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Playing by the Rules

I recently read Flock of Dodos (no relation to the movie of the same name). It’s a hilarious no-holds-barred send-up of the lies and poor reasoning of the intelligent design movement. I was particularly struck by a quotation from William Dembski’s Intelligent Design.

We are dealing here with something more than a straightforward determination of scientific facts or confirmation of scientific theories. Rather we are dealing with competing world-views and incompatible metaphysical systems.

That cuts to the essence of what we are confronting on Science-Based Medicine. We are trying to evaluate the science behind claims that are often not based on science but on beliefs that are incompatible with science. The claimants are happy to use science when it supports them, but when it doesn’t they are likely to unfairly critique the science or even to dismiss the entire scientific enterprise as a “materialistic world view” or “closed-minded.” We are talking at cross purposes. How can we communicate if we say “this variety of apple is red” and they insist “it feels green to me”?

We get frustrated when we show these folks the scientific evidence and they refuse to accept it. Homeopathy is not only implausible, but it has been tested and has failed the tests. Yet proponents refuse to acknowledge those failures and still want to talk about data from the 19th century and make claims for the memory of water. We have to realize we are not even speaking the same language. We are trying to play a civilized game of gin rummy and they are dribbling a basketball all over the card table. Before getting into a debate, doesn’t it make sense to define what game you’re playing and what the rules are?

Science has been a very successful self-correcting group endeavor. It wouldn’t be successful if it didn’t follow a strict set of rules designed to avoid errors. [Note: there are no rules written in stone; I’m talking about conventions that are generally understood and accepted by scientists, conventions that grow naturally out of reason and critical thinking.] If proponents of alternative medicine want to play the science game, they ought to play by the rules. If they won’t play by the rules, they effectively take themselves out of the scientific arena and into the metaphysical arena. In that case, it is useless for us to talk to them about science.
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Posted in: Science and Medicine

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Chopra and Weil and Roy, oh my! Or: The Wall Street Journal, coopted.

The quest of advocates of unscientific medicine, the so-called “complementary and alternative medicine” (CAM) movement is to convince policy makers, patients, and physicians that it does not deserve the rubric of “alternative,” that it is in fact mainstream. Indeed, that is the very reason why “alternative” medicine morphed into CAM in order to soften the “alternative” label. Increasingly, however, advocates of such highly implausible medical practices appear no longer to like CAM as term for their dubious practicies, because it still uses the word “alternative.” That is, of course, because they recognize that labeling something as “alternative” in relationship to scientific medicine automatically implies inferiority, and CAM advocates are nothing if not full of hubris. Such a term conflicts with their desire to “go mainstream,” and they most definitely do want to go mainstream, but they want to do it on their own terms, without all that pesky mucking about with science, evidence, and rigorous clinical trials. Consequently, they increasingly use a new term, a shiny term, a term free of that pesky “alternative” label. Now they want to “integrate” their unscientific placebo-based practice with real, scientific medicine. Thus was born the term “integrative” medicine (IM, an abbreviation that is the same as that for internal medicine, an identity that I don’t consider coincidence).

One of the biggest complaints we at SBM (or at least I at SBM) have about the attitude of practitioners of scientific medicine towards CAM/IM is that most of them do not see it as a major problem. Dr. Jones characterized this attitude as the “shruggie” attitude, and it’s a perfect term. Equally perfect is her analogy as to why “integrating” pseudoscience with medical science is not a good idea. I myself have lamented the infiltration of pseudoscience and outright quackery into medical academia and the role that the National Center for Complementary and Alternative Medicine (NCCAM) has played in promoting that infiltration. In addition, wealthy patrons of CAM/IM such as Donna Karan and the Bravewell Collaborative have been generous spreading their money around. In this increasingly cash-strapped health care environment, hospitals know on which side their bread is buttered and see the “integration” of woo into their service portfolio as a means of beefing up the bottom line with cash on the barrelhead transactions that require no mucking about with nasty insurance forms. In fact, services such as reiki, homeopathy, acupuncture, and others often require no forms other than credit card receipts for the patient to sign.
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Posted in: Medical Academia, Politics and Regulation, Science and Medicine, Science and the Media

