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Science, Reason, Ethics, and Modern Medicine, Part 3: Implausible Claims and Formal Ethics Statements

The Ethics of Implausible Medical Claims (IMC)

In Part 2 of this series* we learned from David Katz, MD, a key member of the Yale School of Medicine’s “integrative medicine” program, that he had been “pushed toward integrative medicine by the needs of [his] patients.” We also learned that Dr. Katz’s rationale for this decision justifies a wide range of quackery—both in principle and in fact. I had previously alluded to arguments like those of Dr. Katz in a comment on SBM several months ago:

…we must be true to medical ethics, no matter what else we do. If that means losing a few patients, so be it. Patients are free agents, and we can only do so much to influence them. To the extent that we don’t do that as well as we might (which is obviously true in some cases), we might do better. But our ethical obligation is to science and truth; it is not, as many modern physicians would have it and as much as we may lament sometimes losing patients to woo, to seducing patients to stick with us no matter what, if the “what” includes engaging in a charade about “integration” or “complementary therapies”…

Realizing that some might argue that physicians’ obligations to patients ought to trump their obligations to “science and truth,” I later revised that statement:

Several weeks ago I argued here that a physician’s primary ethical obligation is to science and truth. In retrospect I probably should have put it a slightly different way: a physician’s primary ethical obligation is the same as everyone else’s. It is to honesty and integrity. For physicians, however, that means being true to real medical knowledge, among other things, and real medical knowledge comes from science.

In spite of that revision, two readers whose opinions I respect challenged my assertion. Dr. Peter Moran’s worthy efforts to educate patients about the realities of “alternative” cancer treatments are considerable. Here on SBM he has repeatedly challenged us to explain how, when confronted with testimonials of “alternative” cures, we ought to respond without using “a high-handed, ‘we know best’ stance” and thus “appear to want to distance [ourselves] from the intimate concerns of [our] patients.” I was thinking mainly of him when I wrote the revision above, because on this key topic—how to respond ethically, but with compassion, to patients who want to believe in implausible treatments—I’ve come to think of Dr. Moran as the “conscience” of Science-Based Medicine. Those with cancer, he has reminded us, “are folk very like you and me who are simply grasping at any straw that might save or prolong their lives.” His take on why IMCs are appealing to those with less ominous problems is well-developed and agrees with my own, mostly. We part ways, however, when he concludes (also here and here) that ethical physicians might have good reasons—unlike Dr. Katz’s—to entertain benign, if implausible treatments:

I thought KA was similarly slightly off-target when defining the primary ethical obligations of the physician as being to science without even mentioning the patient. That would certainly apply in an ICU or in the operating theatre, and in most specialist neurological or oncological practices (hint!), but there may be quite sound reasons why many family doctors don’t yet want to completely abandon dubious but relatively safe methods in favour of the contents of their drug cabinet.

Co-blogger David Gorski also took issue with my assertion about honesty and integrity/science and reason:

…ethically as a physician, my first obligation is to the patient and seeing that the patient is treated as effectively as she can be (sorry, Kimball, my first obligation when treating a patient is not to science or reason). Telling a patient too stridently that her dubious therapy is, well, a dubious therapy risks doing one of two things: (1) driving her away from effective science-based therapy or (2) making her reluctant to tell me everything she is taking.

Dr. Gorski and I, however, don’t really disagree. The relevant terms in his passage and in my second passage quoted above are “primary,” “first,” and “too stridently.” I have no trouble with Dr. Gorski’s description of how he responds to patients who ask about or elect dubious treatments:

As long as they tell me about it and it doesn’t interfere with scientific-based treatment, patients can do whatever they like. If they ask my my opinion, I will tell them, as non-judgmentally as possible, but I’m not going to push too hard.

My original assertion about medical ethics, quoted above, did not argue that our obligation to science and reason trumps our obligation to our patients. It argued that our obligation to science and truth (reason is also fine) trumps “seducing patients to stick with us no matter what, if the ‘what’ includes engaging in a charade [see Dr. Katz] about ‘integration’ or ‘complementary therapies’…” Later I used the term “primary ethical obligation,” which was unfortunate because the word “primary” distracted from the real point: Honesty and integrity, which in medicine must not clash with science and reason, are necessary for fulfilling our ethical obligations to our patients.

It is beside the point to quibble over whether, on some numbered list, our obligation to our patients should precede or follow our obligation to honesty and integrity. We can’t fulfill our obligation to our patients if we don’t fulfill our obligation to honesty and integrity, and we can’t do that if we overlook science and reason.

Formal Treatises

Most modern statements of medical ethics include both an obligation to patients and an obligation to honesty and integrity, which in turn is either explicitly or implicitly linked to science. The recent “Medical Professionalism in the New Millennium: A Physician Charter,” a joint project of the American College of Physicians and the European Federation of Internal Medicine, has three Fundamental Principles, the first two of which are:

Principle of primacy of patient welfare. This principle is based on a dedication to serving the interest of the patient. Altruism contributes to the trust that is central to the physician–patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle.

Principle of patient autonomy. Physicians must have respect for patient autonomy. Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Patients’ decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care.

There is also a Set of Professional Responsibilities, among which are:

Commitment to professional competence. Physicians must be committed to lifelong learning and be responsible for maintaining the medical knowledge and clinical and team skills necessary for the provision of quality care. More broadly, the profession as a whole must strive to see that all of its members are competent and must ensure that appropriate mechanisms are available for physicians to accomplish this goal.

Commitment to honesty with patients. Physicians must ensure that patients are completely and honestly informed before the patient has consented to treatment and after treatment has occurred. This expectation does not mean that patients should be involved in every minute decision about medical care; rather, they must be empowered to decide on the course of therapy.

Commitment to scientific knowledge. Much of medicine’s contract with society is based on the integrity and appropriate use of scientific knowledge and technology. Physicians have a duty to uphold scientific standards, to promote research, and to create new knowledge and ensure its appropriate use. The profession is responsible for the integrity of this knowledge, which is based on scientific evidence and physician experience.

Among the more venerable AMA Principles of Medical Ethics are these:

I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

The AMA code also has several relevant policies:

E-3.01 Nonscientific Practitioners
It is unethical to engage in or to aid and abet in treatment which has no scientific basis and is dangerous, is calculated to deceive the patient by giving false hope, or which may cause the patient to delay in seeking proper care.
E-3.04 Referral of Patients
A physician may refer a patient for diagnostic or therapeutic services to another physician, limited practitioner, or any other provider of health care services permitted by law to furnish such services, whenever he or she believes that this may benefit the patient. As in the case of referrals to physician-specialists, referrals to limited practitioners should be based on their individual competence and ability to perform the services needed by the patient. A physician should not so refer a patient unless the physician is confident that the services provided on referral will be performed competently and in accordance with accepted scientific standards and legal requirements.

E-8.20 Invalid Medical Treatment
The following general guidelines are offered to serve physicians when they are called upon to decide among treatments: (1) Treatments which have no medical indication and offer no possible benefit to the patient should not be used (Opinion 2.035, “Futile Care”). (2) Treatments which have been determined scientifically to be invalid should not be used (Opinion 3.01, “Nonscientific Practitioners”).

E-9.132 Health Care Fraud and Abuse
The following guidelines encourage physicians to play a key role in identifying and preventing fraud: (1) Physicians must renew their commitment to Principle II of the American Medical Association’s Principles of Medical Ethics which states that “a physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character, competence, or who engage in fraud or deception.” (2) Physicians should make no intentional misrepresentations to increase the level of payment they receive or to secure non-covered health benefits for their patients.

H-480.963 Folk Remedies Among Ethnic Subgroups
The AMA: (1) does not recommend the sole use of unvalidated folk remedies to treat disease without scientific evidence regarding their safety or efficacy; (2) encourages research to determine the safety and efficacy of folk remedies; (3) physicians should be aware that the use of folk remedies may delay patients from seeking medical attention or receiving conventional therapies with proven benefit for disease treatment and prevention; (4) practicing physicians should routinely ask patients whether they are using folk medicine or family remedies for their symptoms. Physicians can educate patients about the level of scientific information available about the therapy they are using, as well as conventional therapies that are known to be safe and efficacious; and (5) physicians should be aware of folk remedies in use and the level of scientific information available about such remedies, and should include this information when discussing conventional treatments and therapies with their patients.

H-480.964 Alternative Medicine
Policy of the AMA on alternative medicine is: (1) There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies. (2) Physicians should routinely inquire about the use of alternative or unconventional therapy by their patients, and educate themselves and their patients about the state of scientific knowledge with regard to alternative therapy that may be used or contemplated. (3) Patients who choose alternative therapies should be educated as to the hazards that might result from postponing or stopping conventional medical treatment.

