impact. “ and “And, with the unstated qualifiers – which don’t add up to much – it is basically the truth of the matter.” Leave me wondering if you believe that impact is placed above accuracy on a hierarchy of effective science writing skills. Science is not about “painting with a broad brush” (and sbm is about science,no?)and I can get that type of broad brush science reporting from any mass media product. I also disagree with the idea that because blogs are “different” (i.e. have a lower bar for accountability and accuracy?) that anything goes. That may be true for most blogs, but my impression was that sbm tries to distinguish itself from the pack. Perhaps my impressions have been wrong for the past year and I should just realize that a blog is a blog is a blog…..hence my decision to view this site as an entertainment venue.
Dr Hall – You’re providing a very fine example of how an intelligent and educated person can be seduced by pseudoscience when it confirms their “common sense” feeling or opinion about a subject. Even when the experts have pointed out the bad science and how the science is being manipulated for ideological ends! Because you like the sciency feel of Lomborg’s book, even though you don’t actually have the expertise to analyze the science in this case, and you consider yourself to be “scientifically minded” and agree with his opinions, you give him total credence and just brush off the actual experts as being “emotional”. This is not very different from people into CAM who think that medical pseudoscience supports their opinion or “common sense” belief.
We all tend to think our own opinion or approach is “common sense”, it’s a very common form of confirmation bias and cognitive trap. It’s why you get engineers and graduates of computer and political science who think that the “science” part or having done statistics means they’re equally qualified in medical science. Climate science is complicated and we certainly don’t know everything (this is also true of medical science) – that’s why reliable experts are so important and discussions need to be based on good science (meaning in reality!). It’s also why proponents of pseudoscience and experts who bastardize science for ideological reasons need to be weeded out AND we need to be vigilant for the tendency for confirmation biases in ourselves. It’s one good reason to read ideas and to talk with people we disagree with, be they experts or not.
And, yes, the Al Gores, Lomborgs and the energy industry (from oil/gas, hydro to “alternative”) – and their other public faces – all have ulterior motives that include money, fame and power. Just because all these competing commercial and ego interests that pose as left/right (liberal/conservative) are using the issue of climate change to further personal, political or corporate agendas doesn’t mean that climate change and environmental damage from pollution isn’t happening. It’s just disaster capitalism in action, it’s hardly a new way to make oodles of cash (one good reason to know history is to be able to see patterns repeat themselves). Scientists have been discussing the impact of climate change, environmental pollution and finite resources since the 1970s. Of course, no one really listens to scientists – particularly when it requires making changes and there’s a lot of money and power at stake and industry has more clout. (Poor Carter tried to wake up the US regarding energy independence and the environment but was trounced out of office for it. Then the decades of deregulation got rolling – under both neo-liberals and neo-conservatives.)
If you’re genuinely worried about clean water then reducing and cleaning up industrial pollution and domestic waste is essential, as is not polluting the land and water during wartime by using depleted uranium weapons, or mining by removing whole mountain tops, and so on. There are a 101 reasons – many of them public health reasons – to reduce industrial pollution of our environment and to recognize that we need to use finite resources more wisely. Technology is undoubtedly part of the solution but so is simply stopping doing some really stupid things for short term profit or because we’re energy gluttons. If you’re concerned about malaria, not using poor nations as industrial dumping grounds and factory fodder is part of that picture.
Dr Hall, clearly you share some political views with Dr Tuteur and feel aligned with her on a wide variety of subjects. I don’t particularly take issue with that if you’d both be honest about your personal biases (with yourselves and us) instead of insisting that your personal opinions or beliefs are evidence based when they’re not. Dr Tutuer has shown herself to be entirely uncritical of the commercial aspects of medicine, and of pseudoscience when promoted by industry. Her prejudices lead her to make up lies/emotional accusations about those she disagrees with for ideological reasons (often in areas where she is clearly not an expert).
Starting from her first blog, she’s been called out by medical researchers for misinterpreting data or research methodology and assigning nefarious intent to researchers she disagrees with (which is an attempt to manipulate using emotion). Clearly she’s not exactly an expert or experienced vis a vis medical research (being a practicing doctor IS different than being a researcher). Her post on antidepressants not only accused psychologists of having nefarious intentions but entirely ignored the professional context of the discussion within psychology and psychiatry about anti-depressant use. She also ignored the well-known fact that pharmaceutical companies got caught red handed cooking data around SSRIs (surely relevant to the discussion). She focused on one meta-study to try to discredit all criticism of SSRIs, she ignored a critical story by a much more qualified expert than herself in the NYT to make sensationalist accusations about lack of context and sensationalism in MSM reporting (which is pretty ironic), and so on.
All of these are the tactics of woo merchants that peddle pseudoscience to promote an ideological position and Fox news reporters and not of SBM bloggers or skeptical thinkers. Skepticism has to be universally applied – and we also need to be skeptical about our own “common sense” feelings and beliefs – for it to be true skepticism. If we simply routinely read or support opinions because they align with our own then we’re simply feeding a confirmation bias. If we want to constantly reduce complex issues with areas of scientific uncertainty to sensationalist opinion pieces that contain no scientific evidence on an SBM blog we have no grounds to complain when the MSM does it (in fact, we’re bigger hypocrites). There’s nothing wrong with opinion pieces or a good rant – many of us enjoy reading them and having our emotional reactions and biases confirmed (and some of us enjoy having them challenged). The problem arises when we try to pass off our opinions and emotional rants as being science, or distort or misrepresent the scientific evidence (or scientists) to support our personal bias, or try to claim scientific authority in fields we’re not experts in and dismiss the experts as being “emotional” or having nefarious intent when there’s no evidence that they do. So far Dr Tuteur has done all these things repeatedly and then claims to be being victimized for being called out on doing so (unless it’s a research scientist doing so who’s caught her inappropriately presenting evidence, then she’s all about the suck up…which would be fine if she was actually learning from it and didn’t simply then repeat the same emotionally-based ad hominem type of attack to try to discredit a research scientist she disagrees with yet again!) All of these things combined are what make Dr Tuteur into a cargo cult science blogger and makes it a real shame that she’s using SBM as a platform to promote ideological positions as SBM rather than using this platform to educate lay people about SBM, how science and medicine work, and the difference between science and pseudoscience and how to spot bloggers and writers that promote pseudoscience.
Fifi: “(being a practicing doctor IS different than being a researcher)” Dr. Tuteur is not a practising doctor, correct?
“The reason that the doctors and scientists who read SBM don’t criticize my posts is because the aren’t published in peer reviewed journals?”
My point was that you aren’t even a part of the conversation in the scientific community on cesarean section or anything else.
But since you mention it, there have been several doctors and scientists on this website who have criticized or questioned your leaps of logic, including Dr. Hall (AAP/ACOG position on circumcision), Dr. Gorski (the point of a metaanalsysis), TimMills (log graphs), Edgar (pretty much everything), winddriven (cesarean section, can’t remember the exact objection), and then there are the dozens of commenters who I have no idea who they are, but have been critical. Of course, most of these are with errors in your logic, not necessarily your conclusion. Particularly critical of the numerous errors and direct contradictions in your circumcision post.
As for academic ob/gyn researchers, I’ve only seen one, possibly two, agreeing or disagreeing with you.
Your trademarks are false causation (life expectancy and numerous “conclusions”), false dichomoties (cesarean section or unattended homebirth), ad hominem attacks of midwives, continuous assignment of nefarious intentions or academic misconduct to researchers (Johnson and Daviss, McDormand, Villar, Glezerman, the depression scientists from last week), hasty generalization (Colorado midwives association), conclusions from anecdotal evidence (individidual homebirth stories), appeals to emotion (630 babies will be killed by breech deliveries!!!), and numerous strawman (midwives demean women who want epidurals, for example). And appeals to common practice (that’s the way it’s done, so it must be right).
Oh, and on your intro to the board, there were several medical doctors who were “stunned” that sbm had chosen you.
Most people eating organic food aren’t longing for a past that never existed, they simply worry about the effect of things like pesticides on their children or want to support more environmentally friendly production methods. Nothing makes me more annoying than the fallacy that organic = ancient production methods. Having worked in a science department at ag school that did work on organic production methods, let me tell you they were’t using horse-drawn ploughs. What they were doing is developing alternative methods to improving productivity to rival Monsanto & Co. using SCIENCE…not ancient magical augers or buckets drawn by goats. You should really attend a real organic ag conference…all the presentations are about science. Maybe you are confusing biodynamic, which is about ancient magical stuff, with organic.
And who said that paleo dieters want to go back to the stone age? We simply advocate eating food that is good and appropriate for humans in an evolutionary context. You don’t have to be a luddite to simply want to eat human food.
http://huntgatherlove.com/content/human-health-quadrants
Zoe237 said, “The reasons that scientists don’t criticize you is that you DON’T ***PUBLISH*** in peer reviewed journals!”
Amy replied, “The reason that the doctors and scientists who read SBM don’t criticize my posts is because the aren’t published in peer reviewed journals?”
Do all the scientists on SBM read the ob-gyn studies you are discussing in your blog articles to be able to accurately critique your critiques? I do believe that other scientists have asked questions about your statistical analysis in previous blog articles. Perhaps publishing in peer reviewed journals in your medical specialty could be quite beneficial for advancing science and academia in your field, especially since other researchers have got it wrong in numerous cases?
Let’s call a spade a spade. You don’t want to contribute to obstetrics and gynecology through research and discussions in the fora of your peers, but would rather focus your intellect and energy on becoming a successful Internet blogger as a Fox News style pseudo-medical expert and moral pundit. “Ask Dr. Amy”! Fair enough, but don’t claim to be flying the flag for science-based medicine.
Billy Joe said in defense of Amy’s style “With Amy, you have to read between the lines.” Is this really the goal of science writing, to prompt readers to substitute their own intuitions and biases for objective fact stated with clarity and precision? I think not (sbm editors, correct me if you disagree.)
It does seem very much like blogging at SBM is about career/reputation/audience/customer building for Dr Tuteur and not actually about truly being a skeptical blogger and supporter of the practice of SBM. She reminds me of Penn & Teller (who I find entertaining but who veer into pseudo-skepticism and sensationalism, and have professional ties with industry that blatantly influence what they promote at times). Why does it appear this way?
1-Dr Tuteur appears to use the blogosphere to promote herself as a product (a book, an iphone application, “personal advice” for sale on her own blog). Kind of odd at SBM since other doctors who use their credentials or professional authority to sell opinions, woo/ideologies or products/books are regularly taken to task here (and rightly so). There’s a commercial driven conflict of interest here that the other SBM bloggers simply don’t have (that I’m aware of anyway, most seem very, very ethical in this regard and have no monetary interest in skeptical blogging or promoting a public image of themselves as skeptical…as retired or practicing doctors and researchers they generally seem to genuinely care about good science and medical practices).
