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Resistance is futile? Hell, no! (A call to arms)

Well, I won’t back down
No, I won’t back down
You can stand me up at the gates of hell
But I won’t back down

Gonna stand my ground
Won’t be turned around
And I’ll keep this world from draggin’ me down
Gonna stand my ground
And I won’t back down

From “I Won’t Back Down” by Tom Petty, 1989

This week, in a little bit of a departure, I have a minor bone to pick with our fearless leader and his podcast partner in crime Rebecca Watson (a.k.a. the Skepchick), who both managed to annoy me a bit the other day. (Don’t worry, Steve and Rebecca, I still love you guys…)

I’ll explain. You see, I had originally had a much different topic in mind for this week. Indeed, I even had my post mostly written by Saturday morning, when I had to take care of some mundane personal business, namely getting an oil change and some minor work done on my car. Since I need my car to commute to work and the maintenance needed was relatively minor, I decided to wait for the work to be done. As is my wont when sitting in waiting rooms with nothing much else to do, I decided to plug my earphones into my iPhone and catch up on some podcasts. Since the dealer also had free wifi, I brought my laptop along as well, the better to finish up my originally intended post.

The first thing I realized as I perused the list of unlistened-to podcasts was that I had fallen far behind in listening to one of my favorite podcasts, The Skeptics’ Guide to the Universe. To begin catching up, I decided to start with what was at the time the most recently available episode, specifically the July 9 podcast, figuring I could work my way back to through the earlier ones and thereby catch up with at least two episodes before my car was ready. In the second segment (beginning around 14:31 minutes into the podcast), Steve Novella and crew discussed a bit the recent news that the National Institute of Mental Health was trying to resurrect a dubious and highly unethical clinical trial proposed to test chelation therapy as a treatment for autism, referencing his excellent post on this very blog about why the trial is scientifically dubious (at best) and totally unethical. So far, so good.

Then the conversation veered into another area that I agree with, namely the utter uselessness of National Center for Complementary and Alternative Medicine (NCCAM) and how its main purpose is more proselytization for “alternative” and “complementary” medicine than actual rigorous scientific research, as I pointed out before in one of my earliest posts for SBM. As Steve pointed out that, for all the hundreds of millions of dollars spent by NCCAM, not a single new medicine or treatment has been added to the armamentarium of modern medicine, nor, even more importantly, have CAM practitioners abandoned a single bit of unscientific medicine due to any of the negative studies. Indeed, their enthusiasm hasn’t been dampened in the least. This line of discussion led to the question of whether we, as skeptics and advocates of science- and evidence-based medicine need to rethink and refocus our efforts.

It was at this point that Steve pointed out that there are quite a few of us dedicated to science-based medicine who are a bit pessimistic, using my post, which I dubbed, tongue-in-cheek of course, Resistance Is Futile. Steve and Rebecca’s reaction to my post made me think that perhaps I should be rethinking more than just how I’m going to contribute to promoting science-based medicine and opposing the infiltration of pseudoscience into academia, because apparently Steve, at least, interpreted my post as though I were saying that the whole fight is pointless and that we might as well give up. (Rebecca, I think, didn’t actually read the article, but she should.) In any case, Steve seemed to think my article was a perfect representation of this pessimistic attitude, which Rebecca characterized as as a “useless attitude to have,” a sentiment to which Steve agreed.

I agree that’s a useless attitude to have. Of course, if that were truly my attitude, I would have politely informed Steve long ago that I no longer feel it’s worth my while to contribute to this blog. Yet here I remain, as cantankerous and histrionic as ever, and my other online activities against quackery and antiscience continue apace. If that were truly my attitude, I would no longer bother to write letters, open or otherwise, to station managers about “investigative reporting” that is no more than parroting of anti-vaccine propaganda. I would not take the chance that such letter-writing would come to the attention of the public relations director at my institution. If such were truly my attitude, I would not spend so much time reading and learning about CAM in order to understand it well enough to understand what is useless (the vast majority of it) and what little gems might be found in it.

After all, if it is true that “resistance is futile” and we have already lost, why bother? Better just to hunker down, keep my head down, save what can be saved, and avoid making too many waves.

In retrospect, I suspect that perhaps I didn’t make the tongue-in-cheek aspect of my post clear enough. As regular readers of SBM know, I’m usually not particularly subtle, and I didn’t think I was subtle with my post. However, I did give my geek side free rein, complete with allusions to Star Trek: The Next Generation, the Borg, and Locutus of Borg. It makes me wonder if Steve failed to recognize my loving appropriation of other direct quotes other than the famous “resistance is futile” from Star Trek: The Next Generation‘s best villains of all time, the Borg, slightly altered in order to make my point. When I said, “The Brave(well) New World is upon us. Resistance is futile. Your life as it has been is over. From this time forward, medical culture will adapt to service CAM. Science is irrelevant,” I was actually having a bit of fun making my point, as Star Trek fans probably recognized. Not enough, apparently. Perhaps next time I’ll put a smiley emoticon after it.

Sadly, of course, there are many reasons to be pessimistic. There’s no way of getting around it. By any measure you care to name, scientific medicine is presently losing the war against quackery at every level. Advocates of scientific medicine are outnumbered, outfunded, and outmaneuvered, while the vast majority of medicine and–this is what really galls me–even academic medical faculty remains apathetic. Consider:

  1. As both Wally Sampson and Kimball Atwood have pointed out, advocates of unscientific medicine have cleverly coopted the very language of science and medicine, turning it against those who would resist the infiltration of pseudoscience, leading to Wally’s lament over how accepting we as the medical profession have become towards pseudoscience. What once was “quackery” or “pseudoscience” is now merely “unconventional” or “complementary,” and extreme lack of scientific plausibility for a treatment modality seems no longer to be a barrier to clinical trials.
  2. Through the passage of the DSHEA of 1994, the federal government has hobbled the FDA and in essence given free rein to supplement manufacturers to make almost any dubious health claim they wish, as long as the claim is sufficiently vague. Meanwhile legislators such as Dan Burton and Ron Paul lobby aggressively for “health freedom” laws that would in essence inoculate quackery from prosecution and allow quacks to operate without any pesky interference from the FDA or FTC.
  3. Due to high profile cases where state child welfare agencies have attempted to strip parents of custody of children with cancer to prevent them from choosing quackery over scientific medicine for their child, ill-advised laws, such as “Abraham’s Law” in Virginia, have been passed that in effect strip protections against quackery from teens and older children unfortunate enough to have parents who believe in unscientific medicine.
  4. As I and others have pointed out, quackery has infiltrated academic medicine to such an extent that not only are many of our major academic medical centers dedicating divisions, centers, or departments to what Dr. R. W. Donnell has termed “quackademic medicine,” but at least one has required it as part of the mandatory medical school curriculum from day one, bringing a whole new meaning to the term “integrative” medicine, as it integrates scientific medicine with pseudoscientific quackery.
  5. Meanwhile, Dr. Andrew Weil has succeeded in “integrating” pseudoscience into the eight family practice residencies, with more virtually guaranteed to follow, and Dr. David Katz at Yale has constructed the foundation for an academic empire of woo based on a more “fluid” concept of evidence.
  6. The Bravewell Collaborative has many millions of dollars to spend promoting unscientific medicine to any medical school or academic medical center willing to receive its largesse.
  7. NCCAM has a budget of over $120 million a year and has spent over $1 billion so far researching, but also promoting CAM. Worse, it is funding trials that are not only scientifically dubious but arguably downright unethical; for example, the TACT trial of chelation therapy for atherosclerotic coronary artery disease, the trial of the “Gonzalez regimen” for pancreatic cancer, and the proposed trial of chelation therapy for autism. Adding an approximately equal money to the pot of CAM funding is the National Cancer Institute, which funds over $120 million a year worth of CAM research related to cancer.
  8. Legislatures are passing laws that not only recognize unscientific “healing” traditions as legitimate professions but some states have even mandated that health insurance plans pay for such “treatments.”
  9. Anti-vaccine activists are sowing fear and distrust over vaccines, even going so far as to march on Washington. As a result, in the U.K. measles, once thought conquered, has become endemic again, and in the U.S. measles outbreaks are increasingly common.
  10. Our government is making deals with China to study “traditional Chinese medicine,” possibly as a quid pro quo for the Chinese granting the FDA inspection stations in Chinese cities, possibly as an attempt to control adulteration of Chinese herbal medicines.

Yes, folks, it’s bad out there in medicine right now. Real bad. Horribly, bad. So bad that even our ever optimistic leader Steve recently agreed when Quackwatch webmaster Stephen Barrett characterized the era we live in as the “golden age of quackery and antiscience.” There’s nothing to be gained for us by pretending otherwise other than perhaps the happy self-delusion of ignorance, and we have to face facts: The situation isn’t going to get better any time soon, no matter what we do. In fact, it very well may continue to get worse for the foreseeable future. That’s not being “pessimistic.” It’s being realistic. The forces arrayed against scientific medicine are strong, well-funded, and utterly ruthless about forwarding their agenda, the “integration” of antiscience with science. Maybe resistance is futile. Maybe science is irrelevant. Maybe scientific medicine will be forced to adapt to serve CAM. Maybe Rebecca and Steve characterized my attitude correctly. Maybe we advocates of science-based medicine have already lost the struggle.

To which I reply: Hell, no! Or, to echo Rebecca Watson’s words right back at her, “Screw that!”

I can speak for no one but myself, but, as Steve said in his podcast, while breath remains in me and I can still do something, I will not give up, even though I do not anticipate anything resembling victory in the few decades I’m likely to have left on this earth. The stakes are too high, and future generations will not judge us kindly if we surrender to antiscience with a whimper. In this age of seeming science, where the human genome has been sequenced, where we understand more than at any time in history about how the body works and where things break down to result in disease, it is a bitter irony that it is at this very same time that academic medicine is retreating to therapies based on pre-scientific concepts of how nature and the human body work. Thanks to unprecedented scientific advances in our understanding of disease, we stand at the threshold of what could be a golden age of medicine and surgery. It is profoundly disturbing to me that it could be reasonably characterized by anybody as a “golden age of quackery.”

I happen to be a World War II buff and have been ever since I was around 12 or so. As a teenager, I used to devour books on World War II history. When I was a teenager I had a simplistic understanding of the war, but as I got older I realized that the situation was always more complex than the simple narrative that we are taught in school. I also now realize that using World War II analogies is fraught with danger in that it’s hard not to fall prey to Godwin’s Law. However, I point out that World War II remains a good analogy for not giving up even when things seem utterly beyond redemption.

Think of the world in May 1942, six months after Pearl Harbor. Put yourself in the Allies’ place. Europe was in the hands of the enemy, who was rapidly advancing east into Russia, having only been stopped within sight of the minarets of the Kremlin, only to advance on new fronts to the south in the spring. In the Pacific, Japanese forces had driven U.S forces out of Guam, the Philippines, Wake Island, and virtually the entire Pacific west of Hawaii other than Midway Island and Australia. By any measure, the Allies were in deep, deep trouble. I imagine myself alive at that time, beset by a constant barrage of bad news, of loss after loss and retreat after retreat. How could anyone alive at that time believe that the Allies would eventually not just prevail but utterly destroy their enemies less than four years hence? Or picture yourself in London in the fall of 1940, with wave after wave of bombers hitting your fair city and other cities in Britain, pushing the RAF to the brink of destruction fending them off. How could any Londoner alive in late 1940 ever envision total victory less than five years hence?