H-480.983 Clinical Ecology
It is the policy of the AMA (1) to continue to monitor the published literature on clinical ecology and to report as appropriate; and (2) that those who support a new test, procedure, or treatment must prove by appropriately controlled peer reviewed trials that it is effective for the purposes for which it is used and that the burden should not be shifted to opponents to prove that a new test or therapy is invalid.

E-8.085 Placebo Use in Clinical Practice.

A placebo is a substance provided to a patient that the physician believes has no specific pharmacological effect upon the condition being treated. In the clinical setting, the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient.

Physicians may use placebos for diagnosis or treatment only if the patient is informed of and agrees to its use.  A placebo may still be effective if the patient knows it will be used but cannot identify it and does not know the precise timing of its use. A physician should enlist the patient’s cooperation by explaining that a better understanding of the medical condition could be achieved by evaluating the effects of different medications, including the placebo. The physician need neither identify the placebo nor seek specific consent before its administration. In this way, the physician respects the patient’s autonomy and fosters a trusting relationship, while the patient still may benefit from the placebo effect.

A placebo must not be given merely to mollify a difficult patient, because doing so serves the convenience of the physician more than it promotes the patient’s welfare.  Physicians can avoid using a placebo, yet produce a placebo-like effect through the skillful use of reassurance and encouragement.  In this way, the physician builds respect and trust, promotes the patient-physician relationship, and improves health outcomes (I, II, VIII).

Other pertinent entries among the AMA ethics policies are Withholding Information from Patients (Therapeutic Privilege) and several statements about Health Fraud.

Although the language could have been more definitive, it seems to me that the statements above deem it unethical for physicians to offer implausible treatments, to refer patients to others for implausible treatments, or, if asked, to fail to inform patients of the implausible nature of such treatments. They also deem it unethical to administer a placebo without the patient’s informed consent, or to mislead patients about the reasons that implausible treatments make some people feel better. Thus it is dishonest to recommend acupuncture or homeopathy in a disguised attempt to elicit a placebo effect.

I will not argue that physicians must, perforce, honor certain written edicts. On the contrary, if these treatises contained language condoning the cited practices, I would reject them. My reason for citing the statements above is not to pose as a petty, medical ethics traffic cop. It is to remind us that these ethical precepts have been considered at length by thoughtful, committed physician-ethicists, have been around long enough to have made their way into formal opinions, and have persisted in those opinions. Thus physicians practicing in disregard for them—especially those, such as Dr. Katz and other IMC enthusiasts, who have been flouting them for several years—should be aware that they have chosen to repudiate the considered opinions of wise men and women, regarding an issue that is fundamental to medical ethics: the relation of honesty and integrity to science and reason.

The medical profession as a whole ought to acknowledge that as well. The time has come for the profession to revisit those ethical precepts and decide whether they have become obsolete. If not, it’s time to clean house.

Next week: Physician as rational consultant and more.

……………..

* The Science, Reason, Ethics, and Modern Medicine series:

Science, Reason, Ethics, and Modern Medicine Part 1: Tu Quoque and History

Science, Reason, Ethics, and Modern Medicine, Part 2: the Tortured Logic of David Katz

Science, Reason, Ethics, and Modern Medicine, Part 3: Implausible Claims and Formal Ethics Statements

Science, Reason, Ethics, and Modern Medicine, Part 4: is “CAM” the only Alternative? And: the Physician as Expert Consultant

Science, Reason, Ethics, and Modern Medicine, Part 5: Penultimate Words

Posted in: Health Fraud, Medical Ethics, Science and Medicine

Leave a Comment (91) ↓

91 thoughts on “Science, Reason, Ethics, and Modern Medicine, Part 3: Implausible Claims and Formal Ethics Statements

  1. Harriet Hall says:

    As I read through the AMA code, I wished every MD who advocates alternative medicine would read it. Then I realized it wouldn’t make any difference. They would read those ethical statements, convince themselves that whatever they want to do IS backed by science, and carry on as usual.

    I hate to say it, but a lot of MDs really don’t understand how science works. They are convinced by testimonials and poor quality studies. They go by belief rather than good evidence. They should all start reading this blog. :-)

  2. daijiyobu says:

    One ‘medical ethics resource’ I’m familiar with is at the U. of WA’s School of Medicine (http://depts.washington.edu/bioethx/ ). I particularly like their entry on “professionalism” (http://depts.washington.edu/bioethx/topics/profes.html ):

    “professionals have a fiduciary duty toward those they serve. This means that professionals have a particularly stringent duty to assure that their decisions and actions serve the welfare of their patients or clients, even at some cost to themselves. Professions have codes of ethics which specify the obligations arising from this fiduciary duty. Ethical problems often occur when there appears to be a conflict between these obligations or between fiduciary duties and personal goals.”

    One form of CAM’s / alt.med.’s deceit, in my view, is ‘a clear lack of full disclosure’ / ‘accurate contextualization’ — particularly, a language manipulation that requires decoding.

    For instance, take the recent article in All You magazine (08-01-2008) on alt. med. and naturopathy by Jan Sheehan

    (posted on the AANP’s site, and written in consultation with the AANP’s current President, Alschuler, per
    http://naturopathic.org/images/bulletins/Articles/Lise%20Alschuler_All%20You%20Magazine%20-%20August%2008.pdf ),

    which states:

    “philosophy: naturopathic doctors [...] believe that the body has the potential to heal itself naturally [...] they treat [...] the whole person – their physical, mental and emotional health.”

    This is grossly incomplete, as usual — and therein, unprofessional in a manipulative-deceitful kind of way. This is how the AANP operates. Lets dust the house a little, lets complete and accurately represent naturopathy’s philosophy.

    Go to one of their schools to decode the Sheehan / Alschuler language [so you can actually be informed, as opposed to manipulated / deceived]:

    a) healing is due to a life force figmentation (see http://www.bridgeport.edu/ub/nm/Six_Prithree.htm );

    b) whole includes a spirit figmentation (see http://www.bridgeport.edu/ub/nm/Dean.htm );

    c) life force itself is spirit [figmentation upon figmentation!] (http://www.amazon.com/review/R1IXX4PKA2CBVK/ref=cm_cr_rdp_perm ) .

    Dr. Atwood, speaking of Houses, the AANP emailed me yesterday concerning their bill in the MA House [it has already passed the MA Senate, they say], the Naturopathic Licensing Bill, S2820.

    They seek to make MA “the next licensed state.”

    I wonder what kind of language they’re employing [abusing]. It will be fun to decode / expose.

  3. David Gorski says:

    I’ve pointed out time and time again that most physicians are not scientists. I’ve even pointed out that all too many physicians’ understanding of the scientific method is woeful. Indeed, that’s the reason there are so many physicians out there who are creationists.

  4. pec says:

    Your logical error is in assuming that nothing is true unless it has been verified by formal research.

    First of all, most hypotheses have not even by thought of by medical researchers, let alone formally tested.

    Secondly, there is no simple way to evaluate the results of formal medical research, and “truth” often changes as science progresses.

    There are, and have always been, many folk remedies. Some might work, others might not — people recommend things to each other and the most widely recommended things are, quite possibly, at least somewhat effective.

    The same holds for CAM treatments. If a treatment has not been thoroughly studied and discredited, and if large numbers of people have tried it and swear by it, chances are it is not completely worthless.

    What you fail to recognize is that there are informal, as well as formal, scientific processes. The informal processes have been going on since our species first appeared, while the formal processes are new. The formal scientific process is superior in some ways, but it is also extremely slow and expensive. We can’t always wait years to find out the results of medical research. And even then, the results are not definitive and are often overturned by later results.

    I am not advocating CAM or folk treatments. I am saying that your division of all medicine into true and scientific vs quackery and woo is terribly unrealistic and irrational.

    If a treatment is natural and unlikely to be harmful, but not studied by medical science, you have no scientific reason for assuming it is worthless.

    If millions of people try something and it does not work, eventually everyone gives up on it. Energy healing, for example, has been widely used for so long and people have not given up on it. Therefore it seems unlikely that it has no validity whatsoever.

    Some people are fools most of the time, most of us are fools some of the time. But in general, the natural informal scientific process tends to work and to weed out ridiculous ideas. We don’t always need mega-funded formal studies to find out what works. Although, of course, in the non-existent ideal world there would be enough time and money to study everything with controlled double-blind research.

    Your real problem with energy healing is mostly that it seems implausible to you, given your current scientific understanding of the body. But scientific understanding is supposed to evolve and grow, not stagnate.

