Mar 20 2008

A Golden Age of Quackery and Antiscience

Sometimes it’s useful and instructive to take a step back and look at the big picture. While many who read this blog (and affiliated blogs, and listen to my podcast) may see it only as a source of information (and hopefully at least mild amusement), it is also very consciously and deliberately part of a greater struggle for the very nature of human society and civilization. That may seem grandiose (and I am not making any judgments about the scope or impact of my humble efforts), but this has always been part of public intellectualism – engaging in the broader conversation about the nature of knowledge and the human struggle to grapple with it and ourselves.

The big picture is that homo sapiens is a curious species that is pushed and pulled in divergent directions by psychological and cultural forces both conscious and subconscious. There is a literal struggle for dominance among these various forces – each carving out a niche while often trying to defend and expand its territory. Some of my colleagues have recoiled at this military analogy – but I feel it is apt. It is a struggle for dominance and resources – and that is what all war is about.

My side in this struggle marches under various banners, all imperfect and faded at the edges, leading to internal struggles as to which banner is best, without any clear consensus. Mine is the side of science, scientific skepticism, rationality, reason, and methodological naturalism. No one label captures all of that, and attempts to do so have spectacularly failed, in my opinion (remember the “brights”). But we know who we are and we are increasingly organized and active, thanks largely to the internet.

Arrayed against science and reason are those who advocate for the virtue of faith, spirituality, post-modernism, anti-intellectualism, various ideologies, pseudoscience, and anti-science.

Whenever I interview a guest for my podcast who has been engaged with science and skepticism for decades I invariably ask. “How are we doing?” What’s the long view? I have been doing this for about 13 years so I have some perspective, but I appreciate the insights of those who have been doing this for 30-40 years or more. Here is the feedback I have received:

Paul Kurtz, arguably the founder of the modern skeptical and secular humanist movements, who has been doing this the longest, is also the most positive. He sees the struggle of science vs unreason as going in cycles, and yes we had a bad patch around the turn of the millennium but there is no reason to panic. There is no crisis, just more in an endless series of issues. There will always need to be skeptics to defend science and reason, the pendulum will swing back and forth, but he does not feel there is any larger trend toward anti-science.

In a recent episode of Science Talk, the podcast of Scientific American, Argonne National Laboratory director Robert Rosner has many pessimistic observations to make about science in America. Specifically – the brain drain of talent away from this country, the lack of support for science in the government, and the lack of adequately trained technology workers to maintain our science and technology based infrastructure.

In my field of medicine the outlook is a bit more gloomy. Wallace Sampson wrote today in our Science-Based Medicine blog that the trend in medicine over the last 20-30 years has been frighteningly bad. The FDA no longer aggressively fights against fraud and quackery; they are underfunded (perhaps deliberately), incompetent, and uninterested. Medical schools are being infested with the promoters of woo, corrupting the next generation of physicians. Politicians are largely scientifically illiterate and ideological. The zealots are winning and science-based medicine is suffering – perhaps an endangered species.

By coincidence I interviewed Stephen Barrett last night for this week’s episode of the Skeptics’ Guide to the Universe. He says we are in a “golden age of quackery” created by various forces. He points primarily to the National Center for Complementary and Alternative Medicine (NCCAM) – which he believes has falsely legitimized and promoted pseudoscience in medicine. Quackery has been rebranded as “alternative” creating a safe haven within medicine for quacks and frauds.

To balance this I will say that during a conference at which I spoke along with Marcia Angell, former editor of the New England Journal of Medicine, she expressed her view that science works, the public generally understands and respects this, and over the long haul this advantage of science will win out over nonsense. So we can put her in the optimistic camp.

Where do I stand on all of this? My views have become, if anything, more complex and conflicted. I can see both sides and I am not sure how this will all play out in the future.

Taking the very long term perspective, I think it is undeniably true that in recent centuries the overall trend has been toward enlightenment, toward a larger role for science in society and a diminishing role for faith-based belief systems. I am hopeful that this large trend will continue, and that we should not be overly worried about what may turn out to be a short term reversal lasting only decades. I also agree with Marcia Angell that science has a distinct advantage – it works, its principles are valid, and in the end it seems to work out.

But my long term optimism is tempered by two pessimistic possibilities. The first is more dire, if less likely. It may be true that the long term trend over the last 600 or so years has been positive – reflecting the rise of science and reason in human civilization. But if we take an even longer view we see that at other times in human history the light of science and reason has been extinguished – for example the death of empiricism in ancient Greece and the other historical factors that lead to 1500 years of Dark Ages.

