Articles

Why bother?

It can be rather frustrating to refute the same old canards about alternative medicine.  There’s always been argument as to whether this is even useful.  Critics (some verging on “concern troll-ism”) argue that skeptics are convincing no one, others that we are too “dickish”. The first view is overly pessimistic (re: our impact), the second overly optimistic (re: the benign nature of our critics).   The truth always bears repeating, even at the risk of becoming the old guy at the end of the bar who always starts his stories off with, “Did I ever tell you…?”  The answer is always “yes” but if the story is good, and well-told, it may stand up to re-telling.

We tell many versions of the same story over and over, not just to entertain each other, but to refine our thinking, to convince those who can be convinced, and to point out the weakness in thinking apparent in others.  We do this not to be “dicks” but because repeated assaults on reason require repeated defense.   Scientific medicine gives us a powerful tool for analyzing new ideas and old ones dressed up in new clothes.  It allows us to find ourselves to be wrong in particular facts, if not in our overall approach.

A common theme in many of our writings at Science-Based Medicine is that science-based practitioners are willing to be proved wrong, and that altmed supporters are not.  The history of medicine is littered with the corpses of abandoned therapies, while altmed fetishizes the past, preferring to recycle old ideas rather than discard them in the face of overwhelming negative evidence.

This can be done in many ways.  I recently examined a paper that purported to support the use of a homeopathic preparation to treat sinus infections.  Leaving aside the nearly-miraculous reported results, there was a fundamental error in thinking at the very beginning of the paper.

The present trial was designed to demonstrate the efficacy and safety of Sinfrontal compared with placebo in patients with AMS confirmed by sinus radiography. As well as measuring the clinical efficacy of this homeopathic medication, the study also investigated the ability of subjects to work and/or to follow their usual activities of daily living—both during and following treatment with active medication compared with placebo—to assess the treatment success of this homeopathic medication as an integrated symptomatic therapy for AMS.

Compare this to another study on sinusitis treatment:

The value of antibiotics in acute rhinosinusitis is uncertain. Although maxillary sinusitis is commonly diagnosed and treated in general practice, no effectiveness studies have been done on unselected primary-care patients. We used a randomised, placebo-controlled design to test the hypothesis that there would be an improvement associated with amoxycillin treatment for acute maxillary sinusitis patients presenting to general practice.

The difference is dramatic.  All studies build on pre-existing knowledge, but good studies start with a question, not an answer.

Many in the altmed movement aren’t persuaded either by absence of evidence or evidence that directly refutes their hypotheses.  When that evidence is overwhelming, or when it is noted that their for their hypothesis to be true, we would have to toss out all we know of chemistry and physics, they fall back to one of their weakest arguments: “our magic is too clever for your science.”

This was demonstrated recently  in a blog post at the New York Times (and ably eviscerated by Orac). I wrote about it as well, especially regarding this particular complaint.   In the Times piece, an acupuncture supporter specifically complained that:

There is a body of literature that argues that the whole approach to studying acupuncture doesn’t lend itself to the Western reductionist scientific method.

What does that even mean?  We’ve seen this argument many times before, and what it usually means is, “we cannot prove our magic works, and rather than abandon it, we are going to abandon all of science, and we demand you do the same.”  That is obviously an untenable position, and to see why, one needs only to ask one question: are the altmed practitioners claiming it works?

If they are claiming their magic does something, then “something” can be measured.  If they are claiming that acupuncture treats arthritis, then we can ask patients if it is so, record their answers, and do some math.  That’s the Big Secret to “Western reductionist scientific method”.  If you are going to claim an effect on a subject, that effect can be recorded and measured.  Period.

Stepping back to examine basic principles and to critique basic errors is not some masturbatory exercise, and it does not have to descend into “dickishness”, but neither does it need to compromise or pull punches.  Some ideas are so laughably stupid that laugher is inevitable. Some are so demonstrably dangerous that scorn is not only appropriate but mandatory.