  5. pec says:

    “I’ve even pointed out that all too many physicians’ understanding of the scientific method is woeful. Indeed, that’s the reason there are so many physicians out there who are creationists.”

    It’s also the reason so many physicians think nothing is true unless it has already been verified by formal research.

  6. pec says:

    “Indeed, that’s the reason there are so many physicians out there who are creationists.”

    And for heaven’s sake Dr. Gorski, the scientific method has nothing to say about how life originated or evolved. There are only hypotheses, conjectures and philosophical preferences.

  7. weing says:

    “If millions of people try something and it does not work, eventually everyone gives up on it.”
    Do you really believe that? I always thought behaviors learned through variable interval reinforcement were the most difficult to unlearn.

  8. David Gorski says:

    And for heaven’s sake Dr. Gorski, the scientific method has nothing to say about how life originated or evolved. There are only hypotheses, conjectures and philosophical preferences.

    I nearly spit my drink out at my computer screen when I read this.

    You’re dead wrong, of course. Science and the scientific method have a lot to say about how life evolved and are starting to figure out how to study the question of how life originated.

    Who knew pec would make a good member of the Discovery Institute?

  9. Harriet Hall says:

    pec said,

    “Your logical error is in assuming that nothing is true unless it has been verified by formal research.”

    No one assumes that. Scientists assume they don’t know whether anything is true until it has been tested.

    “If a treatment has not been thoroughly studied and discredited, and if large numbers of people have tried it and swear by it, chances are it is not completely worthless.”

    There is a chance it is not worthless, and there is also a chance that it is (remember bloodletting). We simply don’t know until we test it.

    “there are informal, as well as formal, scientific processes.”

    What you call informal scientific processes are not real science, and they are not reliable.

    “If millions of people try something and it does not work, eventually everyone gives up on it.”

    What if millions of people try something and it doesn’t work but they think it does? Then they don’t give up on it. Case in point: dowsing.

    “Your real problem with energy healing is mostly that it seems implausible to you,”

    No, our real problem with energy healing is that there is no credible science to support it. If we had evidence that it worked, we would not reject it just because of implausibility.

    “scientific understanding is supposed to evolve and grow, not stagnate.”

    That’s one of the things that shows that the energy medicine research is not good science: it’s scattershot and is not evolving and growing.

  10. overshoot says:

    Your logical error is in assuming that nothing is true unless it has been verified by formal research.

    Pec, do you know how to have a discussion where you don’t write both sides?

  11. daijiyobu says:

    Also as regards duty — commerce (typical duty) v. professional (fiduciary duty) — David Colquhoun has an interesting quote in his “DC’s Improbable Science” blog today regarding chiropractic (http://dcscience.net/?p=241 ):

    “B.J. Palmer said that their chiropractic school was founded on ‘a business, not a professional basis’” [he's quoting from Shapiro's recent "Suckers. How Alternative Medicine Makes Fools of Us All"(ISBN 1846550289;2008)].

    So, seems to me, CAM — by way of NDs and DCs behaviors, & their current & historical verbiage [by DCs I mean chiropractors, not David Colquhouns!!] — regards its duties to the customer in much the same ‘typical duty’ manner as would a used car dealer.

  12. pec says:

    “Science and the scientific method have a lot to say about how life evolved and are starting to figure out how to study the question of how life originated.”

    There is no scientific evidence that can tell us how or why life originated. We know that life evolved, but we have no scientific evidence showing how evolution works. We have Darwin’s theory which says random mutations plus natural selection can adequately account for the increase in complexity that has occurred, but there is no experimental verification for that. RM + NS are of course involved in evolution, but we cannot assume they are the driving force.

    I think there is a natural tendency for life to evolve in the direction of increasing complexity. This is not creationism and has nothing to do with the Judeo-Christian creation myth.

    I don’t want to go off on the evolution tangent. But you have of course been mislead by materialist “skeptics” into thinking science has proven any particular theory of evolution. Evolution has been proven, its mechanism is still unknown. That doesn’t prevent people from thinking they know.

  13. pec says:

    “remember bloodletting”

    I doubt that bloodletting was practiced for hundreds of years. It was probably just a fad.

    “What you call informal scientific processes are not real science, and they are not reliable.”

    Both formal and informal science are empirical methods of learning. Neither is perfectly reliable. Formal science is fine Harriet, but we can’t always wait around for it to give us answers. And we can’t rely on those answers either, as you have acknowledged. We need replications and meta-analysis, and it becomes overwhelmingly confusing even for statistics experts.

  14. pec says:

    “What if millions of people try something and it doesn’t work but they think it does? Then they don’t give up on it. Case in point: dowsing.”

    In my opinion it has to work for some people at least sometimes. Things that simply do not ever work are weeded out by the informal scientific process, eventually. It might take decades, but people do lose interest in things that are obviously a complete waste of time.

    Dowsing is still controversial and you can’t discount it based on a small number of negative experiments.

  15. pec says:

    “No, our real problem with energy healing is that there is no credible science to support it. If we had evidence that it worked, we would not reject it just because of implausibility.”

    I don’t know if that’s true, since there has been a lot of energy healing research. Some of it is probably credible, but stay tuned for my lit review (limited by my lack of access to journals).

    I am reading the rest of Gary Schwartz’s books. I admit he is a very poor philosopher, very bad at explaining why he believes all that alternative science stuff. But maybe I can re-frame some of his ideas (which I largely agree with) in a more logical way for you “skeptics.”

  16. pec says:

    “That’s one of the things that shows that the energy medicine research is not good science: it’s scattershot and is not evolving and growing.”

    I could say the same thing about mainstream research in cancer and schizophrenia. You may be collecting ever more detailed information, but you are not making sense out of it.

  17. David Gorski says:

    There is no scientific evidence that can tell us how or why life originated. We know that life evolved, but we have no scientific evidence showing how evolution works. We have Darwin’s theory which says random mutations plus natural selection can adequately account for the increase in complexity that has occurred, but there is no experimental verification for that. RM + NS are of course involved in evolution, but we cannot assume they are the driving force.

    This is so full of scientific ignorance that I’m now beginning to understand why pec is enamored of energy medicine. She has no understanding of science.

    Of course, there are enormous quantities of evidence telling us how evolution works, and evolution has gone far beyond Darwin’s theory. There are also many, many experiments verifying the theory of evolution and demonstrating speciation.

    Get thee to Talk.origins, in particular this:

    http://www.talkorigins.org/faqs/comdesc/

    Another site:

    http://www.pandasthumb.org/

    Geez, I think I need to do a post about evolution in medicine sometime in the next month.

  18. pec says:

    “Of course, there are enormous quantities of evidence telling us how evolution works, and evolution has gone far beyond Darwin’s theory. There are also many, many experiments verifying the theory of evolution and demonstrating speciation.”

    You have been misinformed. You only know the neo-Darwinist propaganda.

    The cause of evolution is entirely unknown and the currently accepted theory is completely without empirical verification.

    But arguing with materialists about neo-Darwinism is a waste of energy. I have been through it many times.

    I know a lot about evolution, and it is one of the areas I have studied carefully. You can call me stupid and unscientific to make yourself feel smart, but that only shows how feeble your understanding of the subject really is.

  19. pec says:

    One of the reasons so many people misunderstand the evolution controversy is that EVOLUTION HAS BEEN PROVEN and all the evidence is for evolution, NOT for any particular theory about what causes evolution.

    People who have not studied the subject carefully (and I’m sure that includes Gorski) are easily fooled into mistaking evidence for evolution for evidence for a particular theory of evolution — that it is caused entirely by RM+NS.

  20. pec says:

    The cause of evolution is still unknown. Talk Origins is a propaganda site. They cite tons of evidence for evolution and fool you into thinking that counts as evidence for neo-Darwinism.

    There have been, and are, alternative theories of evolution.

  21. pec says:

    And none of the theories of evolution has been proven, and there is no scientific evidence for or against any of them. The question is still very much open.

  22. pec says:

    I’ll say it again: Evolution has been proven, we have tons of evidence for evolution and common descent. If you go on and on about the scientific evidence for evolution you are wasting your time, because I already believe in evolution.

    I have read pandasthumb and talkorigins and many other things, way before the web, and probably starting before you learned to read.

  23. David Gorski says:

    People who have not studied the subject carefully (and I’m sure that includes Gorski) are easily fooled into mistaking evidence for evolution for evidence for a particular theory of evolution — that it is caused entirely by RM+NS.

    What an amazing straw man for modern evolutionary biology.