2-Dr Tuteur doesn’t seem to actually be as engaged in practicing professional medicine or academic research as much as she is with promoting herself as a commercial medical expert/brand (with associated products, including her reputation/expertise, to sell at $4.95 a “personal” email…medical advice by email…really? What’s next? Fortune telling?). Actually it’s pretty clear that despite liking to be sciency and elevating herself on an SBM soapbox to legitimitize her opinions, Dr Tuteur isn’t actually experienced as a medical researcher and is hostile to researchers that don’t support her ideological position (going so far as to make ad hominem attacks on them and casting aspersions on their professionalism). Hence the cargo cult aspect of her presenting as an SBM blogger.
3-Then, like many dodgy experts there’s incomplete bio info to be able to properly contextualize her expertise (fair enough in PR terms to promote what sells, a bit dodgy in SBM terms not to provide full disclosure regarding current and past professional experience). She reminds me of Dr Phil in this regard (the mistaking folksy “common sense” for actual scientific evidence, the vagueness about current credentials, the down home cosiness of using a first name, etc). There’s no disclosure on her bio here on SBM that she’s got commercial interests that involve selling her “expert” opinion…or that increasing traffic to her own site by being controversial here or elsewhere may well bring her increased profits and at the very least improves her visibility and, with SBM’s blessing, her brand’s “authority” and marketability. In PR the “there’s no bad publicity” motto is common because it’s all about visibility and being in opposition to another brand (natural childbirth) makes business sense. In SBM blogging and scientific research, good reputation and scientific authority can be greatly damaged by bad publicity based on bad behavior and promoting bad science.
4-Dr Tuteur uses all the same tactics as woo merchants in trying to discredit commenters, research scientists who don’t support her opinion and those she’s in financial competition with; in cherry picking the science she presents to support her pre-existing opinion and doing a cargo cult ritual of being scientific; and by trying to pass off opinion as SBM. The fact that she’s critical of anything “natural” and seems to associate anything medical that isn’t pharmaceutical or surgical with woo, and is totally uncritical of pharmaceutical companies and the commercial aspects of medicine, makes her a one sided pseudo-skeptic. (Besides, what isn’t natural for goodnesses sake?! talk about perpetuating a false idea about nature and reality!)
5-She’s also acting exactly like woo merchants when she claims she’s being “censored” when she’s being called on doing the things woo merchants do, or when she claims everyone else is being emotional and she’s being scientific (when all she’s doing is projecting her own motivations on others or making unfounded accusations), or when she writes something incorrect and then goes back and changes it after the fact and then claims people have misunderstood what she wrote and are “out to get her.” Another very problematic habit she has is that she pontificates and claims expertize in areas where she’s very clearly not at all up on the latest research or qualified as an expert in! (And yet she mades ad hominem attacks on actual experts in the field and accuses them of bias!)
It’s pretty outrageous (but interesting) to watch all this unfold on an SBM blog. It also makes me curious as to how she ended up blogging here…. How did she? Who recommended her? Where they aware that she makes money selling herself as a “skeptical blogger” and Dr Amy is a brand and not really just an SBM blogger without these kinds of conflicts of interest?
“2-Dr Tuteur doesn’t seem to actually be as engaged in practicing professional medicine or academic research as much as she is with promoting herself as a commercial medical expert/brand (with associated products, including her reputation/expertise, to sell at $4.95 a “personal” email…medical advice by email…really? What’s next? Fortune telling?). ”
Are you serious? $4.95? Did not know that.
My main confusion is why she’s allowed to plug in old blog entries of hers, when everybody else writes new, pertinent entries every week.
$4.95 is the special introductory offer to have Dr. Amy explain to you how likely it is that you, personally, are pregnant right now.
Otherwise, it’s $14.95 for a detailed answer to any question about a woman’s health.
“Do you prefer a confidential, personal response?
Do you need a long and detailed response?
Purchase a guaranteed, detailed, personal e-mail response to your question by ordering below.
Disclaimer: Keep in mind that this is not medical advice and is not a substitute for medical advice. Only a doctor who has examined you and is familiar with your medical records can give you medical advice.
Ask Dr. Amy.com accepts credit cards and PayPal. You do not need to have a PayPal account to purchase Premium Services.”
http://www.askdramy.com/premium.html
Fifi,
Lots of words, but no actual facts. Just your personal opinion repeated over and over again. A number of people have already chastised you for your obvious bias, and asked you to stop. No one is fooled.
“$4.95 is the special introductory offer to have Dr. Amy explain to you how likely it is that you, personally, are pregnant right now.”
See what I mean about a personal desire to discredit because you feel threatened? You’ll throw anything against the wall to see if it will stick in the hope that you can convince yourself and others that they don’t have to listen to me. It’s not working.
Do you know how many questions I get each month? One or two. I instituted that method to cut down on the hundreds of personal e-mails I otherwise get each day, and it has been very effective.
How about sticking with the actual facts? Or do you avoid them because you know you can’t win?
Yes, I just discovered that she charges for “expert advice”! I’m really pretty surprised that the SBM editors think this is okay if they knew about it. And to be clear, making a living as a practicing physician or medical researcher is a different thing in the context of SBM blogging – if one is honest about their professional affiliations – than making a living selling oneself as a brand or commercial expert where the blogging is part of your PR, branding or reputation building and is actually part of making a profit. It’s not like being an SBM blogger actually makes you more money as a physician or is a source of income – and if you’re a truly skeptical blogger that takes on unscientific medicine across the board then it may even harm your chances of being hired or promoted.
Of course, now that I know that Ask Dr Amy is a commercial site and Dr Tuteur is selling herself/her identity as a brand, it makes many of her tactics here make more sense than they first did to me. It’s why context matters for understanding anything – be it a scientific study or an opinion piece. Context and how inappropriate to the context of SBM Dr Tuteur’s post were is what first made the alarms go off for me because her posts are so similar to those of CAM cargo cult science bloggers and her tactics are no different than sketchy PR image management shenanigans…walks like a duck, quacks like duck…produces and sells quackery like online medical advice (for entertainment purposes and not meant as medical advice of course)….hmmm…. What I would really like to know at this point is how Dr Tuteur came to be blogging at SBM and if the editors knew about her commercial interests when they hired her and, if they did, why they don’t see this as a conflict of interest or at least worthy of disclosure in her bio…
Comments on this post alone:
Alison: more than 40
Zoe: more than 40
Fifi: more than 30
And most say the same thing over and over again, not to mention the same thing they have posted on other threads for completely different topics.
Don’t be silly, people! Ask Dr. Amy doesn’t need to make money from answering email questions, there’s plenty of revenue from carrying GoogleAds for sites like this -> http://www.ourpregnancymiracle.com
And don’t forget
Plonit: 10 (oops, 11 now) but then I had 40+ comments on a post by Kimball Atwood. Not quite sure what that is meant to show….
Amy Tuteur on Alison Cummins:
“You’ll throw anything against the wall to see if it will stick in the hope that you can convince yourself and others that they don’t have to listen to me.”
Not listen to you about what? You keep saying that I am defending myself against your truth, but I have no idea what you mean. I often agree with you, and when I challenge you it’s most often about your logic.
“Do you know how many questions I get each month? One or two. I instituted that method to cut down on the hundreds of personal e-mails I otherwise get each day, and it has been very effective.”
That sounds very savvy!
Other medbloggers have disclaimers explaining that they can’t respond to personal questions, but I’m sure your method works just as well.
“How about sticking with the actual facts?”
The quote from your website is a fact. I didn’t offer any commentary or interpretation at all.
“Or do you avoid them because you know you can’t win?”
Can’t win what? I have no idea what you’re talking about. I wasn’t aware that I was fighting anything. As I stated in my comment upthread, “I actually prefer the idea that [Amy Tuteur] is deliberately using a pedagogical technique of withholding crucial elements or including distractors to get her readers to think for themselves. If so, it works and I (mostly) appreciate it. (Yes, yes, I know, I am “making this up” on the basis of no evidence.)” My conjectures might be completely wrong — that’s typical for conjectures — but how is that a war?
“$4.95 is the special introductory offer to have Dr. Amy explain to you how likely it is that you, personally, are pregnant right now.”
Alison, how much is it to tell if I’m pregnant by phone?
That’s just rich.
http://felopio.com/
Also advertised on Ask Dr Amy.
Amy,
I’m not quite sure what you’re getting at. Don’t we all have a stake in our personal healths? I mean, I’m interested in Science-Based Medicine in the first place because I want to know what the best treatments are for particular conditions. I have an annual physical with my doctor because I want to ensure that I’m in the best possible health I can be because the best available evidence indicates that regular checkups help to promote health. Likewise, I eat a paleo diet because the best available, peer-reviewed medical research that I can find indicates that it’s the best way to lower the risk factors for chronic conditions such as heart disease, diabetes, etc.
You keep insisting that I “wasting my time,” in adopting a diet geared towards lowering my risk factors for chronic disease but you have consistently failed to back up your statements with any citations to the literature to demonstrate that my position is false. You say that diabetes is a condition of old age, and yet in the Lindeberg 2007 study I cited above, it’s worth noting that of the Type II diabetics who were given a paleo diet, every single one had normal fasting glucose levels and normal insulin sensitivity by the end of the study. Every single one. And this article isn’t an outlier or the only piece of research demonstrating similar results, either. This greatly undercuts your thesis that Type II Diabetes is merely a disease of old age.
Every time you have asked me for research to support my claims, I have provided it. So now let me ask you this: what is your evidence to support your thesis that diet has no impact on risk factors for heart disease and diabetes?
And if you reply with a “you’re twisting my words” argument, feel free to clarify your position. I simply ask that you support whatever position that you do hold with actual evidence.
Dr Tuteur – It’s not particularly relevant how much money you make at the moment by selling your expertize on your Ask Dr Amy website, being unsuccessful doesn’t mean you haven’t tried to commercialize your expertize and that you aren’t trying to sell medical expertize online. Nor does it mean you’re not overly invested in maintaining a public image or protecting a brand in a way that creates a conflict of interest on an SBM site. (And may cause some confusion for you regarding SBM as a practice and your professional/personal identity as a “skeptical blogger” that means ego comes into play in areas that should be about evidence.)
You may have fooled some people with your posturing as an SBM blogger and skeptic – just like CAM and antivax pseudoskeptics and climate change deniers fool some people by posturing as if they’re promoting science and skepticism – but you’re actually pretty easy to spot for anyone who is a critical thinker familiar with certain PR/propaganda/debating techniques and who isn’t just looking to affirm a particular bias they share with you. (The fact that you constantly assume that anyone who critiques you is promoter of your pet peeves and not an advocate of SBM only strengthens the impression you’re into black/white thinking and not actually SBM.)
You’re particularly easy to spot for those of us who are familiar with the tactics used by people peddling CAM pseudoscience (and marketing/propaganda techniques). You don’t actually need to be able to analyze all the scientific studies to do this as a skeptical thinker, there are rote clichés and tactics that get used when people are doing cargo cult science blogging or misrepresenting ideology as being evidence/science-based and you’ve used most of them. Also, if one is at all interested in basic cognitive science or psychology then it’s easy to spot the cognitive traps us humans fall into unconsciously if we’re not on guard for them, and sometimes even when we are. You really don’t seem to be very well informed in these areas (but then you’ve expressed some hostility towards cognitive science and psychology and seem to equate then with woo so that’s not surprising).
