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Snipers – A Short Reflection

The blogosphere held no fascination for me before my involvement with sciencebasedmedicine.com. I had checked into a few blogs, and found some capturing attention, allowing exploration of ideas and personal views in greater scope than allowed for in scientific papers. But many seemed not to expand discussion after an original post.  When the blogger would describe some series of events or ideas, there would follow a series of pro and con short commentaries, whose authors seemed to enjoy sniping at irrelevant issues. The emotional level rose with each series of exchanges. One had to search for pages with comments that expanded knowledge, and were not just argumentative.Some commenters took off on small details in the original.. Then ensued a series of yes I did – no I didn‘t, you said – I said, you said – I meant, you‘re a blank – you’re a worse blank, and on, as readers know.

I wrote an article or two for an online ‘zine, and the format allowed for extended exchanges, like the blogs. Comments followed a similar pattern. They continued for 2 weeks. Same thing happened when I critiqued traditional Chinese medicine, implausible claims, ethics of “CAM” in editorials in an online journal. Questions there were screened by editors, but I filled more space  elaborating answers than I was allowed by the word limit to the original articles. I noted that even news items in online news sources were followed by series of comments, challenges, counterchallenges and on they went, often getting uncomfortably personal. Lost in some of this was the meat of the original article as small point after smaller point appeared.

All this is old stuff to most of you readers, but to me, it was new. And I wondered not only about the format and policies that allowed ongoing sniping, but had to look at my own reactions, often surging in the same direction of telling people off. I keep telling myself not to answer snipes, but the temptation sometimes wins. Too much chance to show cleverness and to enjoy that basic, innate joy of putting it to someone who wrote something that really ticked me off.

I also wonder about people who do not write original material but who find blogs, listservs, zines, and Net news services and then criticize and rail against whatever tweaks them that day. The pattern reminded me of snipers in combat Snipers are dispersed along lines of enemy advance to harass and kill without hope of immediate tactical advantage. Sniping is almost senseless killing except that it serves a strategic purpose. It instills fear and doubt in the minds of the enemy. One of my nephews, a marine lead man in Viet Nam was victim of one.

I cannot forget a weekly magazine photo essay during the height of the Bosnia-Herzogovena war. It featured a young mother, holed up in a second or third floor apartment with a months-old baby in a crib, and a window view to a no-man’s land area. Beside her was a high powered rifle with a scope sight pointed toward the road. The caption described her as taking shots at whoever might cross the road, collecting a bounty for every body she could drop. I don’t recall her body count, but neither age nor sex, civilian or uniform, religion or nationality mattered. Nor was there identified who paid. Sniping was apparently her means of support. Chilling.

Snipers are necessary cogs in the function of radical politics, in which tearing down of the social order is a prelude to victory by revolution or evolution. Some of the sniping on this and other blogs reminds me of revolutionary tactics, directed strategically against the structure of science and reason.

Quackery sympathizers use sniping commentary to insert irrational material into the medical system and to attempt to induce distrust of medical science. Another object is to draw authors and others into unproductive counter-sniping, hoping for challengable material, which they perhaps could use elsewhere. Readers will understand not answering irrational snipers routinely.

Snipers with no expertise or productive intent do not add usable information to a discussion, but their comments can be useful for teaching purposes – recognizing their behavior patterns, and as examples differentiating substantive material from the insubstantial.

Nevertheless, as for reading snipers and answering them, despite their tempting bait, except for using them as an object of sociological study, I’d rather go swimming.

Posted in: Basic Science, Science and Medicine

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25 thoughts on “Snipers – A Short Reflection

  1. ama says:

    Welcome to the club.

    http://www.sciencebasedmedicine.org/?p=7#comment-6762

    One must use a clear and strong strategy.

    1. no mud!

    It is a pity that most people (despite their education and job) do not realize this. We have people, who know enough to write books, but they prefer to dive in the mud of forums.

    We can tell these people as precisely and and as broad as possible, uncounted times, but the end is always the same: they play in the mud.

    2. no occupational therapy!

    There are two totally different areas: in commercial sites and in private ones. In a private site the owner can do as he likes. Up to the point where the lawyers show up.

    This is the situation we have in Germany. Many critical sites are attacked by (mostly companies) those, who are critizised. This leads to many emigrating to foreign countries and making their sites anonymous. A good example is
    http://www.esowatch.com
    http://blog.esowatch.com/

    Commercial sites cannot emigrate. So some censor the contents: before being published, each post is controlled by an editor.

    What is the end? Answer: occupational therapy.

    One point not be be forgotten is where the money comes from: advertising. So, each access to a web page means plain cash. As consequence the newspapers added commentary sections to their articles. Each reader and each commentator counts.
    Weeding out to keep only the valuable comments would reduce the incoming money.

