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Reflexive doubt

Those of us who study, practice and write about medicine cherish the hope that explaining the science behind medicine (or the lack of science behind “alternative” treatments) will promote a better understanding of medicine. Certainly, I would not bother to write about medical topics if I did not believe that promoting science based medicine would lead to increased understanding of medical recommendations and decreased gullibility in regard to “alternative” remedies. Nonetheless, lack of scientific knowledge is not the only reason for the current popularity of “alternative health. Indeed, many advocates and purveyors of “alternative” health are impervious to the scientific evidence. What else might be going on?

Belief in “alternative” medicine is a complex social phenomenon. Like any complex social phenomenon, the explanation cannot be reduced to a simple answer. But I would argue that there is an important philosophical component, developed by and promoted by advocates of “alternative” health. That philosophical component is the rise of reflexive doubt. Simply put, among a significant segment of society, it has become a badge of honor to question authority.

As an obstetrician, I am most familiar with its expression among childbirth activists. They recognize that many people hold the common sense belief that modern obstetrical practice has made birth safer, and have worked ceaseless at undermining this common sense view. Craig Thompson, a professor of marketing, has examines this tactic in his paper What Happens to Health Risk Perceptions When Consumers Really Do Question Authority?:

…[U]sing the natural childbirth community as a context … helps us understand how groups of people come to deeply believe in anti-establishment risk norms… Natural childbirth activists believe that low-tech midwifery … provides the best labor outcomes, except for in a small percentage of high risk cases. They also believe that the medical practices of childbirth pose a host of unnecessary and avoidable risks…

…Childbirth reformers interpret … innovations … as unnecessary intrusions whose primary function was enabling physicians to display technical skill…

… During the past 50 yr., many obstetric interventions that were once deemed to enhance the safety of birth or to improve postpartum outcomes—shaving of the women’s pubic region; mandatory intravenous drips … enemas …have all been discarded as ineffective, unnecessary, and in some cases, potentially harmful. The natural childbirth community invokes this historical legacy to argue that many contemporary obstetric interventions are likely to meet a similar fate.

In other words, the apparent success of modern obstetrics is illusory. Innovations were unneeded and developed simply to enrich physicians. Moreover, obstetrics has been mistaken in the past so no one should trust it in the present. Therefore, questioning the claims of physicians, and reflexively doubting explanations is not merely necessary, but is the mark of and “educated” and “empowered” consumer of health care.

Such tactics may have originated with the “natural” childbirth movement, but they have arguably reached their apogee with the vaccine rejectionists. That’s why millions of parents consider take former Playboy Playmate Jenny McCarthy a reliable source on vaccination. No one argues that she has any formal training in immunology or even that she understands the science behind vaccination. That’s not necessary. She is admired by a community that has come to believe that reflexive doubt is a sign of sophistication and education.

As Hobson-West explains in Trusting blindly can be the biggest risk of all’: organised resistance to childhood vaccination in the UK, vaccine rejectionists generally ignore the actual scientific data, focusing instead on whether parents agree with health professionals or refuse to trust them. Agreement with doctors is viewed as a negative and refusal to trust is viewed as a positive cultural attribute:

Clear dichotomies are constructed between blind faith and active resistance and uncritical following and critical thinking. Non-vaccinators or those who question aspects of vaccination policy are not described in terms of class, gender, location or politics, but are ‘free thinkers’ who have escaped from the disempowerment that is seen to characterise vaccination…

This characterization of vaccine rejectionists can be unpacked even further; not surprisingly, vaccine rejectionists are portrayed as laudatory and other parents are denigrated.

… instead of good and bad parent categories being a function of compliance or non-compliance with vaccination advice … the good parent becomes one who spends the time to become informed and educated about vaccination…

… [vaccine rejectionists] construct trust in others as passive and the easy option. Rather than trust in experts, the alternative scenario is of a parent who becomes the expert themselves, through a difficult process of personal education and empowerment…

The ultimate goal is to become “empowered”:

Finally, the moral imperative to become informed is part of a broader shift, evident in the new public health, for which some kind of empowerment, personal responsibility and participation are expressed in highly positive terms.

So vaccine rejectionism, like most forms of “alternative” health is about the believers and how they would like to see themselves, not about vaccines and not about children. In the socially constructed world of vaccine rejectionists, risks can never be quantified and are always “unknown”. Parents are divided into those (inferior) people who are passive and blindly trust authority figures and (superior) rejectionists who are “educated” and “empowered” by taking “personal responsibility”.

As Prof. Thompson notes in regard to believers in “natural” childbirth:

Importantly, their beliefs are far more than an abstract system of thoughts. The natural childbirth model shapes childbirth choices by being accepted as a structure of feeling…

…The risks singled out by the natural birth model express cultural anxieties over the unintended and dehumanizing consequences of technology; the loss of individual independence through the workings of complex ‘expert’ systems; and a political project of supporting midwifery over the socially-accepted knowledge of the medical establishment.

Similarly, the purported “risks” of vaccination express cultural anxieties over unintended or dehumanizing consequences of technology, expert systems, and supporting self “education” over the accepted knowledge of the medical community.

In counseling patients about the claims and remedies of “alternative” health, we may need to do more than simply explain the  underlying science (or lack thereof). We may need to  address the philosophical beliefs about the value of reflexive doubt. Reflexive doubt is not laudatory in and of itself and it certainly is not a sign of being “educated.” It is just a mindless rejection of authority, with potentially devastating consequences.

Posted in: Science and Medicine

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485 thoughts on “Reflexive doubt

  1. TimMills says:

    On an anecdotal level, I have to agree. I have a friend who, when she moved to a new city, started looking for an “alternative” dentist. Not sure what this even meant, I asked her about it. She replied that she had always been against authority, and felt that she didn’t want to just go with the herd. “Alternative” for her isn’t a choice that’s made on a case-by-case basis (she didn’t even know what an alternative dentist would do differently from a conventional dentist). It’s a matter of identity. And that is a much harder nut to crack, for skeptics trying to raise people’s level of awareness about the evidence.

    On the other hand, “reflexive doubt”, when backed up by a commitment to examine and accept the evidence, is a central characteristic of science and skepticism. When we come across a claim for which we have no evidence one way or the other, our proper response is to withhold judgment – to doubt the claim.

    And, as with any general human tendency, we should be aware that the skeptical community is prone to the same mode of thinking. Not all of us examine claims like UFOs or CAM in detail. Instead, bolstered by the consensus of our community, we reflexively dismiss any claim that falls under the general heading of “alternative” or “paranormal”. Not as in withholding our judgment, but as in labelling new claims false. In most cases, I think this is okay: our dismissal is backed up by actual research done by others in the community. But, on an individual, sociological level, what we are doing is not vastly unlike what the “alternative” crowd is doing.

    (Let me reiterate: I am a skeptic, and I think we are justified in rejecting most of the claims of paranormalists and alternative health purveyors. I’m just saying that, psychologically, we are vulnerable to the same gotchas. Constant vigilance!)

  2. jimpurdy says:

    Why does the word “authority” get used so often in these discussions? That attitude of superiority starts the typical doctor-patient relationship off poorly.

    A patient who has spent decades living in her body knows things about her body that a doctor cannot discover in the typical 10-minute visit, especially when seven of those minutes are spent typing prescriptions.

    Consider the fact that patients are wanting help from doctors, or they wouldn’t even go to doctors in the first place.

    The problem often begins not with the patient, but with the doctor. who barely pays any attention to the patient before prescribing the standard one-size-fits-all plan: “Take a daily aspirin, a daily beta blocker, a daily metformin, a daily diuretic, a daily statin, and come see me again in six months for your next 10-minute visit.”

    Give me a break! Why is it so hard to understand why patients don’t respect doctors who don’t listen to the patients?

    Dear “Doctor Authority” — please kiss my a**.

    The 50 Best Health Blogs

  3. Mojo says:

    The problem often begins not with the patient, but with the doctor. who barely pays any attention to the patient before prescribing the standard one-size-fits-all plan: “Take a daily aspirin, a daily beta blocker, a daily metformin, a daily diuretic, a daily statin, and come see me again in six months for your next 10-minute visit.”

    Oddly, this sounds nothing like my doctor.

  4. sheldon101 says:

    Fact finding decisions on Wakefield, Walker-Smith and Murch 2 pm GMT January 28th.

  5. BillyJoe says:

    jimpurdy,

    “Why does the word “authority” get used so often in these discussions? That attitude of superiority starts the typical doctor-patient relationship off poorly.”

    The doctor does have superior knowledge to the patient. Inherently the patient realises this, otherwise why is he going to the doctor in the first place.

    “A patient who has spent decades living in her body knows things about her body that a doctor cannot discover in the typical 10-minute visit, especially when seven of those minutes are spent typing prescriptions.”

    That sounds like a 3 minute consult (7 minutes spent typing the prescription???). That would be for a relatively minor problem such as a cold. I don’t think the doctor would not need to know what it is like to have spent decades living in your body to solve that little problem.

    “Consider the fact that patients are wanting help from doctors, or they wouldn’t even go to doctors in the first place.”

    Yes, to use their superior knowledge to diagnose a problem they have do not have the knowledge to solve for themselves. Life’s a bitch aint it?

    “Give me a break! Why is it so hard to understand why patients don’t respect doctors who don’t listen to the patients?”

    Sounds to me like you need to change your doctor.

  6. “Dear “Doctor Authority” — please kiss my a**.”

    QED!

  7. “On the other hand, “reflexive doubt”, when backed up by a commitment to examine and accept the evidence, is a central characteristic of science and skepticism.”

    I used the term reflexive doubt because one of my citations used it, but “questioning authority” is probably more accurate.

    In science, reflexive doubt has nothing to do with authority. It’s about doubting claims until you see the evidence supporting them (and sometimes even after). In “alternative” health, it has nothing to do with the evidence at all. For example, vaccine rejectionists tend to be evidence resistant; it makes absolutely no difference what the evidence shows. Instead they claim virtue and “education” in simply questioning authority.

  8. Michelle B says:

    Good post, Amy. The CAM types like this Purdy guy fit your description to a T. I also have never been treated by a doctor described by Purdy. My doctors listen to me and give me feedback. I ask further questions and we decide on a treatment plan. If drugs are involved, my doctor has to give me a clear reason why I need to take them or I don’t take them. It seems types like Purdy have a hard time not caving in in front of authority so instead they put authority in the bad bag and badmouth all forms of it and avoid it because they do not know how stand up for themselves. How very stupid, and they are only hurting themselves.

  9. I like the term “reflexive doubt” myself. It designates the process as not having any thought behind it. It’s also common to call someone with that tendency a “contrarian”.

    It is a pervasive thing, not just in medicine and science. It can be seen more in poliitics for example.

    If you really want to see it in action, make some substantive criticisms of a friend’s favorite sports team!

  10. Zoe237 says:

    IVs aren’t mandatory anymore? Well, that’s good!

    As in most things, there is a balance there. I’m the annoying type who has no qualms about asking for a second opinion.

