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Naturopathy and science

Naturopathy has been a recurrent topic on this blog. The reasons should be obvious. Although homeopathy is the one woo to rule them all in the U.K. and much of Europe, here in the U.S. homeopathy is not nearly as big a deal. Arguably, some flavor of naturopathy is the second most prevalent “alternative medical system” here, after chiropractic of course, and perhaps duking it out with traditional Chinese medicine, although naturopathy does embrace TCM as part of the armamentarium of dubious medical systems that it uses. In any case, some sixteen states and five Canadian provinces license naturopaths in some form, and in some states naturopaths are fighting for–and in some cases winning–the power to prescribe certain real pharmaceutical medications and order real medical tests. For instance, in California, naturopaths can order laboratory tests and X-rays, which reminds me of a conversation I had with a mammographer from California at TAM last summer. He told me a tale of the dilemma he had when naturopaths and other “alt-med” practitioners ordered tests at his facilities. Specifically, the dilemma came about because he doubted that the naturopath knew what to do with the results. Meanwhile, in Oregon, naturopaths can prescribe certain types of pharmaceutical drugs (as opposed to the usual supplements, herbs, or homeopathic remedies they normally prescribe). Meanwhile, moves are under way to expand the prescribing privileges of naturopaths in Canada, as Ontario (which is, remember, just across the Detroit River, less than two and a half miles as the crow flies from my cancer center—a truly frightening thought to me).

Unfortunately, naturopathy is a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease. As a result, typical naturopaths are more than happy in essence to “pick one from column A and one from column B” when it comes to pseudoscience, mixing and matching treatments including traditional Chinese medicine, homeopathy, herbalism, Ayurvedic medicine, applied kinesiology, anthroposophical medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine. Despite their affinity for non-science-based medical systems, naturopaths crave the imprimatur of science. As a result, they desperately try to represent what they do as being science-based, and they’ve even set up research institutes, much like the departments, divisions, and institutes devoted to “complementary and alternative medicine” (CAM) that have cropped up on the campuses of legitimate medical schools and academic medical centers like so many weeds poking through the cracks in the edifice of science-based medicine. Naturopaths also really, really don’t like it when they encounter criticism that their “discipline” is not science-based. Indeed, the president of the American Association of Naturopathic Physicians, Carl Hangee-Bauer, ND, LAc (he’s an acupuncturist, too!), wrote a revealing post on the official AANP blog entitled Science and Naturopathic Medicine.

Science. You keep using that word. I do not think it means what you think it means.

The President of the AANP takes umbrage

Apparently criticisms of naturopathy as unscientific have started to penetrate even the reality distortion field of the AANP, because Carl Hangee-Bauer has noticed them, and he’s not happy. Oh, no, he’s not happy at all. First, he begins by enumerating his bona fides as a science-loving geek, in order to prove to readers just how dedicated he is to science. These bona fides include a love of marine biology and a mention of how much he originally wanted to become a marine biologist. (Hey, I loved The Undersea World of Jacques Cousteau when I was a kid, too, you know.) Hangee-Bauer then discusses how he “took every course in biology, chemistry, physics, etc.” that he could in school and in college majored in biology, with dual minors in physics and chemistry. Then, somehow, while he was in the U.S. Army, he developed an interest in medicine as a Medical Service Corps officer, and that led him to naturopathy. Personally, this story leads me to ask: What happened to Hangee-Bauer? How could someone who was so interested in science go so far off the rails? Whatever happened, Hangee-Bauer’s narrative leads up to this lament about nasty bloggers like us:

I tell you this to let you know that I am no stranger to science. I still find it fascinating and appreciate the many ways it helps us understand the workings of nature and the world, helping us separate what appears to be the truth of things from reality. Studying naturopathic medicine, and especially acupuncture, presented me with many challenges, and I learned along the way that our medicine, as well as all other systems of medicine, are really a combination of science and art. When we work with our patients, we draw from both in order to stimulate the vis and provide well-rounded care to our patients.

Thus it has become an increasing concern to me when I read articles and blogs on the Internet blasting naturopathic medicine for being “unscientific.” These frequently polemic articles, while professing to come from scientific logic, to my eye are biased misrepresentations of the truth. They often lambast our profession and philosophy as unscientific, yet I have yet to see any one of them provide a critical analysis of research done by naturopathic physicians and researchers. It is sad that science can be used in these political ways.

It’s very hard for me not to point out that in Hangee-Bauer’s case science has apparently not been particularly successful in helping him to separate “what appears to be the truth of things from reality.” He is, after all, an acupuncturist and naturopath. It’s also apparent from the website of Hangee-Bauer’s practice, which treats all manner of ailments, as listed here on this page. Out of curiosity, I started clicking around on the conditions for which Hangee-Bauer provided links. For example, naturopaths frequently claim to be able to treat allergies (whether you have them or not!); so I gravitated to the page on allergies first. After a description about how “allopathic” medicine treats allergies by blocking histamine, having the patient avoid the allergen, and desensitization, we then see this passage:

Let’s look briefly at an example of TCM treatment for allergies. John presented with acute allergy symptoms of one-month’s duration which included sneezing, runny nose with lots of watery phlegm, extreme fatigue and occasional loose stools. After taking his history and doing an examination, his acupuncturist assessed his condition according to TCM as Wei Qi Deficiency resulting from a weakness of the Lung and Spleen. In addition to general recommendations for his condition, John was given Minor Blue Dragon formula which has decongestant properties for those with copious clear phlegm, as well as Astra 8, an herbal formula designed to tonify the Lung and Spleen Qi. He was also told to minimize or avoid dairy products and excessively sweet or spicy foods. As John’s condition improved, he and his acupuncturist developed a plan to strengthen his immune system in preparation for next year’s allergy season. This plan included replacing coffee with green tea, which is rich in catechins which exert anti-allergy effects, as well as taking quercetin, a bioflavonoid which has been shown to stabilize mast cells thus slowing the release of histamine and other chemicals related to allergic symptoms.

One wonders what “science” supports the vitalistic prescientific notion that allergies are due to “Wei Qi Deficiency” or detonification of “Lung and Spleen Qi” requiring “tonifying” (whatever that is). In all fairness, however, I will give Hangee-Bauer credit for one thing: on the same page, he actually states that applied kinesiology “may be of no value in testing for an allergy.” Imagine my relief, except that he should have said “is of no value whatsoever” for diagnosing allergies. That relief is also tempered by Hangee-Bauer’s suggesting that “strengthening the immune system” in an allergy would be a good thing in preparation for next year’s allergy season. Given that allergies are due to an excessive histamine response to a particular kind of antigen, “strengthening the immune system” might well make it worse. Of course, “strengthening the immune system” is a meaningless phrase, as we’ve pointed out many times before, but apparently, for all his love of science, Hangee-Bauer hasn’t figured that out.

But let’s move on. Elsewhere on the web page, Hangee-Bauer’s practice recommends breast thermography as an adjunct to mammography. I was shocked. No, I wasn’t shocked that he recommended thermography, as thermography is very popular among the “alternative medicine” set. Rather I was shocked and relieved that Hangee-Bauer apparently still recommends mammography. Even so, his website parrots scientifically unsupported claims common among CAM practitioners that thermography can find cancer ten years before breast cancer is identified by other methods (claims of the sort that I wrote about recently), and that it should be done at least once a year to screen for breast cancer. Amusingly, there was then this claim:

Finally, licensed acupuncturists can use thermography to detect slight temperature variations which reflect disturbances in the flow of Qi and blood, which can result in pain and dysfunction. Concrete evidence that acupuncture therapy actually restores blood flow and normalizes disrupted temperature patterns has been proven by thermographic studies.

I would so love to see the scientific studies demonstrating that thermography can detect disturbances in the flow of qi and how acupuncture restores it and blood flow. Surely there must be such studies; Hangee-Bauer, after all, claims that he is all about science and just bristles with outrage at the commentary of bloggers who correctly castigate much of naturopathy for being unscientific. What he does is based on science, isn’t it? So show it! What is the science demonstrating that thermography can detect disturbances in the flow of qi?

These are but a couple of examples that stood out of unproven treatments modalities and scientifically–shall we say?–”debatable” statements that I found on Carl Hangee-Bauer’s web page. I encourage SBM readers to check out other examples, such as the pages on tips for lung health (complete with recommendations for regular acupuncture sessions to “increase your resistance to both viruses and allergens”), treating springtime allergies, naturopathic “detoxification” (it’s always about those evil “toxins,” isn’t it?), and, of course, treatment of heavy metal poisoning. You know, whenever I see the term “heavy metal poisoning,” I can’t help but think of Ozzy Osbourne being the way he is as a result of 40 years of heavy metal poisoning. Oh, wait. It was the alcohol and illicit drugs. And perhaps the heavy metal poisoning.

But I digress.

Perhaps the most bizarre bit of ostensibly “science-based” recommendations to be found on Hangee-Bauer’s website is something called biotherapeutic drainage. I must admit, I had never heard of biotherapeutic drainage before. It turns out that if you Google the term “biotherapeutic drainage,” you’ll find that naturopaths appear to love this particular treatment modality. But what is it? Erika Horowitz, one of Bangee-Bauer’s naturopath partners, describes it thusly:

Detoxification is a big part of naturopathic theory and practice.

I can’t help but interrupt right here and say: No kidding! Too bad these “toxins” are as fantastical as the “science” that naturopaths invoke to support “detoxification.” Horowitz then continues:

Helping the body eliminate toxins safely and effectively can play an important role in improving health and preventing disease. One of the most useful detoxification therapies I use in my practice is the use of UNDA numbers, which are unique combinations of liquid homeopathic formulas founded on the theories of Chinese medicine, homeopathy, and anthroposophy.

Wow. Apparently one woo isn’t enough; so Horowitz combines three. It’s hard for me not to imitate a commercial and say something like, “Biotherapeutic drainage. It’s three, three, three woos in one!” Oh, wait. I just did. In any case, I had never heard of UNDA numbers before, which means I’m definitely learning something while writing this post. Unfortunately what I’m learning is that, even though I’ve been at this several years now, I still haven’t learned all the forms of unscientific medicine and treatments that exist out there. I can still be surprised, and UNDA surprised me. Apparently, it’s this:

UNDA numbers consist of homeopathically prepared low-dose combinations of plants and minerals. The plants possess specific characteristics as to how they affect an organ or organ system; some may have a stimulating effect, whereas others will calm or sedate an organ’s functions. The minerals in the compounds affect how the cells carry out chemical reactions that are necessary to efficiently begin the detoxification process. So the plants guide the remedy to the appropriate organ system (be it digestive, cardiovascular, or respiratory) and the minerals help change the cells’ biochemical function. These remedies help the body detoxify by helping cells work more efficiently and eliminate waste effectively, and by improving how our organs of elimination work.

UNDA numbers treat both acute ailments and chronic disease, addressing symptoms but more importantly concentrating on the reason that the body is manifesting the symptoms in the first place. The remedies are nontoxic, won’t interfere with other allopathic or holistic medications, and have a gentle yet deep-acting effect.