    THE problem of all is the contents. Content must be paid for. So the maintainers of the sites try to find ways to get contents for free. One method is free web-space, free blogs, free email. An other: make the people curious. Forums and commentary sections are good for that.

    What is the end? Answer: occupational therapy.

    There are EXTREMELY few sites who do a strong weeding. One is http://www.laborjournal.de
    Its English sister: http://www.labtimes.org

    I am one of the doorkeepers of
    http://www.transgallaxys.com/~kanzlerzwo/

    That is the toughest forum in the web. We collect information in depth. Gossip is deleted.

    There is an extra space where original pieces of proof are stored:
    http://www.transgallaxys.com/~aktenschrank

    If a crook shows up, he will be sorry. If we let him in, we won’t let him out. We collect scalps…

    We do that for years. Others now adopt our method. Because… it works.

    ama

  2. Michelle B says:

    How to encourage comments at a blog so as to expand upon the blog entry? One aspect is the physical setup (comments need to be easy to enter, able to be previewed before entering, numbered so they can be referred back to, etc.).

    Another aspect is the moderation/policing aspect. The best blog I know for expanding upon the original discussion is PZ Myers’ (Pharyngula). Not all of the threads are examples of blog entry expansion, but enough are for me to keep coming back. If you want the kind of blog that supports topic expansion, you need both to keep a recurring base of curious, knowledgeable, eager-to-be-informed-and-eager-to-learn-more commenters, plus new blood or else the comment section just becomes a clique or a disjointed mass of bickering and sniping.

    Myers does not suffer fools lightly: first they are warned by him, next they are disevoweled (which is so funny, to just see a mash of consonants), and they they are thrown in the dungeon (with their contact info if you want to continue sparring with them and the reasons for their placement in the dungeon, at the Dawkins site, they are placed in a separate, troll thread). He also comments quickly if there is any unsavory surfacing of sexism, homophobia, and racism. It takes work to have a thriving, fruitful blog, work beyond just excellent writing.

  3. David Gorski says:

    Actually, Wally, what you appear to be referring to are not “snipers.” In online-speak, they’re called trolls. The word “sniper” is a poor analogy for the phenomenon that you’re talking about. A successful sniper is never seen as he shoots once or twice from a great distance under deep camouflage, and the victim is gone. Meanwhile the victim’s fellow soldiers scatter or take cover. In marked contrast, trolls need to be seen to succeed. They keep inserting themselves into the conversation in the most obnoxious way that they can for the purpose of stirring things up and provoking angry responses, hence their name. They’re “trolling” for a reaction. That’s a very different thing. That’s where the response “don’t feed the troll” (i.e., don’t respond to the troll and thus give him or her what he or she wants) comes in; longtime online denizens know that if everyone can ignore a troll long enough, the troll will eventually tire and go away. The problem is, unanimity is needed, and there’s almost always someone who will feed the troll.

    A bit of history might be helpful. Trolls are nothing new to the blogosphere. They existed in online discussions from the very beginning. My experience in online discussions goes way back to the mid-1990s and Usenet, a text-based global free-for-all of discussion forums that preceded web-based discussion forums and blogs. That’s where the term “troll” originally came from.

    I also think you’re being a bit harsh and unrealistic in your expectations for “expanding” the conversation. Think of blogs with unmoderated comments as a conversation in which virtually anyone can join in. In real life, how long does a conversation stay on one topic before drifting off into other topics? Not very. Similarly, when a discussion thread after a post grows beyond a certain length, it is virtually certain that its topic will drift away from the topic of the post, even if everyone is perfectly civil and no trolls intervene. Whether that’s a good thing or bad thing may depend somewhat on your view on the purposes of blogs, but personally I don’t see it as a bad thing. For one thing, it often allows aspects of the issue at hand or issues tangentially related to be aired in unexpected ways. For another thing, it’s part of community-building.

    Make no mistake, a good blog can turn into a virtual community. It can become a place where people turn to for discussion of topics of interest to the community. Readers come to know the bloggers (at least, as much as it is possible to know anyone through their writing) and regular commenters become known to the bloggers. It’s a very cool thing, and sometimes we even get to meet each other. Steve knows this from his experience with his podcast. The price, of course, is that some people are assholes, and there is never any escaping that anywhere were humans congregate, whether in a physical community or a virtual community. Indeed, trolls are more like the drunk at the party inserting himself into random conversations, puking on guests’ shoes, and then passing out in the doorway than like snipers. They use grenades rather than precision marksmanship.

