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494 thoughts on “Longing for a past that never existed

  1. Zoe237 says:

    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.

  2. Zoe237 says:

    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.

  3. Fifi says:

    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.

  4. Zoe237 says:

    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…

  5. Basiorana says:

    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.

  6. Basiorana says:

    “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.

  7. Zoe237 says:

    “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.

  8. Fifi says:

    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!

  9. Alex Knapp says:

    Bariosana -

    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.

    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.

  10. squirrelelite says:

    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.

  11. yakattack says:

    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.

  12. yakattack says:

    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.

  13. Zoe237 says:

    “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!

  14. squirrelelite says:

    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.

  15. squirrelelite says:

    It’s OK, Zoe237.

  16. Marco Rosaire Rossi says:

    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.

  17. Zoe237 says:

    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.

  18. Zoe237 says:

    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.

  19. JMB says:

    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.

  20. rnikoley says:

    @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’.

  21. Alex Knapp says:

    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.

  22. Harriet Hall says:

    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?

  23. Alex Knapp says:

    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.

    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.

  24. BillyJoe says:

    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. :)

  25. R Lamb says:

    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.

  26. wales says:

    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.

  27. Tatyana says:

    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.

    :)

  28. wales says:

    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.

  29. BillyJoe says:

    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

  30. Bonnie says:

    wales:

    “admitting that CAM can be as effective as placebo”

    That’s kind of funny. “As effective as placebo” means “not effective.”

  31. 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.

  32. Fifi says:

    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.

  33. squirrelelite says:

    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!

  34. Bonnie says:

    “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?

  35. Fifi says:

    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!” :-)

  36. Fifi says:

    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.

  37. Fifi says:

    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.

  38. Zoe237 says:

    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.

  39. “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.

  40. Alex Knapp says:

    Amy,

    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.

    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.

  41. Fifi says:

    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).

  42. “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.

  43. Fifi says:

    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.

  44. Fifi says:

    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!

  45. Alex Knapp says:

    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?

    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.

    You (and others) really, really, really want to believe that if you eat “right” and exercise you will avoid getting ill.

    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.

    Be honest. You personally practice the diet that you advocate because you think you are protecting yourself.

    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.

    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

    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.

    you just might get CAD or cancer anyway.

    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.

    That’s what I mean by feeling threatened.

    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.

  46. Fifi says:

    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.

  47. wales says:

    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.

  48. wales says:

    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.

  49. wales says:

    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.

  50. squirrelelite says:

    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

  51. lillym says:

    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.

  52. Fifi says:

    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.)

  53. BillyJoe says:

    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.

  54. lillym says:

    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.

  55. BillyJoe says:

    Who the hell is Marco? I can’t find him anywhere?

  56. Plonit says:

    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.

  57. BillyJoe says:

    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.

  58. BillyJoe:

    “There is some evidence – mostly from small trials of short duration and doubtful use of controls …”

    I agree!

  59. weing says:

    “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?

  60. weing says:

    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.

  61. JMB says:

    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.

  62. Zoe237 says:

    “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.

  63. weing says:

    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?

  64. Zoe237 says:

    “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

  65. Zoe237 says:

    “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). “

  66. Harriet Hall says:

    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.

  67. StatlerWaldorf says:

    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.

  68. weing says:

    “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.

  69. weing says:

    “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.

  70. BillyJoe says:

    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.

  71. David Gorski says:

    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.

    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

  72. Fifi says:

    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 :-)

  73. 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.

  74. Fifi says:

    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.

  75. weing says:

    “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.

  76. 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.

  77. Zoe237 says:

    “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.

  78. 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.

  79. “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.

  80. Harriet Hall says:

    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.

  81. Plonit says:

    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?

  82. Harriet Hall says:

    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.

  83. “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.

  84. Fifi says:

    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).

  85. Fifi says:

    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).

  86. Fifi says:

    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.

  87. David Gorski says:

    My understanding is that her role is to increase traffic at SBM.

    Your understanding is in error.

  88. Zoe237 says:

    “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.)

  89. wales says:

    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.

  90. David Gorski says:

    or Steven Milloy

    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.

  91. 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?

  92. David Gorski says:

    No, Lomberg certainly isn’t a AGW denier

    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.

  93. Zoe237 says:

    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.

  94. Harriet Hall says:

    “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.

  95. Zoe237 says:

    “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.

  96. Zoe237 says:

    “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.

  97. 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

  98. Harriet Hall says:

    “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.

  99. wales says:

    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.

  100. wales says:

    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.

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