If they’re homeopathic, then I can’t really argue with two out of the three claims made for UNDA numbers. They certainly must be nontoxic and I’m sure they don’t interfere with other medications. Speaking of homeopathy…

One huge reason (among many) that naturopathy can’t be scientific

After this detour to Hangee-Bauer’s website, where we can find ample evidence suggesting that, when the rubber hits the road (or the patients hit the exam rooms) his dedication to science-based medicine is not nearly as strong as he proclaims in his message to the AANP, let’s move on to the single most glaring reason why naturopathy can’t be scientific. It begins when Hangee-Bauer lionizes Joseph Pizzorno, a prominent naturopath on the faculty at Bastyr University, arguably the most influential school of naturopathic medicine in North America, as having spent the past 25 years trying to use science to increase the credibility of naturopathy. Now I’ll give Pizzorno credit. For example, he did recognize as quackery Hulda Clark’s “parasite”-zapping “syncrometer,” which is a lot better than a lot of proponents of “natural medicine” have ever done.

On the other hand…

Pizzorno is currently the President Emeritus of Bastyr University, having been its founding President. Presumably he is still involved in Bastyr University, but until 2000 he was the one running its day-to-day operations right from the very beginning. Hangee-Bauer lauds Pizzorno as being a visionary in terms of trying to make naturopathy science-based, but there’s one problem with that view. Pizzorno’s school embraces homeopathy uncritically. It is, after all, a school of naturopathy, and there is are few forms of woo that naturopathy doesn’t embrace uncritically. Indeed, Bastyr not only embraces homeopathy, but requires its students to study it. Don’t believe me? Let’s start by looking at Bastyr University itself. Here is what the Bastyr University website says about homeopathy. First, it describes homeopathy as “natural” and “nontoxic” (the latter of which is hard to argue with, given that homeopathy is nothing more than water). It goes beyond that, though. Bastyr also offers homeopathy services in its clinics. As you may know, one of my favorite litmus tests for any CAM advocate’s connection with science and reality is how he reacts to homeopathy. If he embraces it, then I know that any protestations of being “science-based” are utter piffle. Bastyr University embraces homeopathy, just as naturopathy in general does.

More pertinent to the question of whether naturopathy embraces homeopathy is this answer to a question in Bastyr’s FAQ about homeopathy:

Q. Do all naturopathic physicians use homeopathy?

A. All naturopathic physicians are trained in the use of homeopathy, but not every naturopathic physician will use it as part of their treatment.

Let’s repeat that: All naturopathic physicians are trained in the use of homeopathy.

All. Of. Them.

Consistent with the answer to this question on the Bastyr University FAQ, there’s a lot of homeopathy being taught and practiced at Bastyr. For example, if you look at its curriculum to become a doctor of naturopathic medicine, you’ll rapidly see that Bastyr requires a full year of homeopathy courses spread out over three classes for a total of 8 credit hours. The same is true for Bastyr’s five year track and its combined degree of Doctor of Naturopathic Medicine (ND)/Master of Science in Acupuncture (MSA) or Acupuncture and Oriental Medicine (MSAOM). In addition, Bastyr has a clinical homeopathy department and homeopathy teaching clinic. The department chair is a naturopath and homeopath named Richard Mann, ND.

But it’s not just Bastyr. Taking on Hangee-Bauer’s claims that the AANP is all about the science, let’s take a look at the AANP itself. If you take a look at the official AANP blog and search it for the word “homeopathy, you’ll rapidly see that the largest “professional” organization of naturopaths not only embraces homeopathy but defends it against attacks. Perhaps the best example of the attitude of the AANP towards homeopathy is found in this post from several months ago entitled Getting over it. In it, a naturopath named Christopher Johnson gets all indignant about recent “1023” campaigns that skeptics and proponents of science-based medicine have been using with some success to demonstrate the utter ridiculousness of homeopathy. (Indeed, one such event occurred recently, on February 5.) In response, Johnson writes:

They named their campaign “10:23″, a reference to Avogadro’s number. This number is significant to chemists in that it supposedly sets the limit below which no material elements are likely to be present in a given dilution. Homeopathic remedies are made with solutions far more dilute than Avogadro’s number.

Do these “skeptics” really think the public cares about Avogadro’s number when homeopathy has just significantly improved their toddler’s autism or offered help with any of a vast range of diseases which respond so well to homeopathic (and often not to conventional) treatment?

This is just another tantrum by the clueless wing of the scientific/medical community that can’t understand why the people don’t praise them for their ideological purity and courage, even when the fruits of their scientific labors rot like a brown banana. Note to protestors: maybe they’re just not that into you.

Remember, this is the official blog of the AANP—the organization of which Hangee-Bauer is the current president!—and it’s not just attacking, but rabidly attacking, a valid criticism of homeopathy. This valid criticism is nothing more than pointing out that most homeopathic remedies are diluted far, far more than Avogadro’s number, meaning that it’s highly unlikely (damned near impossible, actually) that a single molecule of the original starting material of the homeopathic remedy remains for dilutions of 12C or greater. When a typical homeopathic dilution is 30C (thirty 100-fold dilutions, or a 1060 dilution), that’s almost 1037-fold greater than Avogadro’s number. The magnitude of this dilution is simply incredible, and the odds against a single molecule remaining are just as incredible.

Particularly amusingly, Johnson likens these 1023 events to the persecution of Galileo in what is arguably one of the most hilariously over-the-top invocations of the “Galileo gambit” I’ve ever seen before. Behold:

These hooligans purport to stand up for scientific principles, while in fact their zealous dogmatism and denial of evidence would make Galileo’s persecutors proud. Score one for book burning and witch trials.

Because a little skeptical activism poking fun at the ridiculousness of the beliefs underlying the pseudoscience of homeopathy in such a way as to point out to nonscientists why it is pseudoscientific nonsense is exactly like putting Galileo under house arrest and burning books and witches. I am thankful for small favors in that Johnson restrained himself from comparing skeptics to Hitler or Nazis. Just barely. (Come on, Mr. Johnson, let it out. Play the Hitler/Nazi card! You know you really, really want to, and you’ll feel much better after you do.)

Science versus naturopathy

So far, all I’ve looked at is Bastyr University and the official blog of the AANP. In fact, though, every school of naturopathy whose curriculum I’ve ever examined includes homeopathy as a requirement, even as the AANP requires and defends homeopathy. It’s no wonder, too. There is actually a North American Board of Naturopathic Examiners, just like medicine’s National Board of Medical Examiners. The NABNE even has a certifying examination, just like real doctors! It’s all science-y and medicine-y, too, with all the trappings of science-based medicine but none of the rigor. This examination, the NPLEX (Naturopathic Physicians Licensing Examinations), which is required for naturopaths to be licensed in the sixteen states and five Canadian provinces that license naturopathic physicians tests naturopaths on homeopathy (emphasis mine):

The current examination, based on these original blueprints, forms the Core Clinical Science Examination now required by every state and province that regulates the practice of naturopathic medicine. The Core Clinical Science Examination is a case-based examination that covers the following topics: diagnosis physical, clinical, lab), diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy, counseling, behavioral medicine, health psychology, emergency medicine, medical procedures, public health, pharmacology, and research. Two additional treatment examinations (Minor Surgery and Acupuncture) may also be required for eligibility to become licensed to practice as a naturopathic physician in some jurisdictions.

[...]

The NPLEX Part II – Core Clinical Science Examination is designed to test your knowledge of: diagnosis (physical, clinical, and lab), diagnostic imaging, botanical medicine, nutrition, physical medicine, homeopathy, counseling, behavioral medicine, health psychology, medical procedures, emergency medicine, public health, pharmacology, and research. The examination is comprised of a series of clinical summaries followed by several questions pertaining to each patient’s case. For example, you might be asked to provide a differential diagnosis, to select appropriate lab tests, to prescribe therapies which safely address the patient’s condition, and to respond to acute care emergencies.

I would love to see what questions the NPLEX includes regarding homeopathy. My guess is that the multiple choice questions would be a hoot; that is, if I didn’t know they were completely serious. Unfortunately, as Kimball Atwood points out, no one other than naturopaths really knows what’s on the examination. Indeed, Dr. Atwood observed that naturopaths seem to take great pains not to let scientifically-minded physicians see a copy of an actual NPLEX examination. Be that as it may, homeopathy is but one example of how strongly naturopathy embraces pseudoscience. Be it myofascial analysis, vega testing, traditional Chinese medicine, Ayurveda, germ theory denialism, or even distant healing, there is no nonsense that naturopathy excludes as being too unscientific for it. Yet none of this stops Hangee-Bauer from bragging about how next year at the AANP Convention, it’ll be all about the science:

On August 16, 2011, the Tuesday before the start of the 2011 AANP Convention, the AANP will be sponsoring a scientific summit. While only in the early stages of planning, it promises to be a gathering for the different players in the naturopathic profession to connect and define how the AANP mission, naturopathic research, and evidence-informed health policy can join and result in healthier patients, a more effective health-care system, and a flourishing naturopathic profession. Core discussion points will include articulating policy and practice issues driving our research agenda, where the profession is now and what future possibilities exist, and defining the core research questions relating to safety, effectiveness, and costs.

You might recall that I wrote about last year’s AANP Convention, as did Dr. Atwood, both in the context of lamenting the appearance of Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine (NCCAM) as a speaker. You might also recall that last year’s AANP Convention was chock full of pseudoscience, including (of course) homeopathy, “medical intuitive” scans, emunctorology, “detoxification,” functional medicine, water-only fasting, and many others. If you click around the Naturopathic Physicians Research Institute (NPRI) website a bit (which Hangee-Bauer referenced in his post), you’ll find “research” about chelation therapy for autism and cardiovascular diseases (which is an utterly useless and potentially dangerous intervention) and homeopathy in pediatric care. I do have to thank Hangee-Bauer, however. I’ll keep my eye out for when the AANP announces its speaker list and agenda for its scientific conference on August 16 and the AANP Convention to follow immediately. I’m sure it’ll provide at least one good blog post in a few months.

In the meantime, if I may be so bold, I will make one small suggestion. If Hangee-Bauer is truly serious about making naturopathy science-based, there’s one thing he could do right away to prove it. It would be a simple, powerful, and unequivocal indication of the strength and sincerity of his intent. It’s all Hangee-Bauer has to do as a first step, albeit tiny, to demonstrate that he is not simply mouthing the words in praise of science and proclaiming how much he loves science and wants naturopathy to be based on science. All he has to do is to state that homeopathy is quackery, that it should no longer be considered part of naturopathy, and that he is going to put the weight of the AANP behind removing homeopathy as a required component of training in naturopathy and the examinations used to certify naturopaths. Extra points would be given for correctly stating why homeopathy is nothing but water and how there is no evidence supporting the law of similars as a general principle. If Hangee-Bauer does that, I might start to take his pontificating about the wonders of science and the scientific rigor of naturopathy somewhat seriously. If he can’t do it, then I know it’s a load of hot air.

After Hangee-Bauer deals adopts a science-based approach to homeopathy, then we can talk about purging distance healing, anthroposophy, applied kinesiology, and many of the other bits of pure pseudoscience embraced by naturopaths. However, like infants naturopaths have to creep before they can crawl and crawl before they can walk and walk before they can run. Eliminating homeopathy would be that first attempt at creeping. Does anyone want to lay any odds on whether or not the AANP will take that first creep forward?

Posted in: Homeopathy, Naturopathy

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100 thoughts on “Naturopathy and science

  1. fpinsard says:

    My first post here.
    My biggest problem with homeopathy is not even the science (or lack of) behind it, but that it is not even coherent in it’s own framework. There is a lot to say, but my biggest question is : even if I accept all the basic “science” of homeopathy and that this water will cure me, then why is it that most of the time, I am given a SUGAR pill ? Is there some sort of memory transfer from water to sugar ? And that’s just one point. No need to resort to science to point out the stupidity of most cranks.
    PS : excuse my english, it may not be so correct, but I’m trying my best.

