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…)
Today the UK Parliament will have a vote for the chair of the Health Select Committee. The two choices could not be more starkly different, so much so that this vote might be seen as a referendum on two world views, one that respects science and another that confuses pseudoscience and spirituality for medicine.
On one side we have Sarah Wollaston, the previous chair, who is a former general practitioner and has taken a solid stand against pseudoscience in medicine. She has previously tweeted, for example, “Homeopathy can also have serious harms when masquerading as a ‘vaccine’.”
Tredinnick, on the other hand, has previously argued that the NHS should incorporate astrology into the healthcare system. I have previously argued that homeopathy is the most absurd and easily debunked major form of alternative medicine. Astrology, however, is arguably more absurd, I had just never heard it offered as a basis for healthcare. Tredinnick has at least accomplished setting a new low bar for alternative medicine nonsense.
Tredinnick appears to be a true-believer, fully steeped in the propaganda that is CAM (so-called complementary and alternative medicine). He has said:
Ninety per cent of pregnant French women use homeopathy. Astrology is a useful diagnostic tool enabling us to see strengths and weaknesses via the birth chart.
And, yes, I have helped fellow MPs. I do foresee that one day astrology will have a role to play in healthcare.
The First Amendment of the United States of America, guaranteeing freedom of speech
For those of you following the defamation lawsuit against me by Dr. Edward Tobinick, there has been a significant and positive update. For quick background, Dr. Tobinick filed a suit against me personally, the Society for Science-Based Medicine, Yale University and SGU Productions for an article I wrote here critical of his claims that perispinal etanercept can treat a variety of neurological conditions. All the defendants but me have since been removed from the case.
There are three plaintiffs in the case; Dr. Tobinick himself, his California corporation, and his Florida LLC. Last year I filed a motion to strike some of the claims as they apply to the California corporation under that state’s anti-SLAPP statute. The update is that last week the judge in the case ruled in my favor on this motion. These are public documents, so you can read the entire decision here. It concludes:
For the foregoing reasons, it is hereby ORDERED AND ADJUDGED that Steven Novella’s Special Motion to Strike (Anti-SLAPP Motion) [DE 93] is GRANTED. Tobinick M.D.’s claims for unfair competition under 28 U.S.C. § 1338(b) (Count II), trade libel (Count III), and libel per se (Count IV) are STRICKEN from the Amended Complaint.
Wally Sampson, MD
March 29, 1930 – May 25, 2015
I’m sad to report that Dr. Wallace (Wally) Sampson, one of the original authors at Science-Based Medicine, passed away on May 25th at the age of 85. Wally was a valued member of the SBM community, a mentor to many of us, and a tireless crusader against health fraud and pseudoscience in medicine. He carried the banner of defending science and reason within medicine for a generation, and his is one of the giant shoulders on which SBM currently rests. His contributions to this website can be found here.
Wally was fighting against health fraud back when it was still called health fraud, rather than “alternative medicine” or whatever the latest marketing term they have adopted is. I would often go to him for perspective on the long range trends in our struggle to promote science in medicine. He had put in the decades of service necessary to have such perspective.
I personally owe Wally a great deal for my own career battling medical pseudoscience. Wally was keen to identify and nurture new people interested in promoting science in medicine. As a much younger skeptic, prior to social media, when I was only running a new and obscure local skeptic group, Wally invited me to speak at conferences, and eventually to be one of the assistant editors for The Scientific Review of Alternative Medicine, a print journal of which he was the first editor (available online here). Such nurturing was not common in my experience. He gave me the experience and platform upon which I eventually built Science-Based Medicine.
CAM: More branding than medicine.
One of the persistent themes of SBM is that CAM (complementary and alternative medicine, or integrative medicine) is nothing more than a marketing brand. Its recent popularity is not based upon new evidence or a changing paradigm of medicine as its proponents claim. Its popularity is increasing despite the lack of evidence for specific CAM treatments and despite a dedication to evidence-based medicine within the medical profession.
CAM is also modern mythology, which I guess all really effective advertising and branding is. It floats atop a number of demonstrably false marketing claims. One is that the popularity and use of CAM is surging. This is partly a self-fulfilling prophesy, and no doubt it is increasing, but the degree to which CAM is popular has been consistently exaggerated by proponents (largely as a way to justify its existence).
This myth is largely perpetuated by redefining CAM as needed, including things like prayer, massage, and taking vitamins. I suspect that praying for a sick loved-one has always been popular and doesn’t represent a trend toward CAM. When unequivocal alternative modalities are considered, their use is still tiny and not increasing. The most recent NIH survey found:
Use of acupuncture (1.1%), homeopathic treatment (1.7%) naturopathy (0.2%), and energy healing (0.5%) was miniscule.