“there’s plenty of revenue from carrying GoogleAds for sites like this -> http://www.ourpregnancymiracle.com”
Hmm. You make 100% of your income by practicing midwifery. Why should we dismiss your criticism because of your obvious economic conflict of interest?
Dr Tuteur – My repeating my analysis of the way you communicate can certainly be brushed off as personal opinion. You keep doing the same things over and over again, so I point them out again. (For instance, you were called out on your very first blog for inappropriately accusing researchers of having nefarious motives and fiddling data – an emotional and ad hominem attack – and then you did exactly the same thing again in your blog about antidepressants. Yet you cherry pick data to promote a personal opinion over and over again…this particular blog post was pretty much nothing but personal opinion about an area you’re clearly no expert in!)
Since you keep making the same claims to be being victimized and projecting motivations onto commenters here over and over again as if doing so makes it true, clearly you don’t actually have a problem with that kind of thing when you’re doing it yourself! When you start acting like a reasonable SBM blogger instead of behaving like a desperate narcissist frantically engaged in image control, you’ll get treated like the other SBM bloggers do. Your personal narrative about the kinds of responses you get is as faulty as it is self-aggrandizing – it’s also very familiar from antivaxers and the most nutty alt med promoters!
Exsqueeze me? Midwives in the UK get paid for doing their job (which includes employing the best available evidence) regardless of whether their recreation is commenting on SBM or yoga. And regardless of the positions they take on SBM (or indeed in yoga). So…I’m not sure what your argument is regarding conflict of interest….
It surely is strange for an SBM blogger to get revenue from GoogleAds for services such as this http://felopio.com/
I think my reply may have got eaten by moderation, but you obviously know nothing about the remuneration of UK midwives if you think any economic benefit accrues from my “web presence”.
Amy,
Yes, I comment a lot. As I stated upthread: “I follow her blog for the community of argumentative commenters that she builds.” I haven’t gone through every single comment, but in my first 14 comments I responded to you 5 times and to other commenters 11 times.
I responded to your request for explanation of why it might be unjustifiable to conflate population health and population size; to your explanation of the Down syndrome theory of menopause; to your request for evidence that parental longevity leads to increased child survival; and to your definition of alternative medicine.
I don’t recall discussing any of these topics on any other thread, which is why this thread is interesting.
Heh. Plonit is a practicing health professional like the practicing doctors and researchers who blog and comment on this site are – it’s not at all the same as selling yourself as a brand or online expert (plus plonit is not promoting herself professionally, she’s discussing medical issues and the evidence using a pseudonym). Sure she makes her living as a midwife but she does so as a part of a medical system where she isn’t competing for customers and works cooperatively with OBs. You may as well accuse Dr Gorski of having a conflict of interest or any of the other working medical professionals here. However, none of them stand to profit from writing their blogs (or commenting here). You stand alone in being in the position of having a commercial aspect to your identity as an online “skeptical” blogger and are clearly marketing a Dr Amy brand and not just sharing professional expertize regarding SBM or certain issues.
It’s pretty telling that you can’t actually discern what is and isn’t a conflict of interest!
Some of my posts are getting delayed by “waiting in moderation” too. No biggie but kind of entertaining in light of Dr Tuteur’s highly emotional claim that we are trying to censor her
I do enjoy irony! (And am well aware that it’s more likely a software thing and not a personal attempt to silence – self mocking sarcasm on – my oh so powerful commentary because Dr Tuteur is so scared of my insights and how I challenge her deeply held beliefs! Sarcasm off/ that said, she does seem to mistake critique of style or content as a personal attack and be fond of using ad hominem attacks against researchers she’s writing about and doesn’t agree with.)
In all fairness, that’s not entirely true. I’m paid for my other blogging gig. It’s not a lot compared to what I make at my real job, but it’s not just a few bucks a month, either, and it’s based on traffic. One could argue that I have a conflict of interest in maintaing that other persona. On the other hand, I try hard to keep that persona (mostly) separate from my work at SBM, although regular readers of both recognize that from time to time I crosspost. Sometimes I recycle text between the two, although hopefully in the context of making two sufficiently different posts that they’re both worth reading. Sometimes I resurrect old posts from my other blog that I am particularly proud of and update them for SBM. Sometimes I cobble together old posts from my blog relevant to the topic at hand, update them, and add a new section about whatever new development that inspired my post. Most of the time, though, I write new material for SBM.
Fifi, speaking of sbm bloggers “However, none of them stand to profit from writing their blogs (or commenting here).” Do you know this for a fact? I know nothing of the compensation agreements between the sbm bloggers and what I gather are affiliated entities Science Blogs or Seed Media, or what corporate entities might be contributing to Science Blogs and Seed Media and SBM. Anyone have any information to offer? I ask that purely in the interest of transparency and imply no conflict of interest, merely questioning the assumption that no profits are involved in blogging for sbm.
Plonit -
I don’t think it’s fair to criticize Amy on the basis of her Google ads. As the owner of a site that runs Google ads myself, I know that you have virtually no control over what pops up–often to great frustration. For example, when I was commenting on one of SBM’s great takedowns of acupuncture on my blog and went further on about it (acupuncture being something I can’t help railing against), it was only natural that ads FOR acupuncture showed up!
Plonit – To be fair, most site owners have little control over which google ads appear on the site. I wouldn’t even take issue with google ads really myself. For me the issue is that she sells medical advice online as part of her Ask Dr Amy brand (and it’s as a “premium service”). When I looked up ownership of the site, it was indicated that she also owns other domain names. I have no idea if any of them are active or make any money (or if that’s accurate, but then I don’t trust Dr Tuteur to be honest either at this point anyway). However an SBM blogger really should be giving full disclosure regarding their commercial interests and associations – being transparent about one’s associations is a pretty basic part of being ethical in science and SBM blogging too!
cubestat says she made $30 a day from ad revenue 9 months ago and, when I updated, that she now makes about $17.50
http://www.cubestat.com/www.askdramy.com
And the Whois search results…
http://whois.domaintools.com/amytuteur.com
Whois Record
Registrant Search:
“Amy Tuteur” owns about11 other domains
Email Search:
is associated with about 12 domains
is associated with about 232,100 domains
is associated with about 364,632 domains
Registrar History:
1 registrar
NS History:
1 change on 2 unique name servers over 4 years.
IP History:
1 change on 2 unique name servers over 4 years.
Whois History:
16 records have been archived since 2007-10-25 .
Reverse IP:
283,150 other sites hosted on this server.
Ultimately, you are responsible for what appears on your own website.
If you regularly have prominent advertising for sCAM products trading on the misery of infertility (e.g. http://www.naturalypure.com , in addition to those already posted upthread) – then you have some responsibility for that.
No one forces anyone to carry GoogleAds. People who do so are willing to sacrifice editorial control in return for the income generation.
Lost in moderation again…let’s just say you cash in your integrity when choose to carry advertising with no control over the content.
Dr Gorski – Thanks for being open about it and owning up to how you may have a conflict of interest that you need to be aware of. I wasn’t aware of your other blogging gig was paid but I was aware you also blogged under a (notorious) pseudonym elsewhere because you mention it in your bio. Since you don’t mention what it is or link to it though, you’re hardly using this blog to drive traffic there. (Though perhaps NOT giving out the info and mentioning notoriety is a clever bait and switch type of scheme to get us all out there trying to solve the puzzle…mouhahaha.) No, seriously, you seem to have managed to divide the two in an ethical and honest way – unless it’s Big Pharma or Big sCAM paying you to blog or some such and then it would be relevant because of the potential influence on what you publish here.
Conflicts of interest and confirmation biases happen – it’s just part of reality and part of SBM is being honest about these things and mitigating their effect as much as possible. That’s why I’ve been taking issue with how Dr Tuteur makes her arguments (accusing research scientists of being biased simply because she disagrees with them and they don’t confirm her biases, and using so many of the same emotive, sensationalizing and flat out dishonest tactics that are so often critiqued by bloggers on this very site…even Dr Tuteur while she’s busy doing the same thing!)
“Comments on this post alone:
Alison: more than 40
Zoe: more than 40″
I have no idea the point you were trying to make here, but it was 34 at the time you made that comment. Mostly in response to people quoting me.
I’m not sure it’s entirely ethical to charge people to tell them if they are pregnant by EMAIL!!, particularly when one is not licensed or insured. But others would know far more about that me, and I do note the disclaimers.
I think Plonit was being tongue in cheek with her comment about Dr. Tuteur’s ad revenue.
So doctors don’t get paid to blog here? Why does Dr. Tuteur never write new material for the blog like everybody else? I have to say the number one reason for me reading this particular website (as simple as it sounds) is that there are no ads and I can change the size of the text. But then, what is the funding source?
Wales – SEED media publishes the science magazine SEED and hosts ScienceBlogs. It’s worth familiarizing yourself with if you’re interested in science and good magazines (though their fondness for humanism and art, and some other factors, does make me positively biased towards them).
http://seedmagazine.com/
http://en.wikipedia.org/wiki/Seed_(magazine)
As far as the discussion of Dr Tuteur’s style, I think most medical doctors would recognize the style as a provocative style of teaching used by attending physicians and residents to get medical students to think for themselves. The goal of the style was to teach students how to think, beyond just regurgitate facts for a test. There is a difficult transition for a medical student graduating from the task of answering questions on a test, to the task of making decisions to help a patient. The attending would often make a statement that would result in a lot of discussion, but a lot of errors in thought processes would be revealed and opened up for criticism. That was a process not easily duplicated on a test. Usually the statements by the attending were carefully crafted (often by years of experience and repetition) to scatter traps for unsuspecting students.
I used to teach in medical school. I remember how a group of PhD educators complained about my use of such techniques in computer aided instruction. Such a style is not common in general education, but common in medical education. Is it justified? That’s a matter of opinion. However, it is effective at getting some students to be much more circumspect about how to solve a problem using medical literature. It is pretty hard to come up with other methods of teaching problem solving, other than practical experience. It is an attempt to develop some skills in medical students before they assume responsibility for care of a patient as a resident. While the teaching could be pretty harsh, the price of incompetence in a resident is high. It does tend to give a unique flavor to discussions about science by medical scientists.
It may seem harsh in a blog, but I can guarantee it is tame compared to medical school (although medical schools may now be much kinder and gentler). Strip away the emotional overlays, and there is still an underlying emphasis on interpretation of scientific evidence. To make a recommendation for a patient based on scientific evidence requires a rigorous approach by the professional doctor to evaluate scientific evidence. That ability is not easily taught.
Many medical students didn’t like that approach, so the backlash is to be expected. I don’t think there is any motivation in the approach, other than it helped Dr Tuteur, so Dr Tuteur feels others should be exposed to the method for possible benefit.
