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Agnotology: The Study of Ignorance

A comment from the blog:

Every single time – bar none – I have had a conversation with someone about CAM and its modalities, they are absolutely astonished when I explain to them what the modality really is. One story I love telling comes from my friend in the year behind me. His parents are professional chemists and he came home one day and saw his mother had a bottle of homeopathic medicine. He asked why and she gave the typical non-committal response of “well, I thought it may help and I saw it on the shelf at the pharmacy.” He explained what homeopathy actually is and they were absolutely dumbfounded. They are well aware of Avogadro’s number, after all. People generally don’t study what the CAM in question actually is – merely the fluff PR garbage that gets touted around and without direct and clear demonstration of harm, give it a pass as a result. After all, the business of real medicine is time consuming and difficult enough.

Participating in activities that have a permanent record gives one the fortunate, or unfortunate, opportunity to revisit the past and see just how you worked early in a career.

It was sobering, as third year resident, to see the notes I had written as an intern. Man. It was amazing how unsophisticated my medical thinking had been a little over two years’ prior. How little I understood about the ins and outs of diagnosis and treatment even after four years of medical school. It is part of the reason I think it is a joke, albeit a cruel joke, that naturopaths and other pseudo-medical providers think they can function as primary care providers after a few years of alternative edjamacation.

I have a similar experience every now and then when I see the notes from early in my Infectious Disease practice, now heading into 24 years. Not quite as painful, but still remarkable in how much I didn’t know then. My ID podcast is an ongoing reminder of how much I still do not know. The last 34 years have been my personal linear acquisition of knowledge from the exponential production in the medical, and non-medical, world. Ignorance isn’t bliss, but an ever-expanding hole that can never be filled.

There is nothing wrong with ignorance per se. It depends on what you do with it. Ignorance can be a condition you can spend a lifetime attempting to overcome.

My early career in the world of SBM was defined by a remarkable naiveté. I thought people who used the various pseudo-medicines were simply ignorant, they lacked basic information about the topic and all I had to do was supply that information. They would read/listen to my explanation and think, ‘Oh. That’s how it works’ and move on. That is partly how medical training works. Once you learn how some therapy or procedure does or does not work, you behave accordingly. Eventually. Change is painful, and I do notice as I age how much harder it is to make an intellectual change. Habit is so comfortable.

There was certainly a large helping of ignorance with a side of hubris on my part. But that is how you increase knowledge. Discover the gaps and fill them.

I have not thought much about ignorance. Most of my time is spent on the hows and whys of the acquisition of knowledge. Part of my job and my hobby is to be an educator. I think of residents, myself, and my readers as an empty glass to be filled with facts and their relationships. A simplistic idea, but how I spend a huge amount of my time. I take in information, organize it, synthesize it, and then pass it to others, hopefully in a clever manner.

Others have thought about ignorance in a more comprehensive way. Robert N. Proctor is such a person and he has coined a term for the cultural production (and study) of ignorance: Agnotology. The author delineates several kinds of ignorance in the paper, and they make for a good conceptual framework for understanding ignorance.

And though distinctions such as these are somewhat arbitrary, I shall make three to begin the discussion: ignorance as native state (or resource), ignorance as lost realm (or selective choice), and ignorance as a deliberately engineered and strategic ploy (or active construct).

And he points out that:

Ignorance has many interesting surrogates and overlaps in myriad ways with—as it is generated by—secrecy, stupidity, apathy, censorship, disinformation, faith, and forgetfulness,

I have tended to think of ignorance only in the first definition: simply lacking knowledge on a topic or having wrong or incomplete knowledge. No one can know everything or anything perfectly. It is the kind of ignorance I thought I was combatting when I started my blogging career and why I spend an inordinate amount of time on Pubmed.

It leads to the second kind of ignorance, that of selective choice. Due to time and interest (not all topics in the universe are equally interesting) there are areas about which I choose to have a minimal knowledge. Diet, I admit, bores me. I pay little attention to the ongoing debates as to the best diet and what is good and mad to eat. I eat for pleasure or fuel and not for health and it is not a part of my professional life.

Other examples of selective ignorance occur in professional education. Medical schools and residency give short shrift to pseudo-medicine and critical thinking, and probably justifiable so. There is just so much time and neuronal space for the jaw-droppingly huge amount of information that becoming a physician requires. I have mentioned before that I was in medical school and training from 1980 to 1990. That decade of my life was spent learning my profession. My kids used to like to watch I Love the 80’s on VH1 and I recognized nothing from the show: the movies, the music, the fashion, the memes were are new to me. Most people lose a decade of life to drugs or alcohol; mine was to medicine. I have a huge selective ignorance concerning the 80’s and if the show is any evidence, it was a good thing.

Even more impressive in their selective ignorance is the training in pseudo-medicines:

Ignorance is a product of inattention, and since we cannot study all things, some by necessity—almost all, in fact—must be left out. “A way of seeing is also a way of not seeing—a focus upon object A involves a neglect of object B.”

And best typified by the curricula at a naturopathic school, but the same is true for any pseudo-medical education. Vast quantities of time are spent on areas divorced from reality: homeopathy, acupuncture, hydrotherapy etc. The effort to absorb these fantasies is, by their nature, going to prevent acquisition of knowledge about reality.

There is a similar process occurring at chiropractic schools, where they like to brag about their education:

According to the American Chiropractic Association, the course of study to become a chiropractor includes 4,200 hours of classroom, laboratory and clinical experience in “orthopedics, neurology, physiology, human anatomy, clinical diagnosis including laboratory procedures, diagnostic imaging, exercise, nutrition rehabilitation and more.”