Of course, the battle we are in is not World War II and CAM advocates are certainly not Nazis (with the possible exception of Ernst Zündel and Dr. Lorraine Day; every movement has its bad apples, I guess), but in terms of whether medicine continues to strengthen its fragile commitment to a scientific basis for its treatments or retreats to the age of Samuel Hahnemann it is every bit as apocalyptic. In terms of the strategic situation, we advocates of science-based medicine are the Allies in 1942, except that we cannot count on a brief battle during four days in June near Midway Island to turn the tide of the war. There will be no sudden reversals. Our task is more akin to the “island hopping” that the U.S. Marines undertook in the Pacific, in which Marines starting with Guadalcanal had to take one little island after another away from the Japanese, than it is to D-Day.

And, yet, despite how badly we are outgunned, outnumbered, and out-spent, there is reason for hope. It is at the moment but a glimmer, but if we can convince enough physicians that there is a serious problem we may have a chance. Particularly heartening to me is that in the last year we have seen something I cannot recall ever seeing before: three major books on alternative medicine that do not represent feel-good, credulous acceptance of the tenets of unscientific medicine. They are not books whose authors you are likely ever to see on The Oprah Winfrey Show any time soon. No, rather they are hard-nosed, skeptical, and they take no prisoners in describing why the vast majority of so-called CAM is nothing more than a demonstration of the power of the placebo effect and all-too-human cognitive shortcomings that all humans, doctors and patients alike, have. I’m referring, of course, to R. Barker Bausell’s Snake Oil Science: The Truth about Complementary and Alternative Medicine; Simon Singh’s and Edzard Ernst’s Trick or Treatment: Alternative Medicine on Trial; and Rose Shapiro’s Suckers: How Alternative Medicine Makes Fools of Us All. Moreover, as the popularity of CAM grows and as it infiltrates “conventional” medicine more and more, inevitably its profile will become high enough that even the apathetic physicians may become alarmed as stories of patients who come to harm through quackery come to light. There will be a backlash; indeed, the backlash may have already started. For example, just last month, the FDA, roused out of its torpor for reasons known only to its leaders but nonetheless fortuitously, started an aggressive campaign to stop the selling of fraudulent cancer “cures.” Meanwhile, there is a growing and vibrant movement in the medical and scientific blogosphere to counter the pseudoscience that makes up so much of “alternative medicine.” Indeed, that may be our last, best hope for ultimately prevailing. All is not lost, but it could be if we allow ourselves to fall into complacency again.

Of course, what the Allies had in World War II were leaders who would not give up, who would not surrender, no matter how hopeless the situation seemed. There was Winston Churchill saying in the darkest depths of the war after the fall of France and the retreat at Dunkirk:

We shall go on to the end, we shall fight in France, we shall fight on the seas and oceans, we shall fight with growing confidence and growing strength in the air, we shall defend our Island, whatever the cost may be, we shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender, and even if, which I do not for a moment believe, this Island or a large part of it were subjugated and starving, then our Empire beyond the seas, armed and guarded by the British Fleet, would carry on the struggle, until, in God’s good time, the New World, with all its power and might, steps forth to the rescue and the liberation of the Old.

Where is science-based medicine’s Winston Churchill?

Speaking of World War II analogies, I’d even settle for science-based medicine’s Bluto Blutarski (from one of the greatest comedies of all time, Animal House) asking, “Was it over when the Germans bombed Pearl Harbor?” and confidently rallying the troops by bellowing, “Nothing is over until we decide it is”:

How’s that for a more accessible pop culture reference than the Borg? That scene from Animal House always makes me laugh. In this context, I can’t help but think that an SBM Deathmobile would be an über-cool thing to have, perhaps with the head from a statue of Samuel Hahnemann bolted to its hood instead than the head of Faber, as was used in the movie. The humor aside, the scene above also has a very cogent message for us: No matter how bad things are, never give up. There is always something that can be done, although in our current predicament as advocates of scientific medicine what should be done probably doesn’t involve armor-plating a car, painting it black with skulls on it, and crashing it into the grandstand at a parade. Bummer.

I realize that I’ve not only painted a very dire picture but probably also gone completely off the deep end with the World War II analogies. No doubt some of the woo-friendly commenters here (and perhaps even some of those on “our” side) will react to this post with the conclusion that Gorski has completely lost his friggin’ mind–or at least lost all sense of proportion and restraint. (I can see Steve holding his head in his hands, muttering under his breath something about what on earth was he thinking when he invited me as a regular on SBM.) But desperate times call for desperate rhetoric. Just as I painted an intentionally bleak picture in my last post as a wakeup call, in this post, I want to do the same thing, but without being so dark. I want you to realize that, as bad as things are now, there is still some reason to hope, but nurturing that hope from a sputtering spark to a roaring flame will require fuel, and that fuel is passion coupled with an understanding not only of what we’re up against but the will to act against it. Either that, or I’m bipolar, with my original post being written when I was in a depressive phase and this post being written while I am in a manic phase. You be the judge.

Fortunately, I also don’t think that resistance to the infiltration will require that a “really futile and stupid gesture be done on somebody’s part,” as Animal House tells us in the scene above. Taking the long view, I realize that it may, however, require the proverbial fight with conventional weapons that will take years. It will, mainly, require that advocates of science-based medicine who have until now been keeping their head down become involved and vocal. Too, it will require years, if not decades, of resistance, diplomacy, and, yes, public relations, as much as we hate that term. It will require fighting smart, because that’s the only way to win against forces that are so much stronger than us, and it may require us to get our hands dirty in politics. It may require strategic retreats, and it will definitely require that we as advocates of science-based medicine be willing and sufficiently open-minded to embrace any aspect of CAM that is actually scientifically validated, thereby making its strength our strength. Dedication to science and patient care demands no less, because, as I have said many times before, there is no such thing as “alternative medicine,” just medicine. Most importantly, however, it will require that we rethink what we are doing, because clearly what we are doing is not working. A major change in strategy is clearly required.

Whatever this battle requires, though, I ask myself and I ask the readers of this blog who are dismayed at the infiltration of woo in medicine: “Are we just the guys to do it?”

Well, are we?

And, if we are “just the guys (and gals) to do it,” then what, specifically, are we going to do? We’re getting our posteriors handed to us in a sling right now. Something has to change. I don’t yet know just what yet (stay tuned), but, as Pete Townsend once so eloquently put it, “The music must change.”

My answer to the question “Is resistance futile?” is this: Hell, no! And, even if it were, when the day comes when I lie on my deathbed looking back at my life, I would never be able to forgive myself if I just gave up now. But we need to realize something. If we don’t change tactics, we will lose, and it could be many decades before scientific medicine recovers.

So I ask again: What are we going to do about it?

COMING ATTRACTION: In a future segment (although probably not next week), I will try to lay out some suggestions of just what can be done now. Hopefully, I will accomplish this in a much more coherent and less histrionic fashion.

Posted in: Medical Academia, Politics and Regulation, Science and Medicine, Science and the Media

Leave a Comment (109) ↓

109 thoughts on “Resistance is futile? Hell, no! (A call to arms)

  1. daedalus2u says:

    David, all that is needed is something that will work better at triggering the placebo effect than woo. If there was such a treatment that triggered the placebo effect better than woo and is cheaper, safer, easier to use and is science based it will displace woo.

  2. Jules says:

    I object to your suggestion that herbal medicine and TCM is “quackery”. While I view any nutrition claims with a healthy dose of skepticism, many herbs (amongst those used in TCM) actually do contain potent compounds that are mildly to moderately efficacious against common ailments. Of course, this begs the question of what’s “mild” and what’s “moderate” and whether there’s a placebo effect involved, but the science is there to substantiate many of the claims, at least on a molecular level. I would ask you to enter “glycyrrhyzic acid” into PubMed and see what you come up with–you’d be surprised at what licorice can do.

    The studies are weak, this is true. But as I point out (http://onnaturalliving.blogspot.com/2008/06/standardized-plants.html), this is because we are dealing with plants. They simply cannot be willed into growing identically every time. Peter Hyland’s method of “fuzzy fingerprinting” is probably going to be as close as we get to determining the exact chemical makeup of these plants. And if that’s not bad enough, consider, too, that studies can use many extraction methods to isolate their compounds–or worse, the can depend on an “herbal supplement” company to do it for them. I agree that the NCCAM needs to do (much) better in order to ensure that what’s out there is safe and efficacious, but to discount its existence entirely is a bit silly, if you ask me. Just because we don’t understand the mechanism by which some herbs work doesn’t mean that they don’t work.

    Consider tumeric, where the active component is curcumin. Recently, it was found that when it is explosed to UV light, it becomes a very potent phototherapeutic agent (J Invest Dermatol. 2007 Aug;127(8):1992-2000. Epub 2007 Apr 5). Of course, this property had been known to Indians for years–only they didn’t quite put it in those terms. People with skin ailments in India had been smearing tumeric on their skin and meditating in the sun for centuries–the cure for their disease was ascribed more to the prayer than the paste.

    Simply because the language is not scientific is not cause to dismiss the treatment in its entirety. The medical world would be a far different place had William Withering dismissed the story that an herbal tea could help “dropsy” (chronic heart failure) patients, or Edward Jenning laughed off the cowpox-smallpox story. If herbal medicines were truly the quackery you espouse them to be, I doubt Germany would bother with an institution devoted to regulating their usage.

    Does this mean that everything alternative helps? Of course not. But rather than dismissing the whole field of alternative medicine, shouldn’t we be trying to find out what works and what doesn’t instead? Absence of evidence is not evidence of absence.

  3. rebecca says:

    I haven’t had time to read back through all the posts yet, but let me just apologize for not being clear on the podcast: I hadn’t read your blog entry and didn’t expect Steve to bring it up (that’s just what happens when doing a show that is so off-the-cuff), so all my comments were only meant to address the point of view that Steve had described. I should have made it more clear on the show that I hadn’t read your exact words. Sorry about any misunderstanding.

  4. RickK101 says:

    I like the angry taxpayer argument. In these times of economic hardship, quite terrible economic hardship, should the American taxpayers be expected to fund hundreds of millions or billions of dollars just to find more entertaining alternatives to the sugar pill?

  5. Fifi says:

    I call “shotgun” in the Deathmobile! Seriously, I think there are some quite practical and relatively easy ways to attractively present science and EBM – science is pretty popular even amongst the fantasists I know (who would drool over the idea of driving the Deathmobile around the Burning Man). (Which, of course, is why pseudoscience is so popular and science is abused by supplement manufacturers and sketchy CAM types – I say sketchy because there are also very genuine and caring people involved in CAM, most CAM practices have some kind of internal logic – or hook into someone’s internal logic/belief system – even if built upon unstable bases or fluffy air castles.)

    No offense meant to anyone in particularly but the whole academic politics of calling things one doesn’t like or all woo “postmodern” (I understand the academic politics behind this use of “postmodern” in the US), but to some of us (well me at least!) who aren’t American it just looks like a misuse and representation of what is essentially cultural theory – I have many quibbles with postmodern theory but they’re not reactionary or based in what appears to be a “I don’t like the new fangled world” way that comes across when I see it used here. This may not be the way the authors who do this intend it to come across, and I understand that there have been bitter political/power struggles in universities like Harvard and Yale that have perhaps led to stupid=Postmodern, but from my perspective as someone who engages in cultural theory, it’s a misuse of the term and promotes a deep misunderstanding of what is often being discussed by authors like Foucault when they’re speaking about power structures, language and meaning. Anyway, all this rambling is to point out that if you want to appeal to a wider audience then sticking to the science and its impact on individual lives – making these topics accessible and easier to understand, and essentially doing some educating, preferably disguised as entertainment – would be more successful. This would be easy enough to do online – though it would require the resources and commitment to do it.