SBM is not a peer reviewed journal publishing original scientific observations, so the articles are not required to have the same rigor in observation and citation. The author may request such citations from responders, so that the critical review can be applied to such papers.
zoe – “I’m not sure it’s entirely ethical to charge people to tell them if they are pregnant by EMAIL!!,”
Actually, it’s even more like fortune telling since it’s about telling people their chance of getting pregnant…oh, wait…it could be either… Either way, it does seem like it’s taking advantage of desperate women who should simply be seeing a doctor to either find out if they’re pregnant or able to become pregnant (both situations that women can feel rather anxious and emotional about and both conditions that can’t really be evaluated via email in any meaningful way).
“Premium response: Chance of pregnancy – This is a personal e-mail response detailing the chance of pregnancy in your specific situation.”
JMB,
Makes sense to me. That was essentially the conclusion I’d come to, though I hadn’t made the link to pimping.
Question: is it normal for attendings to complain that their medical students are censoring them when the medical students notice they are being pimped?
Full disclosure:
SBM bloggers are not paid. In fact, I had never been paid for any of my writing until this January when “O, The Oprah Magazine” started paying me to write a short column. I maintain my own website and I pay for that myself. I have never been paid for public speaking, either, except for receiving a small honorarium for being on the faculty of The Skeptic’s Toolbox last summer. I have never been paid anything by Big Pharma and I have not even been in the same room with a drug rep in the last three decades. Oh, and some of my SBM material is not new: I have reprinted or linked to articles I have written for Skeptic, e-Skeptic, and Skeptical Inquirer and to the PowerPoint presentation I gave at the Skeptic’s Toolbox.
JMB – I don’t buy your explanation since there are other factors at work here and Dr Tuteur’s style and even the content of her posts has more to do with how CAM pseudoscience promoters operate than any medical scientist or doctor I’ve known (including ones that teach). There’s nothing particularly educational about the way Dr Tuteur writes, unlike Dr Crislip, Dr Jones, Dr Gorski or Dr Novella. Sure they sometimes have axes they’re grinding but they’re very rarely simply promoting personal opinion about subjects they’re not experts in as SBM! Nor are they promoting themselves as a brand.
Crikey JBM, I now have an image of Sir Lancelot Spratt of St. Swithin’s
“As far as the discussion of Dr Tuteur’s style, I think most medical doctors would recognize the style as a provocative style of teaching used by attending physicians and residents to get medical students to think for themselves. The goal of the style was to teach students how to think, beyond just regurgitate facts for a test. ”
JMB, how would you describe this style of teaching or writing? Can you describe the use beyond medical school, since I’m unfamiliar with teaching medical students?
“SBM bloggers are not paid. In fact, I had never been paid for any of my writing until this January when “O, The Oprah Magazine” started paying me to write a short column.”
Finally, a reason to pick up O magazine for the first time! Does that mean Dr. Oz is not in there anymore? (I really really can’t stand that man).
Thanks for the explanation.
JMB – I don’t expect SBM to be peer reviewed. I do, however, expect a blogging collective that calls itself Science-based Medicine and purports to support and promote SBM to actually do that. Why? Because otherwise all you’re doing is giving credence to the critics of SBM in the eyes of the public and presenting an image of science that has nothing to do with the ethical practice of science or educating the public. This isn’t a beat up on the interns session, this is SBM blogging that’s meant to support SBM and educate the public about what is science and what is pseudoscience…or at least I thought that was what this site is about!
Dr Hall – That’s pretty funny that you’re writing for Oprah’s magazine, all things and her history here and with CAM considered. No doubt you’ll fit right in with “common sense” Dr Phil and Dr Oz who both promote woo and Suzanne Summers….hey, maybe you’ll even get your own TV show. Fun aside, maybe that means she’s actually learned something from that whole Secret death sauna debacle and is backing away from the woo (or is at least trying to polish her image). One can only hope. I’d say you’re more influenced by having worked in the military than anything else from what I’ve read of your posts and certain very traditional perspectives you promote. I don’t find that particularly problematic, even when it is clear that you have a bias you’re unwilling to own up to (which I only ever really noted on the circumcision thread where you refused to acknowledge that having performed circumcisions may lead a doctor to not want to see them as being harmful).
Plonit – I believe you can also ask for certain ads to be restricted but it’s pretty time consuming. That said, I’ve always found the google ads on skeptic sites to be very funny since they’re almost always advertising woo of some kind. Not much of a problem on a skeptics site really. However I can see how it could lead someone visiting a site with questions about pregnancy to click on one and wander down the path of woo assuming it was somehow sanctioned by the site (fi they don’t understand how google ads work).
Oh well, if it’s time consuming to remove sCAM ads…..
Huh, been trying to give Dr. T. the benefit of the doubt, but this post is sadly lacking in knowledge of anthropology and data to back up the claims. Average life span 35? who says? oh well, shouldn’t have read it, but bored, sick and napping all day.
Alison and others regarding living past menopause. I think one theory is called the “Grandmother hypothesis”. Grandmother’s help with offspring survival. Sorry don’t have a citation, it can be googled by anyone curious. Also sorry if another commentor mentioned it, couldn’t get through the whole lot.
Although I did read many at the end. I must say how much Dr. T’s calling out of Zoe, Plonit and others stuck me as more appropriate to the WWF than SBM.
Plonit — it’s not so much that it’s time-consuming as that it’s like playing Whack-a-Mole. There will always be more woo-woo ads out there. Me, I tend to find a gleeful irony in the fact that woo-woo sellers are, inadvertently, funding their arch nemeses.
Amy Tuteur:
I tried to verify the claim, but unfortunately, your site is blocked at my workplace. (We’ve got an overzealous nanny filter, and it blocks a fair number of pregnancy-related websites for no good reason.) No matter; you have confessed it yourself. Words cannot describe how much this has lowered my opinion of you. You accept money to tell strangers, via e-mail, whether or not they may be pregnant? And you claim you only do this to cut down on unwanted e-mail? Am I misunderstanding something here?
You know, a simpler (and more ethical) method of cutting down on unwanted e-mail is to simply say “I will not answer any e-mails requesting medical advice”, and then simply delete any e-mail that falls into that category. That’s what most doctor-bloggers (active and retired) do, and it is the ethical thing to do. There are also many techniques non-medical bloggers use to avoid undesired e-mail in their inbox — having separate accounts for blogging and for personal business, using e-mail filters, etc. This is not a problem unique to yourself, and frankly, there are bloggers who put up with a lot more than a few hundred e-mails a day. They just have the maturity to draw a line in the sand regarding how many they are actually going to read.
Perhaps there is some way you can explain how charging a fee to give medical advice over the Internet is an ethical way to deal with unwanted e-mail. If so, I would be interested to hear it.
it’s not so much that it’s time-consuming as that it’s like playing Whack-a-Mole.
+++++++++
Oh well, if whack-a-mole doesn’t appeal, then there is always….not carrying GoogleAds. They are not obligatory, and the only reason for carrying them is income generation.
Correct. Peter and I have paid gigs over at ScienceBlogs (marginally paid gigs), but neither Peter nor I nor anyone else here gets paid for blogging for SBM.
michelleinmichigan,
Are you using the Bible as your source for the average life-expectancy of our ancestors? I don’t have a reference either but I think Amy is correct about the average life expectancy. Do you have anything that counters that claim?
Alex Knapp wrote,
“You say that diabetes is a condition of old age, and yet in the Lindeberg 2007 study I cited above, it’s worth noting that of the Type II diabetics who were given a paleo diet, every single one had normal fasting glucose levels and normal insulin sensitivity by the end of the study. Every single one. And this article isn’t an outlier or the only piece of research demonstrating similar results, either. This greatly undercuts your thesis that Type II Diabetes is merely a disease of old age.”
Implicit in this statement is the assumption that the diabetes has been cured in the study. From the medical viewpoint, this represents successful control of the diabetes without insulin or other glucose lowering medications. The doctor would expect that the patient is at greater risk for diabetic problems when they get older, or endure physiologic stress (surgery, pregnancy, severe infection). Some of the patients in the study may never develop overt diabetes if they stick to the paleo diet. Some of them will develop overt diabetes (requiring glucose lowering medication) within five years, even if they stick to the diet.
Chronic diseases of aging may be regarded as a pathway the patient walks down. The pathway is initially set by their inherited characteristics. The pathway may be modified by accidents or infectious diseases, as well as genetic mutations. The age at which the disease becomes manifest depends on the pathway, and how fast they proceed down the pathway. Certain habits affect the speed at which we proceed down the pathway. Diet, exercise, stress, and smoking all affect the speed at which we proceed down the pathway (smoking, and to a lesser diet also affect rate of mutation). Eat a lot, smoke a lot, get no exercise, and you will be running, not walking down the pathway. Whether or not we can identify signs (high fasting glucose), or symptoms (tiredness, increased susceptibility to infections) depends on how far the individual has proceeded down the pathway. Through some medical interventions, we might push the patient to an earlier point in the pathway. That would eliminate manifestations of the disease, but not alter the pathway. A lasting cure would be to alter the pathway (transplant islet cells, rejuvenate mitochondria, alter immune responses are the current hopes).
Diet and exercise will delay the onset of type II diabetes in most but not all patients. In some patients, that delay will be sufficient that they will never suffer the complications of the error in metabolism. Some lucky people will never develop diabetes regardless of their diet.
The interplay of diet, genetics, and aging is a multifactorial process in the development of the disease of type II diabetes. However, that interplay of factors is why type II diabetes is labeled a disease of aging. It can be identified in young people, it can be controlled by diet, but the prevalence of disease will increase as the population ages.
“on the circumcision thread where you refused to acknowledge that having performed circumcisions may lead a doctor to not want to see them as being harmful”
That’s not what I said. I do acknowledge that it MAY; I just don’t accept that it necessarily DOES. There are plenty of doctors who were taught to do circumcisions who later decided to stop doing them, either for medical or ethical reasons.
Alison Cummins wrote:
“Question: is it normal for attendings to complain that their medical students are censoring them when the medical students notice they are being pimped?”
No.
Medical attendings just give the medical student seven study references to look up in the medical school library and present in morning rounds at 7 am the next morning. If they don’t complete the task, they get flunked.
Surgical attendings just call the student a wimp (or worse) and tell the residents to keep the student out of their sight.
“As far as the discussion of Dr Tuteur’s style, I think most medical doctors would recognize the style as a provocative style of teaching used by attending physicians and residents to get medical students to think for themselves.”
Not me. Not in the least. The style is unnecessarily jeering in tone and too simplistic for a rationalist forum. I suspect I represent others who have remained quiet out of politeness until now.
But leave well alone. Few of us can resist some jibes and hyperbole when feeling strongly about the subject matter. Let the drip, drip of adverse comment work its magic for now.
FWIW, I recently sent to the healthfraud list an account of some CME material I received. It reminded me of the tentative way in which real scientists express the results of studies: ” may cause”, “may reduce”, “is associated with”, “linked to”, “may help prevent”. These cautious phrases were noted in six out of seven reports that dealt with specific scientific studies.
