Articles

Archive for Critical Thinking

Don’t just stand there, do nothing! The difference between science-based medicine and quackery

Tree of Life - the first-known sketch by Charles Darwin of an evolutionary tree describing the relationships among groups of organisms (Cambridge University Library).

Tree of Life – the first-known sketch by Charles Darwin of an evolutionary tree describing the relationships among groups of organisms (Cambridge University Library).

The Merriam-Webster Dictionary defines science as:

Knowledge about or study of the natural world based on facts learned through experiments and observation.

And:

Knowledge as distinguished from ignorance or misunderstanding.

While this should distinguish science from pseudoscience, those who practice the latter often lay claim to the same definition. But one of the major differences between science and pseudoscience is that science advances through constant rejection and revision of prior models and hypotheses as new evidence is produced; it evolves. This is the antithesis of pseudoscience. At the heart of pseudoscience-based medicine (PBM) is dogma and belief. It clings to its preconceptions and never changes in order to improve. It thrives on the intransigence of its belief system, and rejects threats to its dogma. Despite the constant claims by peddlers of pseudoscience that SBM practitioners are closed-minded, we know that, in fact, PBM is the ultimate in closed-minded belief. Of course, those of us who claim to practice SBM aren’t always quick to adopt new evidence. We sometimes continue practices that may once have been the standard of care but are no longer supported by the best available evidence, or perhaps may even be contradicted by the latest evidence. Often this is a byproduct of habituated practice and a failure to keep current with the literature. While this is certainly a failure of modern medicine, it is not an inevitable outcome. It is not emblematic of the practice of medicine, as it is with PBM. When medicine is science-based, it strives for continual improvement based on modifications around emerging evidence. (more…)

Posted in: Critical Thinking, Medical Ethics, Public Health, Science and Medicine

Leave a Comment (74) →

What Should We Do in the Absence of Evidence?

Pictured: Smarter than you.

Pictured: Smarter than you.

For every complex problem, there is an answer that is clear, simple—and wrong.

– H.L. Mencken

Despite my multiple personalities, it seems that only the OCD doctor gets anything done. The Goth cowgirl persona? Lazy. And the NBA playoffs are sucking up an inordinate amount of time. Go Blazers. Just not very far. Sigh. But what are you going to do. Work needs doing and someone has to do it.

This week was one of deadlines. In June I am giving a series of talks at the SMACC conference in Chicago and I have to have all my talks ready to go today. So sometimes to meet all my deadlines I need to re-purpose other material.

Spoiler alert: if you are going to be at SMACC and hear my lectures, stop reading here. Everything I am going say in 6 weeks will follow. And really even if you are going to SMACC, it is a content-free post. You might be better off spending your time elsewhere. (more…)

Posted in: Critical Thinking, Humor, Medical Academia, Science and Medicine

Leave a Comment (90) →

On the “right” to challenge a medical or scientific consensus

Jenny McCarthy flaunting her "expertise" at the antivaccine "Green Our Vaccines" rally in Washington, DC in 2008

Jenny McCarthy flaunting her “expertise” at the antivaccine “Green Our Vaccines” rally in Washington, DC in 2008

The major theme of the Science-Based Medicine blog is that the application of good science to medicine is the best way to maintain and improve the quality of patient care. Consequently, we spend considerable time dissecting medical treatments based on pseudoscience, bad science, and no science, and trying to prevent their contaminating existing medicine with unscientific claims and treatments. Often these claims and treatments are represented as “challenging” the scientific consensus and end up being presented in the media—or, sadly, sometimes even in the scientific literature—as valid alternatives to existing medicine. Think homeopathy. Think antivaccine views. Think various alternative cancer treatments. When such pseudoscientific medicine is criticized, frequently the reaction from its proponents is to attack “consensus science.” Indeed, I’ve argued that one red flag identifying a crank or a quack is a hostility towards the very concept of a scientific consensus.

