Even more interesting to me than the question of whether or not acupuncture is effective for any particular symptom is the meta-question of how acupuncture proponents have managed to promote a treatment with systematically terrible scientific data. A new study provides a fresh example of this, which I will discuss below.
I think the behavior of acupuncturists reflects the fact that there are subcultures within science, where each community has its own standards, culture, and typical practices. You see this reflected in how they conduct their research and support their claims. Chiropractors, for example, have what is in my opinion a very unscientific culture. Their treatments are not science-based; science is an afterthought cherry-picked to support what is ultimately their philosophy.
The culture of acupuncture
The world of acupuncture has its own culture as well. Within this world there are special, very permissive rules of science that allow acupuncture to work for almost anything. One trend is to look for anything that happens locally in the skin when you stick a needle into it and then declare that a “mechanism for acupuncture.” The rules of the acupuncture culture also allow for a shifting definition of what acupuncture actually is, allowing the definition to conform to whatever the evidence shows. It’s a neat and subtle trick that allows acupuncture proponents to completely subvert the purpose of science.
Science functions best when it is free from any bias or conflict of interest. All those engaged in the process should value what is actually true more than anything else. Unfortunately, there are many sources of bias in science.
Researchers may want their pet theory to be supported. Journal editors want to publish research that will have a high impact. And of course, corporations would prefer that the results of scientific research favor their products and services. A recent round of editorials accuses the Coca-Cola company of trying to put its thumb on the scale of science in order to deflect attention away from sugary drinks as a source of obesity and overweight. What are they doing and what does the science actually say?
According to The New York Times:
The beverage giant has teamed up with influential scientists who are advancing this message in medical journals, at conferences and through social media. To help the scientists get the word out, Coke has provided financial and logistical support to a new nonprofit organization called the Global Energy Balance Network, which promotes the argument that weight-conscious Americans are overly fixated on how much they eat and drink while not paying enough attention to exercise.
In a recent editorial for the New York Times, Aaron E. Carroll argues, “Labels Like ‘Alternative Medicine’ Don’t Matter. The Science Does.” I agree with this headline thesis, but the details of his argument ironically show the harm that the so-called CAM (complementary and alternative medicine) movement has done.
Carroll starts out well, essentially pointing out that the division between “conventional” and “alternative” medicine, and the division between “Western” and “Eastern” medicine are false dichotomies. Despite this strong start, he muddles his way through the rest of his editorial.
The primary error he commits is to swing from a false dichotomy to a false equivalency, essentially saying that there is no difference between conventional and alternative practice or practitioners. In order to support this contention, however, he has to distort the facts beyond recognition.
In other words, Carroll commits the less-well-known false continuum logical fallacy. Let me explain.
The real differences between SBM and CAM
Recently there was another round of scaremongering headlines and articles claiming that cell phones can cause brain cancer. The Daily News wrote: “The scientists were right — your cell phone can give you cancer.” Many online news sites declared: “SHOCK STUDY: CELLPHONES CAN CAUSE CANCER,” in all caps to make sure you understand that you should be alarmed. None of the mainstream reporting I saw looked past the press release.
Let’s take a look at the actual study: “Oxidative mechanisms of biological activity of low-intensity radiofrequency radiation” published in Electromagnetic Biology and Medicine.
The first thing to note as that this is a review article. It does not present any new data. It is not an experiment or observational study. It’s not even a meta-analysis. It is just a group of researchers looking at the literature and proclaiming that it confirms what they already believed.
Truly understanding placebo effects (note the plural) is critical to science-based medicine. Misconceptions about placebo effects are perhaps the common problem I encounter among otherwise-scientific professionals and science communicators.
The persistence of these misconceptions is due partly to the fact that false beliefs about placebos, namely that “the” placebo effect is mainly an expectation mind-over-matter effect, is deeply embedded in the culture. It is further exacerbated by recent attempts by CAM proponents to promote placebo-medicine, as their preferred treatments are increasingly being demonstrated to be nothing but placebos.
One idea that proponents of placebo medicine have tried to put forth is that you can have a placebo effect without deception. The study most often pointed to in order to support this claim is Ted Kaptchuk’s irritable bowel syndrome study. However, this study was flawed in that it told participants that placebos can heal, so it wasn’t exactly without deception. (more…)
Selling snake oil is all about marketing, which means that a good snake oil product needs to have a great angle or a hook. Popular snake oil hooks include being “natural,” the product of ancient wisdom, or “holistic.”