Dr Hall – Actually, what you said was that it didn’t influence your own position that circumcision is harmless (if I remember correctly) since that’s what was being argued about since it was your opinion on circumcision that was being discussed. What I said was that it MAY and it was reasonable enough that it may influence your or another doctor’s opinion since no one wants to believe they were doing harm to a defenseless child (even if they thought it was in the child’s best interests at the time). I never claimed it ALWAYS creates a bias and obviously many doctors who used to do circumcisions no longer do them for ethical reasons and can admit that even though they did them at the time because it was routine that they no longer consider it good practice. Of course, we could go back to dredge the thread for exact quotes if you would like to or feel the need to do so.
What do you mean by a “medical” reason to stop doing circumcisions? And how is this different than an ethical one (since I’d hope that medical practices are ethical according to the understandings of the time)? I genuinely don’t understand what you mean by “medical or ethical reasons” in regards to performing circumcisions!
If there at one time appeared to be evidence of benefit, and then later the evidence appeared to show lack of benefit – that would be a medical, as well as ethical, reason to stop doing circumcisions? No?
JMB,
Had that been what I meant, that’s what I would have said. What I said was that fasting glucose declined and insulin sensitivity returned to normal levels. Given that the causes of Type II Diabetes are still murky, I would hesitate to label this as a cure.
What’s your evidence to support this? The incidence of Type II Diabetes among the elderly in modern hunter-gatherer populations is virtually non-existent. See, for example, the Inuit studies of Otto Schaefer, et. al. in the 70s and 80s, which found zero cases of type II diabetes among those Inuit who still ate the traditional diet. Lindeberg’s Kitavan studies that I cited above did not check for incidence of diabetes, but the virtual non-existence of ischemic heart disease is suggestive that diabetes rates are low among their elderly population as well.
The incidence of Type II Diabetes was also low among the islanders of Okinawa, the population with the longest life expectancy in the world, until the past decade, when substantial numbers of people there began adopting an American-style diet–resulting in almost doubling the incidence in a 13-year span of time. (see e.g. Takasu et al. Influence of Motorization and Supermarket-Proliferation on the Prevalence of Type 2 Diabetes in the Inhabitants of a Small Town on Okinawa, Japan, Internal Medicine Vol. 46 (2007) , No. 23 pp.1899-1904).
There are a significant number of good researchers out there hypothesizing that at least some incidences of Type II Diabetes are caused by a diet high in grains and refined carbohydrates over a number of years. I think there’s still a lot of work to do, but it’s a strong hypothesis and the data from populations eating traditional, non-Western diets is compelling enough for me to have cut grains out of my diet in an effort to lower my risk factors for chronic diseases.
Alex,
I love sashimi myself too but didn’t those Okinawans eat rice also? In the spirit of Redd Foxx, what are you going to die of when you get old?
Weing,
They ate primarily unrefined brown rice, not refined white rice. They also did not eat it in very large proportions. I myself eat a little wild rice here and there, but overall I don’t need grains. I eat plenty of meat, fruits, vegetables, and nuts with some moderate amounts of cheese and greek yogurt. My diet is plenty varied and I find I really don’t miss the breads, cakes and chips–or the extra weight that came with them!
Plonit – Seems to me, that’s why I didn’t understand medical OR ethical and am not sure if Dr Hall was making a distinction or really meant to write “medical and ethical”.
Plenty of doctors change their practices based on the latest evidence, the majority do I’d suspect (though I have no evidence of that one way or the other). SBM is all about that. However, there are doctors who cling to practices or beliefs despite the evidence – sometimes because it involves a pet theory of theirs (this is where doctors often step over the line into being quacks) and sometimes because it’s a bit horrifying to think you did something harmful when your self image is that of a healer (and you genuinely are a pretty nice and decent person who was just doing whatever the norm was at the time so it’s easier to believe it isn’t really harmful or a big deal).
Alex,
Good for you. My personal feeling regarding these diets is that the quantity of the food and not the quality will turn out to be critical. It’s so much easier to overeat on our western diet. We still have a lot to learn.
Dr. Hall: “That’s not what I said. I do acknowledge that it MAY; I just don’t accept that it necessarily DOES. There are plenty of doctors who were taught to do circumcisions who later decided to stop doing them, either for medical or ethical reasons.”
That seems fair to me, Fifi. If Dr. Hall has a bias on the matter of circumcision, it’s nothing like Dr. Tuteur’s (just look at the difference of their titles of the blog posts on circumcision). That’s why I posted a link to Halls much more reasonable sbm post on Dr. T’s “The benefits of infant circumcision.” Now, I do disagree with Dr. Hall somewhat on circ, but my personal blogging preference is respectful, honest disagreement and balance. And backed up with evidence, and I don’t believe that Dr. Tuteur has provided a single link to back up her statements in 400+ comments (despite promising to a commenting doctor to do so).
Weing,
I used to think quantity mattered more, too, until I reviewed some of the literature on the insulin response to refined carbohydrates and its effect on the insulin response, as well as insulin’s role in fat storage and satiety. This comports with my own personal experience, too. After the first couple of weeks of weaning myself off grains, I don’t count calories at all, but then again I don’t have to. I’m hungry less often, and when I am hungry it’s not the gnawing, “dear god I have to eat now or I will die” hunger. It’s, “oh dear, I should probably consider eating something in the next couple of hours.” But when I do eat, there’s no real skimping. For dinner yesterday I had fried chicken (no breading, of course), a salad, and cauliflower with a heavy cream sauce. That’s a pretty typical meal for me and yet, I lose weight, my triglycerides are lower, my blood pressure is lower, my fasting glucose is lower, etc.
Crap – I submitted too early.
My point being, I am definitely eating fewer calories than I used to, but it’s very natural to do so. For me, at least, cutting out grains means that I’m hungry less often. But that appears to go hand in hand with the role of insulin in satiety.
weing – “My personal feeling regarding these diets is that the quantity of the food and not the quality will turn out to be critical. It’s so much easier to overeat on our western diet. We still have a lot to learn.”
I suspect you’re right in many ways but the quality does also seem to be a factor, in the research that’s been done on fruitflies at least. The key seems to be less food but very nutrient rich. We most definitely still have a lot to learn and it’s a fascinating subject for those of us who love food and eating (and cooking and growing food too).
Alex,
As the blind man said. “We shall see.”
Fifi wrote:
“This isn’t a beat up on the interns session, this is SBM blogging that’s meant to support SBM and educate the public about what is science and what is pseudoscience…or at least I thought that was what this site is about!”
I wasn’t passing judgment on what the correct method for blogging on the SBM site is. The majority of articles on SBM are written with the nuturing style of education. I would assume that the editors will continue to allow different styles, whether provocative or more nuturing. That is a decision for the editors.
I was explaining that proponents of the provocative style argue that if you are to educate people in critical thinking, you must provoke them to engage in their own literature research. Only when they get steamed up will they really learn what critical thinking entails. Many people take such provocations as personal attacks. The key distinction is whether the provocation is trying to make the respondent examine their scientific basis. Many of the perceived personal attacks on this site were just challenges to the scientific basis.
Science education isn’t just about reading a textbook to determine what the consensus of textbook writers determines are scientific facts and concepts. We know many of those facts and concepts will change in a short period of time. Answers will change over time, but the principles of critical thinking have not changed since Galileo. Part of science education is teaching the critical approach to information and conclusion. One shortcoming of science education in secondary education is the failure to teach critical thinking.
Can critical thinking be taught without the provocative approach? I don’t pretend to have a scientific answer. Those with education degrees can discuss that. Academic physicians rarely write articles about education techniques, so the provocative style is just passed on from generation to generation in medical schools. I think it was the subject in a movie about legal education (Paper Chase?). The provocative approach is just one more thing I adjusted to in medical school (I’d like to think I was a critical thinker before that). As a teacher I noticed it would certainly keep students awake in class. I also think different students responded to different styles of education.
zoe – “That seems fair to me, Fifi. If Dr. Hall has a bias on the matter of circumcision, it’s nothing like Dr. Tuteur’s (just look at the difference of their titles of the blog posts on circumcision).”
Oh I agree, that just wasn’t exactly what Dr Hall and I were disputing from what I remember (though perhaps I should go back and re-read the thread to be sure). I totally agree that Dr Hall’s post was much more reasonable than Dr Tuteur’s, even she did get a bit over the top with the fanatics and even if we disagreed on some aspects. I’m neither really pro nor against circumcision, it just doesn’t seem to stand up as a medically necessary procedure or a scientific practice for either boys or girls. Not having a penis, I can’t really comment from a penis having perspective on male circumcision and as a lover of penises it’s all about the individual penis and who it’s attached to so no fetishistic preference there either. It’s kind of interesting that both of the SBM bloggers who took on this subject are women! Hmmm, maybe the men here weren’t ready to touch it with a ten foot pole?
JMB – “Part of science education is teaching the critical approach to information and conclusion. One shortcoming of science education in secondary education is the failure to teach critical thinking.
Can critical thinking be taught without the provocative approach? I don’t pretend to have a scientific answer.”
Fair enough, both my parents are doctors (one was also a researcher) so I grew up being taught how to think critically and around science. Plus my grandmother was a teacher so I knew how to learn well before I got into school (much to some of my boring teachers’ displeasure and my engaged teacher’s joy
I agree that many people never learn to think critically, whether it’s being able to think critically about science or art or literature. However, one doesn’t need to be provocative to teach critical thinking, one needs to teach people how to research, analyse and the basic cognitive traps we fall into that create biases that get in the way of seeing reality or the facts for what they are. (The comon sense fallacies, the seeing is believing fallacies, confirmation biases, etc.) Most of critical thinking entails being able to get beyond either/or kind of thinking, which is one of the most basic cognitive traps there is (it has nothing to do with intelligence, it’s just the way our brain is set up for expediency, so even intelligent people can fall into this trap). The other problem even intelligent people often have is a lack of ability to deconstruct and recognize our own personal biases and the biases of our own culture. The only way to really get over that one is travel and friends from other cultures, actually coming up against other cultures and beliefs so you become aware of your own beliefs (since these are what we construct our personal/subjective realities out of, and it’s these personal/subjective realities that can get in the way of seeing actual/objective reality).
@Alex Knapp
You have many links to provide but do a poor job presenting anything from them that is specific to your point and not diluted by the nuances of the work.
You cite:
Influence of Motorization and Supermarket-Proliferation on the Prevalence of Type 2 Diabetes
But you don’t actually try to say what this paper does to bolster your position. I assume this is because of the nuance – the paper shows trends of increasing supermarket shopping *and* decreases in foot travel. The conclusions depend on both being present. No attempt is made to separate them in this paper.
This citation does nothing for specifically speaking about diet. All conclusions depend on both diet changes and lifestyle changes. This doesn’t mean diet changes don’t correlate to diabetes rates but this paper does not present a clear connection without other associated causes.
Your point is better made if you stop posting links without context and start providing analysis.
JMB – I’d add that one of the most valuable things I learned growing up around science and medicine was that we simply don’t know all kinds of things. “I don’t know” or “we don’t know” are in the vocabulary of every real critical thinker – uncertainty and questioning yourself is your friend as a critical thinker. Absolute certainty is a symptom of ideological infection and faith and not critical thinking or skepticism! Not that I’m not prone to being human myself and growing up around science certainly made me a knowledge junkie and means I love a good debate (or even a poor one sometimes).