  2. ConspicuousCarl says:

    Hangee-Bauer:
    “I tell you this to let you know that I am no stranger to science. I still find it fascinating and appreciate the many ways it helps us understand the workings of nature and the world, helping us separate what appears to be the truth of things from reality.
    [....]”
    Thus it has become an increasing concern to me when I read articles and blogs on the Internet blasting naturopathic medicine for being “unscientific.”

    Sounds like “I can’t be racist, because I took a class on the contributions of [insert race] in college.”

    or

    “Some of my best friends are science!”

  3. Jann Bellamy says:

    “He then discusses how he ‘took every course in biology, chemistry, physics, etc.’ that he could in school and in college majored in biology, with dual minors in physics and chemistry.”

    “Took every course in biology, chemistry, physics, etc.”??? Is this in high school? That’s what he appears to be saying. Certainly he doesn’t mean he took every course he could in these subjects in college. That would be quite a number of hours and I can’t imagine if you took every course you could in physics and chemistry in college that you could possibly believe in homeopathy.

    “Majored in?????” “With dual minors in?????” It is incorrect to say one “majored in” or had “dual minors in” any subject if one did not actually graduate. One can be “majoring in” a subject while a student but when enrollment ends, for whatever reason, you can’t have majored or minored (past tense) in anything unless you graduated. I mention this as it is unclear to me whether Hangee-Bauer actually graduated from FSU (where he says he went to college) — perhaps he can clarify the record on this.

  4. http://www.bastyr.edu/development/newsletter/summer05.asp?jump=9

    “As far back as I can remember, I was drawn to science and exploring the natural world,” says Hangee-Bauer. “I was always turning over rocks!” Because he also was strongly drawn to water, he ended up studying marine biology in college and graduating in ’75 with a BS in biology from Florida State University.

    So he is clear that he did graduate. Whether FSU is just as clear I can’t tell, but he does make a direct statement.

  5. pdxjoe1966 says:

    I’m sure homeopathy will continue to catch on and grow in the US as more and more people follow Queen Oprah and anyone she blesses as her chosen ones.

    I seem to remember reading an article once that stated that when people are faced with actual facts that contradict their own beliefs, it only reinforces their belief.

    Given that, it seems like reason and science are in a VERY uphill battle!

    My view about homeopathy and naturopathy is similar to David’s: you can believe anything you want to believe, as long as you admit that you’re wrong.

  6. The most compelling and damning observation here is the failure of NDs to criticize even the most obvious quackery.

    For instance, I know a naturopath who doesn’t particularly like vega testing, but he still refuses to say anything actually negative about it. He wants to “keep an open mind” … about one of the most obviously scammy “diagnostic” devices I can imagine.

  7. windriven says:

    “When we work with our patients, we draw from both in order to stimulate the vis and provide well-rounded care to our patients.”

    May the vis be with you. Use the vis, Luke! What is this, Spaceballs on echinacea? Mel Brooks should sue him.

    “I can’t help but think of Ozzy Osbourne being the way he is as a result of 40 years of heavy metal poisoning. Oh, wait. It was the alcohol and illicit drugs. And perhaps the heavy metal poisoning.”

    Don’t forget the occasional bat! Probably escapees from Hangee-Bauer’s belfry.

    “For example, if you look at its curriculum to become a doctor of naturopathic medicine, you’ll rapidly see that Bastyr requires a full year of homeopathy courses spread out over three classes for a total of 8 credit hours.”

    I did. Oddly missing from the homeopathy curriculum was a Homeopathy Lab. I wonder why they wouldn’t want their students to witness the power and majesty of homeopathy firsthand?

    Science isn’t just a collection of facts and formulae and processes, it is a structured system for investigating and understanding ourselves and the universe we inhabit. Anyone can call themselves an American Indian and anyone can call themselves a scientist. Embracing the label isn’t the same as living the philosophy.

  8. Jan Willem Nienhuys says:

    @fpinsard on 21 Feb 2011 at 5:57 am

    There are many illogical points in homeopathy, but the sugar is really one of the minor points. For many substances that don’t readily dissolve into water (sulfur, sand, chalk, charcoal, iron, to name a few), the initial preparation is not with water but by rubbing it with milksugar, until one has one part stuff in many parts of sugar.

    Look at section 270 especially footnote 1 of Hahnemann’s Organon.
    http://www.homeopathyhome.com/reference/organon/organon.html

    Most other stuff, especially plants are not diluted in water, but in alcohol, and the dilutions are made with alcohol, not water. The idea that homeopathy has something to do with the memory of water is a modern idea.

    Originally (as you can gather from the Organon) the only thing that mattered was the rubbing and succussion, and the reason was the analogy with how iron was magnetized then (by rubbing with another magnet); magnetism was considered as a kind of spiritual force, it was the time that Mesmer was famous. There was no physical theory at all about why the spiritual healing force was strengthened by diluting and rubbing. This was considered an established fact. Nobody knows how Hahnemann got the idea, but already in 1799 he thought that for so-called provings (tests of a remedy oin a healthy person) only 1/100.000 of a normal amount sufficed.

    Hahnemann must have found out quickly that one also gets lots of ‘symptoms’ in such provings if one gives diluted stuff. So if you give 100 to the power 30 times diluted table salt to a healthy person and he develops, say, an irresistable urge to giggle around teatime, well, then this means that any sick person with an irresistable urge to giggle around teatime should be given Natrum Muriaticum C30.

    Homeopaths will in their propaganda say things like ‘coffee makes you sleepless, so diluted coffee is a medicine against sleeplessness’, but that is just propaganda for the masses. In reality, they recommend Sulfur C200 against itch, because the same thing has caused itch in test subjects. The test subjects were usually students of homeopathy (just like test subjects in psychology are students in psychology, I guess…) who knew of course what to expect.

    If there was a very clever experimenter who had heard of placebos, he would give the test subjects first a bottle with the words ‘this is a placebo to test your suggestibility’. The results were predictable: lots of ‘symptoms’ with the ‘real’ stuff and none with the placebo.

  9. Jan Willem Nienhuys says:

    @ Paul Ingraham on 21 Feb 2011 at 11:57 am

    Vega scammy? Did you study the biotensor? I have heard of a quack physician “diagnosing” cancer with it (“It’s OK, it ‘s not cancer, just an infection”). That quack had a Vega machine as well, and he had already been disciplined for using it. When the patient died of untreated breast cancer the guy was struck off (after five years), and just went on with his business, except he removed the MD-sign from his door.

  10. WilliamLawrenceUtridge says:

    @Jan Willem Nienhuys

    Though mixing solids with milk sugar, talc or other substances is indeed part of the homeopathic preparation process for substances that can’t be dissolved in water, fpinsard is correct that in many cases the substances dissolved are indeed splashed on a sugar pill which is then dissolved under the tongue. Homeopathy uses both liquids and solids to “dilute” the original ingredient. As far as I know, Hahnemann got his ideas from the observation that quinine treated malaria, which caused sweating, but also caused sweating in and of itself.

    I read Homeopathy: How it Really Works by Jay Shelton (Prometheus Books, 2004, ISBN 159102109X) which does a great job of laying out an overview of homeopathy, then procedes to go to town with (scientific) hammer and (logical) tongs. Excellent book, quotes Dana Ullman which is always fun. I’ve recommended it to Mr. Ullman but he never seemed to get around to reading it.

  11. Khym Chanur says:

    My biggest problem with homeopathy is not even the science (or lack of) behind it, but that it is not even coherent in it’s own framework.

    Part of this is probably due to there being multiple schools of thought within the realm of homeopathy, but all the different schools are lumped under the name “homeopathy” with no distinction. Some homeopaths say that homeopathy can be used as a preventative, while others say it can only be used as a curative. Some homeopaths say that homeopathy is only effective if it’s individualized, while others say that the mass produced OTC remedies work as well. And there’s probably more differences that I’m unaware of.

  12. desta says:

    “biotherapeutic drainage”
    The descriptin on the site is so vague I don’t know what to be afraid of, but I do know danger lurks there, because of the word ‘drainage.’ Draining what? To where? Why are they going after the precious bodily fluids???? Positively menacing.

  13. Jan Willem Nienhuys says:

    In 1943 D.K. de Jongh’s Ph.D. dissertation on the subject of homeopathy concluded (among others) after over 400 pages:
    1. Homeopathic theory is a heterogenous complex of untenable, false and improbable statements.
    2. There is a wide gap between theory and practice of homeopaths.
    3. Homeopathic practice is a conglomerate of widely varying treatments that cannot be brought under one communal realistic point of view; the practical effectivity must be considered as very improbable.
    4. Homeopathy as a whole is a failed effort to conduct all therapy according to the fixed scheme of the old similia principle, which has no place in modern medicine.

    Nowadays (2011) and especially in Europe, we have several large homeopathic pharmaceutical companies that get rich from OTC sales. They get their status from physicians that often practice a kind of hybrid homeopathy: diagnosis partly based on medical principles, and a small assortment of standard remedies. The lay homeopaths often practice classical homeopathy without much real medical knowledge. The lay public believes, partly because of the lavish advertising by Big Homeo, that homeopathy = natural herbs.

    The situation somewhat resembles the situation in astrology. The lay people read horoscopes (often written by professional astrologers). The astrologers, on the other hand, keep saying that newspaper horoscopes are nonsense (but they won’t support pleas to put ‘for amusement only’ under horoscope columns) and that the ‘real’ astrology is much more subtle and complicated (the so-called courtier’s argument). But all the same the simplistic mass produced stuff keeps the interest in the hifalutin’ stuff going, and the ‘scholarly’ astrology gives credence to the simple stuff.

  14. “biotherapeutic drainage”?

    This is what you do after drinking a lot of herbal tea*. I hate it when I go to the mall and can’t find a biotherapeutic drainage center.

    *or beer.

  15. Windriven “I did. Oddly missing from the homeopathy curriculum was a Homeopathy Lab. I wonder why they wouldn’t want their students to witness the power and majesty of homeopathy firsthand?”

    Actually, this just made me wonder. What is the water consumption in the homeopathy industry. Seems with all that diluting, is would be substantial.

  16. pmoran says:

    A minor error — Hangee-Bauer says, “An initial thermogram with a 3-6 month follow-up establishes a baseline. Thereafter , annual thermograms are generally recommended. ”

    He does not advocate 3-6 monthly thermography.

  17. windriven says:

    @micheleinmichigan

    “Actually, this just made me wonder. What is the water consumption in the homeopathy industry. Seems with all that diluting, is would be substantial.”

    And I wonder about the provenance of that water. Are we talking distilled water, purified water, San Pellegrino, NYC city water? If dilution potentiates as the homeopathologicals believe, then what of the chlorine, flourides, et cetera if they aren’t using distilled water? Spooky scary. I think the FDA needs to have a close look at this!

  18. morris39 says:

    Hi David
    I am new to this blog; was very impressed by the post on application of Bayesian vs frequentist probabilities to med research. I am somewhat puzzled by the strong tone of your essay. Of course Naturopathy is not science based and probably does some harm but why use sarcasm and ad hominem arguments? Perhaps a more interesting question is why alternative medicine is growing in popularity and what if anything could be done about it. The reason may be the perceived (or real) impotence of conventional medicine to successfully treat chronic disease or help the “clinically” healthy. A personal experience may illustrate the point. I changed my nutrition to a diet strongly recommended against by conventional medicine. I was healthy and not overweight before and am now clearly healthier, 8 months into the diet experiment. I am at sea about the biological explanations for success and concerned about unintended consequences. As my last haematology profile (annual check up) was done 4 months into the experiment I wanted another one to confirm no major harm was being done and so I went to a Naturopath. All I needed from the Naturopath was the lab request. My GP would not ( I assume) agree that such tests are necessary (socialized medicine in Canada) and independent laboratory tests are illegal here.