    Finally, I’m rather disappointed in your apparent disparagement of people who do not write blogs but then go and comment on blogs, criticizing what is said. Not everyone has the time, writing talent, or inclination to become a blogger. Moreover, not everyone–or even most people–launching harsh criticism harshly is a troll (or, in the case of this blog, a cult medicine infiltrator here to “snipe” or disrupt the conversation). You have to understand that online culture is a rough-and-tumble, hurly-burly culture, made more so by the simple observation that raw text on a computer screen cannot convey the facial and body language cues that we rely on in person-to-person contacts. That lack of face-to-face contact can also disinhibit people, so that they say things online that they would never say in person. That doesn’t mean we have to tolerate indefinitely someone like, say, pec, but it does mean that a blogger has to understand the nature of online conversation.

    Besides, I kind of like the hurly-burly free-for-all in blog comments, and in my case at least that harsh criticism, whether trolling or not, helps to keep me honest. Occasionally it even deflates an ego (mine) that all too often can benefit from a bit of deflating. And, as you point out, sometimes it provides a truly enjoyable opportunity to put an idiot into his or her place. More often, though, it allows us the opportunity to expose the errors in thinking, logic, and science behind implausible medical claims, all for the benefit of the more moderate. Also, don’t forget lurkers. In general, less than 5% of people reading blogs ever post a comment and only around 1% are active, frequent commenters, probably less on a blog like this, where registration is required. The rest are called “lurkers,” because they lurk and almost never make themselves known. It’s not a bad thing to show the vacuousness of “sniper” comments to lurkers.

    One last thing. There are certain archetypal kinds of commenters, and if you want to understand a bit more about online communities and discussion forums, one of the best sites I’ve ever seen for that purpose is the Flame Warriors site (several entries from which I’ve linked). Scroll through the different kinds of Flame Warriors, and I bet you’ll recognize some of them. (It’s not for nothing that I’ve frequently referred to pec as Ferrous Cranus, and, in retrospect, I now see that Fifi and pec are “Duelists.”) In online conversations, your post makes me think that you should be aspiring to be the Kung Fu Master or Big Cat. Certainly, in my more deluded moments, I view myself as the Kung Fu Master. However, more often, I probably come across as the Philosopher or Tireless Rebutter. :-)

  4. ama says:

    There are two different areas: people who write in a web-log or forum, and the technique of the scripts to present the whole thing as web-pages.

    From my point of view, the type of people is independent of the technique. So we should not mix up the areas.

    Concerning the technique: A forum has some big advantages. One is that the whole structure of forums, subforums, threads, posts is easier to oversee.

    A disadvantage is that one only sees the subject line, but nothing of the content of a post.

    For a web-log on can get many designs for the layout, including pictures. This makes installation easy. But if the number of posts grows with time, it is hard to get an overview. The only real good overview is that of the newest entries.

    The scripts are nothing but generators to make web-pages by automate, instead of diving through the HTML by hand. But as this automated stuff is automated, it makes all things look the same. This is a big disadvanage for many situations or topics.

    What is needed is a hand-made web-page with overviews. For a web-log this is not very practical. For a forum one can be lazy, duck out, and make a special thread, in which other items of the forum are connected. This does not need HTML by hand, uses the existing technique and still is part of the existing structure.

    What I miss the most here in sciencebasedmedicine is a means to edit the posts. As I – in struggle with small characters on a small sceen and a nasty keyboard – am plagued with masses of typos, I ask to please consider an edit-button.

  5. Jules says:

    I think you need to remember one thing: you don’t have to respond to them.

    I confess that I enjoy the thrill of debating, but at some point it invariably disintegrates into name-calling/libelous/insulting drivel, though usually I stop long before that.

    If you can’t take the heat, don’t play with matches. Anybody who writes about the benefits of vaccines is going to get deluged by a bunch of anti-vaccine assholes. Anybody who write politics is going to get smoked by the other side. What irritates me the most, though, is when people confuse legitimate concerns and questions and couterarguments with trolling. I try not to troll, but I’ll be frank–a lot of what gets posted here about CAM pisses me off. Not because I believe most of it, but the few things I do believe about herbals and physical manipulations (massage, stretching, yoga) gets lumped into energy healing and chi manipulation*–and some aspects of CAM, such as meditation, could go both ways. This blog is interesting and stimulating, but also infuriating in that it doesn’t distinguish between “real” CAM and true quackery.

    *although I have to say, this is really freaky if you try it under guided meditation

  6. Fifi says:

    Dr Gorski – Well called regarding myself and pec (though, in all fairness, I’m certainly not the only person who interacted with her as a duelist and I was motivated by a genuine, if detached, interested in what drove her behavior). I’ve sheathed my sword and am looking forward to wielding less pointy tools of communication here in the future (at the moment I’m just generally enjoying reading and lurking for the most part since the level of discussion has risen).

  7. Fifi says:

    Unfortunately the problem with including an editing feature in any forum where sometimes heated discussions take place is that dishonest people can go back and change their posts making it difficult to hold and follow an honest conversation.

