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Our own slippery grounds

When we were forming the National Council against Health Fraud I wondered aloud to the president, Bill Jarvis, what we would do if society solved the chiropractic problem. Bill laughed and said there would never be an end to quackery claims.

How right he was. But why? Many express surprise that at this time of remarkable intellectual and scientific advance, so many people choose to believe in irrational medical claims. The answer I am used to is the one that explains the difference between the attraction of subjective versus the dryness of the objective; between reflex and conditioned responses and rational thought, and between immediate emotionally gratifying, low-level mid-brain reactions and slow-reacting, cool, higher level intellectual thought. These comparisons are all valid but in trying to answer the question, we can miss the constancy of human nature biology, the dimension of time flow, the changing nature of evidence, and as yet unemphasized, the changes and evolution of measurement.…

Before Evidence Based Medicine (EBM) was devised, and the randomized clinical trial (RCT) accepted as the so-called gold standard, our evidential decisions turned on balances or ratios of science/nonsense, rationality/irrationality, reality/delusion, and an estimate of plausibility/implausibility. We can see now that the concept of EBM introduced a new set of standards to our equations balances – proof by RCT and their derivatives, systematic reviews (SRs). The demand for proof by RCT and and SR relegated the previous standards, the unbalanced ratio concept, to the level of anecdote and “uncontrolled observation.” We had to start over again with a new standard.
There are several thought tangents that develop from this problem – one is describing truth or at least validity in a field in which the objects of investigation are in constant change. At the same time, so are the measuring devices. The problem of change affords our critics a more valid basis for criticism, especially via the tu quo que argument (Hey, your guys aren‘t any more valid than we are…) . But recognizing this set of affairs principle may help us understand why sometimes we feel cornered by quacks’ challenges. We have been relying on answers based in logical argument and rationally obtained data, when the actual nature of investigating nature is a slippery one that has pulled a floor of conviction out from under our feet. We have to investigate a changing, evolving set of conditions and diseases, plus the eruption of new ones such as HIV) and changes in classification from increased understanding of mechanisms. While changes in basic science and technology and we develop increased understanding of disease:health interacions, others of us change our measuring devices. Yikes.

On the other side of the ledger there is a constant strain of human nature that demands belief and solidity for one’s mental health. This need is the direct basis for the various world religions used as explanatory reasons for existence and explanation of the unknown.

As a reaction to beliefs in creation myths and in mystical origins for group ethics standards, Relativism and Post-modernism arose in the 1970s as if a counterbalance the older belief system. PoMo introduced more mischief into the medical system than any other new concept, by undermining the scientist’s reliance on a basic fund of knowledge. They also sabotage rationalists’ efforts to counter scientific nonsense and absurd propositions. .

All this led to several veins of thought that might have been introduced here before, but I cannot recall it. First, the thinking processes of quacks and followers. As delusional, utopian thinking acts as a warping lens of reality, our own standards are not stationary, a fact putting us at an unrecognized disadvantage. The problem becomes one that places our demands for proof on slippery ground – to what standard do we expect quacks to adhere?

Beside the morphing of our facts, our rationalist researcher brethren in their wisdom keep refining our measuring devices as well. The RCT was developed after WW II, mainly after 1960. It was preceded by observational studies and non-randomized, non-blinded trials. But the RCT is still in development – I the fine-tuning stages. Thus, results obtained 20 years ago may not be accurate enough by today’s standards. Then in the 1990s came EBM and its standard, the systematic review (SR). Srs are also still in development and are being shown to be inadequate for disproving claims based I subjectivity and claims that are implausible. The measuring device of the RCT is not fine enough or accurate enough to detect fraud, misrepresentation, and a host of methodological errors.

Thus our definitions of our standards are also movable. These problems place us closer to our post-modern opponents than is comfortable – at least on te surface. We also change definitions of truth and reality. Yet, less our adversaries in quackery, relativism, PoMo, and commercial fraud take hope from this dilemma, there is an answer, based in the same criteria mentioned in the beginning. Rationality, honesty, authenticity, plausibility, and validity will still trump their opposites. (Richard De Mille explains authenticity and validity in his SRAM article on how he investigated the fraud that was Carlos Castaneda.) How to tell? How could we know this? First, we can re-read Kim Atwood’s series on plausibility, and follow this strain of discussion as we develop in future posts. Kim helped to clarify for me the dilemma I faced in 1999 in that Net zine discussion with Renner, Walach, Ernst, and others in which I felt as moderator I had to bring plausibility to a discussion of evidence based on RCTs, yet found it hard to justify it in such a forum. Second, What may be needed is a new approach and a new language to express the four or more criteria of rationality, honesty, authenticity, and validity. Third, the project we are developing on quantifying error and misrepresentation. Can the rest of you offer some angles on this? I will be doing the same, working on subsequent posts the next few weeks.