  19. qetzal says:

    @micheleinmichigan

    I don’t think total water consumption would need to be very high. They probably just do all the early dilutions in very small volumes (10-100 mL?), then scale up at the very end for however many vials of water – er, I mean product they’re making in a batch.

    @windriven

    IIRC, homeopathic manufacturing in the US is supposed to be governed by current Good Manufacturing Practices, so I’d hope they’re using pharmaceutical-grade water.

    I have to say, though, that I’d really, really love to watch cGMP manufacture of homeopathic products. The image of a bunch of people all gowned up in gloves and Tyvek suits, using batch records and SOPs, carefully measuring out each dilution and recording the time, temperature, and mixing parameters at each step makes me giggle.

    The ultimate in cargo-cult science!

  20. Narad says:

    “I can’t help but think of Ozzy Osbourne being the way he is as a result of 40 years of heavy metal poisoning. Oh, wait. It was the alcohol and illicit drugs. And perhaps the heavy metal poisoning.”

    Don’t forget the occasional bat! Probably escapees from Hangee-Bauer’s belfry.

    Might not want to forget the Parkin Syndrome, either.

  21. Toiletman says:

    Naturopaths can prescribe real medication?!?! (It sounds so extremely unbelievable for me as a continental European) I hope atleast no controlled substances but even tramadol and diazepam would be too much…maybe. Just saying you’re a naturopath and then being able to prescribe light opioids, benzos, antidepressants and such stuff…sounds promising :D But the label naturopath wouldn’t find anymore. Maybe narcopath? Anyways, it might be great for people who somehow failed at medical university but always wanted to be doctors ;)

  22. David Gorski says:

    Of course Naturopathy is not science based and probably does some harm but why use sarcasm and ad hominem arguments?

    Ad hominem. You keep using that word. I do not think it means what you think it means. (Sorry, I couldn’t resist.) Actually, I have not used a single ad hominem argument in this post. I even went back and checked. Funny you should bring up the term, though, as there was recently a very good discussion as to what exactly constitutes an ad hominem:

    What “Dr. Jay” is calling “ad hominem insults” are honest expressions of scorn. I should also point out – as has been pointed out repeatedly – that an insult (or an honest expression of scorn) isn’t a fallacy unless it is used to support a claim. In other words, it would be an ad hominem fallacy to say “Dr. Jay is an idiot, so everything he says is wrong.”; it is not an ad hominem fallacy to say “Dr. Jay is wrong in everything he says, so he’s an idiot.”

    As far as sarcasm, well, guilty as charged, and I make no apologies. And, heck, I wasn’t even all that scornful, although I have to ask: Given that you yourself admit that naturopathy is not science based and “probably does some harm, what is your objection to sarcasm.

  23. Chris says:

    morris39:

    I changed my nutrition to a diet strongly recommended against by conventional medicine.

    So you stopped eating vegetables and fruit, and increased the number of calories in fat and added more alcohol into your diet?

    I keep hearing doctors recommend eating more fruit and veg, cutting down on calories, fat and alcohol, plus increasing activity. Kind of like the poor dietitian in this video.

  24. windriven says:

    @morris39

    “independent laboratory tests are illegal here.”

    What is the rationale for banning independent laboratory tests?

    What is your rationale for adopting a diet outside the mainstream of conventional medicine? What is it that you hope to accomplish? What precisely is this diet? Why do you think conventional medicine opposes diets like yours?

  25. OliversArmy says:

    When I read the words I honestly thought that “therapeutic drainage” was going to turn out to be some 21st century form of blood-letting. It wasn’t, but now I wonder what the sCAMmers will actually call it when blood-letting makes its inevitable comeback.

  26. norrisL says:

    Holy ………..! What does it take to get through to these cretins? Ah, sorry, I just remembered, you can’t rationally deal with people like these. (apologies for the ad hominem!)

    The stuff I have read is so absolutely way out there that you have to wonder what it takes for these naturopaths to actually believe it.

    Or, do they actualy believe it? Are they just wanna-be doctors who couldn’t make it into medical school, so they went for an easier path.

    Are they unwittingly conning people out of money for their useless consultations and “medications”, or are they fully aware that what they are doing is a con?

    Sorry for my little rant

    Stuart

  27. morris39 says:

    @ David
    It is not my intent to start an argument. What I meant is that in my view your hammer is too big for the job. Also I am mainly interested in others’ views why alternative medicine seems to be increasing in popularity. As far as ad hominem, I take that to mean an attack on the person rather than on his ideas. “First, he begins by enumerating his bona fides as a science-loving geek, in order to prove to readers just how much of a scientist he thinks he is. These bona fides include a love of marine biology and how he originally wanted to become a marine biologist. (Hey, I loved The Undersea World of Jacques Cousteau when I was a kid, too, you know.)” in my view this is not dealing with his ideas but makes him look lame. Of course I could be mistaken about your intent, if so, I happily retract.

    @windriven
    I in fact began by increasing fruit, vegetables & legumes and reducing red meat all on advice of my GP in view of slowly rising BP. The negative results quickly became apparent, my gum disease quickly and significantly deteriorated and so I reversed the trend and gradually (over 5 months) drifted into the contrary diet. The diet essentially replaces calories lost from avoided grains and legumes with fat, keeping protein more or less constant. Over time I have increased my energy intake by about 25-30% and have not gained fat. I would certainly not have gone into this experiment without having first experienced the negative results.
    As far independent labs in Canada, I believe it is part of a government policy which makes private health service unavailable. I really don’t know.

    @chris
    I don’t bite on sarcasm

  28. Dr Benway says:

    The naturopaths call us, the methodological naturalists, their enemies. They tell the public to fear us because we are cold, calculalting, and only interested in money and poisoning people.

    Time to tell the naturopaths to GTFO our Internet. Let them build their own Internet in their own intuitive way, using the vis and a variety of holistic and chi based methods.

    Until then, GTFO our Internet, Bastyr.

  29. Chris says:

    morris39, you may not bite on sarcasm, but you are doing exactly what I sarcastically accused you of doing! Which makes it even funnier.

    Hope your kidneys keep working!

  30. Dr Benway says:

    Also I am mainly interested in others’ views why alternative medicine seems to be increasing in popularity.

    The popularity results from our excessive politeness and civility toward it, causing the public to imagine there might actually be something to it.

    Ergo, we must crank up the scorn to an appropriate level so that the public are clear what’s what: On the one hand, science leading to Internet, iPhone, and other breakthroughs. One the other: moonbats with no f_ckin’ clue trying to ruin everything good.

  31. David Gorski says:

    @morris39

    Your definition of “ad hominem” is rather–shall we say?–promiscuous. I was merely using a bit of sarcasm to point out that I am not impressed by Hangee-Bauer’s protestations of eternal devotion to science, particularly when the sorts of treatments that he offers are so outrageously non-science-based. Consider it nothing more than setting up the contrast between what Hangee-Bauer says about and what he does as a naturopath–a perfectly legitimate contrast to draw.

  32. Dr Benway says:

    I take that to mean an attack on the person rather than on his ideas.

    At times we are faced with people who unselfconsciously presents a very superficial understanding of the facts. An attempt to reason with such people can, sadly, reinforce their belief that they are somehow intellectually the equal of the more rational and evidence-based party.

    In such cases it’s probably better to stop the clueless git in his tracks before he gets further reinforcement for his delusions of competence.

    What I meant is that in my view your hammer is too big for the job.

    Sadly, no. That’s why we are still here.

  33. morris39 says:

    It appears I stumbled onto the wrong blog. I exit with apologies. Good luck with sarcasm and ad hominem arguments.

  34. Dr Benway says:

    And nothing of value was lost.

  35. daijiyobu says:

    You said it, brother Orac.

    Re: “all he has to do is to state that homeopathy is quackery”…

    If you look at the sponsors for naturopathy’s next textbook

    (right sidebar, http://www.foundationsproject.com/ )

    and how much they’ve supposedly given,

    I doubt North American naturopathy will be sending back the checks.

    Now, those homeopathic drainage pills aka UNDA, are put out by listed naturopathy sponsor Seroyal, who has donated…

    wait for it…

    wait…

    half a million dollars towards the publishing of this Elsevier naturopathy textbook.

    One may argue that naturopathy is beholden to homeopathy lock, stock and barrel.

    When reading the Unda page, it says their raw materials are “biodynamically grown and wildcrafted”, which I think is Rudolf Steiner vitalistic farming

    (see http://en.wikipedia.org/wiki/Biodynamic_agriculture ).

    But, I thought at first it said “witchcrafted”!

    Ooo, eee, ooo, aaah, aaah,
    ting, tang
    walla wall bing bang.

    -r.c.

  36. pmoran says:

    Also I am mainly interested in others’ views why alternative medicine seems to be increasing in popularity.

    answered by –

    The popularity results from our excessive politeness and civility toward it, causing the public to imagine there might actually be something to it.

    I disagree. The upsurge in CAM was upon us almost before any of us was aware of it.

    Homeopathy has been subject to violent opposition and ridicule for two centuries. How well has that worked?

    And was Morris39 the target of your “somehow intellectually the equal” insult? So what? — – no ad hominem to see here, folks!

  37. Robert S. says:

    I read that the homeopathic ‘remedies’ were considered ‘low potency’ not low dosage. Remember that the Zicam swabs were homeopathic but still had enough zinc to cause anosmia. I, for one, would not want to take a 2x Botulinum even if it were marketed as homeopathic.

  38. Robert S. says:

    Damn it, sometimes I hate being right. One example, the product details of ‘Unda 25′ follow which include 10^-4 or 1:10,000 dilutions:

    Unda 25 provides exceptional drainage for the cardiovascular system. It relieves functional pathologies (cardiac decompensation, aortitis, infarcts, myocarditis, and angina pectoris) of the heart and the region surrounding the heart.

    Formula
    # Crataegus oxyacantha (Hawthorn)…….4 X
    # Gelsemium sempervirens (Yellow Jasmine)…….4 X
    # Hamamelis virginiana (Witch Hazel)…….4 X
    # Spiraea ulmaria (Meadowsweet)…….4 X
    # Valeriana officinalis (Valerian)…….4 X
    # Magnolia glauca (Sweet Magnolia)…….4 X
    # Argentum metallicum (Silver)…….12 X
    # Stannum metallicum (Tin)…….12 X

    Recommended intake

    # Adults: 5 drops three times daily.
    # Acute conditions: 5 drops six times daily.
    # Children under 12: 3 to 5 drops three times daily.

    Non-Active Ingredients

    25% Alcohol.

    from https://www.andersonnaturalhealth.com/Store/Product_Detail.asp?PID=UNDA25

  39. David Gorski says:

    @daijiyobu

    I love biodynamic farming as an example of pure vitalistic nonsense. I had thought of writing about it for this blog, but it really isn’t medicine per se. Perhaps the most amusing example of biodynamic farming comes from the wine industry, where “biodynamic” is a popular advertising term used by wineries. Google “biodynamic” and “wine” sometime. Or read this:

    http://scienceblogs.com/insolence/2007/02/your_friday_dose_of_woo_old_macdonald_ha.php

    :-)

  40. Jan Willem Nienhuys says:

    @ qetzal and other

    Dilutions in the homeopathic industry are usually done with alcohol. For the socalled Korsakov dilution distilled water is used. To make a portion of Belladonna 30C one has to repeat the act of putting 1 part of stuff into 99 parts of ‘pure alcohol’ (70% ethanol, usually) into a new unused bottle. So in order to prepare one portion of a 30C remedy almost 30 small bottles plus their alcohol contents have to be discarded. The discarded alcohol is sold to the paint industry. So in the paint on your window sill there are maybe some homeopathic remedies – diluted of course.