  8. David Gorski says:

    I try not to troll, but I’ll be frank–a lot of what gets posted here about CAM pisses me off. Not because I believe most of it, but the few things I do believe about herbals and physical manipulations (massage, stretching, yoga) gets lumped into energy healing and chi manipulation*–and some aspects of CAM, such as meditation, could go both ways. This blog is interesting and stimulating, but also infuriating in that it doesn’t distinguish between “real” CAM and true quackery.

    No, I go out of my way to distinguish between modalities that might have value in scientific medicine and those that are truly woo. Here’s the problem. The lumping together of potentially useful interventions (nutrition, exercise, herbal medicines, etc.) with woo is not the fault of advocates of scientific medicine. Rather, it’s a calculated and intentional tactic of CAM advocates to increase the acceptance of their nostrums. They use the plausibility of such modalities as a means of slipping in the hardcore woo (like homeopathy, applied kinesiology, etc.) along with the more plausible treatments.

    Indeed, as a result of their “CAM-ification,” legitimate evidence-based scientific medicine therapies, again such as nutrition or natural products, have in many cases been unjustly “ghettoized” by CAM after they were coopted by woo-meisters and relabeled as “CAM.” Their new association with woo has made legitimate scientific modalities that have fallen under the CAM rubric take on the taint of pseudoscience and quackery. Even disciplines with a long and distinguished history in scientific medicine, such as pharmacognosy (the discovery of drugs from plants and natural products), have taken on an undeserved taint of quackery and pseudoscience by having been largely relegated to the backwaters of NCCAM for purposes of grant funding. Trust me on this, many natural products pharmacologists are not happy about this development. I know one, and he complains about this all the time. Indeed, the “CAM-ification” of his specialty (natural products pharmacology) has made it more difficult for him to do his work, because the study section reviewers at NCCAM don’t like boring, traditional pharmacological approaches of painstakingly isolating and characterizing active ingredients in plants in order to make them into a reliable drug. They want “holistic” or “synergistic” uses of whole-plant extracts and have little interest in pharmacokinetics or other aspects we normally consider important in drug development.

    Finally, let me repeat once again my view on the very concept of “alternative” medicine. There is no such thing. It’s a false dichotomy. There are in fact only three types of medicine: medicine scientifically demonstrated to work; medicine scientifically demonstrated not to work; and medicine that has not been adequately tested yet to render a judgment. The vast majority of CAM falls into the latter two categories, and the vast majority of untested CAM is in addition highly extremely implausible on a scientific basis. Any “alternative” medicine that can be demonstrated to be safe and effective through the methods of scientific medicine will no longer be “alternative.” It will become just “medicine.” The very reason “alternative” medicine is not considered just “medicine” is because it is a combination of one or more of the following: not tested, tested and found wanting, or not tested but so incredibly implausible on a scientific basis that it seems a waste of scarce resources to test it.

  9. ama says:

    The problem with someone later replacing his text with something different or even deleting it we had in a big forum. Was very interesting and we had much fun with him.

    In our forum we use a time delay. IIRC it is 30 minutes. After that limit editing is impossible. Only people with special acess rights can edit (if they are given this special right).

    As we – in contrast to other forums – concentrate on collecting material from the outside, the only thing we deal with is typos. Guests cannot edit. This we did from the start. We had to be extremely hard because of the special clientele we are dealing with: charlatans, quacks, MLMers, and the like. Those people we won’t give a rope. 99,999 percent do not dare to write in our forum. And those who dare, become very, very sorry… :-)

  10. ama says:

    [quote]Finally, let me repeat once again my view on the very concept of “alternative” medicine. There is no such thing. It’s a false dichotomy. There are in fact only three types of medicine: medicine scientifically demonstrated to work; medicine scientifically demonstrated not to work; and medicine that has not been adequately tested yet to render a judgment. The vast majority of CAM falls into the latter two categories, and the vast majority of untested CAM is in addition highly extremely implausible on a scientific basis. Any “alternative” medicine that can be demonstrated to be safe and effective through the methods of scientific medicine will no longer be “alternative.” It will become just “medicine.” The very reason “alternative” medicine is not considered just “medicine” is because it is a combination of one or more of the following: not tested, tested and found wanting, or not tested but so incredibly implausible on a scientific basis that it seems a waste of scarce resources to test it.[/quote]

    Exactly! This is what we say for years. This passus should be mounted on a central place. Is that technically possible?

  11. Fifi says:

    Jules – As someone who meditates and practices yoga, and is interested in the science of nutrition and research in these areas, I can understand your frustration. Mine is slightly different, I get frustrated that the study of many areas and interesting phenomena has been claimed for CAM and devalued and eventually marginalized due to the misunderstandings and reliance on pseudoscience of many involved in CAM (when nutrition and neurobiology are just medicine, not an alternative). The amount of pseudoscientific chaff created to promote CAM can make it awfully hard to separate out the science wheat.