Posted in: Acupuncture, Science and Medicine, Science and the Media

Leave a Comment (15) ↓

15 thoughts on “Why bother?

  1. cdmerch says:

    Just to clarify something about Phil’s “don’t be a dick” speech: he did specifically say that we shouldn’t be shy about going after the major purveyors of disinformation. His primary was point was that we should try to present a kinder face to the public at large–a public that is all too often turned off by the apparent smugness of the skeptical community.

    I don’t think Phil would have much objection to us hounding the people behind bogus studies, or the celebrities who claim special knowledge that contradicts the science. He’s more concerned, I think, about how we treat strangers, random viewers of our blogs, etc. Sure, being negative appeals to fellow skeptics, but if that’s the goal then, yeah, it is a little masturbatory.

    I imagine you aren’t trying to pick on Phil here, but there’s been a lot of misunderstanding about his speech, and your references to it (lumping Phil in as a “critic,” for instance) seem to perpetuate those misunderstandings.

  2. urodovic says:

    Excellent post as usual Dr. Lipson.

    Either by PZ Meyer’s “random biological ejaculations” or scientific “masturbatory exercises” leading to critical thinking can we achieve the goal of communicating to the lay public what good scientific research and ideas have to say versus all the woo out there. The internet has become a double edged sword in creating and spreading false beliefs. But I am afraid more nonsense can be found in the web than the honest and scientifically valid truth. I believe, this Blog (SBM) is contributing its small grain of sand in trying to stop these insanity.

  3. windriven says:

    “There’s always been argument as to whether this is even useful.”

    Whether or not it is useful, it doesn’t seem to be sufficiently effective. The citadels of medical education have embraced all manner of alt-nonsense and paeans to the miracles of woo appear in the most prestigious medical journals.

    This is truly a sisyphean task. The shear weight of the stone of stupidity (and this is the right word as ignorance is fusible) defies every effort to elevate it no matter how many times that effort is mounted.

    Perhaps the true utility of this effort is in drawing the scientifically literate together, to keep the candle burning as it were.

  4. windriven says:

    “His primary was point was that we should try to present a kinder face to the public at large–a public that is all too often turned off by the apparent smugness of the skeptical community.”

    This is a battle for hearts and minds not much different from the battles in American politics. There are two camps with committed members who are unlikely to be swayed by the their opponents. The battle is for the independents, for those who have yet to make up their minds.

    The sCAMmers have the instant appeal of easy answers to hard problems. We have only incomplete knowledge and sometimes unpalatable answers to offer*. And now these independents are presented with all manner of alt-bullcrap offered at their local hospitals, taught in the finest medical schools and studied in prestigious journals.

    So far we are not winning this battle. I don’t think that wearing smiley badges will improve our position.

    * And before anyone jumps on me about the elimination of smallpox, polio, the precipitous drop in morbidity and mortality in childbirth, etc., bear in mind that those things are now taken for granted by the great unwashed. “What have you done for me lately?”

  5. Canadian Curmudgeon says:

    I really try to not be a dick to my friends, but it gets very difficult when they constantly recommend their chiropractor or acupuncturist.

    I am currently recovering from a particularly nasty bout of sciatica and everyone but my family doctor was attempting to send me in that direction. Some people even tried several times. After a while it gets difficult to be polite.

  6. cdmerch says:

    “So far we are not winning this battle. I don’t think that wearing smiley badges will improve our position.”

    Again, I (and, I think, Phil) am not saying that we should bend to pressure from opponents. You yourself frame this is a “battle for hearts and minds,” and all I’m saying is that leaving a kindly door open to passersby might be more beneficial than behaving in ways that automatically trigger people’s defense mechanisms. You can’t win anyone’s heart or mind with a cudgel.

    This seems painfully obvious, and I have a hard time understanding why people seem so intent on misunderstanding or disagreeing with it. It seems almost willful. As though Phil managed, with a call to kindness, to trigger a collective defense mechanism of the skeptical community. Interesting to think of it that way.