    No evolutionary biologist these days claims that evolution is caused “entirely” by RM + NS. Wherever did you get the idea that that is thought to be the sole mechanism of evolution? Not even Richard Dawkins, one of the biggest boosters of natural selection, claims that.

    Evolution occurs through genetic drift, sexual selection, coevolution, and a variety of other mechanisms. For example, here’s a quote Evolution 101:

    Genetic drift—along with natural selection, mutation, and migration—is one of the basic mechanisms of evolution.

    In each generation, some individuals may, just by chance, leave behind a few more descendents (and genes, of course!) than other individuals. The genes of the next generation will be the genes of the “lucky” individuals, not necessarily the healthier or “better” individuals. That, in a nutshell, is genetic drift. It happens to ALL populations—there’s no avoiding the vagaries of chance…Genetic drift affects the genetic makeup of the population but, unlike natural selection, through an entirely random process. So although genetic drift is a mechanism of evolution, it doesn’t work to produce adaptations.

    There are also mechanisms due to founder effects.

    There’s more to modern evolutionary theory than natural selection, although arguably natural selection is often the most important mechanism of evolution. Darwin got the ball rolling, but scientists haven’t been idle in the 150 years since he published his theory.

  24. qetzal says:

    pec wrote:

    Your real problem with energy healing is mostly that it seems implausible to you, given your current scientific understanding of the body.

    Close, but incomplete. I consider it highly implausible because it’s inconsistent with everything we understand about the body, biology, physics, etc. On top of that, I’m unaware of any decent evidence in favor of energy healing. And yet, practitioners of energy healing, and their acolytes (like you), are convinced it’s real and that it works.

    It’s that whole package that I have a problem with.

    I have no problem with something that’s inconsistent with what we currently understand. That’s how science advances.

    I also have no problem with hypotheses that currently lack significant evidentiary support. That’s how all hypotheses start out.

    I wouldn’t even have a problem with someone who says “I believe in energy healing, and I have a hypothesis about how it works, and I’m going to test it to try to provide good evidence in support.” To those people, I say good luck! Show me some compelling evidence and I’ll happily change my mind.

    I’m just annoyed by people who say “I believe in energy healing, and I have a hypothesis about how it works, but I’m not going to rigorously test any of it. I’m just going to assume it works, and I’m going to charge people money, and if you complain about it, I’m going to accuse you of cultural bias and materialist ideology.”

    Glad to hear you’re still working on the review of the energy healing literature. In the meantime, how about citing some evidence for one of those other types of alternative medicine? You know, the ones where you claimed to already be familiar with the literature? (I’d name them, but you weren’t specific about what any of them are. Curious, that.)

    As for your nonsense on evolution, I just say that this:

    People who have not studied the subject carefully (and I’m sure that includes Gorski) are easily fooled into mistaking evidence for evolution for evidence for a particular theory of evolution — that it is caused entirely by RM+NS.

    Is proof positive that you have NOT studied the subject carefully. Otherwise you’d already know that modern evolutionary theory encompasses more than just RM+NS.

  25. Wicked Lad says:

    I can’t take it any longer. I’m a layperson, but pec is way over the edge, cranking out such a volume of verbiage, I can’t ignore it. The good authors of this blog have day jobs relieving suffering and saving lives, and I get a little desperate when I consider how much time they have to spend on countering anti-scientific polemics.

    Considering the speed with which pec is typing such a flood of words, the (low) quality of his or her arguments is not a surprise. It reminds me of the Gish Gallop. It’s so much easier to pump out facile, uninformed, misleading nonsense than to counter it with well-reasoned, well-constructed explanations, let alone good citations.

    So I’ll just try to answer a couple of these accurately and reasonably, if not completely.

    pec, you wave your hands and impugn talkorigins as propaganda, but you offer not one substantive response to the mountains of evidence cited there. Let me say that again: cited there. The evidence isn’t on talkorigins, it’s documented in a huge variety of studies that talkorigins cites. Can you refer to just a few of those papers, then demonstrate how those papers are inaccurate?

    Harriet Hall wrote:

    That’s one of the things that shows that the energy medicine research is not good science: it’s scattershot and is not evolving and growing.

    pec replied:

    I could say the same thing about mainstream research in cancer and schizophrenia. You may be collecting ever more detailed information, but you are not making sense out of it.

    “Energy medicine” is a putative set of therapies. Cancer and schizophrenia are diseases. What are trying to say? And when you say they’re “not making sense out of it,” are you saying they’re making no progress? Are you saying that scientific medicine’s 1968 treatments for schizophrenia, breast cancer and leukemia were just as good as their 2008 treatments?

  26. Wicked Lad says:

    pec wrote:

    There have been, and are, alternative theories of evolution.

    Viable ones? Like, for example? I’m always up for a good competition of ideas. It would be exciting to see a new theory that explains the facts better than the modern theory of evolution does. Let’s see it! There’s a Nobel prize in it for you, pec!

  27. overshoot says:

    Totally OT — or not.

    Randy Pausch died yesterday. The news reminded me of his Congressional testimony in favor of research on pancreatic cancer (currently the #4 cause of cancer deaths, and rising as we make progress against the others.) He made the point that one reason we’re not making progress against pancreatic cancer is that there’s no funding for research on it.

    Now would someone tell me again how much the Gonzales trial cost and what we learned from it? Would someone tell me again how much the NCCAM has spent, purportedly to advance medical knowledge, and how much knowledge that money has bought?

    Can someone explain to me why Dr. Pausch took a couple of very scarce days away from his children (who may well carry the same genes that likely doomed him) to spend begging Congress for a fraction of the NCCAM’s budget to possibly save their lives forty years from now?

  28. pec says:

    “There’s more to modern evolutionary theory than natural selection, although arguably natural selection is often the most important mechanism of evolution.”

    RM+NS is by far the most important mechanism in the currently accepted theory of evolution. Yes, they love to say evolution theory has made enormous progress and now it’s so much more than RM+NS. But after all the blathering, the theory still boils down to essentially RM+NS. Even with the other stuff added on, you still have no scientific evidence for the theory.

    Evolution has been proven; it has not been explained.

  29. weing says:

    pec,
    Having studied psychology, you must have learned about variable interval reinforcement and how the conditioned response from it is nearly impossible to extinguish. It explains superstitious behavior. So, if a completely useless method of healing is used on patients and just by chance the patient improves, even if only once, he/she will be convinced that it was responsible for the improvement. Again, that is not science, it is superstition. Good luck, convincing them, however. Try to convince the baseball player, that he doesn’t need to do that ritual.

  30. pec says:

    “It’s so much easier to pump out facile, uninformed, misleading nonsense than to counter it with well-reasoned, well-constructed explanations, let alone good citations.”

    And it’s even easier to call something “uninformed, misleading nonsense” than “counter it with well-reasoned, well-constructed explanations, let alone good citations.”

  31. pec says:

    weing,

    Yes we tend to engage in superstitious behavior when the cost is low. It’s just as easy to wear your lucky shirt on an important day, so why not?

    But we invest decreasing amounts of time and energy as the probability of reward seems to decrease.

  32. weing says:

    I prefer my lucky underwear.

  33. pec says:

    “Darwin got the ball rolling, but scientists haven’t been idle in the 150 years since he published his theory.”

    There were evolution theories long before Darwin. Darwin’s theory became popular among materialists because it requires only chance and selection.

    The theory has been elaborated a little and combined with modern genetics. But there is still no scientific evidence in its favor.

    Because neo-Darwinism (or whatever you prefer to call the currently accepted theory) has been settled on, very little attention has been paid to investigating other theories or coming up with new ones.

    I think that RM+NS will be abandoned as the driving mechanism and replaced with concepts from complexity theory. NS works to control evolution and maintain the integrity of species — it is a conservative force, not a progressive force. RM will turn out not to be the only, or primary, source of variation.

  34. David Gorski says:

    RM+NS is by far the most important mechanism in the currently accepted theory of evolution. Yes, they love to say evolution theory has made enormous progress and now it’s so much more than RM+NS. But after all the blathering, the theory still boils down to essentially RM+NS. Even with the other stuff added on, you still have no scientific evidence for the theory.

    pec, I tire of your obtuseness. You clearly have zero–yes, zero!–understanding of evolutionary theory, medicine, or science in general. You have been pointed to the direction of nice summaries of the evidence for current evolutionary theory, and you ignore it. You can’t even come up with a coherent, science- and evidence-based criticism of even a single aspect of evolutionary theory. All you can do is assert that the mechanism is not proven and rant about “materialism.”

  35. overshoot says:

    Off-topic — or not.

    Today Dr. Randy Pausch died. The occasion reminded me to review Congressional testimony begging for money to fund pancreatic cancer research — because at the rate we’re going now, forty years from now his children may be dying of the same cause.