  11. Franklin says:

    I just came across this awesome correspondence from Mark Twain to a patent medicine salesman:

    http://www.lettersofnote.com/2010/01/youre-idiot-of-33rd-degree.html

    What irony that so much of today’s ‘alternative medicine’ is the same simple hucksterism as the classic elixer hawker. Except now they’ve organized, infiltrated scientific establishments, and created a religious following of people who trully believe the stuff works and will sell it for them.

  12. “I’m the annoying type who has no qualms about asking for a second opinion.”

    That’s a good idea and it does not represent reflexive doubt. Questioning the actual recommendation and soliciting other recommendations for comparison is part of informed decision making. In reflexive doubt, the recommendation is rejected simply because it is made by an authority figure, and there is no effort made to determine whether the recommendation itself is valid.

  13. daedalus2u says:

    A term I like better than reflexive is default. If your default is to do the opposite of what ever an authority says, you are not a skeptic, you are not questioning authority, you are a contrarian.

    I think that is probably closer to the original motivation of many of the CAM followers, they want to do the opposite and then cherry pick evidence to support their contrarian position. The CAM practitioners may do that because SBM has a “lock” on all the good techniques, the CAM pratitioners need something different to hook their followers.

  14. mxh says:

    The ironic thing is that those interested in alternative medicine are in fact no more independently involved in making healthcare decisions than those who trust their doctor. The difference is that the CAM leaders don’t claim to be experts. Nonetheless, antivaxers take Jenny McCarthy’s every word as the truth and somehow believe that they came up with her talking points themselves.

  15. bluedevilRA says:

    I always get a kick out of the “I know my own body better than the doctor” notion. Everyone knows their body to some extent, but the reason you go to the doctor is because something is not quite right with your body. You go to see the one profession that specializes in knowing human anatomy.

    How many people who “know their own body” actually have listened to their hearts with a stethoscope, hooked themselves up to an EKG, taken their own blood pressure, etc. And if they did those things, would they even know what signs and symptoms of disease to look for?

    jimpurdy, it sounds like your doctor is just seeing you on a return visit. If you have no new symptoms and there is no reason to change your medications, then why would the doctor spend more than 10 minutes with you if 10 min is all he needs. The drugs you list are part of a pretty standard regime for anyone with heart disease, high blood pressure, and diabetes. However, it is hardly one size fits all. Doctors customize medications to fit each individual patient. The dose is calculated on an individual patient basis and there are many different brands under the beta blocker umbrella, each with their own benefits and side effect profiles.

  16. “I always get a kick out of the “I know my own body better than the doctor” notion. Everyone knows their body to some extent, but the reason you go to the doctor is because something is not quite right with your body. You go to see the one profession that specializes in knowing human anatomy.”

    There is a specific allure to the claim of “knowing” one’s own body. As Kaptchuk and Eisenberg point out in their paper The Persuasive Appeal of Alternative Medicine:

    The person-centered experience is the ultimate verification and reigns supreme in alternative science… Alternative medicine makes no rigid separation between objective phenomena and subjective experience. Truth is experiential and is ultimately accessible to human perceptions. Nature is not separate from human consciousness. Instruments that extend the senses or objective diagnostic or laboratory tests that discern what cannot be felt never replace human awareness… [A]lternative medicine, unlike the science component of biomedicine, does not marginalize or deny human experience; rather, it affirms patients’ real-life worlds. When illness (and, sometimes, biomedicine) threatens a patient’s capacity for self-knowledge and interpretation, alternative medicine reaffirms the reliability of his or her experience.

    In other words, no particular knowledge is necessary to declare yourself an expert (on par with those whose expertise comes from knowledge of science and medicine) because you are an “expert in knowing your own body.”

  17. bluedevilRA says:

    Thanks, Dr. Tuteur. That is an interesting and compelling analysis for why people make such claims.

    My personal experience with this matter involves my roommate. She is one of these deluded souls. Her big claim is that she never gets sick because she has a really strong immune system (I love when Bill Maher and people make this same claim). When her boyfriend pointed out that she was sick several times in college, she admitted she occasionally gets sick but defiantly responded that she only gets sick with a particular infection once, then her all powerful immune system overcomes it and she develops life long immunity to that pathogen.

    I tried to explain to her that such a scenario probably isn’t possible and if it was, she’d be Wolverine. I don’t think she liked the idea of being implanted with a metal skeleton. Joking aside, I patiently explained to her that, as an example, there are hundreds of possible causes for the common cold. She maintained that she had only had one cold in her entire life and that she will never get it again.

    I feel like hers is clearly a case of selective memory (same for Bill Maher), combined with this reflexive doubt (about germ theory and doctors in general). She often claims to be a “strong” woman, whatever that vague description implies, and I suspect that her warped perception of her own body’s capabilities is a part of that as well.

  18. micheleinmichigan says:

    Dr T. read my mind – I was just thinking about the same topic this morning (without the OB references). The word that occurred to me was anti-establishment.

    Zoe237 and daedalus2u beat me to one of my points. I have always thought of questioning authority as generally good. Sometimes there are unjust laws, mistakes made or you learn something.

    Then again, I tend to be a contrarian, but I try to keep it under control. (just taking it one day at a time :)

    I couldn’t agree more with Dr. T. that the problem is when it becomes thoughtless or someone takes an opposite stance and sticks to it automatically. To the effect of “It must be wrong because they said it.” A lot of the conspiracy theorists and cult followers seem to fall into this category. I can see Dr. T’s point about how that is at play in the CAM community.

    I would not say that ALL the members of the anti-vax community are anti-establishment. I don’t mean to imply anyone said they are, just keyboard thinking.

    From conversations and comments, I’d say some are Anti-SBM (generally the Big Pharma deal).

    Some are libertarian/anti-government intervention. “How dare they MAKE us vaccinate. ”

    A pretty big number are paranoid parents who generally trust SBM, but are alarmed by the controversy and are trying to hedge their bets just in case SBM made one of their occasional mistakes.

    I’d say this last group is more motivated by the culture of alarm that we seem to have these days than anti-establishment views.

  19. MaikUniversum says:

    Questioning authority is always a good think, but this thing doesn’t like…well, authorities. What should be pointed out, that we should question that authority with critical thinking, rational and logical arguments, not just assume some conspiracy etc.

  20. StatlerWaldorf says:

    Well, I find myself in the position of being skeptical about following the herd when it comes to medical issues because I am an individual. I realize that there are times where cookie-cutter one-size-fits-all treatment covers me well, but I fear there may be times where I am seriously harmed if I don’t look out for my own individual needs for care. Malpractice happens, and medical personnel get slack when they churn so many patients through their standard procedures. I also perceive birth differently, because I don’t feel like it has to be a medical procedure for all women, as can be seen by the large number of women who can birth without problems. Girls should not be taught that birth is unbearably painful, negative, frightening, and dangerous, and one is lucky if they have a good birth. That was the attitude I had as a girl, and it was very far off my own birth experiences. I appreciate that modern medical care saves lives and don’t think that modern medicine is evil or useless, but there are other factors driving current medical practices that are not necessarily based on every individual getting the best treatment. Money is to be made in medicine, and this has a negative impact on the care that is provided.

    Look at these machines that two companies would love to see attached to every woman and baby in every labour and delivery ward in the US and worldwide. They are called LabourPro (http://www.trigmed.com/index.php?page=labor-about) and BirthTrack (http://www.birthtrack.com/products/technology.html). These are machines with monitors that are attached to the mother’s cervix and screwed into the baby’s scalp to measure cervical dilation and head station etc. Is this really making birth better and safer for women, or is it just a great money-maker for the companies and saves hospital money on resources. What kind of standards do these machines set, and how will it affect the way women birth now and are expected to birth in the future? Can you see the problems with this kind of technology?

  21. Dawn says:

    I believe that you should work WITH your doctors, but respect that they have more knowledge than you in regard to certain things. As a midwife, I am quite comfortable with dealing with my current peri-menopausal symptoms by using only certain medications as needed. My Gyn and I discussed several different treatment options, he gave me samples or prescriptions and allowed me to make the decision on what to try /not to try.

    Working with my orthopedist is different. My knowledge of musculoskeletal issues (especially shoulders) is very basic. We worked out a treatment plan which we have been implementing over the pasy many months. He has told me frankly that I won’t be “cured” without surgery probably (in rare cases, my type of injury, being small, may heal on its own). However, we have worked on alternatives (NSAIDS, therapy, exercises, injected steroids) and, as long as I am stable and willing to live with the occasionally severe pain, he leaves the decision up to me.

    I respect their knowledge where it is greater than mine. I do know my body and my tolerance for menopausal sypmtoms and pain better than they do. So, we work together. However, if either of them said I needed a specific treatment, (like the shoulder surgery) because the risk of not having it is greater than the risk of doing the surgery, then I would accept their expertise.

  22. Fifi says:

    To be entirely fair and real about “reflexive doubt”, it’s not something exclusive to believers in CAM and other forms of woo. (Besides, it’s not like most climate change denialists or anti-vaxers are actually anti-authority, much as they think putting on an “alternative” labels makes them such. They’re usually just appealing to an “alternative” authority – in the case of climate change denialists pseudoscience bought and paid for by oil companies, in the case of anti-vaxers and much CAM it’s various MDs who’ve morphed into quacks who promote pseudoscience. In the case of the religiously motivated, it’s the authority of a holy book or a God. All these count as appeals to authority. That’s the big irony, many of the people who get sucked into Big sCAM are actually just repeating marketing propaganda. Some people who think merely being contrarian or against something is actually thinking critically just don’t understand critical thinking – and mistake “critical” to mean “negative” or “anti” when critical thinking also involves positive critiques and affirmations. Some are just pretending to be skeptics – Scientologists, who are behind a lot of Big sCAM propaganda, are trained to do this kind of thing, lying to non-Scientologists is part of their official doctrine and strategy.)

    To keep this based in reality, some medical professionals react exactly the same way about CAM and aren’t adequately skeptical about their own confirmation biases or the influence of industry on medicine and science. It’s understandable to do so, however it’s still being just as reactionary and is still “reflexive doubt”. This is why being able to say “we don’t know”, “we need to study this more” and “so far the best evidence suggests but there’s more research to be done” is so incredibly important when it comes to science and medicine. It may not be a comfortable position to be in, particularly when dealing with ideologues who claim to be certain and make appeals to “alternative” authorities and pseudoscience, or when attacks feel personalized. (Or when dealing with patients who want certainty and will resort to those who promise false certainty if science, medicine or their doctor can’t provide it.) However, if we don’t respect the limits of our collective and individual knowledge and become ideologues ourselves (and trade in our curiosity for the warm fuzzies and ego gratification of false certainty) we’ve already lost the battle between science and pseudoscience (and reality-based thinking and fantasist thinking). It really isn’t about sacrificing science at the altar of absolute certainty, it’s about fostering the understanding that science isn’t the same as religion but it’s the best tool we have for discerning reality when practiced in an ethical and unbiased way. This is why it’s so very important to keep corrupting influences – whether they’re ideological or commercial – out of science and SBM.