  7. windriven says:

    @cdmerch

    I apologize for what reads as a criticism of Phil’s argument for a less forbidding facade. I do not disagree in principle.

    The point that I wished to make was that we are swimming against the current and are losing ground because the very institutions that should be unshakable champions of SBM have found it expedient to pander to the touchy-feely easy answers of alt-nonsense.

    My comment about the smiley face was an expression of frustration with individuals and institutions that have abrogated their responsibilities, not an attack on the idea of making critical thinking as approachable as possible.

  8. Jim Laidler says:

    I believe that the phrase:

    “…doesn’t lend itself to the Western reductionist scientific method.”

    directly translates to:

    “…has never been shown to be better than placebo.”

    At least, that’s how I interpret it when I read it.

    If the practitioners and promoters of an “alternative” practice are willing to admit up front that their treatment has no benefits that can be detected – i.e. measured or experienced by the patients – they are at least being honest.

    Whether their treatment has some non-detectable benefit is debatable but, ultimately, pointless.

    Jim Laidler

  9. Why Bother? Why Not? I tend to believe if you don’t enjoy the process, if you’re only doing it to win, then you may be endanger of being “dickish”.

    Let your science, medicine, freak flag fly, I say.

    Disclaimer: This is purely from self-observation and may not be applicable to others.

  10. Ken Pidcock says:

    “I imagine you aren’t trying to pick on Phil here, but there’s been a lot of misunderstanding about his speech, and your references to it (lumping Phil in as a “critic,” for instance) seem to perpetuate those misunderstandings.”

    Count me among the misunderstanders. Plait offered not a single instance of the incivility that he claimed to confront. And his defenders seem particularly fond of Pharyngula comments threads. Oh, yeah, that makes the case.

  11. Charon says:

    “a public that is all too often turned off by the apparent smugness of the skeptical community”

    People are irritated when you disagree with them. So, if we try to confront woo in any form, the woosters (no offense to Bertie) will take offense and think we’re dicks. There may be skeptics out there whose arguments are primarily ad hominem “you’re an idiot” arguments, but the vast majority of skeptical argument is 1) based on the assumption that people are not stupid, just ignorant, and need to be educated, and 2) people can be swayed by conclusive scientific evidence. (Both these assumptions are rather too charitable to people.) But I have personal experience that people who buy into woo will call a skeptic smug or arrogant no matter what, even if the wooster went to the University of Google for 10 minutes, and the skeptic has a PhD and years of research experience in the relevant field.

    Conclusion: Phil is wrong. But we need all kinds of approaches in the skeptical community, and if some people want to be flowers-and-bunnies skeptics, that’s fine by me. Just don’t call me a dick. Because, well, that’s a little dickish.

  12. pmoran says:

    Phil is not wrong, in any sense other than that we are not sure what approaches do work best. It probably depends heavily on the individuals involved, as you say.

    One form of unnecessary incivility is to find nefarious intent where there is none . Some sceptics use language that implies that just about every CAM practitioner is a conscious scam artist. The words “scam” and “fraud”should be used judiciously.

    Phil is right that it can take much of a lifetime for deeply entrenched beliefs to change, whereas sceptics do get frustrated, quite frequently resorting to name-calling and insult, or an insolent silence (“don’t feed the troll”), if solid argument doesn’t prevail within a day or two of any Internet exchange.

    I have been suspected of being a concern troll, so I am familiar with how the use of demeaning names makes people feel. I will also punch anyone who challenges my sceptical credentials or my passion about good science.

    If we have any knowledge of the craft of medicine at all, we ought to have some understanding why acupuncturists might be tempted to doubt what they erroneously call the “scientific paradigm” when study after study is being stated as showing ” acupuncture doesn’t work”. We might even have some sympathy for them; we are observing a common phenomenon that is by no mean confined to CAM practitioners.