Indeed, I even cited as an example of this attitude a Tweet by Jane Orient, MD, executive director of the American Association of Physicians and Surgeons (AAPS). This is an organization of physicians that values “mavericky-ness” above all else, in the process rejecting the scientific consensus that vaccines are safe and effective and do not cause autism or sudden infant death syndrome (SIDS), that HIV causes AIDS, and that abortion doesn’t cause breast cancer, to name a few. Along the way the AAPS embraces some seriously wacky far right wing viewpoints such as that Medicare is unconstitutional and that doctors should not be bound by evidence-based practice guidelines because they are an affront to the primacy of the doctor-patient relationship and—or so it seems to me—the “freedom” of a doctor to do pretty much damned well anything he pleases to treat a patient.
(more…)

Posted in: Critical Thinking, Science and the Media, Vaccines

Leave a Comment (136) →

Do two half-truths add up to a complete truth or a complete falsehood?

olivia-twenty-dahl

I swear that the evidence that I shall give, shall be the truth, the whole truth and nothing but the truth

The interwebs are not a court of law, that is for sure. The whole truth. Interesting idea. I have no idea how applicable Godel’s theorems are outside of mathematics, but from a practical point knowledge is always incomplete. There is too much to know and too little time and brain power to acquire perfect knowledge of a topic.

It is why medicine is a challenge. You have to synthesize all the available data, which is often incomplete. You have to decide what is quality information, what is not, and why, and how a given study or fact fits into the overall picture, on the continuous asymptotic journey towards unobtainable total knowledge. But you try for the whole truth, the good, the bad and the ugly.

Half-truths, partial stories, can be hard to challenge. In part because, well, they are half-true. They have an air of truthiness. It is perhaps much easier to counter an out-and-out lie. Well, maybe not. I’m thinking Wakefield here. I suspect that in having to admit that half-truths have some validity, it renders them more believable.

The world of pseudo-medicine, and pseudo-science, is filled with half-truths. I wonder when I read these half-truths whether the author is deliberately avoiding all the information, especially since the rest of the story often results in the weakening the impact of the half-truth. Paul Harvey could have had a field day with the anti-vaccine literature.

One of the greatest challenge facing young people today, is the large scale availability of half truth’s and manipulated facts
– Oche Otorkpa, The Unseen Terrorist

Influenza

Beware of the half-truth. You may have gotten hold of the wrong half.
– Author unknown

Take “Do Not Believe Everything You Read About Flu Deaths” from the October, 2014 Journal of Advanced Practice Nursing. As best I can tell this is a peer reviewed journal. You know, “peer“, as in “to appear partially or dimly.”

I imagine someone squinting over the top of their glasses at the manuscript, muttering, “that ‘peers to be a paper about influenza deaths. Let’s publish it.”
(more…)

Posted in: Critical Thinking, Vaccines

Leave a Comment (140) →

A Scientist in Wonderland

Edzard Ernst is one of those rare people who dare to question their own beliefs, look at the evidence without bias, and change their minds. He went from practicing alternative medicine to questioning it, to researching it, to becoming its most prolific critic. I have long admired his work, and I finally met him in person when we were invited to speak at the same conferences. He shattered my stereotype of the stern, formal, self-important German “Herr Professor Doktor.” He was affable, unassuming, and funny; he was even a jazz musician. I wished I knew more about his history, and my wishes have been granted in the form of his new autobiographical book, A Scientist in Wonderland: A Memoir of Searching for Truth and Finding Trouble.

This is a well-written, entertaining book that anyone would enjoy reading and that advocates of alternative medicine should read: they might learn a thing or two about science, critical thinking, honesty, and the importance of truth.

This is a well-written, entertaining book that anyone would enjoy reading and that advocates of alternative medicine should read: they might learn a thing or two about science, critical thinking, honesty, and the importance of truth.