    So (since this isn’t entirely off-topic) someone please remind me how much the Gonzales trial cost — and what we learned from it. Someone please remind me how much the NCCAM has spent over the years, and what we’ve learned from it. It must, surely, be worth vastly more than any research on the #4 cause of cancer deaths (and rising, given the progress on the others) since it’s funded so much more.

    Somebody please remind me, because I’m not a happy camper this week.

  36. qetzal says:

    I fervently request we not engage pec in a debate over evolution. There are plenty of other blogs I can read for that.

    Besides, I’m still waiting for pec to provide some of those good scientific references for whatever alt med she thinks she knows about.

    How about it, pec? You’ve been dodging us on energy healing by claiming it’s not an area of literature you’ve followed closely. But you claimed you’ve read a lot of alternative research, and some of it is good quality.

    Remember? See here. Also here.

    So come on, pec. Where’s the beef? Give us some sites that’ll knock our materialist socks off. Doesn’t have to be energy healing. Pick a topic you already know well. There are some, right? That’s what you said, and I know you wouldn’t exaggerate or shade the truth, would you?

  37. David Gorski says:

    I fervently request we not engage pec in a debate over evolution. There are plenty of other blogs I can read for that.

    I’m not–anymore.

  38. pec says:

    “You clearly have zero–yes, zero!–understanding of evolutionary theory, medicine, or science in general.”

    Oh yes, that is a rational rebuttal of my argument!

    “You have been pointed to the direction of nice summaries of the evidence for current evolutionary theory, and you ignore it.”

    I told you had already read Talk Origins and Pandas Thumb, and many other things on the topic. I also told you that I BELIEVE IN EVOLUTION!!!!!

    “You can’t even come up with a coherent, science- and evidence-based criticism of even a single aspect of evolutionary theory.”

    Because I don’t criticize it. I believe in evolution. I believe in evolution. I believe in evolution. I believe in evolution.

    I do not think the currently accepted theory explains evolution. Not only is it not proven, it DOES NOT HAVE A SHRED OF EVIDENCE.

    All you can do is call me stupid and ignorant. You have no rational arguments in favor of the currently accepted theory.

    You lose.

  39. overshoot says:

    I also told you that I BELIEVE IN EVOLUTION!!!!!

    This isn’t a tent revival, Pec — you don’t impress anyone by shouting “I BELIEVE!!!!!

    In fact, all you do is reinforce the inescapable conclusion that you just don’t have working receptors for the whole “science” thing.

  40. daedalus2u says:

    pec, what do you mean by complexity theory?

  41. David Gorski says:

    I do not think the currently accepted theory explains evolution. Not only is it not proven, it DOES NOT HAVE A SHRED OF EVIDENCE.

    If you believe that, you’ve already lost any argument on evolution. Oh, and saying that there isn’t a “shred of evidence” to support the current version of the theory of evolution is a criticism; so you have “criticized” evolutionary theory. And I did point you to a very long and detailed summary of evidence for current evolutionary theory.

    Truly, no one embodies Ferrous Cranus better than you.

  42. David Gorski says:

    pec, what do you mean by complexity theory?

    Be very careful and ask yourself this: Do you really want to know what pec means by it? It could open up a whole new avenue of the same sorts of arguments she makes for energy medicine.

  43. pec says:

    “And I did point you to a very long and detailed summary of evidence for current evolutionary theory.”

    You can’t seem to get it. Evidence for the theory of evolution is NOT evidence for the neo-Darwinist theory of evolution.

  44. pec says:

    “you don’t impress anyone by shouting “I BELIEVE!!!!!”

    I was shouting because he can’t seem to hear it. Why keep telling me I’m stupid because I don’t believe in evolution, when I do believe in evolution?

  45. TsuDhoNimh says:

    # pec said: I doubt that bloodletting was practiced for hundreds of years. It was probably just a fad.

    That “fad” was practiced from before the time of Hippocrates until well into the 19th century. That’s over 2200 years.

    It was well established when Hippocrates wrote about it, and still going strong in the time of Galen and Celsus. It continued uninterrupted through Paracelsus’ times and died s slow and reluctant death right about the time homeopathy was invented.

  46. daedalus2u says:

    The reason I asked pec what she meant by complexity theory is that I am pretty sure that it is not even wrong, and obviously so.

  47. pec says:

    I don’t define it any differently. If you have an internet connection, and obviously you have, you can look it up.

  48. pmoran says:

    A blatant appeal to authority, but one that I mostly agree with. The difference between us is that I insist that medicine is about an infinite number of individual contexts and I see many examples where ethical absolutes (actually these are ethical guidelines rather than directives) do not apply or don’t seem to apply very well.

    We scientists are ever-so cautious when making scientific judgments about complex matters;let’s not pretend that arriving at absolutes in medical ethics is a piece of cake, especially when it is not quite clear how anything done with the undiluted welfare of the individual patient in mind can be entirely unethical. I mean, why are we obliged to consider the impact of our decisions upon the fate of the planets (or whatever) when THIS patient needs help? In fact, at least one medical ethicist has gone so far as to state that it is not unethical for a doctor to prescribe a placebo treatment, so long as the doctor believes it will benefit the patient. I don’t quite agree with that bald statement — there should be a rider specifying that this may apply to *some* contexts where there is no obviously superior evidence-based method.

    Here are some examples of the intellectual minefield we have to negotiate.

    1. All the doctors I know would be prepared to call in the witch-doctor if it would help assuage the fears, or help in the management, of a seriously ill primitive tribesman. It seems we are prepared to pander to the superstitions of SOME cultures while despising any similar inclinations in our own.

    2. I have previously asked this question which has to do with public policy in relation to safe “alternatives”. Take ny word for it that every pharmacy in Europe displays “Homeopathie” (or language equivalents) in large letters outside. Would skeptics prefer those using such remedies for their minor and self-limiting complaints to be using NSAIDs or antibiotics or antidepressants instead, treatments that will often in such contexts themselves perform no better than placebo, but at substantially greater risks? Behind the usual healthfraud position there is both an exaggeration of the capacity of modern medicine and insufficient recognition of the harm that it can do. . We definitely do not yet have entirely safe and 100% effective solutions to all of mankind’s ills, and certain imperfections of everyday medical practice can heighten the risks of the use unnecessarily powerful pharmaceuticals. So what is the safest and most pragmatically realistic position here?.

    3. Following on from that — what is the evidence-based answer to non-specific tiredness and unhappiness? If people feel better for taking a multivitamin or an innocuous herb, why should we care? We keep on offering the public temporary answers to these things. prescribing (historically) amphetamines, cocaine, opiates, barbiturates and phenothiiazines in massive quantities, only to take them away when problems such as addiction ensue. Is it right to then turn around and say, well you didn’t really need these things anyway, even denying them any relief that they may derive from “pretend medicines”. The science that matters will be argued out in other arenas.

    That’s to give you some idea of the kind of thing that I am on about. You seem to think I am talking about doctors promoting CAM or placebo treatment as a matter of policy. I am not prepared to go that far, although I think I understand why some doctors might do that.

  49. overshoot says:

    I was shouting because he can’t seem to hear it.

    Holy Warrior Stage One: “if you don’t agree with me, it’s because you haven’t Gotten The Message. Therefore I will repeat The Message, and if necessary shout as though you don’t understand my language.”

  50. Harriet Hall says:

    I said, “What if millions of people try something and it doesn’t work but they think it does? Then they don’t give up on it. Case in point: dowsing.”

    pec said, “In my opinion it has to work for some people at least sometimes. Things that simply do not ever work are weeded out by the informal scientific process, eventually. It might take decades, but people do lose interest in things that are obviously a complete waste of time.
    Dowsing is still controversial and you can’t discount it based on a small number of negative experiments.”

    This demonstrates why we need science. People try dowsing and it “works” in the sense that they find water. They never bother to test whether they could find water just as reliably without dowsing. Plenty of tests have been done, and the dowsers always fail, and they are always surprised because “it always worked before.” They don’t give it up even after such tests because they are convinced it works. People like pec say there could be something there that science doesn’t understand or can’t measure yet. But it has been clearly established that dowsing works no better than chance, and the dowsing phenomenon is fully explained by the ideomotor illusion, the prevalence of underground water, and possibly subtle clues from rocks, vegetation, etc. that the dowsers inadvertently pick up on. I hope pec is not going to suggest we spend research money studying dowsing!

  51. Harriet Hall says:

    pec said,

    “I do not think the currently accepted theory explains evolution. Not only is it not proven, it DOES NOT HAVE A SHRED OF EVIDENCE.
    All you can do is call me stupid and ignorant. You have no rational arguments in favor of the currently accepted theory.”