  23. Dawn says:

    Holy CRAP, StatlerWaldorf! That’s perfectly scary! But, all I can see those doing are causing more csections because the woman isn’t dilating at the rate the machine thinks she should, because she’s not really in labor. But, given that we have one hospital in the area with a 95% epidural rate, 45% Csection rate, and 1 nurse to every 3 patients, I can see them using it so they can have fewer nurses to care for patients.

  24. Fifi says:

    The vast majority of CAM is bogus but there are the occasional things that emerge from leftfield that aren’t – particularly in the realm of subjective experience such as chronic pain and psychology – meditation as a means of managing chronic pain is one. One doesn’t need the woo around it for it to work, it’s just about cognitive training and neuroplasticity. However, it’s worth keeping in mind that the scientific orthodoxy for a long time was that the brain didn’t change. It wasn’t until we developed tools to look at the brain that we started to begin to understand the true nature of the brain and mind. This doesn’t mean that all the religious connotations or beliefs regarding meditation are correct – in fact cognitive science has shown how they’re often incorrect and a result of cognitive glitches – it just means that reflexive dismissal of something (not doubt but dismissal) isn’t a very scientific approach. A lot of CAM advocate sand anti-SBM types – and ideologues in general – seem to be actually practicing “reflexive dismissal” rather than “reflexive doubt”. Doubt leaves room for exploration and curiosity, dismissal is a form of reactionary denial.

  25. micheleinmichigan says:

    # bluedevilRAon 28 Jan 2010 at 8:51 am

    “I always get a kick out of the “I know my own body better than the doctor” notion. Everyone knows their body to some extent, but the reason you go to the doctor is because something is not quite right with your body. You go to see the one profession that specializes in knowing human anatomy.”

    Just to be contrarian… I’ve been surprised to see the “I know my body” or “I know my child” approach criticized a few times in comments here and respectful insolence. I guessing there must be people who use it to an annoying degree.

    But, when a friend has a baby, that is always the advice I give them. “you know your child, if you think they are really sick or something is wrong take them to the doctor. If you feel you are being blown off, take them back or go to a different doctor.”

    Reasons. The time my daughter had an ear infection and fever that went away and then came back two days later with a weird lethargy. Had to insist on seeing a doctor because the call nurse thought it was just a virus. But it was pneumonia.

    A classmate of my son’s was found to have mild CP in his legs, but only after her pediatrician told her not to be concerned when he wasn’t walking at age two, come back in 6 month and we’ll check on it again. She went to another doctor for diagnoses and found that he needed leg braces to learn to walk.

    I don’t want to portray nurses or doctors as incompetent, uncaring, etc. I think the large majority are knowledgeable and committed. But as the patient or parent you have to deal with the chance that you are consulting with someone who is incompetent or mistaken AND you have to do it without being an expert in the field. I have found the “I know my body or my child” approach and internet searches to be helpful in that regard.

  26. StatlerWaldorf:

    “I find myself in the position of being skeptical about following the herd when it comes to medical issues because I am an individual.”

    That’s a twofer! You are an individual (in other words an expert on yourself) and you don’t follow the herd as if doing what others do is constructed as a negative exactly as Hobson-West described (” [they] construct trust in others as passive and the easy option. Rather than trust in experts, the alternative scenario is of a parent who becomes the expert themselves, through a difficult process of personal education and empowerment…)

    “Look at these machines that two companies would love to see attached to every woman and baby in every labour and delivery ward in the US”

    That’s yet another tactic of believers in “alternative” health.

    It usually takes the just the form that you chose:

    “Look at this folks. This is what they want to do to everyone. Isn’t it appalling? If they want to do THIS, you simply can’t trust anything they say.”

    So that’s three tactics from the playbook for “alternative” health advocates, all of which confirm what I wrote above: “alternative” health is about the believers and how they would like to see themselves, not about science. People are divided into those (inferior) people who are passive and blindly trust authority figures and (superior) rejectionists who are “educated” and “empowered” by taking “personal responsibility”.

  27. Fifi:

    “To keep this based in reality, some medical professionals react exactly the same way about CAM and aren’t adequately skeptical about their own confirmation biases or the influence of industry on medicine and science.”

    No, that’s an inappropriate comparison.

    Being skeptical about claims and evidence is science; being skeptical of medical advice because it comes from doctors is reflexive doubt.

  28. bluedevilRA says:

    michele, I would say this is analogous to the skepticism vs. reflexive doubt discussion that is also going on. On the one hand, you must be skeptical. You can always question what a person says, particularly when the claim seems unreasonable. This is healthy skepticism and its completely different from reflexive doubting or contrarian thinking. Just as there is a healthy degree of patient empowerment (the ability to ask your doctor questions about your diagnosis, seek a second opinion, etc.) versus the “I know more about my body than a doctor could ever determine in 10 minutes.”

    I agree with you that certainly a patient or parent can know more about what’s going on than the doctor. That only makes sense. You have a direct comparison of baseline behavior to sick behavior. Doctors rely on the patient or parent’s subjective information to help form the diagnosis. My complaint is that some patients reject the doctor regardless of what he/she says. It is an absolute stance they take. “The doctor can NEVER know more about my body than I do.” It’s a ridiculous position.

  29. “Just to be contrarian… I’ve been surprised to see the “I know my body” or “I know my child” approach criticized a few times in comments here and respectful insolence. I guessing there must be people who use it to an annoying degree.”

    It all depends on why it is invoked. The most important thing I learned from my medical school pediatrics rotation was this: If a mother says something is wrong with her child, something is wrong until you prove everything is perfect.

    That’s very different than the way it is invoked by advocates of “alternative” health, which is: I know my child therefore I am an expert in what type of medical care my child needs or does not need.

  30. SF Mom and Scientist says:

    micheleinmichigan – I see what you are saying, but I think the majority of the time parents are concerned about something that turns out to be nothing. I know this was the case with me. There were many times that I thought something was wrong with my son, only to be reassured by our pediatrician that everything was fine. (And in our case, luckily, he was right every time.) The internet can make you crazy with fear. I had a friend who was terrified because her son was not walking at 13 months, and she read on the internet that this was a sign of something terrible. (I can’t remember exactly what that something was.) Her doctor told her everything was fine, and she was convinced he was being incompetent. Of course, everything worked out fine in the end, but there was a lot of worry for no reason.

    Of course there is some good information out there, but the majority is crap, and you have to wade through the crap which is difficult.

    I think it is important to find a doctor you trust, and one that explains to you why something is/is not an issue, not just pat you on the head and tell you everything is fine. (All my doctors have always been good at explaining, but I hear about these other doctors.)

  31. Scott says:

    When we come across a claim for which we have no evidence one way or the other, our proper response is to withhold judgment – to doubt the claim.

    I would add to this. A proper skeptic, needing to make a decision on a matter for which he or she is unable (for whatever reason, lack of time being the most common) to fully examine the evidence, will provisionally accept the consensus of the experts in the field. The reasoning is that such consensus is a real form of evidence, and lacking counter-evidence, it is the best information available to the skeptic at the point of decision.

    The distinction is, of course, that anti-vaxers, etc. who find themselves in that situation reject the consensus of the experts. And not provisionally, either. It’s very much an irrational assumption that those who know the most about the subject must necessarily be wrong. Which makes it hard, in many cases, for a more rational thinker to comprehend.

    I’m also reminded of a House quote that really is spot on for this subject:

    Nonconformity; right… I can’t remember the last time saw a twenty something kid with a tattoo of an Asian letter on his wrist. You are one wicked free thinker!

    It’s really quite interesting just how conformist nonconformity tends to be.

  32. Fifi says:

    Dr Tuteur – “No, that’s an inappropriate comparison.

    Being skeptical about claims and evidence is science; being skeptical of medical advice because it comes from doctors is reflexive doubt.”

    Not at all. There are medical professionals who have a knee jerk reaction to anything outside of their own knowledge base or anything that is claimed by CAM as being CAM turf (lifestyle and environmental factors regarding disease, for instance). That kind of knee jerk reaction or “reflexive doubt” is not about science, it’s a personal bias. I’m sure you’re aware that simply being a doctor doesn’t make one automatically more science-based (though it would be nice if it did all the time but doctors are people and just as prone to confirmation bias if they’re not vigilant for it, particularly if they’re not also researchers so specifically looking out for biases). A great example of this are the doctors who peddle woo. There are extremists on both sides, just as there are practitioners influenced more by industry and marketing than science on both sides. I guess the flip side of the “reflexive doubt” coin is “reflexive faith” – a little bit of understanding of how our cognition works and how we have to be vigilant for our own biases goes a long way to defusing the dangers of ideological or reactionary thinking and opens us to truly taking a scientific approach which includes curiosity and being able to say “we don’t know (yet)”.

  33. micheleinmichigan says:

    bluedevilRAon 28 Jan 2010 at 11:37 am

    “My complaint is that some patients reject the doctor regardless of what he/she says. It is an absolute stance they take. “The doctor can NEVER know more about my body than I do.” It’s a ridiculous position.”

    Thank you for clarifying. I think I understand it better the second time around. My father was like that. He second guessed the doctors and self-diagnoses so much that ultimately he really undermined his care and pain medication level before his death from cancer. I genuinely don’t think he could help it. It seemed an integral part of his personality and any questioning of his approach (on the family’s part) led to outright rage.

    Dr. T.
    “It all depends on why it is invoked. The most important thing I learned from my medical school pediatrics rotation was this: If a mother says something is wrong with her child, something is wrong until you prove everything is perfect.”

    My new favorite rule. :)

    That’s very different than the way it is invoked by advocates of “alternative” health, which is: I know my child therefore I am an expert in what type of medical care my child needs or does not need.

    Also thanks for clarifying. Having worked as a graphic designer and ruined numerous beautiful designs based on the clients wishes, I try to remember that professionals (of all sorts) are not tools put on this earth to do my bidding. If I hire an expert, I try to respect their expertise and not “step on any toes”.

  34. Zoe237 says:

    Ha! I am hoping that not all doctors are like Dr. House, lol.

    Reflexive doubt does seem to be the standard position for a skeptic, whether the claims are being made by a medical doctor or a quack (or both). Claims have to be proven with evidence. If anybody is going to something “different” to my body that isn’t the natural default position of being, the benefits have to be proven to me, whether it be vaccinations, c-sections, IVs, CEFM, acupuncture, surgery, vitamins, drugs, or anything else. Some people are too quick to reject authority, yes, but for every one of those, there is another person who doesn’t speak up harshly enough to a medical professional who may be making a med mal error. Or yes, I have mom friends who had to be very firm to get a diagnosis for their kids when the pedi brushed them off.

    There are some interesting chapters in Michael Shermer’s “Borderlands of Science” about revolutionary science and the balance between openness to experience, conscientiousness, and agreeableness (trust is one). And these personality traits in various scientists throughout time like Copernicus, Darwin, Sagan, Brahe, Freud, Wallace, etc. Basically, you have to be somewhat open to strange claims (Carl Sagan was a big proponent on SETI), but not so open your brain falls out (as in Freud or Wallace).

    IOW, I agree with the distinction between reflexive doubt and contrarian, the latter is a bit better description.

  35. lizkat says:

    [It is just a mindless rejection of authority, with potentially devastating consequences.]