Posted in: Basic Science, Clinical Trials, General, Health Fraud, Science and Medicine

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5 thoughts on “Our own slippery grounds

  1. maus says:

    “Relativism and Post-modernism arose in the 1970s as if a counterbalance the older belief system. PoMo introduced more mischief into the medical system than any other new concept, by undermining the scientist’s reliance on a basic fund of knowledge. They also sabotage rationalists’ efforts to counter scientific nonsense and absurd propositions. .”

    It’s sad that such a useful tool to expose appeals to authority and the status quo, along with a great many other logical fallacies that inhibit progress is used to revert us back to the dark ages.

    It’s a shame that we don’t teach children the most basic logical and critical thinking skills in school, because we’re not going to get any better, and the internet has made it easier for the pseudoscientific to organize and propagate, but hasn’t made the average person much smarter in discriminating between what is real and what is fantasy (I include placebo with this, independent of the “real” effects.)

    Without teaching children properly, understanding of how science “works” and a full grasp and acceptance of reality is not a guaranteed thing.

    A more than complicit and “human interest” rather than fact-based media only serves to reinforce the idiocy. Instead of improving quality, with diminishing profits they take product placements and fully-written PR fluff pieces in lieu of actual content and journalism.

    I really, truly want to be optimistic. Hopefully Daschle and Gupta can give us some amount of untainted guidance, but I’m not optimistic. It’s very hard to find good visionary leadership in the House and the Senate as well to back the President. I still have a little hope in my heart, at least!

  2. Karl Withakay says:

    “It’s a shame that we don’t teach children the most basic logical and critical thinking skills in school…”

    + infinity to that.

    It’s interesting to note that we teach and expect writing skills in about every subject other than straight math. In nearly every other subject, (history, economics, physics, etc) students are expected to have and use composition skills to write research papers, formal lab write ups, etc. Conversely, Logical and critical thinking skills often aren’t even emphasized in science based classes, let alone other subjects where those skills are equally valuable and necessary.

    I believe that the most important thing we can teach students is to think logically and critically, and we need to emphasize that logical/ critical thinking isn’t limited to scientific studies and endeavors.

  3. Dr Benway says:

    Nice article. I’ve been sculpting my own explanation of the scientific method, as I try to explain why some pseudoscience claim isn’t scientific or why the evidence for the claim is weak. Here’s my latest, over-simplified, short attention span version:

    Scientific discussions are bounded by a few basic, evidential rules:

    1. Corroboration. Claims that can be reliably corroborated deserve more of our confidence than uncorroborated claims.
    2. Falsification. A claim must survive some effort to prove it false before we take it seriously.
    3. Logic. A claim must not be self-contradictory and must not contradict what we already know about the world.
    4. Parsimony. Claims which minimize the need for unfounded assumptions are preferred.
    5. Onus. The person asserting the claim holds the burden of proof.

    Within a particular field of study there may be more detailed evidential rules and procedures. These rules evolve as we learn more about the world, as we discover problems with existing methods, and as new equipment and techniques are developed. But the specifics serve the basics, and the basics don’t change.

  4. Wallace Sampson says:

    1. Maus and Karl Withakay:
    Well stated concerns, with which most of us are aligned. Thanks for that.
    Thinking back on my owm youth, the courses I received, and discussions I had with fellow students, I am not sure I could incorporate the meaning of methodological thinking – the meta-phenomena, that is – let alone master its elemental procedures.
    My friends and I were pretty good at learning the rote material, remembering things like states, nations, and capitals, their geographies and products, then elements of geometry, algebra and trig, but the concepts of evolution, as well as that of culture, sociological behavior, and relationships of language to meaning and cultural differences were all concepts I developed later – through and after college. Was I ready before that? Only maybe and parlty viewed from here. We were pretty good at adopting loyalties to political concepts, constructing good guys and bad guys.
    Now there are few clues to the mentality of our adversaries…One can see them as cases of arreted development.
    WS

    2. Dr Benway: Thanks for that also. There have been a number of criteria for scientific thought, but too often discussed in isolation. Perhaps one could use your outline as a strategy or template for analyzing claims.
    If you expand on it with examples, and publish it, be sure to let us know for reference.

    WS

    Perhaps memory fails here, but the ability to conceptualize scientific principles and metaphenomena to apply to higher order thinking I recall as developing more slowly, some insights have come only as society or science has progressed.
    Nevertheless, inroducing higher concpts is sure worth a try.

  5. Kultakutri says:

    Wallace Sampson: The thing is, developmentally, up to a certain age (15-ish if I remember right), it is actually very easy for children to memorize data. So, using this ability of brain, the teachers/textbooks/curricula do only well when they take a good use of this ability which is later lost.
    On the other hand, it needs another developmental stage, along with some life experience, to synthesise the data in a meaningful manner.

    Someone better knowledgeable about brain development, feel free to correct me, I’m only extrapolating from my knowledge of theory of teaching.

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