    Richard Dawkins and PZ Myers are two evolutionary biologists who have studied this subject all their lives and have spent a great deal of time and ink explaining it to the public. They both think the currently accepted theory explains evolution. What specifically do you find wrong with their data or their reasoning? I’d suggest you go over to the Pharyngula blog and discuss it with PZ directly.

    We’re not going to waste time trying to present the evidence to you here any more than we would waste time trying to defend the germ theory of disease to a germ theory denier.

    And there you go with the “materialist” argument again. How do you think a non-materialist would explain evolution?

  52. Wicked Lad says:

    qetzal wrote:

    I fervently request we not engage pec in a debate over evolution.

    I agree, and I’m sorry I engaged her over this.

    qetzal went on:

    Besides, I’m still waiting for pec to provide some of those good scientific references for whatever alt med she thinks she knows about.

    Yep. I’m sorry I engaged her over anything. In fact, I think I’ll ignore her until she comes up with something substantive. We’ve had some thought-provoking disagreements on this blog. She hasn’t been involved in any of them.

  53. teeps29 says:

    Please, please, worthy bloggers: Give up on pec. Save your strength — that field is apparently barren. Let her rant. I think “Don’t feed the troll” applies here.

  54. overshoot says:

    I think “Don’t feed the troll” applies here.

    The Usenet warning is YHBT: You Have Been Trolled.

  55. nwtk2007 says:

    What an interesting discussion.

    Science, ethics and evolution.

    Ethics is a tough cookie but evolution is not.

    Evolution, in it’s present understanding, is much like a jig saw puzzle; a great deal of the pieces are missing and may never be found, but based upon what there is so far, there appears to be a body of water here, a forest of some sort there, maybe a boat in this corner, and what is beginning to look like mountains on this side here.

    There are a lot of missing pieces but even the kids can see where it seems to be going.

    Medical ethics is a much different character. It’s not based upon what can be seen. It’s based upon what is best for the patient. It is not based upon what is best for science. When people are dying, they could give a hoot about science, as will all scientists.

    I find it interesting that people will revere science with as much dedication as my parents revere their “Word of God”.

    I would ask the doctor this, “If the placebo effect could heal all of their patients, would the doctor employ it?”

    In other words, if a doctor could, against all science, improve the patient’s well being and aid in their quality of life, or death, would he/she do it?

    In the face of a dilemma or problem with a patient’s care, the doctor has to make a decision and the patient has to choose to accept it, or reject it. It’s finally up to the patient, the doctor can only do what he/she thinks is right.

  56. overshoot says:

    Medical ethics is a much different character. It’s not based upon what can be seen. It’s based upon what is best for the patient. It is not based upon what is best for science. When people are dying, they could give a hoot about science, as will all scientists.

    Funny you should mention that on the day that Randy Pausch died.

    His 8 March Congressional testimony was all about funding for science.

  57. pec says:

    “Richard Dawkins and PZ Myers are two evolutionary biologists who have studied this subject all their lives and have spent a great deal of time and ink explaining it to the public. They both think the currently accepted theory explains evolution.”

    Oh yes. Dawkins is a zealot. I studied the subject all my life also and I disagree with Dawkins for many, many reasons. This is not the topic of the post. If you want to believe something merely because Dawkins and Myers say you should, go right ahead. But don’t tell me I should also, just because they believe and you believe. I am a scientist.

  58. pec says:

    “Besides, I’m still waiting for pec to provide some of those good scientific references for whatever alt med she thinks she knows about.”

    The volume of information is tremendous. I have a read a lot over the years but not specifically on energy healing research. With the restriction that I don’t have access to medical journals, either mainstream or alternative, I am doing a little informal lit review.

    If I link the studies as I find them you will say there is only one, or there are only two, they aren’t perfect, they don’t prove beyond a trace of doubt (unlike mainstream studies which, as we know, are always absolutely perfect).

    This is only a hobby for me you so will have to be patient. Or do a little searching yourself if you aren’t too lazy.

  59. pec says:

    “I fervently request we not engage pec in a debate over evolution.”

    Because if you do you will lose. All you know about evolution is what Dawkins and Amazing Randi told you. They are your high priests and you can’t imagine questioning their wisdom.

  60. overshoot says:

    Because if you do you will lose. All you know about evolution is what Dawkins and Amazing Randi told you. They are your high priests and you can’t imagine questioning their wisdom.

    Once again: Pec, do you know how to carry on a discussion where you don’t write both sides?

  61. weing says:

    I think that belief in anything, even evolution, is antithetical to science and the scientific method.

  62. daedalus2u says:

    yes, not even wrong.

    http://blog.wired.com/wiredscience/2008/02/complexity-theo.html

    http://chronicle.com/colloquylive/2001/05/complexity/

    pec, you (and the others enamored with what is called complexity theory) are confabulating cause and effect. The appearance of power-law structures is an effect, not a cause. There is no “challenge”, other than for funding which the newcomers are trying to get by hyping their approach.

    I am extremely familiar with this type of behavior; it is more typically called critical phenomena, where even very simple systems exhibit critical behavior near critical points. In these regions, the properties of they system change exponentially with the closeness to the critical point.

    For example a fluid near the critical point exhibits exponential changes in density with respect to pressure or temperature as the critical point is approached. The fluctuations that are observed have a power-law structure. All fluids exhibit critical phenomena. It is an emergent property of short range repulsive effects and slightly longer range attractive effects. This is what causes fluids to exist as two phases in equilibrium, a liquid phase and a vapor phase. As the temperature is increased, the energy of the system increases and it takes a higher pressure to maintain the two phase mixture. The vapor becomes more dense as the pressure goes up, the liquid becomes less dense as the temperature goes up. At the critical point they both have the same density.

    All of the critical properties derive from the length scale of the fundamental attractive and repulsive forces between individual molecules. Critical theory doesn’t add any new information, it is a way of simplifying the individual behavior of individual molecules and describing the collective behaviors of the interacting bulk phases.

    Similarly “complexity theory” as it is used in evolution doesn’t add any information that would not be contained in the genome sequences of the individuals in that population. It is a way to simplify how diversity in the genomes of the individuals is represented. It is a misconception to pretend that “complexity theory” is driving evolution. Evolution is an emergent property that every population that exhibits reproduction with changes will exhibit.

    pec, you are projecting. None of the scientists here consider anyone to be a “high priest” of any scientific field. That is not the way that science works. It never has, and it never will. That you do not seem to understand that is because on a fundamental level you are not a scientist. Many people working in scientific fields do get caught up in and enamored with “experts”. Such people are not really scientists (at least in so far as they accept an expert’s authority vs looking at that expert’s facts and logic).

  63. David Gorski says:

    What specifically do you find wrong with their data or their reasoning? I’d suggest you go over to the Pharyngula blog and discuss it with PZ directly.

    Heh. I’d love to see that.

    Harriet, I never suspected you had such a nasty streak. :-)

  64. pec says:

    I have discussed evolution at “skeptic” blogs many times. All they could do is hurl insults and appeal to authority. Same as here.

  65. Harriet Hall says:

    nwtk2007 said,

    “I find it interesting that people will revere science with as much dedication as my parents revere their “Word of God”.”

    Who reveres science? I don’t. I simply think the scientific method is the best tool we have. It is imperfect, it is useful. It is not worthy of being “revered.”

    “In other words, if a doctor could, against all science, improve the patient’s well being and aid in their quality of life, or death, would he/she do it?”

    If a doctor could do that, it couldn’t be against all science.

  66. overshoot says:

    I have discussed evolution at “skeptic” blogs many times. All they could do is hurl insults and appeal to authority. Same as here.

    Pec, that’s one of the side-effects of writing both sides of the “discussion” in your own imagination — your opponents inevitably reflect your own limitations.

    Actually engaging with real human beings is much more interesting than blogsturbation.

  67. qetzal says:

    pec wrote:

    The volume of information is tremendous. I have a read a lot over the years but not specifically on energy healing research. With the restriction that I don’t have access to medical journals, either mainstream or alternative, I am doing a little informal lit review.

    Once again: if you’ve read a lot on things other than energy healing, then pick one of those other topics, & give us compelling examples to support them.

    I didn’t ask you to do a lit review of energy healing on my behalf. I just want you to show me good evidence for any so-called alt med that you think the scientific establishment is unfairly rejecting.

    Pick your own topic. Whichever one you already know well. Show me why you think I should revise my opinion of it.