  6. Fifi says:

    I call “shotgun” in the Deathmobile! Seriously, I think there are some quite practical and relatively easy ways to attractively present science and EBM – science is pretty popular even amongst the fantasists I know (who would drool over the idea of driving the Deathmobile around the Burning Man). (Which, of course, is why pseudoscience is so popular and science is abused by supplement manufacturers and sketchy CAM types – I say sketchy because there are also very genuine and caring people involved in CAM, most CAM practices have some kind of internal logic – or hook into someone’s internal logic/belief system – even if built upon unstable bases or fluffy air castles.)

    No offense meant to anyone in particular but the whole academic politics of calling things one doesn’t like or all woo “postmodern” are kind of lame from my perspective (I understand the academic politics behind this use of “postmodern” in the US), but to some of us (well me at least!) who aren’t American it just looks like a misuse and representation of what is essentially cultural theory – I have many quibbles with the many variations on postmodern theory but they’re not reactionary or based in what appears to be a “I don’t like the new fangled world” way that comes across when I see it used here. This may not be the way the authors who do this intend it to come across, and I understand that there have been bitter political/power struggles in universities like Harvard and Yale that have perhaps led to stupid=Postmodern, but from my perspective as someone who engages in cultural theory, it’s a misuse of the term and promotes a deep misunderstanding of what is often being discussed by authors like Foucault when they’re speaking about power structures, language and meaning. Anyway, all this rambling is to point out that if you want to appeal to a wider audience then sticking to the science and its impact on individual lives – making these topics accessible and easier to understand, and essentially doing some educating, preferably in an enjoyable and playful way – would be more successful. This would be easy enough to do online – though it would require the resources and commitment to do it.

  7. llysenwi says:

    Bravo! Any post that can blend Churchill and Blutarski is a winner.

    I think the key is the question “what can WE do about it?”. We can be much more effective as a group than we can as individuals.

  8. Harriet Hall says:

    If our efforts sometimes seem futile, just think how much worse it would be if no one ever spoke up for science.

  9. Fifi says:

    The Catch-22 (to reference another great piece of pop culture) is that a lot of independent and critical thinkers aren’t innately joiners (unlike those of faith who flock together and non-critical believers of other stripes) – we also aren’t all necessarily politically aligned (though we may share some values), may not agree on potential solutions and/or aren’t handily gathered together every Sunday at the local super-church to receive The TruthTM, and there’s some generational/cultural gaps to be navigated.

  10. RickK101 says:

    By the way, just found this in another article about CAM:

    “Providers interested in tools and resources, such as wallet cards, posters, and tip sheets, may obtain them free on the NCCAM Web site http://www.nccam.nih.gov or order them from NCCAM’s information Clearinghouse at 1-888-644-6226″

    Is there a clearinghouse for SBM? Is there a wallet card showing how many lives are saved each year with antibiotics? Is there a brochure showing how 2 million kids a year avoid special education and get higher grades due to Ritalin and it’s derivatives? Is there a handy chart showing how human longevity has increased over the years (and possibly highlighting which part of that chart is due to SBM and which is due to CAM)?

    Is there someplace where testimonial of people helped/saved by SBM can be recorded and mined?

    And while we’re at it, the CAM folks keep good records of how many people are harmed by mistakes in conventional medicine. We (SBM, SGU) could probably do a good job of recording cases where people are harmed by CAM – directly harmed or turned away from proven scientific therapies.

    Many people are influenced more by one good anecdote than by a library full of studies. CAM is reaching those people. There’s no reason SBM can’t as well.

  11. Fifi says:

    Harriet – I kind of look at pseudoscience like racism, sexism or homophobia – worth speaking up about when one runs into because sometimes people just don’t realize they’re being racist/sexist/homophobic/pseudoscientific. If one doesn’t speak up the racism/sexism/pseudoscience – particularly if people know you take issue with that kind of thing – then it’s silently condoning it. If one can manage to do this in a calm, reasonable way that points out the logical fallacy or prejudice – speaking about the idea and it’s flaws rather than pointing to the person as “wrong” – then one has a chance to remedy some ignorance. Of course, there are the willfully ignorant too (and consciously racist, sexist or homophobic) but it’s good to at least put these people in the position where they have to own their prejudice or ignorance. I’ve found that generally the only people who get particularly offended – if one is polite when discussing racism, sexism or homophobia, or pseudoscience – are those who either participate in promoting them or who are unwilling to own their own prejudices or pseudoscientific ideas.

  12. David Gorski says:

    I haven’t had time to read back through all the posts yet, but let me just apologize for not being clear on the podcast: I hadn’t read your blog entry and didn’t expect Steve to bring it up (that’s just what happens when doing a show that is so off-the-cuff), so all my comments were only meant to address the point of view that Steve had described. I should have made it more clear on the show that I hadn’t read your exact words. Sorry about any misunderstanding.

    Don’t worry, I still love you guys.

    Perhaps I should mention that this not-so-little rant started out as an e-mail that I was going to send to you guys. As so often happens when I start typing, it got out of control, growing far beyond what I had intended. When I started inserting YouTube videos and other things, it was at that point I decided what was to be an e-mail would, with a little polishing up and the insertion of some links, make a pretty amusing, albeit hyperbolic, SBM post.

    To the Deathmobile! (I have dibs on the pirate costume.) Now if only I could find a statue head of Hahnemann…

  13. tarran says:

    I suspect things look dark now because evidence based medicine provides really lousy customer service.

    Imagine you own a car. You have a choice between several repair shops. There are a few chain shops who have precious licenses to do engine rebuilds legally, but you have to schedule an appointment months in advance, and these mechanics charge high prices, and can even be unaffordable without car repair insurance.

    Then you have independent mechanics. These guys are forbidden by law from doing engine rebuilds, but are allowed to do replace air filters. They have nice waiting rooms and they charge less money and the mechanics act like they really care. And, they can, as often as not, get the engine to run a little less roughly than it was when it came in.

    Is it any wonder that people go to them?

    Yes, the chain with a legal monopoly on engine rebuilds will do a better job fixing your car. But people who don’t know much about cars are not able to discern which car the unlicensed mechanic can fix and which car can only be fixed by a mechanic doing things he needs a license for.

    When the FDA relaxes its strictures its a good thing. So long as people expect the government is protecting them against quacks they’ll listen to the quacks advertising the latest all-natural homeopathic/hollistic wonder-cure. On the other hand, absent this belief that the gang with a monopoly on violence over this piece of territory is vetting medical services and consumables, consumers would be far more skeptical. Organizations like the FDA, which don’t lose a dime when they do a bad job – whose officers face few sanctions for screwing up – have little incentive to do a good job and many disincentives from doing a good job. Contrast this to Consumer Union, which had entered the drug testing business in the 1930′s (prior to the formation of the modern FDA). These publishers of Consumer Reports – whose wealth and prestige comes solely from their ability to persuade people that their opinions are worth listening to – cannot be easily suborned, and all it would take would be one incident discrediting them and they would lose most of their donors and subscribers and be out on the street looking for work.

    This does not even touch on the social engineering that regulatory agencies attempt routinely. The case that comes to mind is the Japanese analog to the FDA that refused to permit birth control pills for women to be sold in japan well into the 1990′s since they wanted to encourage women to have children.

    I honestly think that activists who are opposed to quackery would get more bang for their buck and man-hours if they worked on reducing the power of state and federal regulators. In economics textbooks, the medical industry is usually used to teach concepts like rent-seeking and cartelization. And the consumer demand that is not being met as a result of these artificially induced shortages is providing a great opportunity for the quacks to make money.

  14. Harriet Hall says:

    Jules’ comments make me wonder if he’s been reading this blog very long. The issues he raises have already been discussed here.

    “The Plant vs Pharmaceutical False Dichotomy” is particularly apropos. http://www.sciencebasedmedicine.org/?p=6

    “rather than dismissing the whole field of alternative medicine”

    We don’t dismiss the whole field; we simply ask for the same kind of evidence we ask of any conventional treatment. We advocate one standard of science for every claim, wherever it originates.

    “Alternative” medicine by definition is medicine that is not supported by good enough evidence to have been accepted by the medical mainstream yet. That covers a wide spectrum. For any given treatment we might:

    Have evidence that it doesn’t work.
    Have no evidence at all.
    Have no acceptable evidence and it is too implausible to waste research money on.
    Have some suggestive evidence and it may be worth further study.
    Have very promising evidence and more studies may soon move it from alternative to mainstream.

    I’m glad you mentioned William Withering, because he was a true scientist. He carefully recorded every case he treated, his successes and his failures, and published them for all to see. And instead of saying “this works” he said that if his results were confirmed by others it “might” prove to be a useful part of the medical armamentarium.

    He didn’t do what some herbal advocates do today: market his foxglove remedy with exaggerated claims and no quality controls.

  15. David Gorski says:

    Does this mean that everything alternative helps? Of course not. But rather than dismissing the whole field of alternative medicine, shouldn’t we be trying to find out what works and what doesn’t instead? Absence of evidence is not evidence of absence.

    Apparently you didn’t see this part of my post:

    It may require strategic retreats, and it will definitely require that we as advocates of science-based medicine be willing and sufficiently open-minded to embrace any aspect of CAM that is actually scientifically validated, thereby making its strength our strength. Dedication to science and patient care demands no less, because, as I have said many times before, there is no such thing as “alternative medicine,” just medicine.

    The problem, of course, is that so little of “alternative” medicine is even scientifically plausible that “gems” in it that might actually be useful as something other than a placebo are, I predict, going to be rare. Certainly that’s what the research thus far leads me to believe. Moreover, those “gems,” if they even exist, will almost certainly be in the area of herbal medicine, because, as several of us have pointed out before, if an herb has a therapeutic effect it is, in fact, a drug. An impure and “dirty” drug, but a drug nonetheless. Too bad “drug” seems to be a dirty word in some CAM circles.

    Also, natural products pharmacology is a branch of pharmacology with a long and distinguished history. There is nothing “alternative” about it, nor should there be. Natural products pharmacology, done according to the scientific method, is science-based medicine. Its appropriation by “CAM” does nothing for it, and in fact lowers its stature in the scientific world. A friend of mine is a natural products chemist/pharmacologist, and he has lamented this very thing.

  16. Fifi says:

    tarranon – With all due respect, it seems to me that free market capitalism may just be part of the problem – look at the problems allowing TV and general adverts for various medications have created by tapping into the same desire for magical solutions as CAM often does. Even though lots of people pay out of their pocket to use CAM in Canada, because our medical system is taxpayer funded there’s much less chance of CAM practitioners sneaking in. (There’d be less people using CAM in Canada if there wasn’t a doctor shortage that is, in large part, created and perpetuated by political decisions and the political desire in some sectors for a private healthcare system – though the general population supports universal healthcare.)

  17. Harriet Hall says:

    “Many people are influenced more by one good anecdote than by a library full of studies. CAM is reaching those people. There’s no reason SBM can’t as well.”

    Have you seen the new website What’s the Harm? http://www.whatstheharm.net/index.html
    It’s a start in that direction.

  18. Fifi says:

    Oh…and the head of Hahnemann should be built of papier-maché so it can be set ablaze!

  19. durvit says:

    RickK101 wrote:

    Is there a clearinghouse for SBM? Is there a wallet card showing how many lives are saved each year with antibiotics?…Is there a handy chart showing how human longevity has increased over the years (and possibly highlighting which part of that chart is due to SBM and which is due to CAM)?

    Excellent suggestion.

    As a way of promoting science-based medical blogs, would it be possible for more blogs like this one to offer a mini-blog like Ben Goldacre’s? I’ve seen several bloggers say that their traffic goes up when he mini-blogs one of their posts. Would that increase the ‘findability’ of blogs that discuss evidence-based or science-based medical issues?