  12. Wallace Sampson says:

    ama notes some of the types of snipers with specific motives. I neglected to recount experience in an ALS listserv during the Gulf War Syndrome concerns. One sniper at rational and scientific notes whom I queried admitted she was a MLM rep for one of the products being touted on the listserv. A second sniper . identified by accident looking for another article in a journal, was an attorney who represented clients who had or could have amalgam fillings removed for claimed heavy metal poisoning. He had written an article published in the journal. One could assume both were trolling for business in the group. Co-bloggers here`are aware of these things, but some readers might not be. Snipers, like trolls, often have personal or ulterior commercial motives.
    As for choices of words, the sniper analogy appealed to me. Trolls recall more benign visions of those little characters under bridges. Sniper appeals to me because of the stronger emotional reaction I hoped it might produce.
    Whether an analogy is appropriate, ideal, or otherwise, depends on opinion and intent, not on the subject’s closeness to the analogized. According to Webster’s New College Dictionary, analogy: 1. Inference that if two things agree with one another in some respects, they will probably agree in others. 2. Resemblance in some particulars between things otherwise unlike. The point here is that when items and concepts are more alike, they would become more identical, rather than analogous.
    “With all due respect” to commenters, I assume blogs allow expression of opinion based in fact, which I personally hope is productive and educational. I find analogies to be one of the most immediate and understandable methods of making points understandable – and interesting.
    So, who sets rules of the blogosphere? Seems they develop by gradual consensus, using both new words and old ones re-used – where have I seen that before? No room for new concepts and new words? And where did we see that before?
    Finally, the definitions of the medicines listed above and discussed are those we developed for our Stanford course in the 1980s. Methods proved to work, methods proved not to work, and methods not proved to work, and are implausible. Somehow this straight and simple list has never been included in any NIH or other popular definition.

  13. Jules says:

    David,

    There are in fact only three types of medicine: medicine scientifically demonstrated to work; medicine scientifically demonstrated not to work; and medicine that has not been adequately tested yet to render a judgment.

    While I agree with this, it often seems as if you and several of the authors here take the third case to mean that it doesn’t and won’t and can’t possibly work.

    Now, for a lot of CAM (reiki, energy healing, etc) this is probably true. But what one comes away with after reading pieces by you is that ALL CAM is bunk, which is simply not true. I realize now that this is not your intention, but you have to realize that that’s what you sound like.

    And as far as “alternative”: what else would you call it if a doctor prescribed some valerian for you rather than Ambien? It’s not like you can go to a drugstore and ask for some (well, you can 18 km to the East, which is Germany) . Or if your doctor suggested you try a yoga course for a bout of sciatica (which I’ve done, and yes, it did work)? I think a huge part of the problem–which your unfriendliness towards the whole of CAM contributes to–is that Western medicine is so rigidly defined: doctor in white coat, listening to your heart, prescribing bottles of expensive pills; so that any deviation from this particular norm is alternative.

  14. mandydax says:

    Long-time lurker, first-time commenter here. I found this via Pharyngula and BadAstronomy back when it was getting started.

    Some of the trolls/snipers remind me of the Black Knight from Monty Python and the Holy Grail. They appear all intimidating, but then you cut their comment to ribbons, and they still insist that they’re winning, so you cut it up some more until there’s really nothing left, so you ignore them, and they yell after you, “Running away, eh?!”

    I wanted to say that I really appreciate this blog, although it sometimes can be a bit depressing how much the medical community seems to be enamored of CAM, even to the point of making courses on it mandatory. :(

    I actually referred to SBM today in my LiveJournal. I got one of those forwarded emails about the CA-125 test for ovarian cancer. Typical of these virals, it had multiple sizes of fonts and various typefaces, lots of bold. Anyway, long story short, and you can see the whole thing if you want, I debunked it, but even before I looked up the references, I thought back to this SBM article, and realized what the facts probably were, and Snopes pretty much said exactly that. False positives will cause women to get biopsies they don’t need, and false negatives will keep women from being diagnosed in a timely manner.

    I’ve learned so much about critical thinking in the last couple of years, and I’m very grateful for these types of blogs. Keep up the good works.

  15. ama says:

    Already the word CAM (“complimentary” medicine) is a fraud with language.

    “Complimentary” implies that to a part A a second part B exists, and that BOTH TOGETHER form the whole (.i.e. medicine). But that is not true.

    “Complimentary” is something like ying and yang. Fits ideally into esoteric way of thinking. Seems to be something wise. But it is not.

    The point with things like “CAM” is, that the very moment that you use them, you have lost. You have lost because you bit into the poisoned fruit. You use words which are not of your world, words, which have more than one meaning, which even might have magic meanings.