    Mindlessly rejecting authority is foolish, of course. Doing anything mindlessly would be a mistake. But mindfully questioning authority is one of the best things we can ever do. When patients think “I didn’t go to medical school and my doctor did, therefore I will trust and believe anything he/she tells me,” they are underestimating their own intelligence. Although the details and the terminology are often incomprehensible to the non-medical public, the general ideas can usually be grasped. And anyone willing to spend the time can learn some of the details and terminology as well.

    It’s important to remember that medical school does not teach all there is to know, since there is a vast amount of medical knowledge and no one can learn it all. And even if it were possible to learn all there is to know in medical school, or in years of practice, the fact remains that most things are simply not known yet.

    So however long you spend in school, and however long you practice, you will never know it all. Most of your patients’ problems will go unsolved. That’s just the way it is.

    Patients really owe it to themselves to become informed, at least to some degree, about their problems. Maybe your doctor just doesn’t happen to know much about whatever is bothering you. Or maybe your doctor is too quick to write out drug prescriptions, or to recommend surgery.

    Each doctor has many patients, but we each have only one body. Not that doctors don’t care, just that their time is very limited. If I am sick I am highly motivated to find a diagnosis and cure. My MD, on the other hand, has hundreds of other patients to worry about.

    Yes, most emphatically yes, we should question authority. We are lucky to live in a free democratic society where questioning authority is allowed. It should be encouraged, not discouraged.

    I remember when hormone replacement was recommended to most women in their 40s or 50s. As soon as I heard about it I thought “that sounds like dangerous nonsense to me.” If I had been as trusting of authority as most people are, I would have been taking hormones.

    I am not an anti-vaccinist or a natural birth advocate, or anything like that. But I can certainly understand why people might want to look carefully at these things. Maybe some obstetric practices are less than ideal. If I were pregnant I would learn all I could about child birth and make an educated decision. I would not assume that my doctor knows all there is to know on the subject.

    There are nuts and fanatics of all types who believe all sorts of nonsense. It is easy to take anti-authoritarianism to ridiculous extremes, and that is not what I’m talking about. I am talking about being a SKEPTIC. Skeptics naturally distrust authority. We may respect authority, but we do not blindly trust it. We know that every authority or expert is a limited and fallible human being, and that groups of authorities and experts tend to become political.

    This blog is supposed to be about skepticism. It should be promoting, not discouraging, a healthy distrust of authority.

  36. “This blog is supposed to be about skepticism. It should be promoting, not discouraging, a healthy distrust of authority.”

    No, we should be promoting a healthy distrust of CLAIMS, not of authority.

  37. Zoe237 says:

    “I think it is important to find a doctor you trust, and one that explains to you why something is/is not an issue, not just pat you on the head and tell you everything is fine. (All my doctors have always been good at explaining, but I hear about these other doctors.)”

    Yes, this is the key. I have a good pedi and OB and orthopedia doctor, but I had to search to find them. There’s a lot of incompetence out there. I don’t trust a doctor just because he/she went to medical school- there are way too many quacks out there.

  38. rosemary says:

    I agree with Amy’s blog. However, I’ll go farther than her. IMO, there is also a very strong anti-male, radical feminist element involved in alt. med. which you find in many nurses, midwives and a some highly intelligent, articulate liberal arts majors. With limited time and space I can only give one example of what has led me to this conclusion. It has been cut and pasted from my webpage where it is presented in a different context.
    http://www.rosemaryjacobs.com/WellnessCenter.html

    Many of you will read a few lines quoted below and dismiss it as lunatic fringe. Oh if that were only true! Rosemary Gladstar is a herbalist who gives lectures to nurses for continuing education credit at the hospital affiliated with Dartmouth Medical School in NH. I have spoken to the nurse in charge of the program who insisted she believes Gladstar is very knowledge about botanical drugs. (I have also complained to the doctor who heads the hospital.) Gladstar has also lectured at my local hospital and I suspect that many of those in her audience were nurses.

    While I know that many, probably the vast majority, of nurses today are intelligent, competent, caring, well educated professionals, there is also a segment, the one embracing and promoting alt. med., which, I suspect for emotional reasons, rejects science and reason. I cringe at the thought of me or a loved one being incapacitated at night alone in a hospital with one of them.

    Here are some quotes from HERBAL HEALING FOR WOMEN by Rosemary Gladstar:
    In every culture throughout the world you will find a great body of folklore concerning the indigenous plants of that region and the wise women who used them. For thousands of years women collected plants from meadows and woodlands and used them to create healing medicines. They gathered herbs by the waning and waxing of the moon, artfully created preparations, and developed herbal formulas. Through an intuitive communication with the plants, women learned the healing powers of these green allies. Their wisdom developed over countless years as remedies were tried, proven, and passed on. The best of these remedies were added to the lore, and the wisdom was transferred from mother to daughter, from wise woman to apprentice for countless generations. This is the legacy we have inherited. Healers, wise women, simplers – these women were the center and source of medicine and healing for their communities. They understood the cycles of the seasons, the ebb and flow of the universe, the sun, the moon, the stars, and the natural rhythms of their bodies. p. 19
    Alchemy and magic are integral parts of herbalism and healing. p.24
    If a plant has been found safe and effective for a thousand years of human use, it may be wise to question the validity and applicability of the scientific tests now being used. There is generally some unidentified magic in the plant in the form of another chemical or an innate natural wisdom that allows the medicine, when taken as a whole, to function in a safe and beneficial manner. p.25
    I think herbs act in a particularly impressive way on women’s health because there’s a natural affinity between women and the plant world… They seem to heal on a cellular level. p.23
    END QUOTES

  39. weing says:

    When a patient comes to me it is because of a problem they have. They do not have my education and years of experience dealing with problems like theirs. I am their ally and adviser in dealing with their problems. They are always in charge. They are always free to see someone else.

  40. micheleinmichigan says:

    SF Mom and Scientist – Too true the internet can make you crazy and particularly in the first few years of the first child’s life it’s easy to get OCD about every little thing. I don’t want to give the impression that I think parents should take their kids to the doctor for every little thing.

    Everyone knows the parent who thinks Billie needs intensive speech therapy because he is mispronouncing his t’s at age 2.
    And that is annoying, hopefully a good pediatrician knows how to deal with that. Family members and friends can be helpful. But, knowing parents of kids who have special needs (hearing loss, facial differences, speech issues) I know some family and friends minimize even significant problems and give bad advice.

    I try to be pretty cautious about the internet stuff. I consult sites like familydoctor.org or mayo clinic which seem to give pretty mainstream advice. I am in yahoo groups for my son’s particular conditions, maybe these groups are above average, but they are particularly good helping you see when you’re worrying too much. I try to double check different sounding info from parents against the condition advocacy groups like the cleft palate foundation. But, from this blog and respectful insolence, I have heard about some of the autism internet groups that are very misguided.

    We have a great pediatrician who may be more cautious than me (some of the nursing staff is not great.) But, we deal with around 7-10 specialists for my son, some of who rotate or take a while to get to know, trying to get a second opinion on every test or procedure would be too weird and time consuming, thus the internet and groups. I have had one or two specialists that I second guessed or was unhappy with, but they were not emergency situations and with some watchful waiting and serious conversations they mostly worked out.

    I don’t know the answer on trying to find a balance. For me I think it’s a cautious feeling (Is this okay?) vs. a bad feeling (this is not right.) But that is NOT science based. Questioning within reasonable amounts AND being open to the answers is important too.

  41. Zoe237 says:

    “I agree with Amy’s blog. However, I’ll go farther than her. IMO, there is also a very strong anti-male, radical feminist element involved in alt. med. which you find in many nurses, midwives and a some highly intelligent, articulate liberal arts majors. ”

    I was wondering when nurses would be added to the “hate” list of midwives and liberal arts majors (aka new agey liberals?) on this website. ;-)

    I know you put the disclaimer in there, but plenty of doctors promote alternative medicine too.

    Nice website Rosemary!

  42. micheleinmichigan says:

    weing on 28 Jan 2010 at 1:28 pm

    “They are always free to see someone else.”

    To any of the doctors/health care providers/patients

    I’ve always wondered how a patient seeking a second opinion or switching doctors after a disagreement is really viewed by doctors. What if the only other “in network” specialist is in the same practice? Is that a slap in the face to the first doctor or uncomfortable for the second doctor? or no big deal?

    Should you send the first doctor a conciliatory note?

  43. bluedevilRA says:

    Lizkat has one skewed view of medicine. “the fact remains that most things are simply not known yet…most of your patients problems will go unsolved.”

    Where did you get that notion from? What “things”? Actual diseases or elusive, vague, non-threatening symptoms? No doctor is claiming to know everything or cure everything (except the quacks). It is precisely because medicine is so broad that we have specialists.

    We know much of the way the body works and how diseases progress. Although we lack good treatments for certain cancers, genetic disorders, and neurological/psychiatric problems, we are all the time progressing towards finding better treatments and cures. So why throw the baby out with the bathwater, which is what you are doing by trying to qualify that “most” diseases are untreatable and unknown.

    As others have pointed out, if this were an ideal world, then we would have all day to sit around and investigate claims to satisfy our skeptical minds. However, most of us don’t have time to do this so we consult the scientific consensus. This is not antithetical to being a skeptical. This is merely practical.

    michele, I think the doctors I work with just appreciate an explanation. Even one as simple as “I was concerned about the risks of treatment and I just wanted to get a second opinion before starting.” The more serious the problem, the more understandable this would be. They might even prefer you stay within the practice because they’re always afraid of losing the business. I think doctors would see a note as a nice gesture, but that’s just me.

  44. SF Mom and Scientist says:

    About second opinions – when I was pregnant a problem was found on an ultrasound, and I was actually told by the doctor that I should get a second opinion. I was surprised, but she said that these things can be tricky and it is best if I got another viewpoint. I’d like to think this means that doctors are becoming more comfortable with patients getting second opinions?

  45. EricG says:

    “Dear “Doctor Authority” — please kiss my a**.”

    oh hark the injured ego of someone who can’t accept that someone might know more than they do. i’m sure you wouldn’t be caught dead asserting your “expert opinion” in whatever field you might be an expert in. ;)

  46. Sastra says:

    I remember a lecture on parenting which I attended when I was a young mother. We women were told that, when we were undecided on what to do, we should go with our “instincts.” As mothers, we are deeply connected to our children, and have a special sense on what’s right for us. Listen to that inner voice. Trust it. And everyone nodded.

    But when I thought about it later, it made little sense — especially as a guide. It’s one thing if you know what you want to do, but someone is telling you to do something else. Do what you want. If you are genuinely torn between two choices, though, there had to be at least a little bit of “inner feeling” going in both directions. Part of you thinks it would be a good idea to let little Tommy stay up late and watch the special movie; part of you thinks that it will not be worth the next day of tired child. So which feeling is the “special instinct?”

    You identify it after the fact. If you are satisfied with your choice, you tell yourself (and others!) that you are sooo glad you trusted that special maternal instinct. And the mystique grows. If you are not happy with the result, you berate yourself for not listening to that little voice telling you it was wrong. And the mystique grows yet again. No wonder we can be secure that, deep down, we always know what’s right: it’s unfalsifiable.