  20. Fifi says:

    A specific website that served as a clearinghouse – or serves as a reliable and trustworthy source of understandable information about recent discoveries minus the spin/hype – would probably be more effective than a list of blogs (not to denigrate your idea, it’s a good place to start and useful too). If you added in an “ask an expert” section for various hot topics and answered one question a week, I’m sure you’d get even more interest (and this would add interactivity and accessibility without making it a free for all and playground for trolls). Design and functionality are critical in creating something that appeals to people online and will reach the public at large.

  21. David,

    Great post, as usual. However, I think you misread the conversation we had on SGU – which, as Rebecca said, was largely a product of the fact that it was unscripted.

    The point that I raised was that the facts on the ground are grim – not that we are giving up or that it is truly hopeless. I was giving the setup using your post – the situation is bad, but we’re not giving up. Rebecca essentially cut me off after the first point before I could make the second. I tried to get back to that point, but Rebecca and Jay were on a role so I let them go.

    I eventually did cut them off to get back to my point – and I said “Those of us who are working against it are not giving up.” “Those of us” includes you, David. I further clarified that we are talking about regrouping and rethinking – NOT giving up. I did think the Resistance is Futile entry was darker than I am, but this is a small point.

    Sorry if the conversation gave the wrong impression – I thought I had adequately clarified it in the end. We are all working tirelessly and hopefully in defense of science-based medicine, while recognizing that it is a steep uphill battle we are fighting.

  22. durvit says:

    Fifi – a miniblog is not a list of blogs or just a different form of blogroll. It is an RSS feed that contains the link to a paper, blog post, news item, and a few words that indicate why it is of interest.

    Ben Goldacre has one (right hand side of home page); Professor David Colquhoun has one (left hand side); HolfordWatch has one. Which is beginning to make it look as if they are popular on british blogs but that might reflect the ones that I read.

  23. Fifi says:

    durvit – Thanks for pointing out my mistake! Sorry, I obviously wasn’t paying enough attention (the obvious wages of procrastinational “multi-tasking” ;-) ) I was also thinking more along the lines of a resource for the general public (and perhaps journalists to fact check!), rather than people interested enough to subscribe.

  24. mjranum says:

    If you consider it as an exercise in letting the stupid people die off younger, before they have a chance to get older and have seriously expensive problems that require treating – it may save society a huge amount of money. With the costs of real medicine, why not fob off the fools who’ll take fake medicine? Caveat emptor and let the suckers die.

  25. RickK101 says:

    Harriet:
    “Have you seen the new website What’s the Harm? http://www.whatstheharm.net/index.html
    It’s a start in that direction.”

    Thanks for that! You’re right, it’s definitely a step in the right direction. There’s a great example cited by that site of the danger of “applied kinesiology” (NAET) for peanut allergy (a personal bugbear of mine). Thankfully nobody died.

    Now, let’s encourage people to submit examples, studies, etc. to that site.

    Jules:
    “Does this mean that everything alternative helps? Of course not. But rather than dismissing the whole field of alternative medicine, shouldn’t we be trying to find out what works and what doesn’t instead? ”

    Completely agree. Clearly some valid, promising medicine gets swept up in the CAM scam. What would really help is if CAM actually dropped a treatment now and then when proven ineffective. CAM seems to have two categories of treatments: (1) proven effective, and (2) effective but not yet proven. No amount of funding and research seems to be able to prove CAM treatments as ineffective. With such an operating model, how can we do what you suggest?

  26. pmoran says:

    (Groan). Trying to pretending that alternative medicine is a great danger to the public hasn’t worked so far, so why would it work now?

  27. David Gorski says:

    So what would work? Or might work?

    Clearly a change in course is needed, as I clearly pointed out in this post. Indeed, part of the reason I wrote this admittedly over-the-top post was to stimulate discussion and the posting of ideas for how to promote SBM.

    So don’t be shy. Feel free to give us some.

  28. daedalus2u says:

    I have the answer, replace the woo mediated triggering of the placebo effect with a pharmacological triggering of the placebo effect. Maximally invoke the placebo effect via increased basal nitric oxide and woo won’t have any placebo effect left to work on.

    Just the way that sham accupuncture works better than real accupuncture. Real accupuncture sticks real needles in the skin, the pain and injury from those real needles detracts from the placebo effect of real accupuncture. Sham accupuncture doesn’t break the skin, so there isn’t actual injury to counter the placebo effect sham accupuncture invokes, so sham accupuncture works better than real accupuncture.

    I appreciate that this idea is too “far out” for most everyone here, but it is the obvious answer.

  29. Fifi says:

    Above I wrote about why people use CAM in Canada but I misspoke when I said that most people pay for CAM out of their own pocket. While some people pay for CAM out of their own pocket, it’s also covered on quite a lot of health insurance plans that some people get as part of their employment (that cover dental, glasses and things like massage and some CAM treatments, which are also tax write-offs as medical expenses if one pays out of one’s own pocket).

  30. overshoot says:

    Now if only I could find a statue head of Hahnemann…

    Sorry, they’ve been shrunk 100C, so as to become more powerful than you could possibly imagine!

  31. DBonez says:

    tarran said:

    “Imagine you own a car. You have a choice between several repair shops. There are a few chain shops who have precious licenses to do engine rebuilds legally, but you have to schedule an appointment months in advance, and these mechanics charge high prices, and can even be unaffordable without car repair insurance.

    Then you have independent mechanics. These guys are forbidden by law from doing engine rebuilds, but are allowed to do replace air filters. They have nice waiting rooms and they charge less money and the mechanics act like they really care. And, they can, as often as not, get the engine to run a little less roughly than it was when it came in.

    Is it any wonder that people go to them?”

    If you deploy an airbag in your car during a fender-bender, are you going to take it to a cheesy little shop with a nice waiting room and hope they fix your airbag and SRS system correctly? Sure your dash might look okay and the airbag light is off, but will you really feel safe and secure following that SUV at 70MPH that your airbags will work correctly again and save your life? When you get in a wreck, your airbags fail to deploy, and you are impaled on the steering wheel, you can, in your last moments of life, think how the mechanics acted like they really cared. Personally, I’ll trust the safety certified dealers with their factory training, “precious licenses,” and OEM parts to do the job right.

    When it comes to my health, I want my doctor well trained, well paid, and well rested so he/she is making the best possible decisions with the best possible information so I get absolutely the best care. Period. Maybe you feel okay with some ND-hack telling you your chi is misaligned offering you a placebo-grade cure in the form of therapeutic touch, or some other such nonsense. I’ll take 95%+ accuracy with test-proven, time proven, science-based diagnoses and treatments.

  32. overshoot says:

    David, all that is needed is something that will work better at triggering the placebo effect than woo. If there was such a treatment that triggered the placebo effect better than woo and is cheaper, safer, easier to use and is science based it will displace woo.

    Only if you’re willing to promise the marks that it will make you 18 again, raise the dead, grow your bodily organ of choice, etc. Unless you’re willing to promise the marks as much as the quacks do, your customers will get their fantasies (un)fulfilled by someone with a shinier fantasy inventory.

    I have seen this in industry for more than thirty years: the management doesn’t really believe that anyone can really deliver better than anyone else (partly because they can’t tell success from failure) so they hand the job to whoever makes the most wildly unrealistic promises.

  33. RickK101 says:

    pmoran: “(Groan). Trying to pretending that alternative medicine is a great danger to the public hasn’t worked so far, so why would it work now?”

    (sigh) If you had read my earlier post you would have seen that I was building on the fact that many people respond better to one good anecdote than to all the double-blind clinical trials in the world. So all I was looking for was a place to find (and warehouse) examples of CAM harm to match off against some of the anecdotes of “dangers of science”.

    Obviously, trying to portray CAM as generally deadly is silly. That wasn’t the point. But, when you’re dealing with something as potentially and randomly lethal as severe peanut allergy, a little CAM can cause a lot of harm. And one good example of kids in an ambulance might just make a parent pause before believing the “naturopath” over the allergist.

  34. wertys says:

    I’ve been thinking about having an awareness week style campaign where users of sCAM are encouraged to donate one week’s worth of their spend on unscientific therapies to the National Health and Medical Research Council, which is our country’s peak health research body,ie they dole out the biggest grants. The result ? Quacks stop getting a free ride and more quack users might stop and think about the evidence for their expensive treatments…and proper, useful science gets a big funding boost !

  35. ama says:

    Perhaps you now will understand the meaning of Aribert Deckers’ fight for a

    [b]fortified medicine![/b]
    http://wehrhafte.medizin.se

  36. ama says:

    Perhaps you now will understand the meaning of Aribert Deckers’ fight for a

    “fortified medicine!”: http://wehrhafte.medizin.se
    ***********************************************************

  37. David Gorski says:

    I might–if I could read German.

    Unfortunately, I can’t.

  38. pec says:

    Well it hardly needs to be said that your frenzied tirade is motivated by faith not reason.

    You and your “skeptic” friends have declared war on CAM because it threatens your materialist worldview, not because CAM is incompatible with science.

    You have admitted that there is evidence for some CAM treatments. However, you say, this evidence is all accounted for by false positive results, which we expect to occur about 5% of the time. (And, bizarrely, you claim that implausible hypotheses are even more likely to result in false positives, perhaps because of a newly discovered law of physics — the Law of Implausibility???)

    Well anyway, what I am leading up to is that we do know that 5% of positive results should actually be false, and you are right about that at least. So isn’t it amazing that your friend Amazing Randi, after testing what you would consider implausible claims for years, has not once come up with a false positive?

    And yet I’m sure you think his tests are fair and scientific.

  39. daedalus2u says:

    overshoot, it is the nature of placebos that they only work for a little while. When one type of woo stops delivering its placebo effect, the victims go to another, and another, and another. Each of them works for a little while and then stops working when the neurogenic placebo effect wears off. The bacteriogenic placebo effect doesn’t wear off. It continues to deliver indefinitely. It restore physiology to normal by restoring normal basal NO levels. Once that normal basal NO level is restored, there is nothing that any placebo can do.

    Maybe there will be some die-hard hold-outs such as that poor woman in the earlier tragic breast cancer vignette. Higher NO levels improve one’s ability to think and people become more rational, less desperate, less apt to do desperate things.

    Dr Gorski was looking for a straw to grasp. I have more than a straw. I have a very sturdy and robust mechanism for NO delivery that can beat the woo-meisters at their own game.

    No pec, we have declared war on CAM because CAM is defrauding innocent naïve foolish non-skeptics. People such as the poor woman who were tricked into doing something ineffective when real medicine and real treatment had a good chance of greatly prolonging her life. CAM is stealing their money, stealing their hopes, stealing their lives, stealing their last moments with loved ones. That poor woman lost her life, her family, her husband and her children, and for what? To enrich one woo-peddler after another.

    The evil that happened to that poor woman is an example of how evil can triumph when good people do nothing.

  40. pec says:

    “the evil that happened to that poor woman is an example of how evil can triumph when good people do nothing.”

    Oh baloney. You take one case and magnify it into a catastrophic threat to human survival. What about all the poor cancer victims who die in spite of your toxic and expensive treatments?

    You have not studied and rejected all CAM treatments based on scientific evidence. You just pretend that you have. You are sure they can’t work because you don’t understand how they could work. And you don’t understand because they don’t fit your materialist ideology.

  41. daedalus2u says:

    pec, no one has determined that CAM treatments are safe and effective. If any CAM treatment were determined to be safe and effective it wouldn’t be CAM any more, it would be mainstream medicine.

    There are only two possible reasons why a particular CAM treatment has not been shown to be safe and effective. The first reason could be because it isn’t safe and effective. The second reason is that CAM proponents have been too lazy to demonstrate it.