Hey JJ,
From just that paper, you’re right–the researchers didn’t distinguish between the diet and the change in exercise levels, and I wouldn’t use just that paper to prove my thesis by itself. If it seemed I was doing otherwise, my apologies.
There is some research to suggest that exercise has very little effect on obesity or diabetes rates, but from this computer I don’t have the citations handy. I’ll look them up and post later.
“I was explaining that proponents of the provocative style argue that if you are to educate people in critical thinking, you must provoke them to engage in their own literature research. Only when they get steamed up will they really learn what critical thinking entails. Many people take such provocations as personal attacks.”
Except Dr. Tuteur is the one claiming to be personally attacked when somebody questions either her simplistic writing or her “authority” status that she promotes. Nobody else, that I can think of, has said anything about feeling attacked personally (although they probably could have, particularly “outing” Plonit as a midwife). On other forums, Dr. Tuteur has gone so far to post full name, city, and occupation of anonymous posters that she feels threatened by (instead of addressing their points).
Also, it isn’t *only* the same 5 posters calling Dr. Tuteur out on her inaccuracies. She has received many negative comments from dozens of different posters, including regulars, on here. I’ve never seen this for another sbm blogger.
To Fifi, I agree that we know far less than we think we know. The smartest professors were often more humble because they had learned the limitations of their knowledge.
To Alex Knapp, I have never stated that diet and exercise were not factors in the development of diabetes. I was just explaining the model of interaction of heredity, age, and diet in the development of diabetes. Anybody that wants to minimize their risk of diabetes which watch their diet. Whether there is sufficient comparative evidence about which diet is best, can be debated by someone with more time and expertise in nutrition than me. There is some evidence that simplifies the issue of diet down to what your weight is as a result of the diet. Bariatric surgery has been shown in some small series to revert type II diabetes more effectively than diet/lifestyle changes, but that probably reflects patient compliance as well.
JMB said “I was explaining that proponents of the provocative style argue that if you are to educate people in critical thinking, you must provoke them to engage in their own literature research.” If Amy wants this “method” to be effective at “teaching” readers, she must therefore cite references, which she rarely does. So how does that work exactly?
Make that voluminous reference citations. See Novella’s Feb 19 post comments where a discussion took place on how it’s necessary to read multiple primary research sources to arrive at any sort of conclusion, and how difficult/expensive it is for lay persons to obtains access to medical journals.
“Part of science education is teaching the critical approach to information and conclusion. One shortcoming of science education in secondary education is the failure to teach critical thinking.
Can critical thinking be taught without the provocative approach? I don’t pretend to have a scientific answer.”
That’s why I was wondering what the provocative approach was, exactly. I certainly have used a “devil’s advocate” position in the classroom as the teacher, as well as the Socratic Method. The students also rarely knew my personal position on a topic- I wanted them to draw their own conclusions, backed by evidence, which is the entire point behind education. But I haven’t seen any of that from Dr. Tuteur.
To JMB,
I misunderstood, then. It looked to me like you were assuming that diabetes was primarily a question of heredity and age and downplaying diet. I apologize for the misunderstanding.
“So how does that work exactly?”
The idea is that the student would have an incentive to start with a question, find references that may apply, filter those references as to how appropriate they are, and analyze their methods and conclusions to arrive at an answer. That is a process that the student will gradually get better at with practice. If references are supplied, that doesn’t fully simulate the problem solving situations that may be faced in the practice of medicine.
“and how difficult/expensive it is for lay persons to obtains access to medical journals.”
While some in academic medicine may enjoy full support of a librarian and a nearby library of medicine, those in private practice are faced with the same problems as the lay person. Too bad it isn’t a requirement that all research supported by public funding, or performed at schools supported with public funding, be made freely available. Most of the difficulty in finding a reference to cite in this blog, is to find one that is freely available.
“However, one doesn’t need to be provocative to teach critical thinking,”
What worked for you might not work for someone else. Different students respond to different methods of teaching. If a faculty member is faced with a student who don’t seem to be making adequate progress in developing critical thinking, then the teacher might resort to a different method of teaching (moving from a nuturing style to a more provocative style). It didn’t always work.
I guess the incentive in the provocative approach was, “Get mad at me, then go prove me wrong.” Some attendings would even make invalid statements, to see who could come up with the best evidence to prove them wrong.
JMB thanks for clarification. In the medical school situation, if a student presented legitimate reference citations at odds with the professor’s teachings how did the professor react? Does the professor summarily dismisses legitimate research that conflicts with his/her theories, while not providing any evidence for his/her theories? Did Amy learn this method in medical school too? And what about the use of qualifiers when communicating? I find it hard to believe that medical school information is taught entirely as absolutes…
I dunno, maybe I’ve become too cynical, but the premise that Amy’s blogging style has been a deliberate “teaching” method seems implausible. Seems more like a Hail Mary pass. I’ve had my fill of this entertainment.
I have only glanced at this thread. I did notice one name that I had never heard of before pop up: Lomborg. Then while checking PZ Myer’s blog I saw it again, with a link to a news article:
Book Review: The Lomborg Deception
(there is a word for noticing a word or incidence shortly after it comes to your attention, I don’t think it is bias confirmation, but something similar)
Wait, he is a political scientist, not a climate scientist!? Isn’t polictical science an oxymoron?
Now back to your normally scheduled attacks and/or support of Dr. Tuteur.
Some attendings would even make invalid statements, to see who could come up with the best evidence to prove them wrong.
+++++++++
Well, that explains everything.
wales wrote:
“if a student presented legitimate reference citations at odds with the professor’s teachings how did the professor react? Does the professor summarily dismisses legitimate research that conflicts with his/her theories, while not providing any evidence for his/her theories?”
Most students got credit for attempting a literature review if they cited references to studies published in recognized peer review journals, regardless of whether it agreed with the professor’s opinion. If the student’s analysis was based on less renown journals, then it would tend to be dismissed without much comment. That is one of the similarities in approach I recognized. What the student learned was to pay attention to the credibility of the source. Now, I am not saying that approach is right for a discussion of SBM, I am just saying that is how we were taught in medical school. It is important to learn that different scientific approaches yield different degrees of quality of information that can be used to make a medical decision. However, that judgment of the quality of the source is an easy way for biases to enter the process.
I cannot speak for Dr Tuteur, I just recognized a style of teaching and a thread of scientific reasoning in the earlier posts that triggered my memories. Whether that is her method, only she knows. I don’t know if she was subjected to that as a student, or if she taught in an academic medical center. Part of the job as a resident is to teach those with less experience, so most doctors have some limited teaching experience. Doctors’ experiences in training are not uniform. I think I was exposed to fairly harsh methods (there was significant morbidity and mortality in my cohort of medical students), more modern teaching programs may have evolved beyond that.
wales,
“You appear to be a champion of brevity and your comments that “I think she paints with a broad brush for impact. “ and “And, with the unstated qualifiers – which don’t add up to much – it is basically the truth of the matter.” Leave me wondering if you believe that impact is placed above accuracy on a hierarchy of effective science writing skills. ”
I suppose I have to say it yet again:
I was responding to posters who claimed that Amy’s opinions on what the evidence says is different to Harriet’s opinion on what the evidence says. I demonstrated that this was not the case and that their views are almost the same. Amy uses brevity for impact, Harriet uses all the qualifiers that Amy merely implies, but there is no disagreement and Amy demonstrated when she unhesitatingly accepted that large paragraph of qualifiers that I offered regarding herbal treatments.
And, again, I have not given an opinion on which method I prefer.
wales,
“Billy Joe said in defense of Amy’s style: “With Amy, you have to read between the lines.”
I was not defending her style, I was describing it.
” Is this really the goal of science writing, to prompt readers to substitute their own intuitions and biases for objective fact stated with clarity and precision?”
How is Amy prompting readers to substitute their own intuitions and biases for objective fact. In fact, she almost does the reverse. She almost shoves the facts – condensed for clarity and impact – down your throat! “CAM is useless” The objective facts are that CAM is useless except for [add a large paragraph of qualifiers which add much to the statement that "CAM is useless"]. Where has she allowed any wriggle room for your intuitions and biases?
…in the penultimate line that should read “which don’t add much”
plonit:
“Ultimately, you are responsible for what appears on your own website.
If you regularly have prominent advertising for sCAM products…then you have some responsibility for that…No one forces anyone to carry GoogleAds. People who do so are willing to sacrifice editorial control in return for the income generation.”
I have a lot of sympathy for that view.
In my opinion, when JREF allowed google ads, which predictably featured all sorts of scam products, they sold out.
JMB,
From her bio on this site: “Dr. Tuteur is a former clinical instructor at Harvard Medical School.”
# JMBon 22 Feb 2010 at 10:10 pm
“I guess the incentive in the provocative approach was, “Get mad at me, then go prove me wrong.” Some attendings would even make invalid statements, to see who could come up with the best evidence to prove them wrong.”
Yes, I’ve seen similar done in art school, but the difference is that when you disagree they do not attempt to discredit you by claiming you are just out to get them or that you are part of a “insert group here” consortium that is just trying to protect their interests. (Oh well, unless their divorce is getting too nasty or the drinking is getting out of control)
They actually argued the art and the principles.
All I can say if you are trying to use that style you should be a lot tighter in your evidence and logic than this article.
Firstly who are these alternative health people? Not alternative medicine, health. For that matter what is mainstream health? How are they the same and how do they differ. I am to belief that alternative health believes that the past was a paradise. Example? who, said what when to demonstrate that?To dispute these hypothetical (strawmen)) “Far from being a paradise, it was hell.” Well gosh, subjective much? Sure, I’d experience it as hell, but then in some possible future there may be millions of people thinking that our life is hell. Does that mean it really is?
As I see it whether the past was a paradise or not is pointless. There were positive aspects and negative aspects. Today there are positive aspects and negative aspects. We look to science to help us build on the positive and eliminate the negative. I’d much rather read about science than some pseudo psychoanalysis of some made up group.
JMB thanks for taking time to explain your point of view. If indeed this is Amy’s modus operandi, I question the belief that this method would be as effective in the real world. It might work in medical school, where the students are a captive audience and where the entire ritual of enrolling in school, paying tuition, and knowing a degree is received at the end reinforces the proscribed roles of student and teacher and supports the learning process, no matter how angry the student feels about the teacher. I have doubts that this method can be effectively transferred outside of academia. In a world where we are bombarded by bombastic and sensationalized news reporting and blogging this harsh teaching method doesn’t have the support and captive audience proffered by the halls of academia. Emulating the Fox News model (or appearing to do so) would seem to narrow the teaching possibilities rather than broaden them, in terms of actually reaching a prospective audience.