    A useless concept, and a useless piece of advice. But oh, it made us feel better at the time. Empowered.

    Michelle B wrote:

    It seems types like Purdy have a hard time not caving in in front of authority so instead they put authority in the bad bag and badmouth all forms of it and avoid it because they do not know how stand up for themselves.

    I wonder if timidity is part of the reason that so many alternative medicine advocates seem to be terribly sensitive to any criticism, critique, or even disapproval of CAM. They want to feel empowered, and they can’t feel that way unless they are given nothing but support. Critical thinking, is criticizing them.

  47. Harriet Hall says:

    It might help clarify our thinking about questioning medical authority if we compared it to questioning the authority of the auto mechanic who tells you what is wrong with your car and what repairs are needed. Does reflexive doubt operate the same in both situations, or is there a double standard?

  48. lizkat says:

    “questioning the authority of the auto mechanic who tells you what is wrong with your car and what repairs are needed. ”

    Oh I could tell you some stories about that! So could everyone I know, for that matter.

  49. Galadriel says:

    Hey, I’ve seen doctors who were just as short, brusque (and frankly, incompetent) as Purdy describes. Not just followup visits, and someone suggests above, but even first-time visits with specialists. I had to chase one neurologist down the hall to get him to order the EEG that was the main reason my primary care doctor had referred me to him, because he was in and out so fast (and completely ignoring all his notes, evidently). It’s not just a lack of face time/bedside manner you get, I could list you quite a few things such doctors have done that were outright dangerous to the patient (or harassing, or simply incompetent).

    But you know…generally, what I do in these cases is to simply move on, find a better doctor. I don’t tell the doctor why I’m not coming back; for all the time and effort they’ve given me, it’s not like they’re going to even remember me anyway. When they’re primary care docs or specialists who are plentiful, just finding somebody else is relatively easily done.

    It’s not so easy if you have restrictive health insurance, though. It’s also difficult to just find another doctor if specialists in the field are not plentiful. I can really sympathize with someone if they’ve *had* to see someone like that, and ended up getting substandard–or flat-out wrong–care.

    (That’s not to say I have any kind of innate distrust of doctors. I’ve also had some downright fantastic doctors, and I adore most of the docs I see now. Just that the rotten ones ARE out there.)

  50. Fifi says:

    Sastra – “I wonder if timidity is part of the reason that so many alternative medicine advocates seem to be terribly sensitive to any criticism, critique, or even disapproval of CAM. They want to feel empowered, and they can’t feel that way unless they are given nothing but support. Critical thinking, is criticizing them.”

    Interesting point. Since CAM involves people, I think there are a wide variety of motivations for believing in it (just as there are wide variety of motivations for people becoming MDs or having absolute faith in medicine or doctors). Of course, as an atheist (born and bred) I’m not particularly big on faith (unearned trust). Trust is great, faith no so much!

    Some people are attracted to CAM because of warm fuzzies but one key feature of a lot of CAM modalities is that they seem to feed unhealthy narcissism. Ideologies are about identity construction, we start to mistake an idea for who we are, so any criticism of the ideology becomes a criticism of identity and a direct attack upon our ego. Of course, this can be equally true in other arenas and there are doctors whose whole careers are built upon feeding their client’s narcissism (or who are ideologues themselves). It’s not really very surprising that LA/Hollywood physician to the stars types so often fall into peddling woo. Or those who primarily service the very wealthy.

    It’s also not very surprising that advocates of woo are often found amongst the moderately well educated. Be it engineers who seem particularly fond of certain kinds of woo – to call out the patriarchal side of woo since the matriarchal side of woo has already been mentioned. I’d suggest that branding matriarchalism as feminism is a mischaracterization of feminism, mainly because most woo isn’t very feminist. Women aren’t goddesses that tap into magical knowledge, we’re people. Feminism is about women being treated equally as human beings, not about being placed on yet another pedestal!

  51. Harriet Hall says:

    I have my own stories about auto mechanics. My point was that both the mechanic and the physician have special knowledge and we ought to judge their recommendations by similar criteria.

  52. lizkat says:

    ” the mechanic and the physician have special knowledge and we ought to judge their recommendations by similar criteria.”

    I do. I am highly skeptical of both. I need them sometimes, but I question and compare. I wish I could work on my own car. I do work on my own health, as much as possible.

  53. lizkat says:

    And by the way, when my mechanic says I need something expensive, I check with Google. If I ever get sick (which is seldom) I do extensive research in the library and on the internet.

  54. mckenzievmd says:

    I think this is part of a larger cultural phenomenon that is a rejection of Enlightenment rationalism alltogether. In the U.S., faith is widely seen as an unquestionable virtue, and there is a deep suspicion of intellectuals generally. Just have a glance at Al Gore’s Assault on Reason, Chris Money’s Republican War on Science, David Colquohon’s comments on The Age of Endarkenment, Susan Jacoby’s The Age of American Unreason, and so on. On the right and among the middle and workig classes, science and intellectualism are held in great suspicion, and among the intellectual left notions of postmodernist relativism hold enough sway that it is hard these days to find anyone who openly supports the philosophical underpinnings of scientific medicine which emegred most recently in the Enlightenment.

  55. “but one key feature of a lot of CAM modalities is that they seem to feed unhealthy narcissism.”

    Indeed, t seems that they promoted in ways specifically designed to flatter the believer.

  56. “Does reflexive doubt operate the same in both situations, or is there a double standard?”

    There is double standard there, as in so many other areas where expertise is required. I don’t notice many people reflexively doubting the safety of tall buildings or the skills of airline pilots.

  57. mckenzievmd:

    “I think this is part of a larger cultural phenomenon that is a rejection of Enlightenment rationalism alltogether.”

    Sadly, I am forced to agree.

  58. EricG says:

    @ mckenzievmd

    couldn’t have it said it better. it reminds me of high school where being smart is inherently uncool and getting a C is an equivalent of being laid back, cool, “whatever” and easy going. its philistinism plain and simple…where that all comes from, you got me. it seems like a silly proposition to mire oneself in childhood norms when there is a big bold world out there to explore.

  59. Fifi says:

    mkenzievmd – “I think this is part of a larger cultural phenomenon that is a rejection of Enlightenment rationalism alltogether. In the U.S., faith is widely seen as an unquestionable virtue, and there is a deep suspicion of intellectuals generally.”

    It’s an attack on reality-based thinking. (I like the term reality-based thinking since that was the term being bandied around the White House regarding what they wanted to discourage and it makes it quite clear what’s really going on.) It’s coming hard and fast from both the left and right wing (and has now spread to Canada, Britain was infected long ago), and much of it is motivated by promoting corporatism rather than liberal or conservative values (and involves buying politicians on both sides). That’s why you’ve seen Republicans such as Orrin Hatch and Democrats like Kennedy reach across the aisle to support woo, and why you’ve got flaky new age types and Christian Fundies both promoting woo and supplements…not to mention the Scientologists and the weirdest players like General Stubblebine and Rima Laibow, who seem to be connected to all kinds of strange unreality-based things. It’s been quite remarkable (and horrifying) seeing exactly the same things start to unfold in Canada vis a vis corrupting public science (as well as dismembering the CBC and “commercializing” it into irrelevance, gagging climate scientists, etc). No doubt we’ll have Jesus riding dinosaurs in the Science Museum before long…sigh.

  60. rosemary says:

    @Zoe, “I was wondering when nurses would be added to the “hate” list of midwives and liberal arts majors (aka new agey liberals?) on this website.
    I know you put the disclaimer in there, but plenty of doctors promote alternative medicine too.”

    Zoe, first I don’t have a “hit list”. I am in no way affiliated with this site where bloggers incidentally debunk alt medders including those with MDs. I’m just a commenter like you and a liberal arts major at that.

    Second, do you have any idea how many MDs promote and practice alt. med. and how many nurses do? If so can you break the numbers down into categories to show how many practice wacky med as opposed to plausible but not proven med and how many practice really dangerous med using dangerous supplements and practices as opposed to the relatively benign kind such as recommending or selling inert or relatively useless but not dangerous supplements for which they can dig up some evidence of efficacy, like vitamins maybe or a practice like acupuncture for headaches where I assume, but am not certain, that they can dig up some studies indicating efficacy even though the body of evidence doesn’t indicate that it works while the likelihood of injury caused directly by the practice is quite small?

    I don’t have such numbers although I know some readers know how many nurses practice TT, Therapeutic Touch. If I remember correctly, the numbers are very high indeed, and it is certainly a “therapy” that I consider wacky, waving your hands over people to redirect their energy to heal them. I wonder if there are any doctors doing TT, not just letting nurses use it on their patients but doing it themselves. I’ve never heard of any.

    If there are institutions giving continuing ed credit to doctors to learn about botanical drugs from a herbalist who states that, “Alchemy and magic are integral parts of herbalism and healing,” and also tells people to go out and pick their own herbs while noting that she, the expert, once picked the wrong one herself and got sick, but luckily not too sick because the plant was only mildly toxic, I’ve never heard of them. If I had, I certainly would consider them just as dangerous giving continuing ed credit for such things.

    I think you said you teach the history of science. If so, I’d be most interested in hearing your comments on Rosemary Gladstar’s statements which I quoted above as well as what you think of a supposedly scientific institution that would offer continuing ed credits to people taking her courses. I would also be interested in knowing if you feel that she is promoting “women’s healing talents” as being superior to men for no reason other than that they are women.

    I may be very wrong, but I have the impression that most readers here consider alt. med. as a field that requires lower levels of evidence to support it than SBM has and that most of the medicine practiced falls someplace in between the two. Based on 15 years of intensive experience with alt. med., I think that is incorrect. I don’t think that alt med and scientific med are different breeds of cat. I think they are different animals. To paraphrase Marcia Angell, if I remember the name of the former editor of the NEJM, when scientific medicine lacks evidence, it considers that a fault to be remedied. Alt med. doesn’t feel the need for evidence.

  61. Sid Offit says:

    How could I have been so blind? All these years thinking for myself when there were experts(and marketing professors) to be listened to.

  62. pmoran says:

    An interesting idea. Reflexive doubt may help explain why those questioning the mainstream tend to gravitate towards the absurd.

    It’s a competitive pastime, perhaps? I have observed that within alternative cancer circles the viewpoint that your doctor is deliberately trying to kill you seems to score quite well and is rarely penalised

    Thus with vaccines, it is thus not enough to express some uncertainty as to the cost/risk/effectiveness of one or two vaccines, something that can be argued with some reasonableness.

    The “truth” evolves into vaccines killing people by the hundreds, while the doctors are trying to hush it up.

    And why would anyone think that they work, anyway? They clearly don’t, on the data we compulsive doubters have carefully selected.

    Most , I admit, stop short of Stage lV, where vaccines cause the very diseases they are intended to prevent, or are employed to spread other diseases, or to produce infertility.