    I don’t need to reject all CAM treatments to know that some are completely bogus. Homeopathy for example. I don’t reject them because I don’t understand how they could work, I do understand how they work. They work via the placebo effect. No mystical non-material hocus pocus mumbo jumbo required. The placebo effect explains virtually all CAM results.

  42. delaneypa says:

    I’d like to point out a few trends in medicine that may in the short-term increase the CAM pandemic.

    First, during the mid-1990′s, the American Association of Medical Colleges decided to encourage medical schools to admit more “well-rounded physicians”, rather than traditional biology and pre-med students. I started med school in 1997, many of my classmates had degrees in English, Art History, and Physical Education. Though quite smart, they took just enough science courses to meet med school admission requirements and pass the MCATs.

    These folks are now just getting out of residency. I have no data, but suspect that these “well rounded” physicians are far less likely to embrace scientific principles and reasoning in the day-to-day medical practice. It takes more than a few basic science courses to really start one thinking scientifically. Medical school is an exercise in memorization, not critical thinking.

    Second, being a physician in general is becoming a less attractive career option than previously. I used to frequent physician websites like SERMO.COM, but posting are more often than not about physicians complaining about more paperwork, longer hours, less pay, more regulation and less autonomy. (Interestingly, though, med school applications are up.) I wonder if this implies lower admission standards.

    Third, as baby-boomers retire, demand for medical services is going to increase… a lot. This will almost certainly mean more nurse practitioners and physician assistants seeing patients in all areas of medicine. They have less training than MDs, sometimes less than 1/2 the training.

    These trends may imply: 1) a higher percentage of physicians with nonscientific backgrounds; and 2) more less-trained non-physicians doing the work previous done by MDs. (I, for example, am now referred to as a “provider” more often than as a physician.) In other words, a medical workforce more susceptible to woo.

    After reading sciencebasedmedicine.org for several months I had been becoming increasing despondent, like Dr. Gorksi. But I like to remember Dr. Novella’s quote about science’s advantage over CAM: “Science delivers the goods.”

  43. ama says:

    @ David Gorski

    In the Germany there is the expression “wehrhafte Demokratie” (= “fortified democracy”). It means that you do not get democracy as a gift, but you have to fight for it. Democracy must be fortified (strenghtened, hardened) to survive against its enemies.

    The same is true for medicine. Surrounded by hords of ignorants, of malicious dealers, of psychopaths, of religiots, of plain criminals, all of them in the cloaks of “medicine men”, a normal citizen has to fight for his life. THIS FIGHT is fiercer than that of democracy, because here, in the first front line, life is at stake. It is a matter of urgent, of extreme self-defense.

    We don’t get democracy for free and we don’t get medicine for free.

    We pay a very high price for it…

    … and either we DO that – or we can shoot ourselves rightaway.

  44. Harriet Hall says:

    pec said,

    “Well it hardly needs to be said that your frenzied tirade is motivated by faith not reason.”

    It doesn’t need to be said because it isn’t true.

    “You and your “skeptic” friends have declared war on CAM because it threatens your materialist worldview, not because CAM is incompatible with science.”

    CAM doesn’t threaten any worldview. Some CAM is compatible with science (certain herbal remedies, for instance) and some isn’t.

    “You have admitted that there is evidence for some CAM treatments. However, you say, this evidence is all accounted for by false positive results”

    No we haven’t.

    “which we expect to occur about 5% of the time.”

    No, we expect that to occur much more than 5% of the time when the research is poorly designed and poorly carried out by people who are not rigorous scientists and who have an agenda. It happens regularly when true believers investigate implausible hypotheses.

    ” isn’t it amazing that your friend Amazing Randi, after testing what you would consider implausible claims for years, has not once come up with a false positive?”

    That’s a valid criticism that other skeptics have already pointed out: someone could pass the test just by chance. I don’t think we have to worry, because Randi hasn’t actually tested anyone yet. No applicant for the million dollar challenge has ever succeeded in passing the preliminary trial – a simple demonstration of their ability. Most claimants haven’t even been able to coherently state what they think they can do and what they would consider a fair test.

  45. Harriet Hall says:

    pec said,

    “Oh baloney. You take one case and magnify it into a catastrophic threat to human survival. What about all the poor cancer victims who die in spite of your toxic and expensive treatments?”

    Some cancer patients die despite the best evidence-based treatments by honest, caring physicians doing their utmost. It is despicable to compare that to a woman who dies because she was misled by unscrupulous or ignorant quacks who think testimonials are evidence.

    “You have not studied and rejected all CAM treatments based on scientific evidence.”

    We haven’t rejected “all” CAM treatments, and we certainly don’t pretend to have studied all of them.

    “You are sure they can’t work because you don’t understand how they could work.”

    No, we are not sure they can’t work. For some of them, we think it is highly implausible, but if the evidence showed they were effective, we would follow the evidence even if we had no idea how they could work.

    “And you don’t understand because they don’t fit your materialist ideology”

    Are you talking about the authors of this blog or about science in general? You denied saying that science was materialist; you said materialism is a philosophy. Even if you accuse individuals of being materialist and having an ideology, science itself is not materialist and doesn’t have an ideology, and science does not accept anything without adequate evidence. If there were adequate evidence for any alternative treatment, science would have accepted it. If science had accepted any alternative treatment, it would no longer be alternative. By defiinition, alternative medicine is medicine that is not supported by enough evidence to have gained acceptance by science. What does any of that have to do with materialism?

  46. HCN says:

    pec, you will never be taken seriously until you show us real evidence that something that is considered CAM actually worked.

    Come on!

    Show us where one of your pet treatments has actually shown to work.

    A very close family member has suffered from chronic migraine headaches for the last thirty years. She has had very bad experiences with mainstream medicine, and some very bad experiences with CAM. Very much in the line with this book:
    http://www.amazon.com/All-Head-Unrelenting-Unreasonable-Enlightening/dp/0738210390/

    Just provide us with some real verifiable studies that any CAM method that has been actually effective with chronic migraine headaches. If you do that my family would be forever grateful.

    If you fail, you will become just another loathsome joke troll. Because, we need results… not stupid talk about “materialism”.

    Tell me PLEASE!!!… what is an effective treatment for chronic migraine headaches!

    (though in full disclosure, this woman has spent time in one county psyche ward where they decided she was bipolar… then she moved to another state where another “incident” caused that county medical staff to giver her a diagnosis of paranoid schizophrenia….. but you and I know it is just a manifestation of that horrible non-relenting chronic headache!… just tell us what CAM would cure her and all will be well)

  47. ama says:

    What is “CAM”? Credophile-addicted magic?

  48. pec says:

    pec: “And you don’t understand because they don’t fit your materialist ideology”

    hall: “Are you talking about the authors of this blog or about science in general? You denied saying that science was materialist”

    I am talking about the authors of this blog, the “skeptic” activists. I don’t know how many times I have said there is no necessary connection between science and materialist philosophy. I will say it again: there is no necessary connection between science and materialist philosophy.

    My criticisms are never directed at science in general or scientists in general. As I keep saying, I am a scientific person myself.

  49. pec says:

    “If there were adequate evidence for any alternative treatment, science would have accepted it. If science had accepted any alternative treatment, it would no longer be alternative.”

    So, according to your clever definition alternative medicine, and alternative science, can never be scientific! CAM is, by your definition, a bunch of ideas and treatments that have never been supported by evidence.

    So when you say no CAM treatment has ever been supported by evidence, you have to be right, according to your definition.

  50. daedalus2u says:

    pec, you don’t understand the distinction I was making.

    An idea expressed as a CAM treatment modality may be factually correct. That hypothesis can only be tested by experiment, by seeing if that treatment modality produces experimental results demonstrating that the CAM treatment modality “works” and is safe and effective.

    If a treatment modality is shown to be safe and effective, it becomes a part of EBM and SBM.

    Chiropractic for treating cancer is CAM. Chiropractic for treating certain types of low back pain is something that even Harriet considers to be EBM.

    The distinction is that there is sufficient evidence to support chiropractic for treating back pain, there is none for using it to treat cancer.

    Using antibiotics to treat a viral infection is CAM, even if an MD prescribes them. There is no evidence antibiotics are safe and effective for treating viral infections. With no evidence to support it, it can’t be EBM, it must be CAM.

  51. David Gorski says:

    As I keep saying, I am a scientific person myself.

    And as I keep saying, your own words show quite conclusively that you are most definitely not a “scientific person.”

  52. wertys says:

    Dr Gorski, perhaps a line from a Tom Waits song will fit this piece as well as the Tom Petty one..

    “We’re chained to the world,
    and we all gotta pull..”

  53. pec says:

    “your own words show quite conclusively that you are most definitely not a “scientific person.””

    There are scientific people outside the Amazing Randi “skeptics” movement.

  54. pec says:

    “Using antibiotics to treat a viral infection is CAM”

    You don’t know what you’re talking about. “CAM” doesn’t stand for bogus useless treatments. It stands for Complementary and Alternative Medicine. It is medical science that does not insist on a materialist ideology.

  55. pec says:

    “Some cancer patients die despite the best evidence-based treatments by honest, caring physicians doing their utmost.”

    SOME cancer patients die???

  56. RickK101 says:

    Pec: “It is medical science that does not insist on a materialist ideology.”

    What does this even mean? “Science” only works in a materialst/naturalist world. It only works within the confines of physical laws. If something is outside of these laws, then by definition IT IS NOT SCIENCE.

    Pec, science is a process of testing ideas and rejecting those that don’t work. That testing can only happen within an agreed set of natual laws. Sometimes ideas challenge those laws and the laws change, but they still fit within the natural or materialst world.

    By advocating something outside that “materialst world”, you are advocating something that is not science.

    If you’re saying that CAM is influenced by undiscovered changes to the current set of natural laws, then I suggest NCCAM take some of its $120 million a year and actually PROVE something that changes the current definition of the natural/materialst world. The money is there. Do something with it.

    If on the other hand you think that we should be “open” to ideas outside of a materialst world, then you are advocating the supernatural, which by definition IS NOT SCIENCE and does not belong in a blog entitled “Science-Based Medicine”.

    You can’t have your cake and eat it too. Science or supernatural – pick one.

  57. pec says:

    [“Science” only works in a materialst/naturalist world. It only works within the confines of physical laws. If something is outside of these laws, then by definition IT IS NOT SCIENCE.]

    You are assuming that all the physical laws are already known and understood.

    “Materialist” is a useless term, first of all, because we know that matter is not material. And there are all kinds of things known to physics, such as fields and energies, that cannot be called “matter.”

    “Natural” means already known and understood by science, but science would never progress if it were confined to studying things already known and understood.

    And, actually, most of the things you probably think are understood by science are not. Gravity is not understood, neither is electricity. Most things studied by physicists are not really understood, although we may be able to used them in our practical lives.

    The ultimate nature of nature is not understood by physics. As the theories become increasing complex, understanding does not increase.

    Alternative science usually looks at things not yet described by mainstream science. There is no hard line between alternative and mainstream science, but one of the most obvious differences is that alternative scientists tend to accept some kind of bio-fields and bio-energies, while mainstream science — for reasons of tradition and ideology, and an interest in maintaining its anti-vitalist position — does not.

  58. pec says:

    “I suggest NCCAM take some of its $120 million a year and actually PROVE something that changes the current definition of the natural/materialst world. The money is there. Do something with it.”

    I am sure that is exactly what they intend.

  59. pec says:

    [If on the other hand you think that we should be “open” to ideas outside of a materialst world, then you are advocating the supernatural, which by definition IS NOT SCIENCE and does not belong in a blog entitled “Science-Based Medicine”.]