    Worries about water that has been elsewhere are not to the point for homeopaths. The preparation only works if the bottles have been shaken between every dilution.

    James Randi mentions this in his speeches and emphasizes that the rule is that you must shake them 10 times up and down, 10 times back and forth, and 10 times from left to right (in which coordinate system?, I wonder). I don’t know whether that is true. But Hahnemann himself mentions that you should succuss the bottle by hitting it 100 times on a hard but elastic object, such as a book bound in leather. Read it! (Section 270 of Organon).

    No succussion? No miraculous multiplication of spiritual powers!

    I guess homeopaths even have done tests with plain diluted stuff versus succussed-diluted stuff, but these tests will have been unblinded. Or the guy who had to evalute the symptom reports of the provers knew which diary was from ‘succussed’. The whole of homeopathy is a testimony to the power of unblinded and uncontrolled testing.

    This judgement applies to many homeopathic RCTs too, I am afraid. You can’t trust the results of such an RCT if there is even the remotest possibility that any kind of arranging data was done after the code was broken.

  41. David Gorski’s fallacy example “Dr. Jay is an idiot, so everything he says is wrong.”; it is not an ad hominem fallacy to say “Dr. Jay is wrong in everything he says, so he’s an idiot.”

    Hmm, I think this may have been one of the questions on the SAT, back in the 80′s.

  42. daijiyobu says:

    @Robert S., from what I understand, the metals in the remedies go back to Paracelsus, inevitably.

    @David Gorski, I don’t know much about biodynamic stuff, but enough to know that Hahnemann called the life force / lebenskraft of homeopathy, that dualistic geist of his physiology so to speak, dynamis. So it’s, perhaps, life force farming, the astrology of agriculture.

    Overall, perhaps the Unda remedies can be so ‘crude’, to borrow language from homeopath Kent, in their eyes, because it has, in their eyes, so much mojo based on how it was biodynamically dynamized, literally.

    Of course, 25% ethyl could be quite a befuddling solvent in itself.

    When I was in ND school, Unda’s were just catching on with them, and fit well into their toxicity obsessions but always came across to me as a form of numerology too.

    -r.c.

  43. Just as a general response to the belief that communicating civilly reinforces mistaken ideas while using scorn or sarcasm overcomes them.

    Does anyone have any evidence to support this believe? And no, not the “we were civil and that didn’t work” kind of evidence.

    In my general observations of human behavior, It has always appeared to me that those people who where willing to engage in a disagreement in a friendly, non-insulting manner had better success bringing the other person around to their side, or if not the other person, then the audience.

    Often sarcasm feels good and powerful and can “rally the troops” but I’ve never seen it being very convincing to the folks in the middle ground, where people often sympathize with the recipient of the sarcasm or scorn.

    This is not to say that I don’t engage is sarcasm or scorn. It’s just that in retrospect, I usually find it hasn’t been productive.

    This is not to suggest David Gorski change his style (god forbid, I suggest that). I am only suggesting that I don’t believe that sarcasm or scorn or superior modes of argumentative communication. To be convinced otherwise, I’d like to see some evidence.

  44. David Gorski says:

    Did anyone here actually argue that sarcasm or scorn is “superior”? Certainly I didn’t. They are, however, legitimate tools in the armamentarium of argumentation, so to speak, and I do not eschew them when they seem appropriate to me to use. Also, some ideas (such as homeopathy) are so inherently ridiculous that sarcasm in response to them is entirely appropriate.

  45. Actually, I thought it was a few posters, but now that I look back, it seemed like it was mostly, Dr Benway, who seemed to be arguing that the sarcasm or scorn was a perfered way to deal. “At times we are faced with people who unselfconsciously presents a very superficial understanding of the facts. An attempt to reason with such people can, sadly, reinforce their belief that they are somehow intellectually the equal of the more rational and evidence-based party.

    In such cases it’s probably better to stop the clueless git in his tracks before he gets further reinforcement for his delusions of
    competence.”

    Sorry for generalizing. I’m off traveling, so sadly won’t be reading any replies for a few days.

  46. windriven says:

    @pmoran

    “Homeopathy has been subject to violent opposition and ridicule for two centuries. How well has that worked?”

    Homeopathy has also been the subject of careful scientific study and refutation for some time. Has that worked a lot better?

    An old aphorism holds that sometimes it takes a hammer and sometimes it takes a rose. In the battle to stem the tide of woo, all legal and ethical tools are legitimate.

    @micheleinmichigan

    I don’t believe Dr. Benway was arguing sarcasm to be superior, only that in some cases it is the correct tool for the job.

  47. David Gorski says:

    Homeopathy has also been the subject of careful scientific study and refutation for some time. Has that worked a lot better?

    Indeed. Whenever Peter makes his criticisms about tone, I always have to ask: What, specifically, would he do differently, and what is the evidence that that would work so much better than what we do?

    On just this blog we have a range that goes from pretty sarcastic and cutting to very reasoned, rational, and patient. In fact, many of us can span that range in just our own list of posts. (Compare my posts from January 31 and February 14 to this post, if you don’t believe me.) As the cliche goes, there’s more than one way to skin the proverbial cat, and we try to use as many strategies as we deem appropriate.

  48. rork says:

    Thanyou michele.
    Perhaps readership and participation can influence tone for this medium. Na.

  49. Jan Willem Nienhuys says:

    Homeopathy has also been the subject of careful scientific study and refutation for some time. Has that worked a lot better?

    The whole endeavor of putting more science into medicine has worked. In the old times it often happened that physicians were disappointed with how little they actually could do. Then, if someone comes along saying how wonderful this homeopathy (or whatever) works, the more adventurous and rebellious doctors are willing to try anything. In some cases the homeopaths believe in their system because they were raised in families where everybody believed in homeopathy.

    I don’t know about other countries, but in the Netherlands homeopathy is slowly on the wane. At least, the organisation of homeopathic physicians is steadily losing members: old members retire or die in larger numbers than young doctors sign up. It’s a slow process, roughly parallelling the steady erosion of church membership. Homeopathy is a kind of religion. Adherents rarely give up, but recruitment drops.

    The difference with religion is that there is no large powerful industry behind religion.

    In different countries the situation is diferent. In some countries GPs and patients have the idea that each visit to the doctor should end with a prescription. Then naturally many doctors are tempted to prescibe a placebo.

  50. windriven says:

    @JWN

    I was not arguing that “putting more science into medicine” hasn’t worked. My argument was that sarcasm is a legitimate polemical tool in the battle against woo. Unfortunately, careful research and logical refutation of homeopathy, while necessary, is not sufficient. There is a segment of the population which is frightfully resistant to logic and reason.

    In the US there has been a 40 plus year battle against smoking tobacco products. For some smokers the scientific argument linking tobacco with lung cancer and heart disease was enough. But for others it was the mounting societal derision of the habit – “kissing a smoker is like licking an ashtray.” Still, as of 2008, about 20% of Americans still smoke tobacco products (American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4559).

    You have to use all of the tools available.

  51. Dr Benway says:

    You’re in the OR of a teaching hospital with windows above and a crowd watching. You’re closing an incision while another chap in a white coat enters. He asks you to stop so he can put some feces in the wound.

    Two options:
    1. You engage in a polite conversation regarding the risks and benefits of feces in wounds.

    2. You say, “GTFO mah OR!”

    In real life when people talk nonsense that might be dangerous others express shock and revulsion. I am arguing that the LACK of this expected social reaction misleads the public with respect to alt med.

  52. Dr Benway says:

    Regarding pmoran’s point about heaping scorn upon homeopathy for 200 years –you can’t ever stop. The work is never done.

  53. Zetetic says:

    Interesting – I share some of the same of Hangee-Bauer’s background as a former military Medical Service Corps officer with a degree in biology. I know it might be considered an ad hominem attack but I wouldn’t be surprised if he applied to medical school and didn’t get accepted. At least in my case, when not accepted to medical school, I chose further graduate education in health sciences instead of naturopathy!

  54. Jan Willem Nienhuys says:

    # windriven on 22 Feb 2011 at 11:26 am

    Don’t be so pessimistic about US tobacco. Over here the same battle is fought, but still 30% smokers. Of course, making tobacco expensive also works, at least when the voters accept that.

    “One horse-laugh is worth ten thousand syllogisms. It is not only more effective; it is also vastly more intelligent.” H.L. Mencken, in The American Mercury, p.75, January 1924. Also in ‘The Iconoclast’, Prejudices: Fourth Series, p. 140 (Knopf, 1924).

    http://grammar.about.com/od/writersonwriting/a/menckwrite07.htm

    Mencken argues that you should try to make your opponent look ridiculous. This is especially applicable to homeopathy and other altomed. The one thing those altos crave is respectability. That’s why they like to imitate science. Heavy sarcasm might be counterproductive.

  55. It’s clear that how we discuss quackery ought to depend on the circumstance and the audience. Nevertheless, there probably isn’t evidence that being polite is any more or less likely to be effective than being sarcastic or angry (or whatever) in convincing people in general that quackery is quackery.

    Intellectual honesty regarding quackery is a different matter. As Dr. Benway has so eloquently explained, it has been mostly lacking within the medical academy in the past couple of decades, to the detriment of medical students and of society at large. If Oliver Wendell Holmes, Sr., were still active at the Harvard Medical School, there can be little question that there would be no “Osher Center,” and that apologies for homeopathy would be met with eloquent ridicule.

    Harsh criticism of nonsense and of nonsense-purveyors has only recently become impolite–over approximately the same period that quackery has been euphemized to “CAM,” and that medical schools and government have embraced it. But correlation does not equal causation.

    For readers who haven’t been with us since the beginning, see:

    How not to win friends and influence people
    http://www.sciencebasedmedicine.org/?p=306

    How SHOULD We Discuss Quackery with Innocents and the Not-so-Innocent?
    http://www.sciencebasedmedicine.org/?p=310

    Misleading Language: the Common Currency of “CAM” Characterizations. Part I
    http://www.sciencebasedmedicine.org/?p=62

    Quackery tolerance – a learned response
    http://www.sciencebasedmedicine.org/?p=318

    A View to the Past
    http://www.sciencebasedmedicine.org/?p=414

    Why would medical schools associate with quackery? Or, How we did it.
    http://www.sciencebasedmedicine.org/?p=150

    A “Shruggie” Awakening – One Doctor’s Journey Toward Scientific Enlightenment
    http://www.sciencebasedmedicine.org/?p=238

    Between a Rock and a Hard Place: A Case Study Exploring the Battle Lines of Science Based Medicine
    http://www.sciencebasedmedicine.org/?p=307

    And more.

  56. pmoran says:

    Regarding pmoran’s point about heaping scorn upon homeopathy for 200 years –you can’t ever stop. The work is never done.

    Just so. Moreover, if we did succeed in eradicating homeopathy from the face of the earth, what then? Does anyone here seriously think that after working our way down the list of quack medicines until we had eliminated every last one of them, another crop would not have already sprung up?

    So what are we REALLY up against?

    What objectives are practical?