  63. Zoe237 says:

    Rosemary, I have no idea. I do know that I left a GP a while back because she started selling natural supplements out of her office. In fact, all of the cases I hear of in the news are doctors promoting alt med. This is probably because they are just higher profile, and get more attention. My mother is a nurse practitioner, deals with a lot of bias from doctors, and is about the least into woo of any person I know. These are anecdotes though, I don’t know the real numbers. However, just because *some* nurses or *some* midwives or some doctors promote alt med doesn’t mean you can generalize about the group. There are plenty of quacks to go around. I mentioned before that Nancy Snyderman’s book (NBC medical correspondent) mentions that doctors like integrative medicine. Maybe it’s not true, but I tend to believe that the entire field of medicine is corrupted.

    I have to say that I LOVE the auto mechanic analogy. I think most of us would agree that it’s a bad idea to reflexively doubt OR reflexively trust an auto mechanic. The stakes are lower, but you might just end up pretty poor if you believe everything the dealership tells you is wrong with your car and the thousands needed to fix it. ;-)

  64. EricG says:

    Here’s something of tangengial interest. in researching a personality inventory for a selection battery, i came across this little gem of an abstract:

    “This paper reports two studies with similar methodology. Students completed the NEO Personality Inventory-Revised (NEO-PI-R; Costa & McCrae, 1992) and three different intelligence measures (Baddeley, 1968; Philips & Rawles, 1976; Wonderlic, 1992) soon after arriving at the beginning of their course. These scores were then related to a reliable graphological analysis of their hand-writing in exam scripts few months later (Study 1) and twenty-months in another (Study 2). Results showed that the 14 graphological variables factored into two interpretable factors called dimension (size, width, pressure, percentage used etc) and details (loops above, below, dotted i’s, crossed t’s). Correlation and regression analyses in both studies showed fewer associations with the Big Five personality variables than maybe expected by chance. Graphological variables did correlate with both participants’ gender and intelligence, but the pattern was different in the two studies reinforcing the idea that chance factors were influential. Thus, once again, despite attempts to use both psychometrically valid personality measures and reliably measured hand writing factors collected under non-self-conscious conditions there appears to be no robust relationship between graphology and personality.”

    Here we are in 2010 still dutifully providing credence to crank claims in order to make absolutely damned sure that handwriting has nothing to do with personality, intelligence, job performance or…anything. reminds me of continually providing evidence to the efficacy of vaccines whilst little contrary evidence ever rears its head, muc to the chagrin of other shovel ready research projects in need of funding.

    @Sid Offit

    “yes! if Napoleon says it, it must be right!” Puh-Leeez! save the straw men for some other board.

  65. micheleinmichigan says:

    Dr. H and mechanics.

    Well, with mechanics I only trust the ones that take me back into the shop and show me the malfunctioning parts, the worn rotors, etc. I dislike the ones that are dismissive of my reports of a strange symptom…I mean noise or dysfunction.

    A few differences are: When the mechanic repairs my car, usually all I have to lose is money. (With the exception of the time my Dad “repaired” my brake lines, which never happened again.) Mechanics receive a lot less respect and salary. But, there are NOT thousands of websites devoted to disputing established mechanic practices or touting alternative car repair. It least I don’t think there are. On the other hand a lot of people DO work on their own cars or at least used to before they became so computerize.

    The conclusion, SBM must implant patients with algorithm coded microchips and check engine lights, which we patients will all consciously ignore.

    The last difference is, of course, when a mechanic offers to give you the broken parts that he has replaced you think he is honest. When a doctor offers the same…

  66. “All these years thinking for myself”

    Ironic, isn’t it? You’ve simply been following the herd all along, just a different herd.

    I find the sociology of “alternative” health very interesting. It goes a long way toward explaining how believers in “alternative” health are resistant to evidence, and why they perpetually confuse defiance with being “educated.”

  67. “It’s a competitive pastime, perhaps?”

    It is within the “natural” childbirth community. The latest is unassisted birth, having a baby at home with no professional attendant of any kind. It’s nothing more than a self aggrandizing stunt.

  68. micheleinmichigan says:

    Sastra – regarding intuition

    You might be interested in one or two books I read years ago. They were Gavin De Becker’s, Gift of Fear and Malcolm Gladwell’s Blink. They are not scholarly works, but they are interesting in their views on human intuition.

    Both view intuition as a process where the brain is collecting data via the five senses, processing it unconsciously and quickly sending a feeling to the conscience mind. Somewhat how you might be turning to look at the blur in your peripheral vision before you thought about it. They are not spiritual or mystical.

    Becker, who has a security background, focus’s mostly the idea that many people intuitively recognize the signs of a dangerous situation (like a robbery in process) before they consciously do. But he also covers the fact that intuition not only fails but is under minded by reflexive anxiety.

    Gladwell, who is a science journalist, talks particularly about intuition’s strengths and weaknesses. The most successful times being people very experienced in a field, where observations have become so automatic that they become unconscious. I believe the times it often fails most spectacularly are when people have unconscious prejudices or are in highly stressed/emergency situations.

  69. StatlerWaldorf says:

    But you see Amy, you assumed. When have I said that I am more expert on myself than a medical professional running tests, using their medical knowledge etc.? What I want is someone to listen, and work with me on my own health concerns and those of my family. Yes, I do try to read up because I studied biology through to elective courses at university. I like to be educated on health/medical issues, but don’t think I know more than professionals in the field. My family and I have received poor medical care on many occasions and this is why it is good to be knowledgeable.

    I use osteopath and massage to treat my back issues because it works! I used strong muscle relaxants in the two cases where I had major spasms and could barely walk. Saw my GP for that of course. Any time my family members or I are sick we go to our GP. I always check the medicine package inserts for dosage, don’t just follow the sticker put on by doc or pharmacist in case there is a discrepancy. For pregnancy I see an ob-gyn and midwife. Because of mistrust with my former ob-gyn and falling through the cracks at the hospital with my first birth I chose ob-gyn prenatal care but a home birth with midwife for my second child (a great birth!). Recently I have become aware of an ob-gyn who supports natural birth and does waterbirths in a hospital setting, so if I have a 3rd that might be the way I will go. I selectively/alternatively vaccinate my kids, and choose the brands to use. E.g. No vaccinations at birth. No BCG at all, Hep B vaccine when there is a gap in vaccination schedule at around 3 yrs old. Prevnar and Infanrix 5-in-1 not given on the same day because of the combined aluminum amount, instead stagger those a month apart. H1N1 vaccine – chose single dose vials of a brand to make sure there was no thiomersal or adjuvant (and if that wasn’t available to me, yes, would likely not have vaccinated for H1N1 at all). We have never had any seasonal flu vaccinations and I just can’t see my family and I taking several flu shots every year for the rest of our lives (safety research for that?). I don’t see the sense in that, because it isn’t possible to rid the world of influenza.

    I don’t make these choices to thumb my nose at medical professionals or to feel superior amongst my mommy friends. Most certainly I am open to learning what is science-based and what isn’t and consider medical choices with that information.

  70. StatlerWaldorf says:

    Amy said, “It is within the “natural” childbirth community. The latest is unassisted birth, having a baby at home with no professional attendant of any kind. It’s nothing more than a self aggrandizing stunt.”

    Really? Have studies on unassisted birth shown that women do it as a “self aggrandizing stunt” or is that your own personal bias speaking.

  71. micheleinmichigan says:

    bluedevilRA and SF Mom and Scientist

    Thanks for the pointers on second opinions. Much appreciated!

  72. micheleinmichigan says:

    My new rule. I will only use reflexive doubt when talking to a mortage broker or telemarketer.

  73. rosemary says:

    Zoe, you can’t learn about alt. med. from the news. You have to talk to the practitioners and believers in person or on one of their forums. I’m pretty sure a person as rational as you appear to be will be astounded by what you learn. I certainly was. And it isn’t about homeopathy or chiropractic. It is about selling “dietary supplements”, the fuel that feeds the industry for the big players, not the small true-believers they feed on. It is about money not health. It is about conmen and the gullible people they prey on.

    You said, “just because *some* nurses or *some* midwives or some doctors promote alt med doesn’t mean you can generalize about the group,”

    I didn’t generalize about the groups. I said, “While I know that many, probably the vast majority, of nurses today are intelligent, competent, caring, well educated professionals, there is also a segment, the one embracing and promoting alt. med., which, I suspect for emotional reasons, rejects science and reason. I cringe at the thought of me or a loved one being incapacitated at night alone in a hospital with one of them.” But you dismissed that as a “disclaimer”. I realize that communicating on the Internet is tricky at best, but I really meant that when I wrote it.

    I also am sure that if your mother is an NP that she has found many doctors who are a real pain. I certainly have met a few as a patient, and I have not hesitated to tell them off in no uncertain terms.

    In my experience, which is anecdotal, while many doctors who believe in scientific medicine do practice the unscientific kind, they do it for different reasons and they do it cautiously. Some do it for the profit. (I’ve always said it should be illegal for anyone treating patients to sell them the products they recommend. Such a law would put most quacks out of business very fast.) Others succumb to the pressure from patients and society as a whole. Others do it because they think that it calms and relaxes patients which makes it easier for them and more pleasant for the patient. As an example, when someone with a cold demands an antibiotic, some doctors who know it is not warranted will find it easier to talk the person into taking vitamin C instead. Some will sell it to him for the money and because “it won’t hurt and he’ll just buy it from someone else anyway.” That is bad in my book but it is at least rational. Thinking that you can wave your hands over people and redirect their energy is not rational as far as I’m concerned.

    Perhaps no one reads my comments. I find it astounding that the majority of the people here could read the Gladstar quotes I posted, learn that she lectures nurses at Dartmouth for continuing ed credit where they believe she is knowledgeable about botanical drugs and not have the same visceral reaction I had. As far as I am concerned this is in a different category than pushing vitamin C instead of an unwarranted, possibly harmful, antibiotic.

    If you ask your mother to look at the Gladstar quotes and also ask her about nurses practicing TT I’d be most interested in hearing what she says.

  74. “Perhaps no one reads my comments. I find it astounding that the majority of the people here could read the Gladstar quotes I posted, learn that she lectures nurses at Dartmouth for continuing ed credit where they believe she is knowledgeable about botanical drugs and not have the same visceral reaction I had.”

    I read your quotes and I share your reaction. It’s just that iI no longer find it surprising because I’ve seen similar things so often. In certain circles of midwifery, things are even worse.

    In some midwifery programs certified professional midwives (the midwives who don’t have a college or a nursing degree) take courses in “gem energy” and “flower essences.” Then they are surprised that no one takes them seriously.

  75. Zoe237 says:

    “I find it astounding that the majority of the people here could read the Gladstar quotes I posted, learn that she lectures nurses at Dartmouth for continuing ed credit where they believe she is knowledgeable about botanical drugs and not have the same visceral reaction I had. ”

    I read them, and I’ve read similar before (I have a colleague who actually trained with her and espounses the same religion). I just don’t have any reaction against nurses when I read it. The wellness center you spoke of, at North County, is run by doctors turned administrators, I’m assuming. I don’t know for sure, but I’m betting that there is a similar trend in my local hospitals. Other classes they have at that hospital wellness center include reiki, inspirational journaling, and “your heavenly future” (woo boy!). Like I said, I think you let doctors off the hook too easily.