    The natural vs. supernatural dichotomy makes no sense. As science investigates and observes things, those things are added to what we know of nature. Nothing that science considers part of nature can be called “supernatural.” Something might be considered supernatural today, but would be considered natural once studied and described, and to some extent understood.

    So there is absolutely no reason scientists can’t study something just because it might be called “supernatural.”

  60. Hermano says:

    Gorski writes “May 1942, six months after Pearl Harbor. Put yourself in the Allies’ place. Europe was in the hands of the enemy, who was rapidly advancing east into Russia, having only been stopped within sight of the minarets of the Kremlin”
    The minarets of the Kremlin?
    Come again?
    Is this the extent of your “scientific” knowledge, David?

  61. pec says:

    [And as I keep saying, your own words show quite conclusively that you are most definitely not a “scientific person.”]

    Well that’s because you define a scientific person as someone who, like you, is at war with CAM and alternative science.

    But there are a growing number of scientifically-educated people who are interested in alternative science. I predict that the more creative and non-conforming among future generations of researchers will be attracted to CAM and alternative science. Until, of course, alternative science is no longer alternative.

    Raving like a maniac will do nothing to prevent science from evolving.

  62. daedalus2u says:

    Psychoanalytic psychotherapy is not “CAM”. What about psychoanalytic psychotherapy is “materialistic”?

    The defining characteristic of Complimentary and Alternative Medicine is that it has not been demonstrated to be safe and effective via the standard methods that EBM and SBM use. Some CAM modalities are old such as acupuncture, and blood letting, some are of moderate age such as homeopathy and subluxation manipulation, and some are new, such as auditing, E meter work and stem cell injections.

    With that definition, antibiotics for viral infections are CAM.

    If you have a different definition I would be happy to hear it.

  63. weing says:

    There is no such thing as alternative science, only pseudoscience and science. One follows the scientific method, the other doesn’t.

  64. Hermano says:

    Here is the famous painting
    http://en.wikipedia.org/wiki/Image:Yuon_RedSquare_Parade_1941.jpg
    of the Soviet troops parading in front of the Moscow Kremlin en route to fighting Nazis outside the city, a month BEFORE the Pearl Harbor.
    Front and Center is the Saint Basil’s Cathedral with its famous onion domes, on the right, the Kremlin’s main symbol, the Tower of the Savior.
    No minarets.

  65. qetzal says:

    pec,

    Rather than debate over materialism, ideology, etc., let’s bring this back to something concrete.

    On a previous thread, you argued that there is a lot of valid science being conducted on energy healing. You cited a couple of papers by Schwartz, but you said you posted them in a hurry, and even you agreed they were not very good examples.

    At the time, you promised, “I am going to read up on energy healing research, and will be ready to comment next time one of the “skeptical” bloggers here trashes CAM.”

    Do you have anything more compelling to cite yet?

    I, for one, would very much like to see what you (or anyone) consider to be compelling evidence that energy healing may be ‘real.’

    Please note: I freely admit that I don’t expect you to find anything compelling, because I don’t believe energy healing IS real. That said, I am quite willing to be persuaded otherwise by decent scientific evidence. And whatever you may think of most people’s research qualifications in these threads, I think I’m at least as well qualified as you: PhD in mol biol, 20+ years as a practicing scientist in biotech, various peer-reviewed papers (nothing spectacular), direct involvement in multiple projects to develop novel human therapeutics, many of which made it into (but sadly, not through) clinical trials.

    Looking forward to a substantive response.

  66. pec says:

    qetzal,

    My lit review on energy healing will take more than one day, especially since I work full time and do not have work-related subscriptions to CAM journals. I am not going to spend my whole paycheck on this hobby!

    But I’m sure I can find some interesting and promising research on energy healing, given those limitations. I am searching the web and the public library, so just stay tuned. I do not expect absolute proof one way or another, since scientific CAM research is relatively new.

  67. Hermano says:

    David,
    You have got to be arrogant AND ignorant to insist that the Moscow Kremlin has minarets.
    “Minarets (Arabic manara (lighthouse) منارة, but more usually مئذنة) are distinctive architectural features of Islamic mosques.”
    http://en.wikipedia.org/wiki/Minaret
    There are no Islamic mosques in the Moscow Kremlin.
    The Kremlin has numerous Christian churches and cathedrals, such as the Saint Basil’s Cathedral with its onion domes.
    “An onion dome (Russian: луковичная глава, lúkovichnaya glava) is a type of architectural dome usually associated with Russian Orthodox churches.”
    http://en.wikipedia.org/wiki/Onion_domes

  68. RickK101 says:

    Me: “I suggest NCCAM take some of its $120 million a year and actually PROVE something that changes the current definition of the natural/materialst world. The money is there. Do something with it.”

    Pec: “I am sure that is exactly what they intend.”

    If you include the time before the NCCAM, when it was the “Office of Alternative Medicine”, then between 1991 and now NCCAM has spent around a billion dollars of taxpayer money and has added exactly ZERO to science based medicine. What’s more, they’ve not managed to disprove anything either – not one CAM treatment has been dropped even in the face of negative tests.

    A billion dollars! Nothing proven, nothing disproven.

    As we say in my office – put up or shut up.

  69. weing says:

    I disagree. I think that they’ve proven that $1 billion has been great marketing for big CAM. They’ve legitimized it in the eyes of the gullible and unwary public so that they find it in the local drug store and can’t tell the difference from legitimate meds.

  70. overshoot says:

    overshoot, it is the nature of placebos that they only work for a little while. When one type of woo stops delivering its placebo effect, the victims go to another, and another, and another. Each of them works for a little while and then stops working when the neurogenic placebo effect wears off.

    No, I don’t have to accept it. Both the history of superstition and mountains of behavioral psychology research teach us that. The self-rewarding system and social reinforcement are quite sufficient to keep people believing in a totally baseless notion. Individuals can hold onto a “lucky token” for most of their lives and die believing in it; whole societies can take it a step farther with mutual reinforcement and can pass arrant nonsense through the generations.

  71. DBonez says:

    pec said: “And, actually, most of the things you probably think are understood by science are not. Gravity is not understood, neither is electricity. Most things studied by physicists are not really understood, although we may be able to used them in our practical lives.”

    Okay, that is absolutely ridiculous. Maybe YOU don’t understand those concepts, but they are extremely well known and understood. Maybe anti-gravity doesn’t exist, yet, but that doesn’t mean it’s not well understood. Electricity has been fully understood, controlled, manipulated, transformed, and defined to the sub-atomic level for centuries. As an Electronics Engineer, my entire career is based on fully understanding electricity and applying it predictably and consistently.

    While this may be an utter waste, pec, try to comprehend this thought:

    Science = Repeatability

    Get that? Regardless of what is understood, or what results are being sought, if anything can be tested, demonstrated, controlled, and repeated, it can be considered a science. My engineering field, and certainly with Science-Based Medicine, the very basis of our understanding is repeating findings to a high degree of accuracy. Nothing is perfect or 100% accurate and science doesn’t claim to be perfect, but many, many areas of science, including medicine, the repeatability of theories approaches perfection (laws).

    Pec, please show me something in CAM, homeopathy, energy healing, etc. that is repeatable to some degree of accuracy that is not anecdotal. Give me an example that is even slightly repeatable beyond the results of noise/random chance/placebo/luck. I’ll bet everyone on this blog would be ecstatic to learn of an example of CAM or energy fields that can be repeated regardless of what science claims to “know.”

  72. TsuDhoNimh says:

    pec said:

    And, actually, most of the things you probably think are understood by science are not. Gravity is not understood, neither is electricity. Most things studied by physicists are not really understood, although we may be able to used them in our practical lives.

    The laws in real science have several things in common. They are predictable, they are repeatable, they are testable, they are internally coherent, and they work the same no matter who is using them.

    Predictable: When my roomie designs a circuit to do “X”, he uses the known and accepted laws of physics, and the measured and observable characteristics of semiconductors to construct a collection of resistors and transistors to do “X”.

    Repeatable: Someone else can take his notes and follow his process to make a circuit that does “X”.

    Observable or Testable: It is possible to predict the results, or observe the results, of what would happen if your hypothesis is right and what if it’s wrong.

    Here’s where woo practicioners fall flat on their modalities. They are so sure they are right that they don’t try to test their notions in a manner that removes their personal biases and ability to decieve themselves. They get a resultand declare victory and go home.

    Internally coherent: The chemistry of microbiology, the chemistry of semiconductors, and the chemistry of the plastics industry are all the same chemistry. Hg(CN2) doesn’t develop new properties and a new name when it moves from one industry to another.

    So pardon us for not believing that Hg(CN2) not only has an effect when diluted so much that our chemistry laws (Avogadro’s number) say there is nothing left, but has an effect that gets stronger when there is less of it.

    There are many “alternatives modalities” in CAM that are mutually exclusive among themselves … is it miasms, psors, blocked qi, cell salts, vitamin deficiencies, imbalances in the humours, vaccines, or demons that produce diseases?

    Works for everyone: When I open my hand and release a golf ball, it will fall to the ground. All the time. You don’t have to be a specially gifted gravity master to make a ball drop. You don’t have to specially treat the ball by thwapping it on a leather pad to sensitize it to the vital gravitational force. If it doesn’t reliably work, if it’s so ineffable a phenomenom that scepticism effes it up, it may as well be witchcraft.

    ***
    Yes, there are a few areas where discussions can get intense in science … because there are some areas where if one side’s idea has repeatable, testable evidence behind it the other side’s idea is going to be wrong. But after the evidence is shown, the dust settles, and everyone checks their own area’s theories to see if the new evidence illuminates some of their own fuzzy areas.

  73. Harriet Hall says:

    pec said,

    “You are assuming that all the physical laws are already known and understood.”

    No, science assumes that all the physical laws are knowable, not that they are already known.

    ““Materialist” is a useless term, first of all, because we know that matter is not material. And there are all kinds of things known to physics, such as fields and energies, that cannot be called “matter.””

    Materialist includes anything measurable, anything that can be observed in our shared material world, including fields and energies.

    ““Natural” means already known and understood by science, but science would never progress if it were confined to studying things already known and understood.”

    No, natural means knowable in the material world.

    “The ultimate nature of nature is not understood by physics.”

    That’s true. Physics never aspired to that. Physics only claims to discover how matter and energy behave in the material world and how to predict that behavior. Understanding the ultimate nature of nature is a metaphysical goal, not a scientific one.

    “Alternative science usually looks at things not yet described by mainstream science.”

    No, real science looks at things not yet described – that’s how science has made progress.

    “alternative scientists tend to accept some kind of bio-fields and bio-energies”

    Inasmuch as it accepts things without evidence, it is not science.

    “mainstream science — for reasons of tradition and ideology, and an interest in maintaining its anti-vitalist position — does not.”

    Science is not materialist. It does not rely on tradition. It has no ideology and is not anti-vitalist. It can’t be against any philosophy because it is not a philosophical endeavor.

    I keep trying to tell you: science would be happy to accept vitalistic phenomena if there were any way to verify them. I’ve asked you repeatedly to suggest how that could be done.

  74. overshoot says:

    I keep trying to tell you: science would be happy to accept vitalistic phenomena if there were any way to verify them. I’ve asked you repeatedly to suggest how that could be done.

    HH, you’re not understanding pec here. She can tell you thousands of ways to verify woo — that is, after all, how believers come to be believers.

    What she can’t tell us is how to disprove her beliefs. That is the unbridgeable gulf: to us, the impossibility of disproving the mystical takes it off the table. To believers, the impossibility of disproof is support for their beliefs.