    How can we best achieve them?

    What approaches may lead to unnecessary alienation?

    The mind sets and the methods of science reduce the likelihood of error on many matters, but they don’t ensure “rightness” in extremely complex matters such as “why is the public prone to use quack medicines?”, where there is not a lot of direct evidence to guide us (other than the instantly and totally disregarded opinion of the actual users).

    Our own biases and preconceptions need to be examined, just as rigorously as we might test a scientific hypothesis to destruction.

  57. Dr Benway says:

    I’m not interested in stamping out quackery generally. I just want it out of my medical school.

  58. Dr Benway says:

    Against my better judgment, Imma share this WTF moment because I am human.

    Two CCHR related entities now have business dealings with a program I consult with.

    The empty verbiage on the websites and in the written materials is so transparent to me but not to the masters-level people at the top of the organization, who have been charmed.

    I just want to give up the fight and go sailing.

  59. aaronupnorth says:

    I’m really interested in the content of the certification examination! As an emergency doctor I am surprised to find out that naturopaths are experts in emergency medicine.
    I wonder if any naturopaths haunting the blog would outline the naturopathic approach to a basic emergency medicine case like sepsis, STEMI, Diabetic KetoAcidosis, or multi-trauma? How do naturopaths manage the airway?
    If naturopaths are really treating rapidly progressive diseases with dichotamous outcomes (rather than fluffy diseases with general regression to the mean) lets see some of the data, heck lets even see a case or a ‘proving’.
    Dr. J

  60. @aaronupnorth:

    For an example of the naturopathic approach to a life-threatening asthma attack, scroll down to “Case II” here:
    http://www.sciencebasedmedicine.org/?p=143

  61. aaronupnorth says:

    @Kimball Atwood:
    Thanks for the link, that certainly answers my question. In that case it looks like the ND could not even identify the child as acutely ill never mind offer any sort of actual emergency treatment.
    The credentialling and expanding role of these pseudo-doctors makes it seem like we are moving back to the era before the Flexner Report…
    Dr. J

  62. Dr Benway says:

    Dr. Atwood, I need a hug.

    Whose idea was it to let Peter Breggin on the Joint Commission? Now the JCAHO is making us do herp and also derp.

  63. pmoran says:

    Windriven:“Homeopathy has been subject to violent opposition and ridicule for two centuries. How well has that worked?”

    Homeopathy has also been the subject of careful scientific study and refutation for some time. Has that worked a lot better?

    I wholly agree. What about us trying to trying to understand the reasons for that?

    The scientist in us assumes that it should be easy to reason folk out of their neutral or favorable stances towards quackery. .

    But think about it.

    Even with homeopathy that process would require the detached examination of a truly enormous amount of information and experience from several different fields of science.

    Certain mental faculties would have to be switched on and exercised, ones that most people don’t have to use much. They include the ability to retain, sift through and weigh up an enormous amount of sometimes conflicting evidence.

    How many lay people can do that? We have seen how even brilliant scientists like Linus Pauling have gone astray when faced with some of the complexities of medical research.

    The desired end-point is also an extremely sophisticated one, an Occam’s razor type of overview of medicine in its entirety, that picks up upon its peculiarity as a field of inquiry, that is, its ability to generate an infinite number of often quite strange “scientific” hypotheses to explain the one empirical observation (people subjectively feeling better.).

    Given all this, the miracle is that so many stick with proper medical science.

    That has its own explanation. Most such, including myself and I expect many on this list, have never had to undergo the tortuous process I have described, although we might imagine that we have. For quite separate reasons that I don’t entirely understand, we have grown up in such a manner as to mostly trust science and what scientists say. We have always had the much easier task of post hoc rationalising of what we already expected to be true.

    So one message is that we cannot expect it to be easy for others to do what we have never had to do themselves. We should expect, and keep a lid on our frustrations.

    Another message is that our task is much one of winning public trust as arguing out the facts. We should certainly not risk jeopardising any trust we have by forgoing normal human courtesies or acting like utter pricks .

    This is why I have difficulty seeing personal insult as acceptable tool. We have seen too often how it instantly terminates dialogue. There may be a place for it — perhaps in academia where highly educated and supposedly smart people probably should know better.

    And, dare I add, the above is just one of the difficulties we face. I have tried now and then to develop discussion on other matters that encourage medical pseudoscience: the almost insuperable appeal of the personal testimonial, the genuinely unmet medical needs, historically high expectations of medicine, etc.

  64. pmoran,

    You aren’t wrong. But you aren’t complete either.

    Different people respond to different things. Some people like to be soothed by calm, rational explanations. Others are more convinced by someone who appears to care passionately about what they are saying. Still others enjoy taking sides in a fight more than they care about the number of chicken pox vaccines the AAP is recommending in 2011. And so on and more.

    Asking people to stop expressing themselves as if they care is pointless and counterproductive. Pointless because your pleas will be disregarded; counterproductive because if you are successful in changing the tone of all the posts to something more pleasing to you, then all the people who would have been engaged by a more challenging tone will be lost.

    This isn’t the only source of medical information in the universe, or even the blogosphere. Sciencebasedmedicine.org is valiantly doing its bit; it doesn’t have to do everything.

    Even within sciencebasedmedicine.org, there’s a really nice commenting community. Some commenters tend to the snarky, others are serene and wise.

    I think that sbm as a whole is healthily mixed. Since it’s only part of an overall mixed diet, it doesn’t have to be perfect.

    Or do you think there is a single approach that works for everyone, every time? That can simultaneously engage all people who don’t otherwise care, convince all irrational advocates of unsupportable modalities, and be a complete source of information for all curious readers? That’s accessible to the visually impaired, that exists in a simplified-vocabulary version with graphics, that has multiple citations for every statement, and that is available in 2,000 different languages?

    If it’s sufficient to reach only english-language readers with internet access and a college-level vocabulary (since one of the goals of SBM is to reach journalists, this seems fair) why is it such a problem that the blog might also alienate people uninterested in critical thinking?

    If blog posts were written in such a way as to appeal to readers with little education and poor critical thinking skills, it would risk being unable to model the usefulness of education and critical thought — something that the writers are trying to get journalists to care about.

    As I said, I don’t think you’re wrong. I think you’re asking too much. If the posts were blander I would have dropped the site long ago — to my detriment.

    Kind of like — I would rather enjoy a mixed diet with curries and bitter greens and bananas and chocolate than survive on Boost. If David Gorski is bringing a particularly hot curry to the potluck then your contribution of banana coconut raita will be gratefully received by many. That doesn’t mean there’s anything wrong with curry.

    That said, David Gorski’s curries aren’t particularly hot. There are sites out there that I don’t bother with because they are just people being clannish about being smarter than all the idiots out there. I don’t spend time on those sites because they bore me. Clearly, others are attracted to them. Great. So some perspective: David Gorski brings mild to medium curry, and others bring other stuff. For the really firey sauces we have to go somewhere else.

  65. pmoran says:

    Alison, thanks for your comment, with which I mostly can agree. It IS about context, as is everything else about medicine, in this instance “who are you talking to?”

    I think David may sometimes be a trifle over-involved with personalities for a science-based blog, and I too thought the present piece was mild.

    I was herein (initially) responding to Dr Benway’s insult, the one that appears to have resulted in Moose39′s abrupt departure.

    “An attempt to reason with such people can, sadly, reinforce their belief that they are somehow intellectually the equal of the more rational and evidence-based party.”

    This, after two (?) posts very politely questioning the use of (perceived) sarcasm and ad hominem in David’s piece. I admit his story about his diet was weird, suggesting that he has a bit to learn about interpreting such material.

    Now there is no doubt that sarcasm and ridicule and perhaps insult are soothing for, even enjoyed by the like-minded, and that reassuring the faithful is a legitimate purpose of such a blog as this. But are you quite sure they have a positive effect on those we might wish to influence?

    IOW we can allow that their use is reasonable when writing for the likely readership of this blog, but still see Moose’s comment as a warning that they can be repellant and risky when talking to people we barely know.

    Also, are these also the only way to express strong feelings? There’s always “I have strong feelings on this”.

  66. Dr Benway says:

    Playing the tone card is an old strategy used by people who can’t argue evidence. I pretty much write off all tone police commenters as idiots, unless they also do a fair job of addressing the actual points being made.

    If the human race is too stupid to figure out which is more important, the truth or the tone, then it is doomed no matter what a small titmouse happens to think.

    BTW, I really wish there were a wordfilter at sciencebasedmedicine.org that would replace vowels with underscores in naughty words, so my comments wouldn’t get trapped in the spam filter. I really need that “bullsh_t” word and I don’t always have the presence of mind to fudge it myself before I hit “submit.”

  67. pmoran says:

    Thanks Dr Benway. The only question remaining is the level of tolerance of other participants for non-responsive, obliquely abusive material.

    i expect few will express misgivings even when they have them. Never mind — carry on, and I will continue to publicly distance myself from your remarks when they go too far for my taste.

  68. Artour says:

    About naturopathy, science and medicine
    I teach breathing retraining. To be more accurate I teach how to breathe slower and less since medical research studies have found that over 90% of modern normals suffer from chronic hyperventilation. Their minute ventilation rates are about 2 times greater than the medical norm. Normal minute ventilation is 6 L/min for a 70-kg person at rest, but modern normal subjects have about 12 L/min. For details of these studies, visit:
    http://www.normalbreathing.com/i-hyperventilation.php

    Furthermore, tens of medical studies have found that sick people (heart disease, diabetes, asthma, COPD, cancer, chronic fatigue, epilepsy, cystic fibrosis, and so forth) breathe even more than that or about 12-18 L/min.
    http://www.normalbreathing.com/i-hyperventilation-syndrome.php

    Hyperventilation causes reduced perfusion and oxygenation of all vital organs (tens of research studies), over-excited states of nerve cells, production of free radicals and oxidative stress, immuno-suppression, promotes chronic inflammation and other pathological effects. Most of them relate to CO2 deficiency.
    http://www.normalbreathing.com/CO2.php

    Mainstream medicine continue to ignore the epidemy of hyperventilation in modern population. For example, I posted these medical research tables (with about 50 medical studies related to hyperventilation prevalence) on Wikipedia web page “Hyperventilation Syndrome” and got a vicious attack from 4 medical doctors who 3 times deleted these data claiming that this was my “original research”. You can see our discussion here:
    http://en.wikipedia.org/wiki/Talk:Hyperventilation

    Do I teach naturopathy or not, I do not know. You may decide. But a patient can come with heavy mouth breathing to a GP or family physician asking, “Doctor, what is wrong with me?” and this doctor would organize blood tests, various examinations, etc. still ignoring the cause.

  69. Dr Benway says:

    I’ve been arguing with naturopaths (and friends of naturopaths and “not-a-naturopath-buts”) for a few years now. The ones that arrive bawwwing about tone never get any better.

    I challenge you to prove me wrong.

  70. Dr Benway says:

    Oh one more thought, pmoran. When you talk about alt med you sometimes paint a picture of an unsophisticated older patient who “just wants something that works.” Harshing on alt med then, for you, seems like harshing on some sweet old lady.

    Alt med for me is the CCHR. It’s hang-up calls from Clearwater. It’s threats to “find out what I need to know about you” from strangers.

  71. pmoran says:

    Autour, I don’t believe most of what you say either, mainly because those levels of hyperventilation would be obvious on simple inspection of patient/subjects, measuring of resting resp rates, or blood CO2/bicarb levels.