    If we’re going to villify doubt and glorify trust in doctors, then people could just as easily trust Dr. Weil, Chopra, Oz (etc etc etc), or the GP of mine who started selling herbal supplements. I don’t buy it. But you’re right, as a teacher and a liberal arts one at that, every bone in my body says “question and doubt” whether it is an authority or not. So I guess I’m biased.

  76. Zoe237 says:

    Oh to add, with people against childhood vaccines, the problem isn’t that they are questioning doctors, it’s that they are coming to the wrong conclusions for some reason. They are replacing one authority with another completely unqualified authority.

    A big part of it is fear, part of it is not knowing how to objectively evaluate sources (wikipedia is no good, neither are celebrities), part of it is trust in anecdotes (knowing people with autism, not knowing anybody with measles) and then confusing correlation with causation (18 month shots, autistic kids within a few months). Part of it is a lack of understanding how vaccines work and the process of science. Part of it is this huge push in ALL parts of society against technology (even as we embrace our ipods and ipads); the pendulum is swinging. It will swing back though.

  77. StatlerWaldorf, what evidence did you use to design a superior immunization schedule to the one recommended by the American Academy of Pediatrics?

  78. StatlerWaldorf says:

    Alison Cummins, I don’t live in the United States and am not American. Is there such thing as a superior immunization schedule? For example, is the one recommended by the American Academy of Pediatrics superior to those found in European countries? If I did hijack the topic with a long explanation about my vaccine choices, would it matter? Anything other than what the AAP has recommended would be seen as non-science based. :)

  79. BillyJoe says:

    Regarding second opinions:

    In my opinion, second opinions are largely a waste of time. Of course your opinion on this may differ. But which of our opinions is correct? And that’s my point:
    Look at it this way. Why do you get a second opinion? Is it because you don’t trust the first opinion or because you don’t trust the doctor giving it. If you don’t trust the doctor giving it then you need a new doctor, not a second opinion. And what happens when you get your second opinion. If the second opinion agrees with the first, will you be happy? Or perhaps the second opinion was as wrong as the first (same school, same drug company rep, same mentor). Worse still, what do you do if the second opinion is different from the first? Flip a coin? Get a third opinion? And what then?

    On the other hand, can you just accept blindly what is recommended by your doctor?

    When my father developed prostate cancer, the opinion was that I should have a prostate test. Just before doing so, I coincidentally discovered, through a link to an article I happened to read on line, that the RACGP do not, and have never, recommended prostate cancer testing. I investigated further and discovered that this advice was indeed evidence based. And more recent large clinical trials in America and Europe seem to back up their opinion.

    I don’t know the solution to this problem.
    I don’t have the inclination nor the time to investigate every medical problem as thoroughly as I investigated prostate cancer testing.

  80. StatlerWaldorf says:

    I said, “Look at these machines that two companies would love to see attached to every woman and baby in every labour and delivery ward in the US”

    Amy replied, That’s yet another tactic of believers in “alternative” health.

    It usually takes the just the form that you chose:

    “Look at this folks. This is what they want to do to everyone. Isn’t it appalling? If they want to do THIS, you simply can’t trust anything they say.”
    ——————————————————————-
    Amy, where did I say that “they” (obstetricians or medical staff?) could not be trusted because two companies produce such machines? If you will note, I said the COMPANIES would love to see these machines attached to every woman and baby (so good for mom and baby and docs, and great money for them!). It remains to be seen if maternity departments feel the same way about such machines. If this technology is viewed as an invaluable tool in obstetrics, then perhaps it will have a very high uptake and women in the future may not be giving birth without it. What is your view on these machines?
    ——————————————————————–

    Amy said, “So that’s three tactics from the playbook for “alternative” health advocates, all of which confirm what I wrote above: “alternative” health is about the believers and how they would like to see themselves, not about science. People are divided into those (inferior) people who are passive and blindly trust authority figures and (superior) rejectionists who are “educated” and “empowered” by taking “personal responsibility”.”
    —————————————————————————–

    Well, seems you’ve got us all pegged.

    Amy, what kind of feeling do you get when you post your articles on here and your infamous blog… you wouldn’t by chance be feeling superior to all of us nitwits who don’t have medical degrees or PhD’s in science and yet dare to question medical authority? ;)

  81. StatlerWaldorf, Cool! I’m not american either: I’m Canadian. Where do you live?

    I referred to the AAP because I made a faulty assumption that you were american. Sorry. So I’ll rephrase my question: what evidence did you use to design a superior immunization schedule to the one consensus science recommends for your country? I’m not asking you to repeat it all, just to cite your sources.

  82. overshoot says:

    For example, vaccine rejectionists tend to be evidence resistant; it makes absolutely no difference what the evidence shows. Instead they claim virtue and “education” in simply questioning authority.

    It’s not “questioning” if you never pay attention to the answer.

    What you’re describing is the nominally adult version of the preschooler’s continual “why?” It’s not a question, it’s a power play to take over the conversation.

    What you’re describing sounds a lot more like oppositional defiant disorder, where it doesn’t matter what the “authority” says, the subject knows it must be wrong. Exercise? Gotta be bad for you. Limiting sugar? Sugar must be good. Salt? Salts must cure everything. Etc.

  83. “Amy, where did I say that “they” (obstetricians or medical staff?) could not be trusted because two companies produce such machines? If you will note, I said the COMPANIES would love to see these machines attached to every woman and baby”

    It makes no difference. You inserted a non sequitur into the discussion for exactly the reason I described: “If they want to do THIS, you simply can’t trust anything they say.”

  84. micheleinmichigan says:

    # BillyJoe – regarding second opinions

    I would say that our approach to second opinions is very similar. Not sure if your post is in response to mine (second opinion etiquette) or anothers.

    Within my framework the “second opinion” could be more of a tentative switch in doctors. I was thinking of a situation I had once. There were mis-communications between the doctor, nurse (who relayed test results and procedures to me) and I. I also had my doubts on the doctor recommendations, when I understood them. Looking online, it seemed like many patients with the same condition were receiving more testing before drugs or procedures were recommended.

    I did met with the other specialist in the office (due to insurance) with the intent that I may or may not switch. Sometimes a different person can explain something in a different way and things become more clear. It seemed the communication would be better with the second doctor but overall his recommendation would be the same (like you mentioned in your post).

    I was in the rare situation that declining treatment would not negatively effect my health, so that is what I did. Six months later I found I had auto-immune thyroid inflammation. This might have been revealed if the doctors did more testing or maybe not. Auto-immune diseases being quite funky things.

    Other reasons I can see for seeking a second opinion could be as follows.

    To clarify a difficult diagnoses or get a fresh set of eyes on a ongoing problem (like having a proofreader). I have heard about this being advantageous in long term or undiagnosed illnesses.

    To investigate a different approach (certain surgeons have different methods to correct a problem, with different advantages or disadvantages). Some surgeons specialize in a particular, newer, less invasive procedure.

    When you suspect that you doctor’s recommendations might be out of the norm or there are serious disadvantages to a procedure that he/she is not revealing. I think in this case it would be better to leave the practice or go to another hospital for a second opinion so you are getting a different school of thought.

  85. micheleinmichigan says:

    Again second opinions.

    Just wanted to add. I often hear this rule “ALWAYS get a second opinion”. If you only seek medical care once every 5 years, that might work. Otherwise, I think that is incredibly impractical.

  86. rosemary says:

    @ Zoe, “The wellness center you spoke of, at North County, is run by doctors turned administrators, I’m assuming.”

    Your assumption is quite wrong. The center is run by women who have no training in health care or science. Actually, I’m not even sure that doctors run the hospital today.

    Zoe, “If we’re going to villify doubt and glorify trust in doctors, then people could just as easily trust Dr. Weil, Chopra, Oz (etc etc etc), or the GP of mine who started selling herbal supplements. I don’t buy it. But you’re right, as a teacher and a liberal arts one at that, every bone in my body says “question and doubt” whether it is an authority or not. So I guess I’m biased.”

    I agree that you are biased but I think it is against doctors because your mother, an NP, has had professional problems with them. I think your bias is apparent in your responses to Amy on other threads. Please note, I am not sure that this is true. There is no way that I can know that for sure. I just suspect that it is. And I suspect that it is similar personal biases that elicit such strong emotional responses to her blogs from others here.

    A few of the reasons for my guess about you are that in the link to my webpage I never included the word “nurse”. I did write, “If only my doctor had done that, I wouldn’t be gray today.” On the introduction page http://www.rosemaryjacobs.com/ I wrote, “If my doctor had read the medical literature instead of the ads I wouldn’t look like this today.”

    Yet despite this you state, “If we’re going to villify doubt and glorify trust in doctors, then people could just as easily trust Dr. Weil, Chopra, Oz (etc etc etc), or the GP of mine who started selling herbal supplements. I don’t buy it. But you’re right, as a teacher and a liberal arts one at that, every bone in my body says “question and doubt” whether it is an authority or not. So I guess I’m biased.”

    I have most definitely stated that it was my naive doctor who disfigured me on the page I linked to and I never mentioned the word nurse there. I mentioned nurses in a comment here because it was nurses at what is usually considered an outstanding medical institution who were giving continuing ed credit for Gladstar’s classes and stating that they believed she was a reliable source of info on botanical drugs, something I didn’t know when I posted the article on the Wellness Center.

    If you were to read all the material on my website, and I surely don’t expect you to do that, you would see that my one reference to a nurse was quite positive. She was the one, a nurse/nun/pharmacist who originally diagnosed me.

    I believe that I have actually posted here about Weil noting that he he is setting himself up as the “wellness brand” just like Martha Stewart sets her self up as the “style brand”. (I’m not saying that very well. I think I said it better then.) While I don’t think you were reading the blogs when I posted that, you are now certainly assuming that I never criticize Weil or doctors which is most certainly not true.

    I have also stated in a comment regarding your doctor selling supplements that I believe that should be illegal. That is another thing I’ve stated repeatedly on public forums. Yet you disregard all that and conclude that I am favoring MDs and being unfair to nurses while at the same time equating selling of what are usually inert supplements to the selling of the dangerous ones and the promotion of the idea that when scientific studies don’t demonstrate what we want them to that they must be wrong and should be disregarded.

    The one message I try insistently to get out is, “Don’t believe the experts. Look at the evidence.” However, I include in that the entire body of evidence which includes expert experience and opinions.

    I believe I’ve been accused of being overly sympathetic to Amy on another thread. (Not the right words which escape me now.) Well I guess that is correct. From her statement above it appears as if she has been forced to practice medicine with wacky people who reject science and reason and that she has been forced to try to alert unsuspecting pregnant women to the inaccuracies and dangers of what they preach while at the same time being personally attacked by educated rational people who are biased against her because she is an MD or for other personal reasons.

  87. rosemary says:

    Statler, do you believe that doctors, midwives or nurses have the right to refuse to do procedures that they either find too risky or are uncomfortable doing because they feel they lack the requisite skills? Or do you think they should be required to do whatever patients want?