  75. pmoran says:

    David >Clearly a change in course is needed, as I clearly pointed out in this post. Indeed, part of the reason I wrote this admittedly over-the-top post was to stimulate discussion and the posting of ideas for how to promote SBM.

    >So don’t be shy. Feel free to give us some.

    PM When I’ve worked it out I’ll let you know. :-)

    Can I run some thoughts by you on the meantime?

    The patient is the key — put their interests first and and there is almost no tenable contrary position.

    The patient-centric stance acknowledges that even stupid “alternative” methods may be helping some people in limited ways, that the public has the right to use them, and alternative practitioners and salesmen have the right to provide them so long as their claims meet reasonable cost/risk/benefit standards.

    Approaches which dwell upon the scientific atrocities undoubtedly being committed by AM may have their place, but they have not proved useful in public debate concerning the shape of medicine. Most people can either not grasp the scientific issues or they are not prepared to entirely discount the mass of personal testimonial.

    This “science-based skeptic”, as opposed to the perhaps more medically savvy skeptic, has other problems. They tend to get locked into or associated with completely unrealistic objectives. Their very rhetoric suggests the desire to consign alternative medicine en masse to hell — a sure way to alienate the fence-sitters and the freedom lobby..

    Not only that, but the “save our science” position is invariably selective concerning the science that needs saving, favoring evidence that tends to minimize the significance of placebo reactions in everyday medical practice, even while sometimes invoking placebo reactions to explain away the often dramatic benefits claimed by alternative supporters.

    Other issues briefly —

    – be clear-sighted — don’t exaggerate or you can look foolish. Alternative methods are NOT generally intrinsically unsafe, it is human stupidity and ignorance that rarely makes them so, or the lack of adequate oversight and quality control –these last can be fixed.

    And science is NOT collapsing in a heap because a few nuts can persuade some others to their way of thinking. The public is probably not, in general, being persuaded to any anti-scientific viewpoint, they see AM as merely something to try out to see if it helps and nearly all STILL see conventional medicine as the first port of call if they sense they have an important medical problem. And this even when AM may have reached a zenith and is ready to decline, if the amount of more skeptical material appearing in the the media is any guide.

    And I don’t think there is any organised conspiracy to corrupt science, just as there is none to suppress alternatives. It can just look that way to those who are unable to credit opponents with sincere belief.

    – give the public the credit for some sense. Considering the potential for harm from alternative medicine and its practitioners the number of persons clearly harmed seems remarkably small.

    There is also no assurance that the total elimination of alternative medicine would result in its victims using conventional methods. There always a few who believe that they can cure all ills with nuts and honey, or whatever.

  76. overshoot says:

    And science is NOT collapsing in a heap because a few nuts can persuade some others to their way of thinking. The public is probably not, in general, being persuaded to any anti-scientific viewpoint, they see AM as merely something to try out to see if it helps and nearly all STILL see conventional medicine as the first port of call if they sense they have an important medical problem. And this even when AM may have reached a zenith and is ready to decline, if the amount of more skeptical material appearing in the the media is any guide.

    I recall Clarke’s Law to everyone: “Any sufficiently advanced technology is indistinguishable from magic.” Well, to the general public medicine is well past the threshold and isn’t likely to ever return [1].

    What that means is that even though we may understand that scientific medicine (or medical science) are not magical and that there are real, objective, differences between medicine and magic that can literally make the difference between life and death for that same public — they don’t, and likely never will.

    So, I ask, how do you pick out a fer-sher sorcerer from the posers?

    [1] I propose that the middle half of the 20th century was the low-water mark for magic. Almost all of the cool technology in use could be fairly readily understood by someone with at most a high-school education. They could take apart a car down to the smallest parts and put it back together, and if they wanted to they could do the same with radios and televisions. If it broke, they had a fair chance of fixing it. Try that today. It’s all magic, and it only runs until the magic smoke escapes.

  77. pmoran says:

    I meant to add — what message would we most like to get across? What about “even after some decades of opportunity and encouragement, alternative methods have been unable to provide an answer to any of medicine’s great unsolved problems, or a cure for any disease.”

    That message will be easier to sell if it is allowed that alternative methods have been able to help some people in other ways.

  78. clgood says:

    Turns out there are lot’s of reasons not to trust your “alternative medicine” doctor.

  79. Harriet Hall says:

    pmoran,

    It seems you are really talking about complementary medicine. Perhaps we could get the idea across to the public that “neither a placebo nor a CAM therapy is going to cure anything that will not resolve itself or that the body does not have the capacity to deal with.” (Bausell, Snake Oil Science). And then let them try any safe CAM treatment that appeals to them and that might elicit the placebo effect.

    And why not tell the patient “There is no scientific evidence that X works, but some people think it has helped them.”?

    I see no reason we can’t be “permissive” about CAM and still be “rigorous” about evidence and science.

  80. ama says:

    [*QUOTE*]
    —————————-
    # pecon 21 Jul 2008 at 7:28 pm

    “the evil that happened to that poor woman is an example of how evil can triumph when good people do nothing.”

    Oh baloney. You take one case and magnify it into a catastrophic threat to human survival. What about all the poor cancer victims who die in spite of your toxic and expensive treatments?

    You have not studied and rejected all CAM treatments based on scientific evidence. You just pretend that you have. You are sure they can’t work because you don’t understand how they could work. And you don’t understand because they don’t fit your materialist ideology.
    —————————-
    [*/QUOTE*]

    So let’s analyze…

    [*QUOTE*]
    —————————-
    You take one case and magnify it into a catastrophic threat to human survival.
    What about all the poor cancer victims who die in spite of your toxic and expensive treatments?
    —————————-
    [*/QUOTE*]

    These are typical statements by esotters. There is an insane logic behind that. It works like this:

    1.
    Esotters cannot count and they DO NOT WANT to count. They ALWAYS come up with anecdotal stuff.

    This way they shove away ALL the victims of esottery. If a “healing” method somehow has one survirvor, the esotters will NOT say that the chance of survival is 1:1000, they will claim “IT WORKS!”

    2.
    Even if there are NO healing effects – or, worse, there are no survivors at all – the esotters will cling to their “healing” method. But WHY and HOW? Answer: With an insane argument: “We KNOW it works.”

    You might think that only idiots would argument that way. Yes, you are right with that, but you should consider our German government to react JUST THAT WAY. Concerning homeopathy and anthroposophic “medicine”, German politicians DECLARED: “We know it works.” They even went further and claimed: “These methods have been proven successful.”

    How could they do THAT? Answer: Take trick number 1.

    3.
    Esotters reverse cause and consequence.
    Esotters take the wrong part of the statistic selection.

    “pec” does it: “What about all the poor cancer victims who die in spite of your toxic and expensive treatments?”

    “pec” does not say: “What about all the poor cancer victims who SURVIVED BECAUSE OF your toxic and expensive treatments?”

    Esotters can be so deeply insane that they claim that 98 percent of all “school medicine treated” cancer patients die, AND that their guru has a healing method where more than 95 percent of his patients survive. BUT they cannot even show ONE SINGLE survivor of their guru’s method.

    To stress this even more, they claim that “school medicine” does not want to let their guru’s patients survive, an so there are none..

    Not all esotters are that insane, but there is a very broad range…

    Clear fact: one cannot discuss with esotters. They live in their mental “somewhere”, but not on this earth.

    You NEVER can convince them as their “logic” is THE BASE to their existence. Even scratching their “logic” would immediately show, that they are nuts, that through all their life they messed up everything, that they are responsible for grief, sorrow, and even for death of family members. To get rid of that guilt, esotters MUST never confess that they are wrong.

    The consequence is, that even slightest scratching of their pseudointellectual surface makes esotters PERSONALLY ATTACKED and puts them in rage. As they have no real facts, they use even the most stupid, aggressive and imbecile tricks and rhetoric to fight against their “attackers”.

    You see: One cannot discuss with esotters, one must write ABOUT them and uncover their methods. We do this for more than a decade now, and … IT WORKS! :-)

    Some short example:

    [*QUOTE*]
    —————————-
    You have not studied and rejected all CAM treatments based on scientific evidence. You just pretend that you have. You are sure they can’t work because you don’t understand how they could work. And you don’t understand because they don’t fit your materialist ideology.
    —————————-
    [*/QUOTE*]

    1.
    One major trick of esotters and snakeoil-dealers is to put the burden of proof onto those who oppose them.

    One MUST NOT fall for this trick! There are several reasons associated with this trick:

    a)
    Even if – in a study – it were possible to prove that the esoteric method is wrong, the esotters win years of time. During this time they have

    – ad 1 the additional boost BECAUS OF THE STUDY to claim that “even school medicine is trying it”.

    – ad 2 years of time to make big cash because they are not blocked of, but instead (see above) are SUPPORTED by their critics.

    b)
    Most of the studies would be illegal because of unnecessarily endangering/risking the lives of the probands.

    So it is absolutely impossible to make these studies. DESPITE THEY DO KNOW THAT, esotters insist on such studies. We find many examples for that in the anti-vacc scene. These “persons” even insist on destroying OTHER PEOPLE’S vaccination shield. The anti-vaccs in Germany wanted in a public petition to the Bundestag to stop that insurance companies pay the HPV vaccination. More than 1000 lives can be saved EACH year, and so the anti-vaccs obviously do want these women to die…

    c)
    If such a study would prove that the esoteric claim is wrong, the esotters STILL would go on with their wrong claims. The best known example for this is hompeopathy, a pile of insane lies, which for more than centuries is spread across the continents and cost uncounted lives.

    If “alternative” medicine WERE trustworthy, its proponents would behave honestly. But they don’t, see a, b, c.

    2.
    Esotters defend their “science” by claiming that the critics do not understand them. This is one of the most widely used and most primitive lies. And it is so very easy to use. Even the dumbest bloke is very fit in using it.

    An example:

    [*QUOTE*]
    —————————-
    You just pretend that you have. You are sure they can’t work because you don’t understand how they could work.
    —————————-
    [*/QUOTE*]

    One cannot argue about that because esotters are autistic. So, all one can do is to SHOW IN PUBLIC how damned stupid esotters are. And this really IS easy to do.

    3.
    Esotters do not live on earth:

    [*QUOTE*]
    —————————-
    And you don’t understand because they don’t fit your materialist ideology.
    —————————-
    [*/QUOTE*]

    Whatever science may bring, esotters do not accept it. To make their insane world keep on going, they always take it out of the real world. The rhetoric trick: “You just cannot measure it, but this does not mean that it does not exist.”

    Esotters develop “super-science”. An Austrian claims to dry walls with energy coming from “space”. Several “scientists” work with it, but no real scientist can measure it. “BUT IT IS THERE!” Interestingly, although it cannot be measured, this energy can do PHYSICAL work. The best work: it sells esoteric stuff…

    Here is an analysis of such a messy “science”:

    http://www.fgf.de/publikationen/newsletter/einzeln/NL_04-01/Betrachtung_Theorien_Meyl_NL_01-04d.pdf

    (Sorry, seems there is no English translation available. But, please, ask the FGF if they would translate it. The other newsletters by them ARE translated.)

    So, this “super science” exists, does work, ONLY the school medicine” or “mainstream science” is either to stupid to accept it, to measure it, or to prove it.

    What is this? Answer: This is magic. Magic is only for those with insight, for knowing, for the elite.

    This trick is a multifunctional tool. It is an EXTREMELY stupid bullshit, but even the greatest idiot ever can handle it easily.

    – It EXPLAINS why “school medicine” or “mainstream science” cannot find it, measure it, use it or prove that it does no work or exist.

    – WHATEVER “school medicine” or “mainstream science” would do or say, EVERYTHING would PROVE how stupid they are.