    Certainly many illnesses can CAUSE hyperventilation, as might the act of measuring ventilation, but neither of those afford it the central significance within medicine that you ascribe to it.

    This might be a good subject for one of the principals of this blog to address. I noted recently that NCI studies show “deep breathing”, if that is what is being referred to, as a surprisingly popular alt method.

    http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm

  72. Tone, Tone, Tone, there, now I don’t have to worry about Dr Benway listening as I discuss tone further. :) *

    With more thought, I would say I was wrong in my initial inclination that scorn and sarcasm (I think ridicule is a better word) are a counter-productive tact.

    Firstly, the impact of face to face conversations (my first example) is different than that of distant (written, drawn, recorded voice, etc) communication. Distant communication allows for and can require a more forceful presentation.

    Secondly, when one considers the use of ridicule or scorn historically it’s hard to deny it’s impact (for the good and bad, but I will focus on what I consider good.)

    Political cartoon such as James Gillray and Thomas Nast used large doses of scorn and ridicule to effect change. Check out this overview.
    http://www.loc.gov/rr/print/swann/craws/craws-exhibit.html

    Then, one can consider Jonathan Swift, Mark Twain and other writers who used satire to denounce, deride, etc.

    But, these artists didn’t make the impression that they did only because they used scorn or derision. The quality and craftsmanship of the scorn and derision is important. Sarcasm executed well can engage and provoke change, sarcasm used clumsily can make the writer look juvenile and petty** If one wishes to use satire, scorn or derision effectively, it is probably important to consider and study the craft.

    BUT – It seems to me that there are two tasks at hand. One task is to denounce woo, scam, cam. One is to persuade the public and medical institutions of the superior effectiveness of SBM.

    While scorn and satire lend themselves well to denouncing, I think they are not so effective in persuading one of the positive attributes of SBM. At least I’m not thinking of a good example of scorn or satire being used to persuade or attract.

    I might also note that woo, seems to have been particularly effective in the persuasion department.

    This leaves me with the question, strategically when is it better to denounce, when is it better to persuade? If scorn and ridicule are tools (along with others) that can be effectively used in denouncing, what tones are appropriate for persuasion?

    That’s as far as I got. Don’t know that it’s interesting or relevant to anyone else, but it was interesting to think about while traveling.

    *Although, that seems a bit like a painter who’s won’t listen to criticism of their color palette. I mean, if they like pink, that’s all that’s important, right?

    **See FOX news and MSNBC.

  73. @ pmoran and deep breathing

    There is one post on this topic or similar. http://www.sciencebasedmedicine.org/?s=Buteyko+breathing

  74. Dr Benway says:

    How about honesty? That’s good too, right?

  75. Dr Benway
    “How about honesty? That’s good too, right?”

    Do you ever really trust someone who tells you they are “just being honest?” I don’t.

  76. Dr Benway says:

    I try to *be* honest without saying that I’m being honest. Still you should not trust me as I am no one of any particular authority or importance.

    When a representative of the anti-science team begins with a few vague terms and fallacies, there is some chance of a productive conversation. He may not realize where his thinking went off the rails and may benefit from some feedback.

    But the ones who start right in with complaints about tone are generally intent upon *keeping* the discourse focused upon tone. In response to this strategy you have two options:

    1. avoid giving offense and stick to the topic at hand
    2. de-legitimize the tone police strategy

    The first response has advantages in front of a naive audience. But anyone playing the tone card right off the bat is likely an 8th degree blackbelt in taking offense, so good luck with that. You must ignore implicit attacks upon you motives in nearly every comment the other party makes.

    If I were to market one idea to the public, it would not be “pro-science based medicine.” It would be, “Beware anyone who shifts a conversation to matters of tone before there is clear agreement regarding matters of fact.”

  77. David Gorski says:

    But the ones who start right in with complaints about tone are generally intent upon *keeping* the discourse focused upon tone.

    Exactly.

    With few exceptions, complaints about “tone” in blogs and online conversations rarely serve as anything other than a distraction from the topic at hand. Sometimes that distraction is intentional on the part of the “tone trolls”; sometimes it’s nothing more than a result of being an online newbie who isn’t used to the rough-and-tumble world of online discourse.

    When I first started blogging (elsewhere, of course) over six years ago, I used to become very concerned about not being perceived as “reasonable” whenever a commenter complained about my tone. Over the years, however, I’ve learned that, unless you are completely milquetoast and write about uncontroversial topics (the latter of which, at least, is completely boring and contrary to the mission of SBM), there will always be people who complain about the “tone” of your writing. Always. I’d be willing to bet that even Peter hasn’t completely escaped such charges. for all his efforts to be polite and civil. In any case, no matter how hard you try to sound “reasonable,” it doesn’t matter. Every so often someone will try to derail the conversation with objections to “tone” (and “derail” is the perfect word to describe what is being done).

    As a result, I’ve decided that my best approach is just to write the way I like to write, the way I’m good at writing, and not to worry overmuch about issues of “tone.” No, I don’t go out of my way to be sarcastic or cutting, but neither do I avoid it either when I deem it appropriate. And when it comes to complaints about “tone,” these days I tend to tune them out for the most part, except for occasionally when I’m in the mood to respond, like now.

  78. David Gorski
    “With few exceptions, discourses on “tone” in blogs and online conversations rarely serve as anything other than a distraction from the topic at hand.”

    When I started reading scienceblogs, I came upon a rather powerfully worded article on Whitecoat Underground concerning vaccination. Since I was reasonably clueless to the anti-vax movement, the strength of the tone seemed over the top. I posted a comment to that effect and asking why all the folks on scienceblogs were harping on this topic so relentlessly*. Peter Lipson responded with a sincere and brief summary of why he was concerned with the anti-vax movement.

    I suppose he could have been dismissive of my tone criticism, but instead he took a bit of time to educate me, earned my respect and helped me to consider something in a different way. Because I feel emotionally engaged in children’s health, I did start to take the topic of vaccination more seriously and I attempt to offer what I’ve learned to friends and acquaintances when it seems appropriate or relevant. (Although, I’m sure not as well as many of the folks here. But I hope something is better than nothing.)

    I thought this was the whole point of writing a blog on such topics. To inform people who don’t already know in the hopes that they may spread the information. If one dismisses “newbies” or the uninformed, or perhaps assumes most negative posts are trolling, it seems a missed opportunity.

    On the other hand, I do not think it’s the responsibility of the blogger to personally answer every criticism. I’m just offering an anecdote on how all “tone” discussions are not necessarily useless.

    *I suppose this encounter qualifies as being a “newbie” although, I’ve been online since the mid 90′s… I sort of balk at that description.

    Regardless, I understand that my creative directing past probably makes me a little more fascinated with tone than most, so I will stop harping…or at least, I will really, really, try.

    But, as peace offering or possibly punishment, depending upon how much you like poetry, here is a poem that seems somehow appropriate.
    http://www.americanpoems.com/poets/Billy-Collins/798

  79. pmoran says:

    This episode was never about “tone”, for me. It was about unprovoked and unwarranted personal insult.

    Dr Benway has, defensively, attempted to characterize it otherwise.

    I am not sure what others mean by “tone”. Have I ever used the word?

    In any case, it is difficult to talk to specific aspects of it without an actual example, including context.

    My main complaint previously was when David devoted a long post to attacking a rather simple-minded antivaxer who could have been dismissed in a few words that better explained why that fellow was talking out of his backside. I pointed out at that time that the critical relevant information was not easy to find elsewhere on the blog.

    I had no real complaint about the present post. I might not have complained about Dr Benway jumping to conclusions about his/her relative intellectual superiority if were not for the provision of yet another example loose, simplistic answers to important and complex questions.

    One point. I think we would all like this blog to represent what is best about science and science-based medicine. Might that warrant a different “tone” to that which might be appropriate for a personal blog? Do people come here with certain expectations regarding style and tone?

  80. David Gorski says:

    My tone on SBM is different than on my not-so-super-secret but still not 100% out in the open personal blog. That is intentional. Don’t believe me? Check out my personal blog. Don’t know which one it is? E-mail me and I’ll give you the link. Don’t care? Then don’t worry about it.

    Of course, there is overlap. I do crosspost SBM posts on my not-so-super-secret but still not 100% out in the open personal blog, usually a few days after they’ve appeared here first. Occasionally I’ll crosspost the same post on both the same day.

    In any case, this is a blog. In essence, it’s a daily commentary on all things SBM. That can mean anything from a detailed dispassionate analysis of a recent research paper (which I’ve done many times, BTW) to an amusing little rant about an objectionable article (which I’ve also done fairly frequently and which Mark Crislip, for example, does so very well) to a political screed (which Wally Sampson used to do from time to time, a couple of which I strenuously–and I do mean strenuously–disagreed with). It is not a reference. I wish we had the people power to make it into a reference, but doing that–leaving aside the even bigger project of keeping such a reference up to date after it’s constructed–would require a lot more people-power than we have at the moment.

    We do what we can, and in the meantime this blog is what we can do.

    In the meantime, that is not to say that we don’t have plans one day to make this a more “serious” venue–or at least to add a more “serious” reference-like part of the blog. In fact, we would very much like to do that. There are even moves and developments in that direction by our fearless leader that I can’t tell you about yet that, assuming they come to fruition, will help us a lot with our resource problem. Remember, right now this is an all-volunteer effort by busy professionals who have demanding day jobs. It’s often all I can do to make sure there’s a new post here every weekday.

    I mean, look at this blog. We’re still using a generic WordPress template after three years of existence. Actually, I very much hope that that will change soon. I don’t think Steve will mind my letting you know that we hope to do an overhaul of the site soon to make it look a lot spiffier. After all, the quacks have professional-looking website and blog templates; we should too.

  81. pmoran says:

    Points taken, David.

    Pax.

  82. Dr Benway says:

    pmoran,

    morris39 defined an ad hominem (understood to be a bad thing we shouldn’t do) as “an attack on the person rather than on his ideas.”

    I tried to counter with an illustration of when an “attack on the person” would be a good thing. I used the example of someone with an “unselfconscious superficial understanding” resistant to reason, and even feeling more confident, thanks to smart people paying some attention. In that case, “GTFO my OR” would be better than politeness.

    morris39 –who denounced personal attacks– then attacked those commenting (presumably myself and David) and flounced away. LOL irony.

    pmoran, I don’t mind your attacks upon me. But it does make me a little sad that you never engage with the things that are very important to me, like the rich alt med bad guys in our med schools.

  83. pmoran says:

    Dr Benway the sad thing is that we share so much, and I respect some very sensible and perceptive comments that I have seen of yours.

    Why cannot you see that any ability of yours to sift right from wrong on medical subjects is the result of privileges that others may not have had the benefit of?

    That, along the fact that few of us are aware of our own limitations and biases, makes me cringe when you and some others resort (in my opinion), too readily to personal insult and name-calling.

    I am sure that our task is as much building trust as winning arguments. I am also fairly sure that arrogant displays of dogmatism don’t help.

  84. Dr Benway says:

    Why cannot you see that any ability of yours to sift right from wrong on medical subjects is the result of privileges that others may not have had the benefit of?

    I’m not smarter. I’m just normal. But people like Mercola, Mike Adams, etc., are morons on purpose. They could be smart, but they’d rather *act* smart.

    The only people I intentionally insult are the ones that I feel are trying to cheat, the ones that derail the conversation, and the ones that make me mad, usually because they scare me a little.

    I don’t think I’ve ever insulted you. If I have, please point it out so I can apologize.