To clarify my point, in the medical school method being discussed, the stick and carrot are being employed simultaneously, and the students are invested in (literally) obtaining that carrot. In the real world (or blogging world) there are multiple methods for obtaining the carrot, other than being subjected to the stick. And since, as Amy pointed out, a large number of the comments she generates are from a small group of individuals, it would seem there is a small group of prospective students. End of observation.
Billy Joe, I apologize for interpreting your comments as support of one method or the other. That was my perception, not necessarily your message.
“I have only glanced at this thread. I did notice one name that I had never heard of before pop up: Lomborg. Then while checking PZ Myer’s blog I saw it again, with a link to a news article:
Book Review: The Lomborg Deception ”
Did not know there was a book coming out against the “skeptical environmentalist.” Will have to check it out.
Amy Tuteur said, “$4.95 is the special introductory offer to have Dr. Amy explain to you how likely it is that you, personally, are pregnant right now.”
See what I mean about a personal desire to discredit because you feel threatened? You’ll throw anything against the wall to see if it will stick in the hope that you can convince yourself and others that they don’t have to listen to me. It’s not working.
Do you know how many questions I get each month? One or two. I instituted that method to cut down on the hundreds of personal e-mails I otherwise get each day, and it has been very effective.
How about sticking with the actual facts? Or do you avoid them because you know you can’t win?
———————————————————
So, let me get this straight. You have a website called “Ask Dr. Amy”, but then you needed to implement some fees to help reduce the number of people contacting you with their personal questions? Wouldn’t it just be easier and more ethical to refer women to their own ob-gyns with their personalized fertility questions, as those ob-gyns are authorized to give actual medical advice?
The disclaimer from your site says,
“Disclaimer: Dr. Amy does not and cannot provide medical advice. Only someone who has examined you and reviewed your medical records can provide advice. Dr. Amy offers explanations and information.
Dr. Amy Tuteur is an obstetrician-gynecologist. She received her undergraduate degree from Harvard College and her medical degree from Boston University School of Medicine. Dr. Tuteur is a former clinical instructor at Harvard Medical School. Her book, How Your Baby is Born, an illustrated guide to pregnancy, labor and delivery, was published by Ziff-Davis Press in 1994.”
Interesting. A reader gets the impression that Dr Amy is a practicing ob-gyn, but just can’t give advice because she hasn’t personally examined the person or reviewed their medical records.
michele – “Far from being a paradise, it was hell.” Well gosh, subjective much? Sure, I’d experience it as hell, but then in some possible future there may be millions of people thinking that our life is hell. Does that mean it really is?”
Exactly! These kinds of value judgments based on personal perceptions instead of evidence are equally as meaningless when promoted by either side that’s fanatically attached to ideas about the past or “modern” life (“modern” is so quaint and retro to use…such “better living through chemistry” science romanticism!). Both are also equally tied up in very colonialist (and incorrect) ideas about other cultures (and our own) that date back mainly to the late 1700s and 1800s. If one is going to talk about history and culture, it’s worth knowing a bit about history and culture instead of just promoting what is essentially anthropological woo!
Neither of these romantic notions are being particularly realistic and both are clearly reactionary and ideological. One is presenting a naturalist fallacy, the other is presenting a techno-industrial fallacy. Neither is actually in line with how anthropologists and archeologists (contemporary ones at least) view or discuss past cultures (or present existant ones other than our own). And both are rejecting science for ideology (apparently technology and science are one and the same in Dr Tuteur’s mind).
One belief system involves creating fantasies about the past and nature as a reaction against fears about the future and present, the other is creating fantasies about the past, present and future, and technology, out of a desire not to see reality as it actually is so as to avoid recognizing the potential longterm consequences of our actions. Dr Tuteur’s apparent prejudice against preventative medicine – and cognitive science and psychology – isn’t very surprising when you see how it’s connected to her belief system regarding actions and consequences. It also seems just as fear based as the beliefs of those who cling to naturalist fallacies, it’s just that Dr Tuteur seems to think that technology is infallible and the “all good” magic to ward off scary nature instead of believing the naturalist fallacy that one can appease nature by being “good” or “in harmony”. Both are pretty silly positions and neither are actually based in reality!
StatlerWaldorf – I’d suspect it’s illegal to give medical advice over the internet (in this kind of context, legitimate telehealth setups associated with reputable health institutions can be very useful for remote communities). All in all, it seems pretty spectacularly unethical to be proposing one can tell someone via email whether their chances of being or getting pregnant are good or not. As you rightly point out, we have no idea if Dr Tuteur still holds a medical license and she does give the impression she’s a practicing Ob/Gyn on her site. Apart from not being nearly as successful, I can’t see how this is particularly different than what the Dr Phils and Mercolas and other TV/internet medical charlatans are doing. Particularly since Dr Tuteur just made an excuse for doing it and tried to brush it under the carpet by once again claiming that she’s being victimized simply because someone pointed out that she’s engaging in unethical behavior that certainly isn’t in line with what one would expect from someone who claims to be an advocate of SBM!
“You have a website called “Ask Dr. Amy”, but then you needed to implement some fees to help reduce the number of people contacting you with their personal questions?”
Heh, that hadn’t even occurred to me! That is pretty funny that the site is “Ask Dr Amy” and then she only wants to answer questions for a fee. (There are tons of other general info sites out there about women’s health and pregnancy so obviously this is about promoting the Dr Amy brand and not just being informative like most skeptics are generally doing.)
Neither did I realize until I visited Ask Dr Amy again that she actually sells all kinds of baby products on her site as well! Rather ironically, considering the subject of this particular blog, she sells organic baby formula and green baby products alongside the Pampers. Nothing essentially wrong with that, of course, it’s just rather hypocritical to spout off against organic farming on SBM and then to cynically exploit people’s desire and willingness to pay more for organic and green products on your site. Heh, Dr Amy’s Pregnancy Store even sells Baby Einstein videos…nice endorsement of baby woo there Dr Amy!
http://astore.amazon.com/askdramy-20
Today Simon Singh goes to court.
He was sued for libel for saying that “there is not a jot of evidence” that chiropractic is useful in the treatment of certain childhood conditions, and that the respectable face of the chiropractic profession, the British Chiropractic Association, “happily promote these bogus treatments”
“there is not a jot of evidence”
“happily promote these bogus treatments”
Hmmm…
BillyJoe – British libel laws are pretty ridiculous and are very often used as a political tool to try to silence people.
Thanks to Fifi for the tip. I did view Dr. Amy’s site and saw the organic products for sale in the “store”. What a load of hypocrisy. Amy writes a post about how toxins are non-existent (Dec. 24) then sells organic diapers and baby food on her site. What other reason for selling “chlorine free” diapers than exploiting parents’ fear of toxins? What gives? Well the entertainment value is certainly deepening here.
I expect if we hear from Amy at all it will be to say that she is just offering a wide range of products to satisfy all parents and that she does not endorse the products she sells….
I thought the chlorine free aspects of diapers was more of an environmental thing (chlorine processing, bleaching, going into groundwater, etc).
Not saying I’m wild about the e-commerce/online pregnancy advice line of work in a SBM blogger, just nitpicking for accuracy.
Well it is a good lesson in critical thinking and doing a bit of research to see if someone’s words and actions align and what their general integrity level is. Just because someone is an SBM blogger and claims to be a skeptic doesn’t mean they actually are one. (Perhaps Dr Tuteur confuses cynicism with skepticism?) While I don’t always agree on all matters with all the (other) bloggers who are part of the SBM collective, I generally have found that the integrity level is pretty high and most can be trusted to be honest and provide insightful analysis. Hey, even when there’s the odd confirmation bias or ideological issue it’s usually pretty minor and doesn’t really impact the actual science being discussed. Hey, we’re all human – it’s only when someone claims to be super-human or immune to human foibles that it becomes problematic.
Since a popular and very successful tactic of purveyors of anti-medicine woo and pseudoscience is to try to make out that SBM isn’t trustworthy and is merely a front for industry or is financially self-serving, it seems crucially important that SBM bloggers actually be pretty spotlessly ethical and not blatantly engaged in the same kinds of mercenary activities as the more nefarious woo merchants. You can’t be a trustworthy whistleblower if you’re doing all kinds of unethical things yourself! That said, it IS interesting and kind of nice to see that “skeptic” as a brand or label is becoming marketable (though unfortunate that it’s often pseudoskepticism that’s being sold since most actual skeptics seem to view educating others about skepticism as more of a public service than a commercial endeavor). I am skeptical of the commercial promotion of skepticism as a brand rather than as a means to better understand reality and the world.
Given Amy’s stance at sbm on toxins I would expect to see her advising parents not to waste their money on the more expensive chlorine free diapers and organic baby food because there is no “evidence” that diapers bleached with chlorine and food grown with chemical fertilizers and pesticides pose any harm to babies.
Michele: I think the theory is that the “environmental thing” is a toxin thing via chlorine leaking into landfills and groundwater(which makes sense to me). And also perhaps that chlorine residue on diapers is toxic to infants.
michele – “I thought the chlorine free aspects of diapers was more of an environmental thing (chlorine processing, bleaching, going into groundwater, etc).”
I would have thought that too but they’re not marketed that way.
Seventh Generation offers a safe conventional diaper without dangerous toxins. Keep your baby dry and comfortable in between changes and through the night, and go chlorine free at the same time.
In addition to being effective at keeping baby dry and reducing the risk of diaper rash, studies show that our absorbent polymer is non-toxic and non-irritating to baby’s sensitive skin.
Features:
Hypoallergenic
Cloth-like covering
Premium fit and absorbency
Resealable tapes & stretchy leg gathers
Fragrance and latex free
Most diapers have been bleached with chlorine, which creates dangerous toxins (i.e. dioxin, furans and other organochlorines) that accumulate in both people and animals. Choose wisely!
Organic babyfood? Profiting off of those who are “longing for a past that never existed” given this exact blog post talking about the stupidity of people who are concerned about pesticides? Huh, enjoying the irony.
If she were so concerned about the amount of email comments about pregnancy she was getting, I guess she could have called it dontaskdramy.com instead of charging people $14.95 for an email from a doctor whose been retired for over 15 years.
If you agree with Amy’s stance on toxins, chlorine leaching into the soil and groundwater shouldn’t be a problem. So it’s still hypocritical to sell these products. Whichever reason draws parents to chlorine free diapers is a result of perceived toxins either in the environment or on the baby.
So which is it? Is Amy a cynical skeptic who doesn’t believe in toxins but panders to the publics fear of toxins? Or is she a believer in toxins who pretends to be a non-believeing skeptic? Or just a good old fashioned American salesperson who believes the public should have options to waste their money whichever way they wish to?
FiFi – sorry, I was going from past memory of my diapering days and the amazon description…
“Hypo-allergenic and offering soft, cloth-like comfort and premium absorbency, these diapers are made of chlorine-free absorbent materials that do not contribute to dioxin pollution.”
But your quote does have a different spin, My bad.
michele – What you said made total sense and I’d have thought it was mainly about the processing and environmental pollution myself but the marketing does play on parental fears (reality based or not) of their children being exposed to toxins.