    Frankly, pec, I don’t believe you when you say you’ve read all this compelling research supporting alt meds. I think it’s a bogus claim, just as your claim on energy healing research was bogus. You had to retreat from that one when the “research” you cited was shown to be pitifully poor quality. I think your latest claim about everything you’ve supposedly read is just as bogus, and you’re just avoiding the topic so you don’t get embarassed again.

    Care to show me I’m wrong?

  68. Harriet Hall says:

    pec conveniently neglected to answer my question “What specifically do you find wrong with their data or their reasoning?”

    If she is going to disagree with the scientific consensus, she should at least explain why. But that doesn’t seem to be the way she operates.

    She supports energy medicine and keeps making vague statements but can offer us nothing of substance. She’s “researching” the subject but “doesn’t have access to the literature.” One can only wonder how good her research will be.

    She keeps saying things like “All you know about evolution is what Dawkins and Amazing Randi told you. They are your high priests and you can’t imagine questioning their wisdom.”

    This is so muddle-headed it isn’t even wrong. I am very insulted by her saying such things, especially after we have tried over and over to explain to her how science works. I am far more insulted by her suggestion that I believe without evidence and follow a high priest than I would be if she had called me all the names she called Fifi.

    The pattern is clear: she gives us unsupported opinions, distorts our words, misrepresents our thoughts and then tries to argue with that misrepresentation, and insults us. She seems not to understand our critiques of her comments.

    She doesn’t discuss, she argues. She doesn’t listen, she contradicts and provokes. She has contributed nothing of substance and has been a disruptive influence, interfering with our attempts to carry on a rational discussion about science and medicine.

    I am fed up. I think from now on, instead of answering her, I’ll post a short comment for new readers explaining “Why we are not answering pec.”

  69. overshoot says:

    I am fed up. I think from now on, instead of answering her, I’ll post a short comment for new readers explaining “Why we are not answering pec.”

    Madam, I would suggest a static page on SBM trolls, and any reply to one who is not, as it were, coming out from under the bridge would simply consist of “Please do not feed the troll” with a link.

    Links, frankly, are thread killers. I suspect that John Scudamore found that out long ago; to my mind that’s why so much of his argumentation consists of nothing much but links.

    It does work both ways, though …

  70. daedalus2u says:

    Back to ethics.

    I am sorry, but all 3 of you are wrong, KA, PM and DG. A person’s first ethical obligation is to themselves, to maintain themselves in a sufficient state of agency, such that they have the ability to decide and to do what ever it is they decide is their second most important obligation. The example I like to use is familiar to anyone who has ever flown on an aircraft. They always tell you that if the O2 masks deploy, and you are with small children or others who need assistance to make sure that your own O2 mask is properly deployed first, then help who ever you are traveling with. That heuristic, when helping others to ensure that your own needs are met first is the appropriate heuristic. Note I said needs, which is distinguishable from wants.

    KA holds that adherence to science is primary, but the net result of that is that it limits his obligations to his patients to those supported by science. Limiting his obligations to what is supported by science fundamentally protects himself. It allows him to work and not be paralyzed by the possibility of error, not to put at risk the non-scientific aspects of his persona. By maintaining strict adherence to science based medicine, he has minimized his chances of error, and has externalized the “fault” when an erroneous or bad treatment is given. He is not guaranteeing his patients will get well, or that he will provide error free treatment, what he guaranteeing is that he will provide treatment that is the best that science knows how to provide at that moment. All he needs to do is keep up with the science, apply it for his patients, and at the end of the work day he knows he has done the best that he can do.

    DG maintains that his primary ethical obligation is to the patient, however if the only way a patient could recover was at DG’s expense that obligation would fail. For an absurd counter-example, if a patient needed a liver transplant and DG was a perfect match, there is no ethical obligation on DG’s part to supply his patient with a piece of his own liver, no matter how much it would help his patient.

    PM appreciates that the approaches of KA and DG are too simple. He is correct in that regard, but I don’t think there can be a complete and consistent system of ethics.

    I would invoke Gödel and say that either a system of ethics is incomplete and there are actions for which the ethical value cannot be calculated, or a system of ethics is inconsistent and the system will derive multiple ethical values for the same action.

    That incompleteness and inconsistency is way beyond the limits of what the quacks are doing. That is clearly unethical where a quack is satisfying his/her wants for easy income by exploiting a patient’s need for effective treatment.

    The problems of ethics and who is being subject to exploitation are not going away. In the US, how medical care is funded is greatly exacerbating these problems. The law is that an emergency room cannot turn away a patient in need of emergency care regardless of ability to pay. But when the care is not paid for, those who provide the care can’t be paid, the supplies can’t be replaced; the emergency room cannot remain open. MDs may have an “ethical duty” to provide free care, but the electric utility doesn’t have the ethical duty to provide free electricity, the farmer doesn’t have the ethical duty to provide free food, the gas company to provide free heat, the pharmaceutical company to provide free drugs.

    Insurance companies have the ability to negotiate what they will pay for certain services. It used to be (at least in my state) that the insurance companies would then pay a portion of the unreimbursed care that the hospital would provide. The reasoning was that hospitals would simply increase their reimbursed charges to cover the unreimbursed ones. That “expense” is one that is very easy for a for-profit insurance company to try and avoid. To the extent it can be avoided, the resulting savings are pure profit. When there are geographical disparities in the amount of unreimbursed care, it is easy for an insurance company to avoid high free-care hospitals, just make them “out of network”.

    I don’t think the problem is “profit” per se, rather I think it is putting people’s wants ahead of other people’s needs. The politicians “want” to provide care, so they mandate free emergency care without providing a mechanism to pay for the “needs” that that care requires.

    In this context, I think it is unethical for a hospital to provide free care that it cannot afford to provide. If the hospital cannot provide free care while sustaining itself as a viable hospital, then it cannot ethically provide free care. DG may voluntary decide to offer a patient a piece of his liver, but no external agent may compel him to do so. It would be unethical to allow DG to donate his entire liver because that would kill him. I think the mandating of free care by government can be analogous to that.

  71. Harriet Hall says:

    daedalus2u,

    Have you read Michael Shermer’s “The Science of Good and Evil”? He has a diagram showing a hierarchy of morality that fits right in with your comments.

  72. daedalus2u says:

    Harriet, I have not. It would not surprise me that someone else would come up with the same type of hierarchy. In looking at a few reviews of his book, there are probably few things I would disagree about. I think that a sense of ethics and morals are in a sense much like the concept of consciousness. Something that may well be an illusion, albeit a very persistent one. I think illusion in the sense that there is no absolute morality, no “morality object” the same way there is no “mental object” that is the mind.

    I see it analogous to the “theory of mind” that people use to communicate with each other. They also have a “theory of morality” which is a neural network cognitive engine which calculates the moral value based on inputs, but the output of that neural network is programmed to some extent by the immediate level of metabolic stress that the organism is subjected to.

    I am working on how “theory of mind” fits in the autism spectrum right now, so applying the same concepts to a theory of morality fits with my current thinking on the subject. I see the NT (neurologically typical) theory of mind as a “hard-wired” neural network that non-algorithmically produces the mental state associated with language and other forms of communication. If the NT theory of mind can’t map the mental concept, they can’t think it, conceive of it, or understand it. I think that ASDs don’t have the same hard-wired neural network, but they can emulate it in their ASD neural network. This kind of works, but is slower and more cumbersome and doesn’t have the speed or the nuance that the NT theory of mind does.

    I think the similarity is that people have a hard-wired theory of morality, which is non-algorithmic. They can generate an algorithm for calculating the moral value of something that is what various laws and stuff are. Under normal circumstances the algorithm and the theory of morality are not in conflict. Under extreme metabolic stress, the output of the neural network conforms to the morality of that extreme metabolic situation. I think this is why in desperate circumstances desperate people do desperate things. Their theory of morality is functioning the way it evolved to function. I think this is what happens in postpartum psychosis, the metabolic stress of unsustainable lactation compels certain behaviors.

    I think that NO is one of the fundamental modulators that regulates those neural networks. Low NO is the signal that indicates one is in extreme metabolic stress, and so physiology modifies the output of those neural networks accordingly. I see low NO as the signal that compels people to desperate things. Low NO causes low ATP (via sGC) and low ATP invokes the physiology of desperation. Many of the hormones that mediate positive social interactions, oxytocin, estrogen for example cause release of NO. That higher NO shifts the individual to a less desperate state where the luxury behaviors of generosity, compassion, forgiveness, are easier to produce.

    I find that I have a very strong compulsion to try and fit everything together into a single (very complex) system. Everything has to fit with everything else or I keep working at it until it does.