Edzard Ernst, the early years

Dr. Ernst was born in post-war Germany; his family had suffered greatly during the war and his uncle had been a general in the Waffen SS. He felt slightly ashamed to be German, and as a result he researched and wrote about Nazi health beliefs and medical atrocities so the history of their misdeeds would not be forgotten.

His father was a doctor, his mother an enthusiastic devotee of alternative medicine who subjected him to homeopathy, ice cold baths, and barefoot walks at dawn through wet grass. Early in life, Ernst began to manifest a tendency towards doubt and irreverence, along with an irrepressible sense of curiosity.

Music was his first love. He earned good money when he and his friends spent their summer vacation busking on the beach at St. Tropez, and he had been seriously considering a musical career until his mother persuaded him to study medicine. He earned an MD in Germany, in an environment where alternative medicine was unquestioningly integrated with mainstream medicine. He received hands-on training in acupuncture, autogenic training, herbalism, homeopathy, cupping, massage therapy, spinal manipulation, even leeches. His first job was in a homeopathic hospital where a colleague chose remedies by dowsing with a pendulum. (more…)

Posted in: Book & movie reviews, Clinical Trials, Critical Thinking

Leave a Comment (48) →

Unfalsifiable Beliefs

sisyphus

As we search for a logo for SBM or the SfSBM, Mark Crislip has been a strong advocate of using an image of Sisyphus, endlessly pushing a boulder up a hill only to have it roll back down again. It’s a bit too self-defeating to be enthusiastic about that suggestion, but it does reflect a common feeling among all of us here at SBM – promoting science can be a frustrating endeavor.

Our frustration reflects a broader phenomenon, that it is difficult to persuade people with facts and logic alone. People tend to prefer narrative, ideology, and emotion to facts. The high degree of scientific illiteracy in the culture presents another barrier.

In recent years psychologists have demonstrated experimentally what we have come to understand through personal experience, that people engage in a host of cognitive defense mechanisms to protect their beliefs from the facts. We jealously guard our world view and are endlessly creative in shielding it from refutation.

A recent series of experiments published by Friesen, Campbell, and Kay in the Journal of Personality and Social Psychology demonstrates that one strategy commonly used to protect our beliefs is to render them unfalsifiable, or at least incorporate unfalsifiable elements. (more…)

Posted in: Critical Thinking

Leave a Comment (186) →

Shedding Light on Unreasonable Decisions

BloodPressure2

One of the biggest frustrations for a doctor is when a patient refuses to take science-based medical advice. We would like to believe that giving a patient accurate information will lead him to make good decisions that will improve his health or save his life. But that’s not how it works. Patients reject life-saving surgery and chemotherapy, patients on essential medications are non-compliant, parents reject vaccines for their children…what are these people thinking? Why would anyone in their right mind knowingly reject a treatment that has been proven to increase their chances for survival and health? What could their reasons possibly be?

This ties into a subject we have debated over and over: why do people choose alternative medicine? Many reasons have been suggested: cost and accessibility, the need for control, dissatisfaction with mainstream medicine, the peer pressure of a popular fad, “belonging” to a group of like-minded people, a need for answers, autonomy, health freedom, ideology, rebellion against authority, a need for hope even if it is false hope, giving more importance to stories than to studies, the post hoc ergo propter hoc fallacy, scientific illiteracy, misinformation, superstition, magical thinking…the list goes on. Studies have been done, but we can’t be sure the reasons people give to researchers are the real reasons. There is a problem with the search for reasons: these decisions are not made on the basis of reason. Physician Lisa Rosenbaum has written a beautiful essay in The New England Journal of Medicine entitled “Beyond Belief — How People Feel about Taking Medications for Heart Disease“, that sheds a penetrating light on what is really going on. It made me think of the subject in a whole new way. (more…)

Posted in: Critical Thinking

Leave a Comment (453) →

Mel asks and I do my best to answer.

Several snarks were painfully maimed in the writing of this blog post

Several snarks were painfully maimed in the writing of this blog post

I read a lot of the pseudo-medical websites. The writing is at best pedestrian, often turgid, and, at its worst, incoherent. It is rarely either engaging or clever.