Perhaps my favorite snake oil marketing ploy, however, is claiming the product represents the latest cutting-edge technology. This invariably leads to humorous sciencey technobabble. There are also recurrent themes to this technobabble, which often involve “energy,” vibrations and frequencies, or scientific concepts poorly understood by the public, such as magnetism and (of course) quantum effects. Historically, even radioactivity was marketed as a cure-all.
One category of technical pseudoscientific snake oil measures some physiological property of the body and then claims that this measurement can be used for diagnosis and determining optimal treatment. For example, machines might measure brain waves, heart rate variability, thermal energy or (the subject of today’s article) the galvanic skin response.
The BMJ is a prestigious medical journal, which just goes to show that prestigious journals can sometimes make awful decisions. They recently published a pro vs con article on homeopathy. Peter Fisher dragged out the current repertoire of pro-homeopathy tropes, while Edzard Ernst did a fine job of summarizing why homeopathy is nonsense.
I also think the article is an excellent example of the difference between evidence-based medicine and science-based medicine. While EBM is led by a misguided notion of “scientific equipoise” or fairness, SBM endeavors to use all scientific knowledge to make the best judgments we can about treatments.
An SBM approach to homeopathy leads only to scathing condemnation, because it is among the purest of pseudosciences. (more…)
The ongoing saga of quackademic medicine continues. The University of Toronto School of Public Health has been caught teaching utter nonsense to its students. Even worse, when called out on this dereliction of their academic responsibility, they defended it. Unfortunately, it is all too clear how something like this can happen.
The department was teaching an alternative medicine course at U of T’s Scarborough campus. The course was taught by Beth Landau-Halpern who is a homeopath Scott has discussed before, and who also happens to be the wife of the dean of that campus (it’s hard to imagine this was not a factor). Landau-Halpern should never, in my opinion, be anywhere near the classroom of a legitimate university.
The fact that she is a homeopath is enough to disqualify her to teach any health topic. On her website she boldly claims that “homeopathy works,” even though the evidence shows that homeopathic potions are indistinguishable from placebo. She also specializes in treating children with ADHD and autism. She advertises her training as a CEASE practitioner – CEASE stands for:
Complete Elimination of Autistic Spectrum Expression. Step by step all causative factors (vaccines, regular medication, environmental toxic exposures, effects of illness, etc.) are detoxified with the homeopathically prepared, that is diluted and potentized substances that caused the autism.
It is clear she is operating under a non-scientific narrative, which is typical of practitioners of alternative medicine.
Peer review, a flawed but vital part of the scientific process.
When I lecture about the need for science-based medicine (SBM), I have to pause about half-way through my list of all the things wrong with the current practice of medical science, and I balance my discussion by emphasizing what I am not saying: I am not saying that medical science is completely broken. It is just really challenging, we need to raise the threshold for what we consider reliable higher than most people think, and there are some practical fixes we can do, some of which are already in the works.
It is easy, however, to “demonize” any person, institution, or philosophy by taking all the negative aspects that are inevitably present and wrapping them up in a frightening package, perhaps throwing in some conspiracy thinking or sensational alarmism.
Take, for example, a recent article by F. William Engdahl, “Shocking Report from Medical Insiders“. The headline alone warns you that you may be in for some sensationalism.
One of the major themes of science-based medicine (unsurprisingly) is that medicine should be based on science. We consider ourselves specialists in a larger movement defending science in general from mysticism, superstition, and spiritualism. We are not against anyone’s personal belief, and are officially agnostic toward any faith (as is science itself), but will vigorously defend science from any intrusion into its proper realm.
The so-called alternative medicine movement (CAM) is largely an attempt to insert religious beliefs into the practice and profession of medicine. CAM is also an attempt to create a double standard or even eliminate the standard of care so that any nonsense can flourish and con-artists and charlatans can practice their craft freely without being hounded by pesky regulations designed to protect the public. These are both insidious aspects of CAM that need to be exposed and vigorously opposed.
A recent article by Dr. Michel Accad demonstrates how brazenly some are trying to insert faith healing and spiritualism back into medicine. He does so by couching his arguments in philosophy and marketing terms, but in the end he is essentially saying that doctors should practice his faith. He doesn’t really make any arguments for this position, but rather simply gives a history of progress in Western thought as if that is sufficient. (more…)