I’ve never understood why people get so bent out of shape about organic food or farming. It’s not like anyone’s forcing them to buy, grow or eat organic food, or support it financially. On the other hand, almost all of us in North America indirectly financially support factory farming of various kinds through all kinds of government subsidies given out – even if we choose to support local or organic agriculture by buying organic or local produce our tax dollars still support factory farming.
“BillyJoe – British libel laws are pretty ridiculous and are very often used as a political tool to try to silence people.”
I was referring more to those short (qualifier free) phrases of his.
The extent to which one ought to employ qualifiers depends on the topic of discussion, surely?
In the case of Simon Singh vs. BCA, he was referring to Chiropractic claims to treat childhood illnesses including asthma. The short phrases without qualification are therefore justified.
Had he been talking about lower back pain, he would no doubt have been more long-winded, discussing the evidence that chiropractic manipulations appear help and discussig whether this was because of ‘subluxions’ or just because chiropractic is similar to other sorts of hands on stuff which also appears to help like massage, osteopathy etc…
Plonit,
Let’s cut to the chase:
Chiropractic is useless for back pain.
You don’t agree?
#
# BillyJoe on 24 Feb 2010 at 6:04 am
Plonit,
Let’s cut to the chase:
Chiropractic is useless for back pain.
You don’t agree?
oh, gotta see a source for that claim.
Has everyone seen the news?
http://skepticalob.blogspot.com/2010/02/i-quit-sbm.html
BillyJoe – Actually, I’d rather see Singh’s quotes in context since he’s actually not just making non-evidence based assertions and generalizations as you seem to think he is when you see him quoted out of context. Just because I agree with Singh (a confirmation bias) and know what he’s talking about (the context) doesn’t actually mean that the quotes you’ve presented are any more legitimate than any other opinion proffered without evidence.
And, in many ways Singh is doing the same things as a journalist that some bloggers here complain about when science writers do them regarding things they don’t agree about (using anecdotes, making assertions about evidence without presenting the actual evidence, relying upon an expert rather than analysing the data himself, etc). I don’t have a problem with that but then I don’t have unrealistic expectations of journalism (or science, medicine or doctors for that matter…though I may apparently have unrealistic expectations regarding the integrity of SBM bloggers practicing what they preach and going by the same rules as ethical scientists do).
A link to the actual article…
http://svetlana14s.narod.ru/Simon_Singhs_silenced_paper.html
To contextualize what Singh wrote and is being sued for…
“You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.”
The libel is around the “promotes bogus treatments” since it implies that the BCA is being intentionally unethical (I have no doubt they are but we’re talking British libel laws here).
What he said about chiropractic for back pain (from the same article)…
“But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.”
Plonit – It is true that chiropractors use some of the same techniques as physiotherapists but that doesn’t actually make chiropractic methods (which rely upon the concept of subluxations) effective, it just means that chiropractors use non-chiropractic techniques. That said, back pain is still somewhat mysterious even to medicine (hence it being a fertile ground for woo). Of course, the biggest problem with chiropractors isn’t that they’re ineffective, it’s that their neck cracking confidence trick can cause strokes.
Alison – Well I guess it’s easier to quit (or whatever happened) than to simply act like a reputable skeptic or ethical SBM blogger. I’m happy SBM will return to being a source of good science and real skeptical thinking. Yay!
Would you mind cutting and pasting? I cannot access anything with the work ‘blog’ in the title.
Alison Cumminson 24 Feb 2010 at 8:37 am
Has everyone seen the news?
http://skepticalob.blogspot.com/2010/02/i-quit-sbm.html
Wow – that is a class act.
Yes, it is true, and an announcement will be forthcoming. In the meantime, I think enough has been said in this comment thread.
hey,
where did Gorski’s post go?
BillyJoe: “Let’s cut to the chase:
Chiropractic is useless for back pain.”
micheleinmichigan said: “oh, gotta see a source for that claim.”
There are plenty of sources and it’s not hard to find them
(Hint: first define chiropractic)
Fifi,
“BillyJoe – Actually, I’d rather see Singh’s quotes in context since he’s actually not just making non-evidence based assertions and generalizations as you seem to think he is when you see him quoted out of context. ”
I don’t think he is.
And that is exactly what I’m getting at.
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.
I think it is legitimate to use both the short, snappy and, for all intents and purposes, true three-second grabs AND the long-winded sit-down, read-and-concentrate, considered response.
BillyJoe,
No.
Unqualified assertions wrt chiropractic’s ability to treat childhood asthma are correct and justified. Simon Singh made them. This was good writing both in the sense of being accurate and in the sense of being clear and easy to assimilate.
Unqualified assertions wrt chiropractic’s ability to treat back pain are unjustified. Writing about chiropractic and back pain would have to choose between being accurate and being easy to digest. Singh chose not to write about chiropractic and back pain and therefore did not have to make this choice.
BillyJoe – I don’t find Singh’s writing or approach to skepticism to be anything like Dr Tuteur’s, are you generally familiar with his work? And had you read the whole article or were you just familiar with the phrase that the libel suit was hung on?
Alison,
“Unqualified assertions wrt chiropractic’s ability to treat childhood asthma are correct and justified. Simon Singh made them. This was good writing both in the sense of being accurate and in the sense of being clear and easy to assimilate.”
Yet there is evidence that chiropractic works for asthma. So it is strictly unjustified to say “there is not a jot” of evidence that chiropractic can treat asthma. What is true is that “given the evidence, a reasonable and informed person would have not a jot of belief that chiropractic is a remedy for asthma”.
(I borrowed that from Tony Lloyd)
“Unqualified assertions wrt chiropractic’s ability to treat back pain are unjustified. Writing about chiropractic and back pain would have to choose between being accurate and being easy to digest. Singh chose not to write about chiropractic and back pain and therefore did not have to make this choice.”
Well, maybe just one small qualifier then: chiropractic, defined as a realignment of subluxed vertebra as opposed to a good massage, is useless for the treatment of back pain.
Fifi,
“BillyJoe – I don’t find Singh’s writing or approach to skepticism to be anything like Dr Tuteur’s, are you generally familiar with his work? And had you read the whole article or were you just familiar with the phrase that the libel suit was hung on?”
I wasn’t comparing Dr. Tuteur to Simon Singh and, yes, I have read the whole article.
Simon Singh uses both techniques.
In the article he said “not a jot of evidence”
Elsewhere he has actually evaluated the evidence that chiropractic helps asthma and other non spinal conditions.
BillyJoe – The main point is that making unqualified statements isn’t SBM writing and it’s the kind of thing SBM bloggers call out both science journalists and CAM promoters for all the time. This isn’t opinion-based medicine or ideology-based medicine….um, isn’t that the big black hole of endarkenment that we’re all trying to prevent science and medicine being sucked into? Isn’t that what CAM is and aren’t we all interested in trying to help people understand that science is about evidence and dealing with reality and not just about personal opinions and cherry picking evidence to promote an emotion-based opinion or ideology? For me at least, science is about learning what objective reality really is (despite how it may seem) and not just promoting a subjective perception of reality. Seeing really isn’t believing and common sense is just as often misleading as it is accurate (and is subjective at best, highly biased at worst). That’s why we developed the scientific method and the tools we have, to get past the limitations of our own senses and kluge of a brain.
Sensationalism, being overly simplistic, relying upon “common sense” over actual evidence, making assertions with no context or recontextualising something so it appears other than it is and making broad generalizations are all the trademarks of tabloid journalism and woo. Blogging can be many things, it can be a personal journal, it can be a soapbox to share opinions with the world or it can be a very credible extension and form of journalism (either editorial or investigative). SBM has established itself as being on the journalism spectrum with both editorial and investigative/analytical aspects. Because science journalists and media, and other researchers, are critiqued here, it’s just a matter of basic integrity to live up to the standards one sets for others. Otherwise you’re back to being just like what you’re critiquing, which makes any soapbox a pretty slippery place to stand when push comes to shove. And, if you’re going to take on ideologues and true believers, and people with commercial interests or a lot to lose if reality is exposed, there is going to be pushing and shoving. (And, let’s be honest, some of the SBM bloggers here aren’t above at least poking – quite deservedly – some of the more ridiculous offenders with a stick…they generally just make sure it’s an evidence stick and not just the pointy end of their ego.)
The other thing worth mentioning is that communication plays a key role in shaping public perception of both CAM and SBM, which is why I personally think it’s a big deal not to use CAM/propaganda/advertising methodology which isn’t about promoting critical or reality-based thinking. If you want to educate people about how to critically read media, how to deconstruct an argument for themselves and how not to get sucked into sensationalist or bogus “common sense” assertions, you can’t use dodgy methods yourself and claim they’re legitimate or critical thinking when you use them but dodgy when others do. It’s entirely possible to be entertaining, provocative and to explain complex ideas in lay terms without resorting to dodgy techniques. A lot of it is about providing context, that’s why the context of who someone is in terms of their actions becomes relevant (and why SBM bloggers bring up things like how someone has spoken at a CAM conference as being relevant to their integrity level, or whether they get funding from drug companies and how they make a living and so on…these things are relevant in medical science in terms of determining integrity and potential biases).
[...] me first link you to the page we’ll be discussing. It’s a blog post by an MD contributor on the website Science-Based Medicine. At this moment [...]
I admit to not reading all of the comments.
If you’re interested in the past, check out Weston Price, in the present, Gary Taubes. If you’re interested in the future, do a search for “The World According to Monsanto” on Youtube.
The dramatic improvement in longevity must, to a great extent, be attributed to improvement in diet, improvement in employment conditions, social benefits and other benefits not related in medical intervention. There is a downside to the changes in food supply. There is an outrageous increase in obesity and other problems that are a product of “modern society” and the modern diet, especially in the US. Mercifully, I live in Europe.
If Ancel Keys has the majority of his work retracted by journals at the behest of the rulers of this blog I might take this blog seriously. Long live saturated and cholesterol – and those who eat them. Now, to get back to my moose liver fried in coconut oil.
I liked Dr. T’s contributions,
but I’m glad she’s gone if only for the fact that I won’t have to come back a week later to see what discussion developed in my blissful absence from internet distractions only to sift through 400+ posts containing mostly mind vomit.
i’ve had facebook conversations about facebook conversations with more direction.
I enjoyed Amy’s takes. I’ll miss her insight. The Amazon sales are a bit hypocritical, but I understand it well. I haven’t ever given in to the dark side of selling nutritional supplements or vitamins, but after hours of work, tons of dictations left, and a whole lot of wasted breath, I sometimes wonder if I shouldn’t just sell the damn things. I can tell people that there isn’t a shred of evidence for many of these “remedies” only to see them back weeks later, carrying those and others. If I sold them at less of a profit then the huckster they are seeing, wouldn’t I be doing us both a favor?…..(naw, then I would just be a low level huckster and I think we should always be our best)…..ok I will just get back to my endless dictations, for my ridiculously low pay and wonder if I shouldn’t be the next vitamin guru
This sight seems to help preserve some semblence of sanity. Thanks SBM bloggers!
Residential Garage Doors…
I found your blog through google, and i will hav to say i am very impressed!…