Wit, the clever bon mot, the amusing turn of phrase or retort, is rare at best. So rare I cannot think of an example. It is ironic that those who engage in fantastical treatments are so often lacking in cleverness with language and thought. The closest you get to humor are the painfully-lame cartoons at the Natural News. I am sure that the readers will flood the comments with examples of all the clever writing I have missed in the world of pseudo-medicine just to prove me wrong. Not that the reality-based world is much better. It is the rare author on the internet whose style keeps me coming back for more.

But for some reason I found “Dear Science Based Medicine, Just a Few Questions About Acupuncture” funny and engaging, at odds with most of the purple quasi-paranoid articles I normally read. Just the right amount of chatty snarkiness to be enjoyable, at least for me. So refreshing given the style of the usual pro-acupuncture comments. Your millage may vary. (more…)

Posted in: Acupuncture, Critical Thinking, Energy Medicine, Traditional Chinese Medicine

Leave a Comment (400) →

Hostility towards scientific consensus: A red flag identifying a crank or quack

pillars3.img_assist_custom

I have yet another grant deadline to deal with, this time for the Department of Defense Congressionally Directed Medical Research Programs, this time around its Breast Cancer Research Program. Unfortunately, that put a high degree of time pressure on me. Fortunately, there’s still stuff in the archives of my not-so-secret other blog that I deem quite appropriate for this blog and that can be updated with minimal effort. If you don’t know what I’m talking about when I refer to my not-so-secret other blog, then it’ll definitely be new to you. If you haven’t been reading that blog for at least four and a half years, it’ll be new to you as well. And even if you have seen it before, I think it’s worth revisiting.

Why? It came up because of an encounter I had on Twitter with Jane Orient, MD, who, as you might recall, is the executive director of the American Association of Physicians and Surgeons (AAPS). I’ve written about the AAPS before. You can get the details in the link, but if you don’t have time suffice to say that it is an entire organization of libertarian-leaning “brave maverick doctors” who think Medicare is unconstitutional, don’t believe that the government should have much, if anything, to do with regulating the practice of medicine, and reject evidence-based guidelines as an unholy affront to the independence of the physician. Along the way, the AAPS, through its journal, The Journal of American Association of Physicians and Surgeons (often abbreviated JPANDS), promoted antivaccine views, including the discredited concept that vaccines cause sudden infant death syndrome, HIV/AIDS denialism, and the scientifically unsupported idea that abortion causes breast cancer (a topic I might have to revisit, given the activity promoting it recently).

In any case, two or three weeks ago, I was having a bit of an exchange with Dr. Orient over anthropogenic global climate change (often abbreviated as AGW, for anthropogenic global warming, for short), the well-accepted science that concludes that CO2 generated by human activity is having a serious warming effect on the earth’s climate. As you might expect, she’s not big on this particular scientific consensus. I forgot about it, but then the other day saw this Tweet exchange between Dr. Orient and Ed Wiebe:
(more…)

Posted in: Critical Thinking, Science and Medicine

Leave a Comment (259) →

Pesticides: Just How Bad Are They?

3D model of DDT, an insecticide

3D model of dichlorodiphenyltrichloroethane (DDT), an insecticide

I think everyone would agree that it would not be a good idea to put pesticides in a saltshaker and add them to our food at the table. But there is little agreement when it comes to their use in agriculture. How much gets into our food? What are the effects on our health? On the environment? Is there a safer alternative?

Where should we look to find science-based answers to those questions? One place we should not look is books written by biased non-scientists to advance their personal agendas. A friend recently sent me a prime example of such a book: Myths of Safe Pesticides, by André Leu, an organic farmer whose opinions preceded his research and whose bias is revealed in the very title. (more…)

Posted in: Book & movie reviews, Critical Thinking, Public Health

Leave a Comment (231) →
Page 1 of 4 1234