Is it possible that we are seeing the beginning of a new age of darkness? I certainly hope not, and I think this is very unlikely – for various reasons. The first is that science is much more broadly and deeply institutionalized than it was at any time in human history. The second is that cultures are no longer as isolated as they were. If the light of science dies in one location it is certain to survive elsewhere (and in fact the Dark Ages were largely a European phenomenon, while science and reason survived in Persia).

So long term I remain optimistic, but I do think there is a small chance of a major reversal that could have long term implications.

Over the short term – the next few decades – I am less optimistic. While I think that science remains strong and continues to progress at an accelerating pace, there are some scary trends. Scientific literacy in the public is not improving, and remains dangerously low. The institutions of science have been weakened by an infiltration of anti-scientific philosophy – specifically notions that science is a “Western” cultural endeavor, a misplaced desire for “tolerance” of other ways of knowing, and post-modernist philosophy that scientific facts are just aesthetic opinions.

Medicine probably has the worst of it right now. Wally Sampson is essentially correct – every medical institution is under siege by nonsense and now very compromised. The defenders of science in medicine are increasingly on the fringe and made to seem as if they are the ideologues. This is all happening at a time when health care itself is in crisis, burdened by their own success. Technology has given us the ability to deliver more health care than we can afford, and we do not have the infrastructure or political will to deal with this problem. Medicine has also become too complex to effectively regulate. So doctors are largely just trying to survive. During this vulnerable time in the history of medicine, the scientific underpinnings of the standard of care are under coordinated attack by those who wish to be free to practice their faith and ideology (rather than medicine) or simply want the freedom to commit health fraud. Effective enforcement of a scientific standard of care is anathema to quacks and con artists.

I agree with Stephen Barrett that we are in a golden age of quackery. The mechanisms of regulation have broken down. The promoters of nonsense have pulled off one of the greatest cons in modern times – convincing the public that quackery, nonsense, and fraud are legitimate “alternatives” to science-based medicine and that they should be “integrated” into every aspect of health care, from the laboratory to the bedside.

While I think that science and reason will eventually prevail, there will be a great deal of long term damage done in the meantime. Institutions and culture have great inertia, and the infrastructure of pseudoscience being constructed within government, academia and medicine will be around for a long time. It is like a metastatic cancer – ever spreading, almost impossible to eradicate, constantly sapping the energy and resources of society. I think the patient will live but with damaged health.

Meanwhile a growing and increasingly organized and energetic skeptical movement is working diligently to defend the integrity of science and to retard the institutions of anti-science. I do think much depends upon how successful we are in this task. I agree in part with Paul Kurtz that this is an endless struggle and there will always need to be skeptics beating the drum of reason. But I also think we are at a turning point in history when the momentum appears to be shifting. It will up to our generation of skeptics to shift it back.

How are we doing? We will see.

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22 responses so far

22 Responses to “A Golden Age of Quackery and Antiscience”

  1. ellazimmon 20 Mar 2008 at 11:30 am

    Perhaps it’s a side effect of living in a very complicated and seemingly intractable world. I think a lot of people want there to be objective meaning in their lives and some are even willing to accept convoluted conspiracy theories in order to have some rule to measure their experiences against.

    Personally I think it’s important to teach children that the universe is a complicated place but that doesn’t mean we can’t figure it out. We need to show them some inroads we have made and give them the tools to push the boundaries even further. After all, who needs fiction when reality is much more interesting? In that respect I think the battle for evolution in the classroom is critical and I’d like to see the skeptical society focus on that issue.

  2. DevilsAdvocateon 20 Mar 2008 at 12:17 pm

    Count me among the +30 year veterans of the skeptical vs. woo wars.

    Ever the reductionist, I can narrow down a huge part of the problem to a very natural human tendency to look always for the simpler, easier way of doing things, of solving problems. Unfortunately, most of the paranormal & pseudoscientific menu of would-be powers, processes, and nostrums constitute just such a simpler, easier way to solve a given problem. Got cancer? You can undergo the long, difficult, painful and expensive course of modern science-based treatment for it, or you might choose to simply pray for a cure.

    That’s a very broad example, but examination of woo and pseudoscience reveals that most all the claims provide a simpler, easier way to deal with things. The corporeal death of a beloved friend or relative need not be final if one believes the psychic can provide post mortem communication -and the complicated and difficult grief process may be obviated, if only through self-delusion.

    Readers here can imagine many similar examples of my premise.