  73. Harriet Hall says:

    “I think illusion in the sense that there is no absolute morality”

    Shermer says there is no absolute morality. He thinks we have evolved to have certain innate feelings about what is moral – feelings that help us survive as a species by not killing, stealing, etc. We then rationalize and construct formal moral standards as a society. Morality is greater than the individual, because it is a joint project of all of us; but is is ultimately based in our biology.

  74. overshoot says:

    We then rationalize and construct formal moral standards as a society. Morality is greater than the individual, because it is a joint project of all of us; but is is ultimately based in our biology.

    Well, that and game theory.

    A good bit of morality is a social construct. For instance our hunter-gatherer ancestors didn’t have much need to develop a sense of “property,” although “territory” is related. As a result “theft” and other property-based mores had to be either created or emphasized; societies that didn’t did the Darwin thing.

  75. pec says:

    “we have tried over and over to explain to her how science works.”

    I know how science works. It doesn’t reject everything that does not fit what is already known. It does not prefer ideology over observation and empiricism. It does not reject ideas merely because they were believed in ancient and traditional cultures.

  76. Harriet Hall says:

    For new readers: Why We Are No Longer Answering Pec

    After many long and fruitless discussions with pec, the blog authors and many of the regular commenters have reluctantly decided to ignore pec’s comments. She gives us unsupported opinions, distorts our words, misrepresents our thoughts and then tries to argue with that misrepresentation, and insults us. She seems not to understand our critiques of her comments. She doesn’t discuss, she argues. She doesn’t listen, she contradicts and provokes. She has contributed nothing of substance and has been a disruptive influence, interfering with our attempts to carry on a rational discussion about science and medicine.

  77. overshoot says:

    For new readers: Why We Are No Longer Answering Pec

    Works for me. Be great as a JavaScript mouse-over.

  78. pmoran says:

    We hardly need to touch upon ethics in these more rarefied and mind-bending ways. We already have a rough formula for assessing the ethical appropriateness of medical care. We simply look at the likely benefits in relation to possible risks and cost. If wished, the concept of risk can be easily expanded to include the public getting quite the wrong idea if doctors sometimes acquiesce in them using unproven or dubious kinds of treatment.

    The ethical objection to ALL use of CAM , as presented by KA, is problematic because of the unspoken assumptions –.

    1. That conventional medicine has adequate answers to all health problems and the public should be content with what it offers.. This applies fairly well to some illnesses but not many others.

    2. That “alternative” methods do nothing worthwhile for those using them, anyway . This view is also context sensitive since considerable scientific evidence suggests the likelihood of symptom relief by the placebo medicines of CAM and from interactions with CAM practitioners.

    3. That science provides a clear discrimination between what works and what doesn’t. Over the long haul that is true. But what do we mean by “works”? Where does the placebo complex of influences fit in?

    And even within the limited reach of EBM (meaning the RCT evidence that excludes placebo and practitioner influences) this assertion now looks a little shaky, when dozens of studies can be performed on methods such as SJW and glucosamine without clear answers, and when most of the “effects” of antidepressants can be mimicked by placebo.

  79. qetzal says:

    Why We Are No Longer Answering Pec

    I agree. However, if pec surprises us all and starts making a reasonable effort to support her claims, I think we should be willing to re-engage with her.

    Until then, I pledge not to address or respond to her any more.

  80. Harriet Hall says:

    “if pec surprises us all and starts making a reasonable effort to support her claims”

    That would be a start, but I’d also want so see some evidence that she could read and understand what we actually write and could respond appropriately. What’s happened over and over is that we say A and she says we said B and B is wrong. And we tell her we agree that B is wrong and she says no we don’t. It’s quite surreal.

  81. pec says:

    “What specifically do you find wrong with their data or their reasoning?”

    Their data and their reasoning are in support of the idea that species evolved, rather than being zapped into existence out of nothing. I don’t find anything wrong with that idea. The problem is that “skeptics” pretend evidence for evolution is evidence for a particular hypothesis about the cause of evolution.

    Darwin collected evidence for evolution and he also developed a theory to explain it. I think his theory is correct — there is variation among members of a species and the ones that reproduce more reproduce more. It’s an idea that has to be true. But Darwin hypothesized that variation plus selection might completely explain evolution.

    Darwin’s theory was not widely accepted until genetics was better understood in the 20th century. At that time biologists decided that Darwin’s idea could possibly work, and it was therefore accepted and never questioned since.

    The currently accepted theory (CAT) of evolution (sometimes called neo-Darwinism) is that genetic variations are random — that is, they do not ever occur in response to the needs of individuals or species. There is no natural drive towards greater complexity, according to this theory.

    One of the main problems with the CAT is that there is virtually no evidence to support it. Believers assume that the complex machinery we call organisms can be created by a random process, given extremely long periods of time.

    No one has figured out a way to verify the CAT experimentally, since we can’t wait billions of years for the results of an experiment. Believers claim that there are computer models that verify the theory, or that the theory is so obviously true it doesn’t need to be verified. The CAT is especially loved by “skeptics” like Dawkins, who deny that nature could posses any kind of intelligence or purpose.

    Alternative science, on the other hand, sees intelligence as a general principle of nature, not merely a product of physical brains. Complex machinery would be expected to originate and evolve within an intelligent universe.

    So there are at least two very different perspectives on evolution, neither of them verified by the scientific method.

    Dawkins is a loud and confident promoter of the CAT because it assumes that a mindless nature can generate complex, intelligent machinery. Dawkins sees religion as the source of all evil, so he does not accept the idea of an intelligent universe, which can be seen as supportive of some religious or spiritual ideas.

    Beliefs about the cause of evolution are philosophical, not scientific. We know that evolution occurs, we know that genetic variation occurs, and we know that natural selection occurs. All of these can be and have been verified scientifically. But we still do not know the causes of genetic variation or how or why complexity increases.

  82. Harriet Hall says:

    For new readers: Why We Are No Longer Answering Pec

    After many long and fruitless discussions with pec, the blog authors and many of the regular commenters have reluctantly decided to ignore pec’s comments. She gives us unsupported opinions, distorts our words, misrepresents our thoughts and then tries to argue with that misrepresentation, and insults us. She seems not to understand our critiques of her comments. She doesn’t discuss, she argues. She doesn’t listen, she contradicts and provokes. She has contributed nothing of substance and has been a disruptive influence, interfering with our attempts to carry on a rational discussion about science and medicine.

  83. Peter M,

    I’ll respond to your comments in Part 4 of the series. I don’t think it would give you the attention that you deserve to do it here.

    KA

  84. pmoran says:

    I thank KA for some kind comments and the respect he is affording some tentative positions that I am exploring. This is how science works. We should be prepared to examine healthfraud dogma with the critical intensity that we apply to any other largely scientific proposition.

  85. pec says:

    And of course, Harriet, you never insult me or misunderstand my comments.

    The problem is mostly that you don’t like seeing your worldview threatened. But there are increasing numbers of scientific people who do not necessarily think Dawkins has everything all figured. out. It will only get harder to cling to your certainty, unless you are careful to only communicate with like-minded “skeptics.” That would be safer for you, I think.

  86. Michelle B says:

    Harriet, I am already enjoying the discussion much more now since the moratorium has been declared on ‘dancing’ with pec, esp Daedalus2u’s very intriguing intellectual grasp of various aspects of the present topic.

    If you can be so vigilant, yes, I think posting your short comment (better than a link for the time being) after every post of pecs makes sense and is worth a consistent try. Your approach is much better than simply banning her.

    As far as the draining and diluting of the intellectual power of these most excellent discussions, in addition to any personal investment of time in engaging with a poster that has shown no ability or desire to engage in intellectually honest discussion despite many patient attempts (esp yours, Harriet), we all need to place a ‘stop loss’ regarding pec.

  87. pec says:

    Yes, it is so much more pleasant when everyone agrees.

  88. daedalus2u says:

    There was a mention over at Denialism about how when health professionals treat people they have emotional feelings about that often the care delivered is substandard. I think this relates to the ideas I am in the process of fleshing out, where high NO levels invoke more of a “theory of mind” cognitive approach and low NO invokes a “theory of reality” approach.

    I think it is the “theory of mind” that causes people to think in anthropomorphic terms, to attribute consciousness to inanimate objects, to attribute human motivation to non-human objects. I think this happens along the lines of “if your only tool is a hammer, every problem looks like a nail”. If the only cognitive tools you have to think with are social and anthropomorphic representations (which are the only methods that work for communication), it is really hard to think in other terms that may be more appropriate to the task at hand.

    This may be the fundamental problem with CAM. The people practicing it are not capable of thinking about things in non-social terms.

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