    Micheleinmichigan, an aside about Gavin De Becker’s, Gift of Fear. I read it many years ago. If I remember correctly, he spoke there about a new social phenomenon in American society in which previously “well behaved” young ladies, American teenagers, started jumping and screaming at Sinatra’s concerts, something psychologists where trying hard to explain and coming up with theories about. I think they may even have given it a name.

    A school friend used to say that her mother would tell a story about walking past a theater in NY as a teenager with a teenage friend. Someone working for Sinatra stood outside and gave them money, a dollar I think, to go in and jump and scream.

    As I said, I’m not sure my details are correct, but when I read DeBecker I thought, I wish psychologists did more investigating and less theorizing.

  88. The concept of endarkenment is incredibly depressing. So besides SBM and other science-based sites, how do we change the culture?

    RE questioning authority/second opinions: I recently wrote about an experience with a medical person (an orthotist) who tried to coerce me into accepting inappropriate treatment for one of the Little Anthropologists. He tripped my BS alarm by making a colossal right/left type of mistake and then bringing me his notes when I pointed out the mistake. His notes clearly stated “Right.” The painfully obvious empirical reality is “Left,” and a cursory glance at my child confirmed that. He then bombarding me with appeals to authority, red herrings, straw men etc. rather than just answering my clarifying questions by providing evidence.

    I sought a second opinion simply to have multiple independent lines of evidence for the proposed treatment, and found a far better treatment option. Supernova better. Supported by lots of peer-reviewed literature and clinical trials.

  89. cha says:

    I vaccinate my kid and take her to mainstream medical doctors. But for my birth I chose a midwife.

    Midwives have much lower rates of C section and lower rates of epidural use than ObGyns. They stay with you throughout the birth process. They know how to ease pain and guide the mother through labor. Some skilled ObGyns also know how to do this, and individually have low C section rates.

    More recent example of empirically unsubstantiated–but still all too common-practices by ObGyns include routine epesiotomies, only recently shown in the NEJM to do no good, on the whole. And other studies have shown no benefit from denying a woman nutrition during labor.

    To disparage an entire field of professionals without even citing data properly is unscientific and arrogant. And to do so without even defining the group you disparage, “natural childbirth’ is imprecise. What is ‘natural childbirth” according to your definition?

    This attitude against midwifery and low level of intervention gets in the way of good care for women. I was lucky to give birth in what i feel is the optimal setting: a birth without drugs with a caregiver who was with me 24/7, who happened to be a midwife, and in a hospital setting in the case of emergency. If more obgyns accepted this system, i suspect the rate of c section in US would plummet from its exceedingly high rate near 30 percent. And fewer women would chose the probably less safe option of home birth, if they could get midwife care in a hospital. Something is clearly wrong with the ObGyn field.

  90. Fifi says:

    Rosemary – “I believe I’ve been accused of being overly sympathetic to Amy on another thread. (Not the right words which escape me now.) Well I guess that is correct. From her statement above it appears as if she has been forced to practice medicine with wacky people who reject science and reason and that she has been forced to try to alert unsuspecting pregnant women to the inaccuracies and dangers of what they preach while at the same time being personally attacked by educated rational people who are biased against her because she is an MD or for other personal reasons.”

    Hmmm, it seems that since Dr Tuteur started posting here that there’s been more misunderstandings between people who support SBM and are not actually that far apart on many issues (apart from our perspectives on Dr Tuteur). I’d suggest a lot of this has to do with the way Dr Tutuer communicates and treats any criticism as being hostile and considers those of us who question her as being supporters of woo. For my part, I’ve often agreed with you Rosemary and still do on many matters – apart from Dr Tutuer’s integrity in matters of SBM and communication.

    No offense intended but if you’re going to get on people’s cases about being honest about our own biases and explanations of why we find Dr Tuteur’s blogs here problematic, then please at least acknowledge that “being overly sympathetic” is being biased! Apply the same terminology and standards to yourself please :-) My parents are doctors, I have no anti-doctor bias (quite the opposite). I DO expect better from women in science and medicine in regards to women’s health issues, and I acknowledge that this may be unfair. However, I’d find Dr Tutuer offensive and not actually promoting SBM if she was a man too. Clearly you believe Dr Tutuer has been victimized in some way. However, it’s not even clear that Dr Tutuer has even practiced medicine for a long time (her bios all seem to indicate she’s been teaching and that she left practicing when her children were born quite some time ago, of course she may simply have posted incomplete or inaccurate bios and that may not be the case…she never did clarify when it was brought up).

    Really, I’m not surprised this has become mainly about Dr Tuteur’s personality because of the way she communicates, the way she has taken on an ideological and highly personalized position in so many of her posts, and the way she treats any questioning of her authority as being an attack on SBM. Add in the fact that she’s made more posts here in a week than most other contributers make in a couple of weeks and seems to relish any and all attention – and has become the queen of constructing strawmen and accusing supporters of SBM of being woo supporters – and it really starts to seem like she’s not actually interested in SBM but just into stirring up controversy to get attention.

    Btw, from what I’ve read no one was actually criticizing Dr Tuteur for discussing the dangers of woo. My critique was of trying to pretend she’s presenting SBM when she’s not presenting all the science to be considered (she cherry picked in both the breech birth and circumcision threads) and does so in an emotionally charged way, and the way she communicates is tactically the same as the promoters of woo.

  91. Zoe237 says:

    I should have been more clear- the wellness center is approved by the trustees of the hospital, of whom some are doctors.

    Rosemary, I didn’t read your whole website, just the main page and the wellness page. I am solely responding to your comment about nurses in the first post here. I have no idea what your biases are or anything else, and I think you’re reading way too much into it my comments. I have merely noticed several negative comments about midwives, and liberals on this websites. I can’t really tell whether you think nursing as a field has a systemic problem with endorsing woo, at least moreso than doctors. It’s exactly like demeaning all midwives because of a few whackjobs.

    My mother is a nursing supervisor and practitioner and well respected by the nurses under her, as well as the doctors with whom she works. She did teach me about being proactive about my health, however, in that she has, in 30 years of nursing, seen the occassional doctor screw up (as well as the occassional nurse). There has also been the occasional doctor (like, maybe two in 30 years)who thinks he is the boss of her, when doctors and nurses have separate management for a reason. So the politics of medicine goes.

    The second statement was not even directed towards you- just a general observation. Again, I have not read most of your website and don’t know most of your story.

    I see Dr. Tuteur has been succesful in linking not wanting an epidural to various kinds of extremist woo, from your statements. That’s too bad. I would have no problem with Dr. Tuteur if she would get her facts straight and be a bit more nuanced, but I appreciate the analysis of my psyche. ;-)

  92. Fifi says:

    Also, the fact that Dr Tuteur seemingly can’t acknowledge the influence of commerce on medicine – particularly in the US – and she belittles any and all non-American professional associations in countries with public healthcare systems is also problematic. Generally speaking, the bloggers here are as critical of the corruption of SBM within medicine and the pharmaceutical industry as they are the attacks on medicine and science by the wizards of woo. They’re defending SBM and calling out non-SBM practices in general and not just taking a reactionary anti-CAM and pro-doctor/medicine stance. I seriously do think Dr Tuteur’s posts do more harm than good in promoting SBM (particularly since she seems to want to post so much that it may end up looking like the Amy Tuteur look-at-me bloggorama).

    And, sorry, her breastfeeding post where she does actually acknowledge a bias seems more like damage control and image repair than a genuine acknowledgment of bias. It’s like she’s practicing cargo cult SBM blogging – with much waving of hands and ritual but no true understanding or content!

  93. Plonit says:

    Pefect! That’s exactly the right description. Cargo cult SBM blogging.

  94. I like to challenge conventional wisdom and even among people who are respectful of science based medicine, there is a lot of faulty conventional wisdom especially on any topic associated with mothering. Since challenging conventional wisdom on childbirth and breastfeeding threaten some women’s view of themselves as “good” mothers, I’ve learned to expect personal attacks.

    I realize that some prefer discussing me and my style. I prefer to discuss the science.

  95. weing says:

    Sometimes people seek a second opinion because they don’t like what they hear. A few years ago there was a basketball player that sought a second opinion from a cardiologist to allow him to play basketball. He dropped dead practicing shots. I forgot his name. It made the headlines.

  96. Fifi says:

    Dr Tuteur – If you’d only been discussing the science from the start and not repeatedly brought other things into the conversation there’d be no conversation about you and your style, or the content of your posts (much of the discussion has been about the content, such as cherry picked science and how context informs content). Simply claiming you prefer to discuss the science when that’s very far from what you do is yet again an example of cargo cult blogging and after-the-fact image management. You want the appearance of being an SBM blogger (and the authority it gives you) without actually being an SBM blogger. This is why I feel the need to bring this up, you’re no different than anyone else who abuses science for their own ends.

    Dr Tuteur – “I like to challenge conventional wisdom and even among people who are respectful of science based medicine,”

    Yes and so do many other people who blog and comment here. Most of the bloggers here do that in a way that is actually about SBM and not just their desire to be controversial. (In fact, many seem to work to dampen false controversies and show how they’re not actually controversial, and not simply stir the pot regarding already controversial issues while adding little new to the conversation.)

  97. Harriet Hall says:

    Fifi said “it’s not even clear that Dr Tutuer has even practiced medicine for a long time (her bios all seem to indicate she’s been teaching and that she left practicing when her children were born quite some time ago,”

    This confirms my opinion that Dr. Tuteur is being treated unfairly. There are two other SBM bloggers who have not practiced medicine for a long time. Why single Dr. Tuteur out?

  98. Fifi says:

    Harriet – It’s not a value judgment, it’s about context and transparency. I’m responding to Rosemary who was proposing that Dr Tuteur has to deal with misinformed patients in clinical practice. There’s nothing wrong with being an academic, it’s just different than being a clinician. Just as being a GP is different than being a researcher, and practicing medicine 20 years ago is different than practicing it today. I can understand that you may feel some kinship and sympathy for Dr Tuteur because of the response to your own post regarding circumcision, and this may be informing your opinion about unfair treatment since you seemed to feel as if you were being unfairly treated when people critiqued your handling of the topic too.

  99. skepchick says:

    Dear Dr. Tuteur:

    Thank you so much for this post. I understand my daughter and her arguments in favor of home birthing and her preference for “organic” foods so much better now. It is really all about control, isn’t it? She believes that no one ought to tell her what to do or how to do it, especially those who are better educated, who, by virtue of that knowledge and training, make her feel inferior.

  100. Harriet Hall says:

    Fifi said “I’m responding to Rosemary who was proposing that Dr Tuteur has to deal with misinformed patients in clinical practice.”

    “Has to deal” is not significantly different from “had to deal.”

    “being a GP is different than being a researcher, and practicing medicine 20 years ago is different than practicing it today.”

    I have been retired for 20 years now, yet no one has suggested that that has any impact on what I write. Just as no one has suggested that my lack of academic credentials, teaching or research experience constitutes a “difference” likely to influence what I write.

    It constitutes unequal treatment to point out that Dr. Tuteur is no longer in clinical practice when no one has pointed out that Dr. Sampson and I have both been out of clinical practice for many years. And it shouldn’t matter: our writings should be judged on their content alone.

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