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Animal vaccinations

Without question, vaccination has been one of the most important interventions in disease prevention that has ever been developed. In spite of the demonstrable, and ongoing, success of vaccination, a small, but vocal, anti-vaccination movement has developed in human medicine, occasionally buttressed by horrifying instances of adverse reactions, as well as the occasional publications in scientific journals (vis, the Wakefield debacle). Vaccine development continues, and human health continues to benefit, as new vaccines are developed and tested prior to release.

In veterinary medicine, vaccination has also proven to be a boon for animal health. Diseases such as canine parvovirus and canine distemper, feline leukemia, or equine tetanus, have been greatly reduced – in some cases, nearly eliminated – by vaccination. And, as in human medicine, a small, but vocal, anti-vaccination movement has developed, regaling fearful listeners with tales of acute harm, or chronic, low-grade disease (sometimes termed “vaccinosis”).
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Posted in: Vaccines, Veterinary medicine

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The Weekly Waluation of the Weasel Words of Woo #9

Resurrection!

Can y’believe it? The W^5/2™, that cesspool of Afflicted Sophistry and Festering Fallacy—not to say that wellspring of Awesome and Absolutely Annoying (Cloying) Alliteration© and that Mother of all Maddening Mixed Metaphors and Sundry Similitudes®—is back! Yup, like the proverbial phoenix rising from the ashes of near-terminal procrastination, and due to overwhelming popular demand, the W^5/2 is reborn!!! Well, it also might have something to do with yer faithful servant needing some time to put together a real paper or two…naaahh! But what the hay, let’s just dive right in and pretend that nothin’s changed, shall we?

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Posted in: Cancer, Chiropractic, Faith Healing & Spirituality, Health Fraud, Humor, Medical Ethics

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

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Who Should Ascend To The Office Of Surgeon General?

President-elect Obama’s nomination of CNN medical correspondent, Sanjay Gupta, for the Office of Surgeon General of the United States has ignited a firestorm of debate across the Internet. Some argue that he is not qualified for the position, others say that his charisma would be a boon to public health communications, though the lay majority appear to have mixed feelings.

It is highly irregular for a Surgeon General nominee to be announced before the Secretary of Health and Human Services is confirmed. This faux pas in itself may speak to an irresistible opportunity for self-promotion, or that the Senate confirmation hearing is not the independent review event that we assume it is.

At age 39, Gupta has long aspired to become the Surgeon General, as sources close to him report that he has been saying (since age 33) that “it’s the next logical step in his career development.”

But before we draw conclusions about who’s right for the job, we need to understand what the job entails.

I asked Dr. Richard Carmona, 17th Surgeon General of the United States, to explain the roles and responsibilities of the office. A summary of our conversation follows:
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Posted in: Politics and Regulation, Public Health, Science and the Media

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Paul Offit Takes On Robert Sears

Dr. Robert Sears, son of the perhaps more famous Dr. William Sears (both pediatricians), has continued his father’s work of publishing popular books for parents. He wrote The Vaccine Book: Making the right decision for your child, published in October 2007. In it he advocates his Dr. Bob’s Alternative Vaccine Schedule. Much of his claims made in the book are repeated on his Ask Dr. Sears website.

In the latest issue of Pediatrics, Paul Offit, along with Charlotte Moser, write a detailed analysis of Dr. Bob’s alternative vaccine schedule, systematically reviewing Dr. Sears’ claims. It is essential reading for anyone interested in the popular vaccine controversy. Paul Offit also recently published his own book, Autism’s False Prophets, in which he goes into great detail about the history and science behind the claims by anti-vaccination advocates of the risks of vaccines, most famously the claim that vaccines are linked to autism.