  85. Dr Benway says:

    Oh and by derail, I don’t mean what we’re doing now, going off on a tangent because it’s interesting to us. I mean people who promote anti-medicine, don’t like something David or others here post, but instead of arguing evidence they tell David he’s too sarcastic or whatever. That’s a derail.

    I love David. I just do cuz he’s so f_ckin’ awesome. Also Atwood. And Harriet. Of course Steve –it’s impossible to *not* love him.

  86. pmoran says:

    I have regularly called Mercola an idiot, mentioning his one-time claim that polio vacciination was not needed because we we would not get polio if we didn’t eat sugar.

    But if I had the opportunity to talk to him face-to-face I would be eager to converse, to try and work out how his mind works, and to assess just how sincere he is in what he professes.

    I think most of the CAM sympathizers who come to skeptical fora do so in order to test out their beliefs, half-beliefs or “wanna-beliefs”. I am inclined to respond to that, not the preemptive aggression and insults with which some announce themselves.

    I might learn something new, while being given the opportunity to test out my own assumptions and preconceptions.

  87. Dr Benway says:

    But if I had the opportunity to talk to him face-to-face I would be eager to converse, to try and work out how his mind works, and to assess just how sincere he is in what he professes.

    I respect you for wanting to make the effort –I mean that. I’m glad there are others who share your feelings.

    I’ve gone down a different path. It would be impossible for me to have a friendly chat-up with someone like Mercola or Mike Adams.

    I would have to get out a roll of Reynold’s Wrap for myself before I could say anything further. There are some very wealthy, very bad people involved with political alt med. People who can read you email, if it pleases them to do so.

  88. Dr Benway “I’m not smarter. I’m just normal. But people like Mercola, Mike Adams, etc., are morons on purpose. They could be smart, but they’d rather *act* smart.”

    How do you know that a commentor is “like Mercola” based on one or two posts? Without physic ability, that is?

    It’s funny how that phrase is only flawed when it comes to the woo folks. When it comes to dealing with commentors, it’s perfectly acceptable.

    But it seems to me a venue where you don’t see the subject, you have limited information and can not follow up, is an excellent place to be concerned with confirmation bias.

    So tell me, in your experience, what percentage of people who comment on tone are “like Mercola”.

    Also, tell me what percentage of people who read those comments and slightly agree, but don’t post themselves are “like Mercola”.

    Because when you write comments, they are not just a response to a particular commentor. You have an audience.

    —————–

    I guess we are different in our viewpoints on commentors. Because I often think that people might be “like me”. Meaning I have little experience in science, required high school biology, one semester undergrad biology. I actually would have loved to take more science, but since I started falling behind in math around 2nd grade and was hopeless by 6th, my options were limited (physics? chemistry? haha). Of course, this was before the days of IEPs and tutors, so most of the math help I got was one hour a year of being yelled at by my father. I think that my family decided that I should be an artist around age 10, since I was clearly not suited to anything else.

    Probably, I should have just ignored them all and gone to medical school. Cause you’re not smart. I’m not smart. And if I don’t know what you know, then I must be a moron on purpose.

    —————
    Also, what’s up with the dark and foreboding conspiracy theories. It’s not that I completely disbelieve you, but I have family members who are schizophrenic and bipolar (two, not one with both) and it just sounds a bit, what? ‘I’m at the epi-center of intrigue and powerful forces, that no one else really knows about, are influencing our lives.’

    Do you realize, that’s how you sound to the folks not on your inner circle? Is that how you want to sound? Or don’t you care?

  89. Dr Benway says:

    How do you know that a commentor is “like Mercola” based on one or two posts? Without physic ability, that is?

    People like Mercola and Mike Adams are morons on purpose. That point has nothing to do with those who comment on this blog.

  90. Dr Benway says:

    Michele, I’ve had people threaten me for speaking out against alt med. Subsequent to that I had a series of odd events over a few weeks that would be difficult to explain as mere coincidence. I could give details but I’m not sure that’s wise at this point.

    The odd events prompted me to visit whyweprotest.net, where I heard a number of similar stories. It’s not the best organized place but I think there’s a subforum or thread about “fair game” there.

    David also has had some hassles because of his attacks on alt med.

  91. Dr Benway says:

    Oh and I don’t have an “inner circle,” lol.

  92. Chris says:

    Dr Benway:

    morris39 –who denounced personal attacks– then attacked those commenting (presumably myself and David) and flounced away. LOL irony.

    And me. I apparently nailed his diet while trying to be sarcastic. It kind of shocked me, and I thought it was funny. He was not amused.

    After the next post where he said not eating fruits and veggies and replacing lost calories with fat was better for him and his receding gums, I just let it go. There has to be something else going on.

    It did remind of a time on another blog where some woman was telling how horrible tooth amalgams were, and how her alternative med. practitioner was helping her. I asked back how, did they remove all her teeth? She said yes, and then did a downward spiral of despair from then on. It seemed she needed the help of a good psych evaluation than a mercury detox.

    Sigh.

  93. Dr Benway says:

    Probably, I should have just ignored them all and gone to medical school. Cause you’re not smart. I’m not smart. And if I don’t know what you know, then I must be a moron on purpose.

    Obviously I suck at communicating and I have made you upset. Let me try one more time to explain:

    I wanted to tell morris39 that scorn shouldn’t be considered illegal, like an ad hominem is illegal. So I invented a hypothetical person, a Dunning-Kruger kinda guy, who might take himself even more seriously if he were treated seriously by experts. In my mind’s eye Mr. Hypothetical didn’t look anything like morris39, although pmoran saw a resemblance.

    Then morris flounced away and I *did* slag on him for flouncing. pmoran thought I slagging on him for not being as smart as me. “I’m not smart; I’m normal” was my silly way of trying to tell pmoran, “My defense of scorn in certain situations has nothing to do with IQ.”

    I don’t know why I would want to insult you, Michele. Maybe you’re upset with me for saying that insults are sometimes good?

  94. In defense of Dr Benway, when I have been made to stop and think seriously about how I am thinking and to take a few steps back it has often been often in response to expressions of exasperation. I’m not a subtle person. GOMOR! would probably get through to me in a way that kindly explaining that rubbing feces into wounds has not been scientifically proven to be of benefit, would not.

    Since this forum does not consist primarily of shrieks of GOMOR! I find Dr Benway’s occasional interjections fill a niche.

    Also, I know someone who was taken to court by the Church of Scientology. They’re a serious and aggressive bunch. Of course I would like to know more about how Dr Benway fell afoul of them, but it’s entirely plausible that she did and that her fears are rational.

  95. Dr Benway says:

    Chris,

    I scrolled up and re-read the diet stuff that I kinda glossed over the first time. I see now why maybe “when faced with…” and “clueless git” came across as my talking *about* morris39 rather than talking *to* morris39.

    I followed the back-and-forth between Orac and Dr. Jay Gordon that David alluded to above before reading this thread. After years of Gordon’s superficial pleasantries combined with his constant whines about tone, the “ad hominem” thing has become a real sore spot.

    At work we’re being made to read empty MBA blather about “respect” and “dignity,” which seems to be code for, “critics are SPs!” The materials quote infamous CCHR personalities, which makes sense in that no one hates criticism more than a Scientologist. But on the other hand, WTF?

    So presently I’m all NRA when it comes to my right-to-bear-scorn:

    YOU WILL TAKE MAH TROLLINS WHEN YOU CAN PEEL THIS KEYBOARD FROM MAH COLD DEAD FINGERS!!!!!!!!!!!!!!!111!1!1

  96. Dr Benway says:

    There are no bad words in my previous post so I am left guessing which text string triggered the filter. If it begins with “Dr.” and ends with “ordon” … LOL.

  97. Chris says:

    Dr. Benway, my personal opinion is that you need to have a backbone to post on the Internet. If you expect to post things like “I ignored my real doctors and went back to a naughty diet and felt better” and not get some kind of negative feedback, then you are in the wrong place. This is not the “CureZone.”

    Unfortunately, I also know from painful family experience you cannot change the mind those convinced that they are influenced by impossible things. Of course, this is part of my disdain for the “Not a Doctor” folks, homeopaths and those who reject real psychological medical care. I am all to familiar with several of the stories in this book. Unfortunately, due to her rejecting the very real help she received at the county psyche wards in two states and resorting to naturapaths and odd online alt-med email listservs, she finally gave up and found final solution in carbon monoxide. She is buried less than ten blocks from where I live.

    I hate naturapaths, homeopaths and other pseudo-medical care folks (like the Scientologists!). But I am trying to be careful with their victims. I often stumble, because it is difficult to determine if they are defiant, defensive or desperate.

  98. Chris says:

    (oops, I deleted a sentence… the “she” in my second paragraph refers to a late relative, one that I had many arguments about alternative medicine)

  99. Dr Benway, I am not insulted by you suggesting that scorn can be okay.

    I did read your comments as directed at Morris39 not as a hypothetical figure, I understand now that that wasn’t your intention. But particularly after the “flounce” reference, it seemed liked it in my reading at the time. It also seemed like you were saying that Morris39 was like Mercola.

    Actually, to some extent, I do agree with Chris that if you enter a board making insulting remarks that one should expect to get swatted. But I didn’t read Morris39 initial post as insulting, I read it as someone who has sadly swallowed some of the Alt med propaganda whole, but was actually attempting to be civil. Much like me and some of my friends*. So, I would have characterized him more as a victim than a perpetrator. That is why the (misread) insulting response seemed counter-productive.

    Regarding the moron kerfuffle, I am not good at communicating. I will try to be clearer. People who are very well educated in a particular area often forget how little others know about those areas. When someone (like me or possibly morris39) isn’t grasping some concept that seems incredibly obvious, it can be frustrating and seem like we are being stubbornly stupid. Sometimes that is the case*, but sometimes we just don’t have the tools to grasp that fact. Maybe we don’t have a familiarity with logic, science, statistics, much less the terminology that goes with it.

    In fact, probably one of the only differences between me and Morris39 is the fact that I’m pessimistic as hell (not inclined to believe in miracle cures) and I have family members who are in the medical field. That’s just luck.

    So maybe some people are more inclined toward alt med just because it’s much more accessible to them based on their current knowledge. And I think that directing scorn at these particular folks is only going to turn them off and possibly others like them who read the comments.

    If I read correctly, I believe that is the point that pmoran was making too.

    So IMO, you don’t need to drop the scorn, only please, direct it more obviously to the perpetrators of the SCAM and try to avoid hitting the clueless, but possibly innocent victims.

    If you take to time to explain in a very accessible way how using proven therapies is more beneficial than the ones Mercola and NaturalNews suggest, you might help someone out and even convince some of those anonymous comment readers too.

    There, I’m sure that was as clear as mud. I envy you ability to be concise.

    ————

    *actually, I really try not to be stubbornly stupid, but, sadly I am stubborn and sometimes I’m stupid, so the laws of chance suggest…

    **Well, my friends are actually more friendly than civil. And I can only think of one (or two) who might actually check out this board, but I can imagine her posting a similar post to Morris39. And I would like you all to be nice to her. I’m pretty sure you would like her if you meet her.

  100. Also Dr. Benway – I am sorry for giving you a hard time regarding the conspiracy* stuff. Although, I’m sure it’s intrusive and rude to admit it, I do appreciate the clear explanation.

    I guess you might say I have a paranoid tendency to look for paranoia. I would discard that, but it’s actually pretty helpful.

    But I wish I had been more respectful about it. I apologize.

    I do have an inner circle, unfortunately it is comprised on one person (me) so the phrase is probably more of a description of girth.

    *for lack of a better word.

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