I am not impressed. That 4,200 hours is 525 eight-hour days, a little under a year and a half. It would be so much more impressive if they said their training was 15,120,000 seconds. The bigger the number the better the education. My internal medicine training was seven years, plus two more for infectious diseases. And what good is all that training if it is being applied to the fantastical ideas of fixing subluxations? It is like learning horse anatomy to take care of unicorns. But it also ensures ignorance in areas of reality-based medicine.

The most interesting form of ignorance is the third:

Ignorance as strategic ploy, or active construct

The focus here is on ignorance-or doubt or uncertainty-as something that is made, maintained, and manipulated by means of certain arts and sciences. The idea is one that easily lends itself to paranoia: namely, that certain people don’t want you to know certain things, or will actively work to organize doubt or uncertainty or misinformation to help maintain (your) ignorance. They know, and may or may not want you to know they know, but you are not to be privy to the secret. This is an idea insufficiently explored by philosophers, that ignorance should not be viewed as a simple omission or gap, but rather as an active production. Ignorance can be actively engineered part of a deliberate plan.

The author uses the tobacco industry as an archetype of an industry that manufactures ignorance and starts the paper with a quote:

Doubt is our product. Brown & Williamson Tobacco Company, internal memo, 1969

The manufacture of doubt is common in the pseudo-medical world. It could not exist without it. I do not know if ignorance is bliss for pseudo-medicine, but it is a requisite.

The false information that underlies all pseudo-medicine, from the popularity of pseudo-medicine in the US, to the efficacy of acupuncture to the safety of chiropractic to the mechanism of reiki relies on the production of massive amounts of ignorance. And so has some aspects of real medical treatments. Pharmaceutical companies have not been hesitant to borrow methods from their tobacco brethren. Although science can be an antidote to the production of ignorance in the real world, the pseudo-medical world is often invulnerable.

Examples of ignorance as strategic ploy in the pseudo-medical world abound and can, for a time be effective, as Megan Sandlin demonstrated, although:

In the end, I couldn’t continue to deny the science. It’s hard to believe now how easily I bought into everything I was hearing from the anti-vaccine crowd. It seems extremely obvious now: doctors aren’t evil, scientists aren’t trying to kill your kids with toxins, and vaccine researchers aren’t just trying to scam you out of your money.

Natural News and the Mercola site are probably the Ford and GM of medical ignorance production, but there are numerous boutique producers. I ran across Why You Never Need A Tetanus Vaccine, Regardless of Your Age or Location by Dave Mihalovic, ND, whose ignorance production I have discussed before

Mr. Mihalovic identifies himself as “a naturopathic medical doctor who specializes in vaccine research.” However, just where the research is published is uncertain as his name yields no publications on Pubmed. BTW. I specialize in beer research. Same credentials.

Tetanus is a rare disease in the US. I have seen one case, years ago as a fellow, in an elderly immigrant who had never received the vaccine. Having every muscle spasm at once is horrible for the victim.

From 1922-1926, there were an estimated 1,314 cases of tetanus per year in the U.S. In the late 1940’s, the tetanus vaccine was introduced, and tetanus became a disease that was officially counted and tracked by public health officials. In 2000, only 41 cases of tetanus were reported in the U.S. … Approximately 20 percent of reported cases end in death.

Tetanus in the U.S. is primarily a disease of adults, but unvaccinated children and infants of unvaccinated mothers are also at risk for tetanus and neonatal tetanus, respectively. From 1995-1997, 33 percent of reported cases of tetanus occurred among persons 60 years of age or older and 60 percent occurred in patients greater than 40 years of age. The National Health Interview Survey found that in 1995, only 36 percent of adults 65 or older had received a tetanus vaccination during the preceding 10 years.
Worldwide, tetanus in newborn infants continues to be a huge problem. Every year tetanus kills 300,000 newborns and 30,000 birth mothers who were not properly vaccinated.

A rare, awful, and mostly preventable disease, it is caused by Clostridium tetani. The bacteria, found in the soil, gets into damaged tissues, releases its toxin and the result is tetanus.

Tetanus toxin, tetanospasmin, is extremely potent and can cause severe disease yet not cause the production of antibody. A curiosity of many toxins made by Clostridia, be it botulism, tetanus or gas gangrene, is the purpose of the toxins in the wild (i.e. the dirt), which remain a mystery. As an anaerobe it can be difficult to grow.

Of course, as is his métier, and no doubt a result of his naturopathic training where his understanding of microbiology and infectious diseases is profoundly ignorant, he says:

The tetanus bacteria may be a factor in tetanus. The toxin may be involved in some way but that these are fundamental causes is nonsense, otherwise the disease would be more common, in view of the fact that the bacteria is so frequently found on and in our bodies.

And:

The real cause of tetanus is not a germ, but dirt and filth. The bacteria are harmless when placed into a surgically clean wound. Tetanus develops when drainage of a wound is checked and dirt is retained in the tissues.

And:

The patient suffering from tetanus should be put to bed, permitted to rest, kept warm and fasting should be immediately instituted. They should receive all the salubrious hygienic influences and the fasting should be continued until all symptoms have disappeared.

Advice and treatment that, if followed, could result a repeat of when parents’ fear of vaccinations nearly killed their son or worse:

Auckland parents Ian and Linda Williams thought they had made an informed choice not to vaccinate their children, but after their son ended up in intensive care with a tetanus infection they realized they had made a terrible mistake.

The problem with reality is it doesn’t care if you are ignorant. You can reject and substitute your own where dirt causes tetanus and vaccines are worthless. Get the perfect storm of bad luck and you will get tetanus if not vaccinated.

Pseudo-medicine is producing ignorance at a vastly higher rate than medicine can produce an approximation of the truth. But it will always be that way. It is why I lobbied for Sisyphus to be the emblem of the Society for Science-Based Medicine.

Posted in: Critical Thinking, Naturopathy, Science and Medicine

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