Dr. Sears does not come off as a hard core anti-vaccinationist. I am still trying to figure out his perspective from reading his articles. It seems as if he is trying to be popular by straddling the fence, and offering what he thinks might be a reasonable compromise. For example, he writes on his site:

The bottom line is that more and more parents want options. If we don’t provide them with options they are comfortable with, more parents will opt out of vaccines altogether. We will then see more and more disease fatalities and complications.

Unfortunately, this is like trying to compromise between mutually exclusive positions, like young-earth creationism and evolution. It doesn’t work. Dr. Sears is left giving his readers, who will likely be comprised of many parents trying to decide whether or not to vaccinate their children, with partial information or misinformation. Offit and Moser do a great job of exposing this deception through misinformation.

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Posted in: Vaccines

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2008 Medical Weblog Awards

I am pleased to announce that Science-Based Medicine is a finalist for a 2008 Medical Weblog Award in the New Medical Blog category. You can see all the categories and finalists here: http://www.medgadget.com/archives/2009/01/the_2008_medical_weblog_awards_the_polls_are_open.html

Of note, our blogging friend, Orac, is also a finalist for Respectful Insolence in the health policies/ethics category, along with our own Dr. Val Jones for her excellent blog, Better Health.

We would appreciate you taking a look and voting for the blog of your choice.  And thanks to all of our readers for your kind support over our first year, and the active and informative discussions in the comments section. We look forward to more SBM in 2009.

Posted in: General

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South Dakota’s Abortion Script: The Hijacking of Informed Consent

In a previous post, I suggested that informed consent could sometimes be misused. South Dakota has provided a clear example of such misuse and has set a frightening precedent reminiscent of Big Brother in George Orwell’s 1984.

A law went into effect in July, 2008, requiring that any woman seeking an abortion in South Dakota must be told that she is terminating the life of “a whole, separate, unique, living human being” with whom she has an “existing relationship” and that abortion terminates “her existing constitutional rights with regards to that relationship.”

It requires that doctors give patients information about medical risks, but it doesn’t leave anything to chance: it specifies what the risks are, including depression, suicide, danger to subsequent pregnancies, and death. The current state of development of the fetus must be described, and the woman must be asked if she wants to see a sonogram of the fetus. All of this must be done in writing, and the woman must sign each page of documentation. Physicians who fail to comply can lose their license or be charged with a misdemeanor. (more…)

Posted in: Politics and Regulation, Surgical Procedures

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Reality is unfair

This space has often hosted musings on the nature of scientific knowledge, on how medical science is based in methodological naturalism (MN), rather than supernaturalism.  MN requires that our acquisition of knowledge about the natural world be based on natural phenomena.  The reason for this should be quite obvious:  the natural world is the only one that exists, for all intents and purposes, and explanations must be based on natural processes.  Can you name any supernatural processes?  Can you measure them?  Of course not.

This bothers adherents of alternative medical practices.   Since science doesn’t support their ideas, they would like to carve out exceptions to natural laws.   Remember, we know quite a bit about the universe.  We don’t understand exactly what matter is yet, but we can measure it and experience it without ambiguity.  We know the universe has matter/energy; we understand pretty well the primary forces of electromagentism, gravity, small and weak nuclear; and there are probably a few other things whose effects we can measure even if they aren’t completely understood (dark energy, dark matter).

All of modern medicine works in ways consistent with our understanding of the universe.  Even when we don’t completely understand something, it does not behave contrary to these laws.  A beta blocker has never caused someone to levitate.  No one has been revivified by electricity, a la Dr. Frankenstein (“That’s Frahnkensteen!“).  Human bodies follow natural laws, and natural explanations are the ones that have explanatory power.

Since these natural laws explain what we see in the clinic and lab, what are the altmed gurus to do?

They have three main strategies, each of which is conveniently described by a logical fallacy. (more…)

Posted in: Science and Medicine

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