    And if it is not stupidity (no, not all are stupid), then it is them being bought by “the “pharmamafia”, by “the big industry” or by another cartell.

    The big catch with this

    “What is this? Answer: This is magic. Magic is only for those with insight, for knowing, for the elite.”

    is, that those who claim, that they know, put themselves up as THE ELITE.

    So, even the greatest idiot ever is part of THE ELITE.

    Really, you cannot dare to touch that, don’t you?

    Even the greatest idiot ever is part of THE ELITE. This shows why it is so important for them to have this shield: it makes them important. Perhaps it even makes them the rulers of this world…

    To take away this base would make their whole world collapse. So we, the scientific thinkers, are aliens to their world. That we want to destroy their world makes us insane aggressors.

    But it really IS easy to crack this.

    Point 1: You CAN NOT discuss with esotters. You only can demonstrate how damned stupid they are.

    Point 2: Esotters ARE stupid. They have no facts, they even cannot count.

    This can be demonstrated e.g. with the homeopaths, who all the time CLAIM about their healing success. But they are too damned stupid to COUNT the succesful cases and the insuccessful cases. And this for more than two centuries…

    In this web-site there are long discussions, but they won’t lead you anywhere. Go to the basics, go to the facts … and see how esotters bite into the carpets.

    ama
    ( rhetoric in the war against patients: )
    ( http://www.ariplex.com/ama/ama_rhet.htm )

    [PS: David, you might put this up as a new thread.]

  81. Militant Agnostic says:

    I would suggest giving every medical student and every nursing student a copy of a book like Snake Oil Science or Trick or Treatment. We need to persuade someone like Warren Buffet or Bill Gates that this is good idea. Perhaps a less threatening book promoting critical think such as “How we Know What isn’t So” might be better received.

  82. pmoran says:

    Harriet >It seems you are really talking about complementary medicine.

    PM I would like to think of myself as more science-oriented than the usual CM (or IM or AM) advocate. I accept that any benefits from AM are mainly from the placebo complex of influences. That includes the ability of medical attentions to satisfy other human needs and the avoidance of nocebo effects if it should seem that the doctors have lost interest in working with the patient. My main agreement with the CM and IM advocates is that medical interactions are more comples than the typical SBM model assumes.

    Harriet> Perhaps we could get the idea across to the public that “neither a placebo nor a CAM therapy is going to cure anything that will not resolve itself or that the body does not have the capacity to deal with.” (Bausell, Snake Oil Science). And then let them try any safe CAM treatment that appeals to them and that might elicit the placebo effect.

    PM That is more or less what I propose.

    Harriet >And why not tell the patient “There is no scientific evidence that X works, but some people think it has helped them.”?

    PM That’s fine with me. As I have said before, patients don’t really care what science says. They have an incompletely resolved problem and would simply like to try X. We need a sound reason if we wish to deter them from doing so.

    SBM has made nervous ninnies of us in this regard, and we are also trying to be ethical superheroes in a very complex human situation. A good doctor should have the freedom to try and help patients in any reasonable way he can, and not have to be looking over his shoulder all the time to see what the purists are selecting out of a veritable soup of scientific and ethical considerations.

  83. DavidCT says:

    I recently noted an attack by the Borg in an unexpected place. I buy a number of books at Amazon.com and because of my tastes, Rose Shapiro’s book “Suckers” came up as something I might be interested in. I noted that it was rated poorly in the reviews. There were only three at the time. On was from a physician from the UK who gave the book a 5 star review. The other two reviews were from rabid alternative types who naturally did not like what the book had to say and rated it 1 star. The average was just over 2 stars. If someone did not look at who had posted the reviews, they might get the impression that the book was not worth reading.

    It might be informative to go over to amazon and look at the reviews. These people really are the Borg.

  84. Michelle B says:

    Perhaps CAM medicine in its present incarnation does not hold much danger for patients in terms of injury, death, etc. (I do not even know if this has been statistically determined, including weighing risks/benefits among CAM, SBM, and no treatment). However, the ‘quisling’ approach, of allowing CAM to play a role in medicine, has its dangers. CAM medicine can eventually become much more dangerous than it is. Pandering to ignorance in the populace can have its disadvantages.

    My focus is that minimizing ignorance in the general population is the healthier trend. Also, I consider peddling ignorance to be supremely insulting and demeaning to humanity. This approach is similar to the one that religious apologists take, they themselves can’t be bothered with religion, but it is good for the masses.

    So though the ‘honey can catch flies’ approach may seem attractive on the surface, do we really want to attract flies?

    In the past, general practitioners, who were not as knowledgeable as present day doctors, indirectly and perhaps consciously used their prestige (to be a doctor in that time was akin to being a god), to pull off the placebo effect and/or to ensure treatment compliance. It seems today, the only option open to doctors is to embrace CAM to equate what their predecessors were able to easily do just by being doctors.

    I think patients should be encouraged to see the value of placebos and that, they themselves, can inexpensively provide them. More research on what the important factors that allow placebos to be effective needs to be done. These factors need to be identified so one can provide custom made placebos.

  85. Fifi says:

    MichelleB – “My focus is that minimizing ignorance in the general population is the healthier trend. Also, I consider peddling ignorance to be supremely insulting and demeaning to humanity. This approach is similar to the one that religious apologists take, they themselves can’t be bothered with religion, but it is good for the masses.”

    I agree wholeheartedly. I also think there’s a very big difference between ignorance based upon innocence (just not knowing something) and willful ignorance (aka denial of evidence). It’s also my experience that most people are quite capable of understanding enough to make an informed decision for themselves IF they’re given enough information and someone takes the time and is patient. For instance, it’s much more sustainable to teach someone how to relax (I found that some of the chronic pain patients I taught relaxation to literally didn’t know how to relax!) than it is to make them reliant and get them into paying someone else every time they want to relax. People naturally continue their bad habits out of the treatment office if they’re not aware of what they’re doing that’s creating the problem, which means symptoms return and they return to be “healed” again. (It is indeed the snake eating its own tail!) Not that I’m opposed to people indulging in massages or pleasurable activities, I just consider it more ethical to teach people to care for themselves than to create dependencies – whether consciously or through ignorance or innocence – particularly if one benefits off of having “patients” dependent upon oneself. Equally, if what a patient is getting is more emotionally therapeutic – some coddling, being listened to and reassurance, some gentle/loving touch, being able to talk about personal problems (often a feature of CAM therapies, it’s integral to homeopathy) – it’s still unethical to encourage a patient to be eternally dependent upon you. (In medicine, not only are pyschotherapists taught about transference and counter-transference but their goal is for their patient to be able to fill their own needs and be independent – even if there’s a period of dependency that is innate and necessary in most pyschotherapy, the ultimate aim is independence and selfcare. Speaking about ethical psychotherapists of course who practice EBM, not ones who are wrapped up in thinking they’re a shaman and so on).

    I’m a big fan (and biased towards) self responsibility and giving people the information and knowledge they need to make their own choices. I’m also aware that “alternative” medicine is tied in with “alternative” lifestyles for quite a lot of people – and with religious beliefs (both traditional and new age). I’ve found that often people just need to learn a bit more about how their body works, and the mind/body relationship, and they’re quite capable of taking care of themselves and making their own decisions.

  86. qetzal says:

    Harriet Hall asked:

    And why not tell the patient “There is no scientific evidence that X works, but some people think it has helped them.”?

    I think this is sometimes a reasonable answer. Other times, I think the only correct answer would be “There is good scientific evidence that X does not work the way it’s claimed, although some people may think it has helped them due to placebo effects.”

    I think some people justify taking a tolerant attitude towards unproven treatments by saying, in effect, it “might work.” While that’s ultimately true, I think we must distinguish between “X might work, but we don’t have enough data to be confident” and “X might work, but only if a lot of other data is somehow wrong.”

    Of course, I’m not an MD, so it’s easy for me to pontificate on what “we” should tell patients. ;^)

  87. pec says:

    I am NOT advocating any CAM treatments. I am saying, again, that research on CAM should be allowed and funded. Gorski et al. want to block that, because they believe for ideological reasons that CAM treatments cannot work.

    There is fraud everywhere that money can be made. Maybe you think the big drug companies love you and don’t care about grabbing your money.

  88. weing says:

    pec,
    Do you think the government should pay drug companies to do research? Why treat them differently?

  89. Fifi says:

    pec, why should CAM be funded because YOU want it to be for your own ideological reasons? Or perhaps for professional/mercenary reasons? You claimed you were a cognitive scientist and had been involved in research…what kind of research was it?

  90. Fifi says:

    I think there may also needs to be a distinction made between “feeling good’ and medical treatment (between pleasure and healing, kinda like how it’s a bad idea to make kid’s medication taste like candy!) – I suspect a lot of people confuse the two. I find it slightly, well, neurotic that pleasurable activities (or non-activities as the case may be) like getting a massage, chilling out, social interaction and intimate conversation, sharing a hug and so on are being medicalized by CAM – these are life skills (or life skill issues if people can’t relax or be intimate within the context of living their life). Not that there’s anything integrally wrong with paying for a hug, sex, a good meal or pleasure, or healthy interdependence. And clearly some people need extra help in areas of their life and in learning some life skills – it’s the profiting off of creating a dependence rather than fostering independence that I find problematic. Just a personal take on it, of course! :-)

  91. David Gorski says:

    Gorski et al. want to block that, because they believe for ideological reasons that CAM treatments cannot work.

    That’s a lie.

    I insist that good science and sound ethics be prerequisites for clinical trials. Many CAM trials fail at one or both (often both). Such trials should not be funded.

  92. pec says:

    “I insist that good science and sound ethics be prerequisites for clinical trials. Many CAM trials fail at one or both (often both). Such trials should not be funded.”

    No research is ever perfect. But I agree that poor quality CAM research should not be funded. That seems too obvious to mention.

    I do not believe there is no high quality CAM research. If the public and some scientists are interested in promoting good quality scientific research on some CAM treatments and ideas, then I see no reason for fighting so desperately against it.

  93. qetzal says:

    I do not believe there is no high quality CAM research.

    Why? So far, you haven’t cited any CAM research that is high quality. In the case of ‘energy healing’ you’ve admitted you need to review the literature before you can offer any examples of high quality research.

    You’re convinced there’s merit in at least some CAM research, but you can’t back that up with any evidence. What’s the foundation for your belief, then? Ideology, perhaps>

  94. pec says:

    qetzel,

    I have read a lot over the years about non-mainstream scientific research. It is not all low quality and to claim that about such a vast quantity of research, especially when you have at most minimal knowledge of it, is ridiculous.

    “Skeptics” think everyone everywhere is a self-deceiving fool, unless they belong to your “skeptics” club.

  95. Fifi says:

    pec – But you previously claimed you needed to go read the literature before showing evidence of well designed studies! Which is it? You’re an expert on “non-mainstream science” or you’re not…which are you? You keep swinging wildly between claiming to be “just a normal person/patient” and an “expert” – between powerless victim and grandiose authority – it’s all seems a bit bipolar.

    For someone who claimed to have a PhD in Cog Sci, you really don’t seem to understand anything about how people DO fool themselves, the unreliability of subjective experience and how perception and cognition function. You remind me of someone who still can’t see the gorilla on the basketball court even when it’s pointed out to them!

  96. Fifi says:

    pec – Just to be clear, I don’t think people who miss the gorilla on the basketball court are fools…only those who refuse to admit it or see it once it’s pointed out to them are fools.

  97. pec says:

    “But you previously claimed you needed to go read the literature before showing evidence of well designed studies! Which is it? You’re an expert on “non-mainstream science” or you’re not”

    I have read a lot about alternative science, not specifically about energy healinig. Idiot.

    Critical parts of your brain are missing. Go away.

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