    The meanings of words create a parallel world, and that EXACTLY is where the esotters live in.

    You use a word, and the esotters use the very same word, but in their world it has a completely different meaning. YOU think it with YOUR meaning behind, and you do not realize that to the esotters it represents something TOTALLY different. So you and they speak with the same words, but you do not understand each other.

    From the side of the esotters this s done willfully. It is the way they make their worlds.

    An example, one of the worst possible examples ever: Ryke Geerd Hamer tells his victims that the healing (of their cancer) is accompanied with pain. So the victims (their health is degrading) at one time begin to feel pain. Hurray! This is what they waited for. They are prepared for the pain. They are made believe that the stronger the pain is, the more actively the body heals. The more pain, the nearer to health. So, when Hamer talks of healing, in reality it is the dying of his victims. What could be more perverse?

    As a result of the double meanings the victims live in a world of their own and do not understand normal-thinking people anymore. And normal-think people go to pieces because they see people die, and they can’t even talk with them. It is the most extreme situation, and families break apart forever under this psychical overload.

    So, do not become a victim of war rhetorics, do not use the enemy’s words. It is NOT “only words”.

  16. matalford says:

    Yes. In fairness to the writers of this blog, I consider their (collective) position on this is pretty clear and consistent. Simply put: Evidence based medicine – IN, until proven otherwise. Everything else – OUT, until proven otherwise.

    As soon as there are sound EB reasons to prescribe a so called “CAM” procedure or treatment it is no longer “CAM”.

    I find Jules’ description of “western medicine” stereotypical, and (like most stereotypes) wholly inaccurate. In addition, his/her anecdotal success with yoga is not the sort of evidence that would elevate a CAM to an EBM.

  17. David Gorski says:

    Now, for a lot of CAM (reiki, energy healing, etc) this is probably true. But what one comes away with after reading pieces by you is that ALL CAM is bunk, which is simply not true. I realize now that this is not your intention, but you have to realize that that’s what you sound like.

    If there’s one thing that Wally and Kimball have persuaded me of (mostly) since I joined them in SBM, it’s that prior plausibility is neglected in the standard evidence-based medicine paradigm. (Believe it or not, before this blog started, we had some fairly extensive and heated e-mail discussions over this very issue.) Let’s put it this way for energy healing modalities. Sure, it’s possible that there is some sort of energy field in living things that science has not been able to measure yet. Sure, it’s possible that some humans can manipulate this energy field for healing intent. But the weight of centuries of science and many decades of exceedingly powerful physics argues that both assertions are incredibly improbable. Now, when faced with a proposition that is unbelievably improbable on a scientific basis, what would be required to persuade skeptics that there might be something to it?

    The answer is simple, and the same as it is for claims of the paranormal: Incredible claims require incredible evidence. I would put it in a less inflammatory manner. In order to convince scientists that energy healing is possible or happens, there needs to be a weight of evidence that at least approaches the weight of scientific evidence that argues that it is not possible and does not happen. That is actually not any different from the evidentiary requirement for overturning any established understanding in science. What it means, however, is that there has to be a lot of clear evidence casting doubt on established science. In the case of energy healing, there isn’t even close to that amount of evidence. In practice, what this means is that, in a world with highly constrained health research dollars, it makes little sense for the government to invest heavily in researching such highly implausible concepts on a scientific or financial basis until a lot more evidence is presented. Ditto homeopathy and other incredibly implausible CAM treatments.

    Finally, ama is correct. The whole term “complementary and alternative medicine” is a sham. Even worse is “integrative medicine,” which implies that there is something of value to “integrate” or that integrating woo with scientific medicine has any value. Wally wrote an excellent article a couple of months ago about the distortions of language CAM advocates use to make their dubious remedies sound acceptable. I just wish he hadn’t made a rather uncalled-for insinuation in this comment:

    So, who sets rules of the blogosphere? Seems they develop by gradual consensus, using both new words and old ones re-used – where have I seen that before? No room for new concepts and new words? And where did we see that before?

    Maybe I’m being too sensitive and correct me if I’m wrong, but doesn’t it seem as though Wally appears likening my comment about trolls/snipers to the very sort of thing he so nicely trashed in the post to which I just linked?

  18. durvit says:

    Maybe anecdote feels like evidence to the person who owns the anecdote? How anecdotal evidence can undermine scientific results.

    The reason for this cognitive disconnect is that we have evolved brains that pay attention to anecdotes because false positives (believing there is a connection between A and B when there is not) are usually harmless, whereas false negatives (believing there is no connection between A and B when there is) may take you out of the gene pool. Our brains are belief engines that employ association learning to seek and find patterns. Superstition and belief in magic are millions of years old, whereas science, with its methods of controlling for intervening variables to circumvent false positives, is only a few hundred years old. So it is that any medical huckster promising that A will cure B has only to advertise a handful of successful anecdotes in the form of testimonials.