    Just talk to them for a while and you will realise that they “know” that “it works” with every fibre of their being. Their pateints are telling them so. There is nothing dishonest about that belief or trivial about the conflict that the supposedly negative clinical trials are creating for them, especially if they have a career hanging on it.

    That understanding is surely important to productive sceptical discussion with them . In addition to helping them interpret the studies, we have to try and help acupuncturists and others understand how certain powerful illusions of medical practice can consistently, and with utter predictability, make any treatment at all appear to have powerful therapeutic effects, readily producing the 80% apparent success rates that CAM practitioners often claim with some conditions.

    The “supposedly” in the second last paragraph raises another critical matter. Briefly, the evidence allows us to say that no version of acupuncture works obviously better than sham, but it does not support a blanket “acupuncture doesn’t work” covering all possible senses of the words.

    We cannot say how useful placebo and other non-specific influences of the acupuncturists’ attentions can be, especially under conditions of heightened patient expectations. In other words both the testimonials of patients and some of the anecdotal experiences of practitioners may some factual basis and it is unnecessarily insulting to both when they are arbitrarily dismissed as not worthy of the least notice.

    The science of all this is not yet clear. We certainly will look like dicks if we yet prove not to have adequately understood our own science.

  13. GinaPera says:

    “Science based medicine” would have an easier time outshining the “woo” peddlers if it did a better job with the chronic, non-life-threatening illnesses.

    Instead, today’s physicians seem to excel at ordering tests and prescribing medications or sending on to other narrow-focused specialists. The younger ones view palpation as if it would give them the cooties. Need I go on?

    The point is, patients are frustrated and so they turn to the “woo.” It would be nice if this problem was occasionally acknowledged so as not to depict patients who seek “alternatives” as stupid, gullible nincompoops.

  14. Newcoaster says:

    I didn’t make it to TAM8, and though I’ve read about Phil’s “don’t be a dick” talk, I haven’t yet seen it, so thanks for the link.

    I am always torn in what tone to take with Alties. I am aware, that like fundamentalist Christians/Muslims, the far Right/Left wing….no argument I can make will convince the true believer. They choose to believe because of emotional or ideological “reasons”, not facts or evidence. The purveyors of nonsense deserve our scorn and I have no problem with being a dick about it for it’s own self-entertainment value.

    The problem of course, is those on the edge, the fence sitters, the undecided observors who are watching the debate.
    This was a perennial problem in the Alt Med room in Yahoo! Answers where I used to hang out and practice my arguments, and get my Altie bashing fix. I think sarcasm and ridicule are appropriate weapons for idiots, but I accept that I changed no minds.

    A dilemma I often run across in general practice/ER is how to approach patients who are gullible and get their health advice from idiots. For example, last night I sutured up a young girl who had a laceration and head injury with mild concussion. Prior to arrival, her parents treated her concussion with homeopathic Traumeel and Arnica. She has never been vaccinated, and she regularly sees a chiropractor for neck adjustments to prevent ear infections. My tongue is raw from biting it.

    My polite and earnest attempt to suggest at a minimum she should consider getting tetanus toxoid/vaccination was met with, “Yes, I agree, we’ll see the homeopath for that”. I know from past experience that stronger suggestions in similar situations have led to “I don’t care for your superior attitude, we’ll see the homeopath” , and that is exactly what happened.

    So, being a dick doesn’t work
    Being polite and non-judgmental doesn’t work
    Why do we bother indeed??

    Because it is important that we do.

  15. teapot says:

    It’s hard not to be smug when the opposition is so dense and so wrong.

    True science is beutiful because there is no alternative motive – simply a desire for understanding. It is hard for most people to admit they are wrong, but for proponents of the scientific method it is part and parcel of discovery. Understanding of this fact is liberating, as one no longer feels bound to usual human tendency of wanting to confirm their previously-held understanding of things.

    This is the first time I have perused this blog and I just wanted to add: Keep up the good work!

Comments are closed.