    Dr Gorski’s observation probably even varies from one country to another:

    Indeed, as a result of their “CAM-ification,” legitimate evidence-based scientific medicine therapies, again such as nutrition or natural products, have in many cases been unjustly “ghettoized” by CAM after they were coopted by woo-meisters and relabeled as “CAM.”

    We have so few allergists who work for the NHS in the UK that, by default, the dubious offerings of CAM are substituting for it with many people. (Seriously, we have something like 6 consultant allergists for the whole of the UK: there may be an additional 15 Registrars.) Unfortunately, this is undermining both the understanding of allergy in the UK and the public understanding of science because both are frequently misrepresented in the UK press.

  19. Fifi says:

    matalford – I agree about Jules’ depiction of medicine and doctors as being a stereotype (and one that’s usually promoted as anti-medicine propaganda by supplement manufacturers, CAM practitioners who feel threatened by science and those who have a personal resentment against doctors for one reason or another).

    I’ll also add that his assertions about yoga for sciatica are naive (not necessarily incorrect but naive). Not because yoga can’t help sciatica that’s muscular in nature, it probably will. But so will almost any physical activity or stretching, taking a 20-30 minute daily walk would be just as effective. However, a physical therapist would be able to prescribe a series of movements/stretches that would more directly target the particular muscles that would be more efficient and effective than the roulette of prescribing a yoga class (potentially doing more harm than good, depending on the level of competence of the teacher – there are certainly many yoga teachers out there who don’t understand basic anatomy or sports safety, and who buy into the whole detox myth that pain is a sign that one is purifying or “cleansing” oneself). Neither yoga or exercise will do much for sciatica that is a result of a disk problem – and it may even aggravate the condition.

    Over my many years of practicing yoga, I’ve found that quite a lot of teachers and practitioners attribute all kinds of very natural physical events to the supernatural, often because there’s a basic misunderstanding about physiology and neurobiology and there have been mythologies built upon these misunderstandings. This doesn’t detract from my own experience of doing yoga (or meditating) but it’s always interesting to see how people get led down the garden path and get attached to believing they’re having supernatural experiences (something some schools of meditation warn against since they seem it as another form of Maya/illusion).

    What often seems to happen is that people take a yoga course or start meditating, have an experience that they (and their teacher) mis-attribute to the supernatural (even though it’s quite natural and explainable), feel special and like they’ve got magical insight so get attached to the supernatural explanation of their experience and get defensive when their belief isn’t supported by science, get angry at doctors and scientists who don’t prop up the magical belief (because being angry at “science” – and idea or process – isn’t as emotionally satisfying as anger directed at another person and is pretty obviously stupid and marks one as being reactionary…not forward thinking innovators, which is how most people into woo see themselves…as being too radical for their time rather than actually clinging to shoddy old ideas that have been reanimated for contemporary consumption. I’ve found that much of woo is “alternative” culture for people who are actually extremely traditional and willing to submit to authority but want to maintain an image of themselves as being anti-authority and socially radical. Generally I’ve found them to be quite the opposite since much woo is rooted in all kinds of incredibly prejudiced and repressive beliefs about women, sex and homosexuality and is often extremely hierarchal.)

  20. Wallace Sampson says:

    So, who sets rules of the blogosphere? Seems they develop by gradual consensus, using both new words and old ones re-used – where have I seen that before? No room for new concepts and new words? And where did we see that before?

    I can see where these sentences caused concern. I was unclear as my mind was wandering through some free associations, not considering you incisively critical readers.

    My first my thought was that the language of the Net and the B’sphere has been an accumulation of new words and re-defined words, with initially differing meanings and implications to different people. A normal development in my opinion. But I saw that a similar thing happened in the development of “CAM” language distortion. I should have elaborated that the former and the latter are not the same, of course. The “CAM” distortion language had a large element of intent to mislead, and I see none of that in the B’sphere jargon. Mechanism similar, intent diferent. Apologies. Nevertheless, I’d like to think my language subs could be considered, too.

    The last sentence hid an even more obscure thought and I apologize for not elaborating. When I contacted the National Library of Medicine about its dropping of “medical cult” and “quackery” labels and adopted “alternative and “complementary” and such, I was told that they were just following common worrd usage for ease of referencing and for public expectation. My suggestions for “anomalous, disproved, unproved, etc. were dismissed as unworkable.

    And, when I complained to an on-line journal about their acceptance of the term “integrative” as accepting intentional propagandistic language manipulation, and requested that they use “sectarian systems” and “anomalous or aberrant claims,” I was told that the policy was made by higher-up offices -the addresses of which I was unable to obtain – which had accepted contributions from a well-known “CAM” supporting foundation. So that’s where I had heard that before.
    In the latter case it seems to require a significant but undetermined amount of usage or number of users to create a language change. And, to librarians and editors, misrepresentation is not a problem, and new words to replace misrepresentation are a problem. That is an “interesting” area for study.

  21. ama says:

    >Wallace Sampsonon 22 Aug 2008 at 1:52 pm
    >
    >When I contacted the National Library of Medicine
    >about its dropping of “medical cult” and “quackery”
    >labels and adopted “alternative and “complementary”
    >and such, I was told that they were just following
    >common word usage for ease of referencing and for
    >public expectation. My suggestions for “anomalous,
    >disproved, unproved, etc. were dismissed as
    >unworkable.

    So by shere “normative force of the factual” truth is killed by lies. THIS is the way language is used as a weapon.

    “Political correctness” is just another view/expression/way/strain of that.

    >And, when I complained to an on-line journal about
    >their acceptance of the term “integrative” as accepting
    >intentional propagandistic language manipulation, and
    >requested that they use “sectarian systems” and
    >“anomalous or aberrant claims,” I was told that the
    >policy was made by higher-up offices -the addresses
    >of which I was unable to obtain – which had accepted
    >contributions from a well-known “CAM” supporting
    >foundation.

    One thinks, that the undermining comes from below. But the truth is frightening: it comes just FROM THE TOP!

    Would you believe that the president of the national association of medical doctors orders you to cooperate with scammers, liars, fakers, murderers “at the same eye-level”?

    In Germany it happened. In 2004. And there was no critic to that, which I heard of…

    To my knowledge, this still is the only critic:
    http://ariplex.com/ama/amahoppe.htm

    And it is not by an MD or by a politician. I am sorry that there is no translation.

    Hoppe did not say “scammers, liars, fakers, murderers”, no he used the words “Dialogforum Pluralismus in der Medizin”.

    The whole attack of Hoppe et al against scientific medicine still is in the web:
    http://www.aerzteblatt.de/v4/archiv/artikel.asp?id=41771

    The most important sentence ist this:

    ——————————————————————————-
    Eine Reduktion der Schulmedizin auf den Begriff der
    “naturwissenschaftlichen Medizin” ist nicht statthaft.
    ——————————————————————————-

    Translated:
    “Reduction of schoolmedicine to the wording ‘natural-scientific medicine’ is not admissible.”

    I do not know how to translate
    “naturwissenschaftliche Medizin”
    better, because in German “Wissenschaft” and “Naturwissenschaft” is not the same. The first is science in general and the second is science about nature.

    Jörg-Dietrich Hoppe, president of the German Bundesärztekammer, the head of the medical doctors in Germany de facto ordered:
    “Reduction of schoolmedicine to the wording ‘natural-scientific medicine’ is ***not admissible***.”

    How far can insanity in medicine go?

  22. Jurjen S. says:

    I can see the sniper analogy, in that I’ve come across plenty of “flame warriors,” both in comments sections and discussion fora, who don’t address the central argument being made, but pick at small points on the periphery (an incorrectly cited link, say). It’s a particular form of sniping that’s rather reminiscent of the kind practiced on the Western Front in World War I or Stalingrad, though, where both sides are firmly entrenched, neither side is making much headway against the other, and sniping at any target that is incautious enough to expose itself is the only way to inflict damage on the opposing side.

  23. weing says:

    There is such a thing as real alternative and complementary medicine. For example, radiation therapy as an alternative to surgery for prostate cancer, tamoxifen complementary to lumpectomy, antihypertensive agents, statins are both. We should insist on using quackery as the correct term. The only feelings hurt will be of the quacks.

  24. ama says:

    ># weingon 23 Aug 2008 at 3:52 am
    >
    >There is such a thing as real alternative and
    >complementary medicine. For example, radiation
    >therapy as an alternative to surgery for prostate
    >cancer, tamoxifen complementary to lumpectomy,
    >antihypertensive agents, statins are both.

    Definitely not so.

    You get caught by a very minute but ultimate effective “blind spot”: it is not “alternative medicine” (as a whole), it is “one of the alternatives in treatment/medication”.

    Radiation therapy is a part of medicine, as well as surgery. Which therapy is chosen depends on the conditions in the very moment in time. Some are use a OR B, some are use in parallel, some in sequence. Whatever.

    Now, as even you do not see this trick, what could all those do, who are medical laymen?

    >We should insist on using quackery as the correct
    >term. The only feelings hurt will be of the quacks.

    Right!

    I thought about starting a lexicon, where – during the years – pieces like this are entered.

  25. Mark Crislip says:

    Like Dr. Sampson, I ignored the blogosphere until my participation in the blog.

    I found this site a nice addition to his post.

    http://betterangels.typepad.com/weblog/2008/08/on-the-nature-o.html

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