    My point is that as long as the human condition presents difficulties in life, we will continue to seek simpler, easier ways to resolve them and that this is a good thing, essentially describing the history of science and technology. However, and unfortunately, necessity is the mother of invention, and acute necessity too often renders the uneducated and credulous vulnerable to the purveyors of woo and pseudoscience, whose claims offer easy solutions. Now cue Dr. Novella’s & others’ references to the NCCAM and the whole ‘alternative’ schtick. This allows another reductionist assertion:

    As long as woo and pseudo-science pays such good profits, modern scientific skeptics will have battles to wage. Of whom has it ever been said, “He made a lot of money off skepticism, logic, and reason…” ?

    The key, as always, is education, and as long as we’ve freedom of speech and freedom of expression, science and skepticism will be at war against pseudoscience and its requisite disinformation, ignorances, and outright lies. The evolutionary survival of the good ideas will slowly, slowly slowly overcome the empty promises of the bad. Just let’s not hold our collective breath waiting on it.

  3. Roy Nileson 20 Mar 2008 at 12:17 pm

    Paul Kurtz, as you noted, is a secular humanist as well as a skeptic, and the combination has given him the basis for his positive outlook.

    That humanist approach offers an alternative philosophy to those that approach life’s problems in ways clearly inconsistent with the findings of science.

    The humanist approach cannot be the only approach that is consistent with science, but what skeptics in many cases either lack or fail to advocate is any workable alternative to these out-dated or just patently ridiculous approaches.

    It’s unfortunately much easier to be a skeptic of others philosophies than to advocate a philosophy acceptable to any significant body of those same skeptics.

    But at the same time, science may well have created a platform from which such new approaches can grow. A platform that, as you have noted, never actually existed prior to the dark ages.

    I sense a movement that takes us back to the future if you will – one towards philosophies more Spinoza-like than DesCartes for example. More again toward the pragmatic than the hopelessly esoteric. More consistent with what we are coming to know of our actual natures, and with our own human purposes than with what we imagined the universe’s purposes were for us.

  4. ellazimmon 20 Mar 2008 at 2:51 pm

    And let us not forget that the publication and popularity of books like The God Delusion and The End of Faith are milestones that have not been traversed before. We live in interesting times and, at the moment, everything is fair game. But we must trust the ability of science and rationality to “deliver the goods”. When it comes down to it, the money knows where to put it’s weight.

  5. arthurgoldenon 21 Mar 2008 at 3:57 am

    Again James Fox wrote what I was thinking – that in this blog entry which I just carefully read that you are “describing your philosophy and the motivation behind your efforts” – and I will trt to keep this information in mind when I post additional information about autism and facilitated communication.

    By the way, as a person past sixty, for many years I have had all the typical western world conditions of aging and many friends have suggested all types of “alternative” medicine. However, I have scrupulously adhered only to modern western medicine for my own health needs. Of course, it is futile to try to convince any of my friends about such matters, so I wish you success in your own professional area of medicine.

    Arthur Golden of Jerusalem Israel

  6. Amy Alkonon 21 Mar 2008 at 10:34 pm

    Believe it or not, we need to teach rational thought. One of the best classes I ever had in school was a logic class in high school. I came into the class a rational thinker, but especially for kids raised by religious parents, this class would be a start.

    Also, Dr. Novella, I’d like to see more doctors and scientists like you and Orac of Respectful Insolence writing pieces for the mainstream press, and on topics that they can related to. Tell people why, for example, Airborne is a waste of money (as Orac did on his blog some time ago), including why “Sally said it worked for her!” or “Invented by a school teacher” aren’t reasons to use it, and you might begin to sway some people toward a more rational approach to life.

  7. DanaUllmanon 22 Mar 2008 at 12:55 pm

    Quackery is commonly defined as the use of unproven methods by practitioners who claim impressive results and who charge a lot of money. When you consider how much of conventional medicine is not evidence-based, and when you consider how much they wear the guise of “science” and how much they charge for their services (and drugs), we ARE living in the golden age of quackery…conventional medical quackery.

    And don’t forgot those surgeons…as much as I respect their work, let’s not fool ourselves into thinking that it is based on double-blind placebo controlled trials. Oh, I see, this “gold standard” is not applicable to every medical treatment, nor is it or should it necessary be expected from every unconventional medical treatment either.

    Hmmmm…there’s a fine line between the gold standard and the double standard. Ahhhh…there’s the rub.

  8. eiskrystalon 24 Mar 2008 at 6:01 am

    That was from 1933. Am i really to believe that the religious jobbies wouldn’t have been trumpeting this from the roofs if it were anything more than hyperbole.
    Talk to the creationists i’m sure they can include the conspiracy in “Expelled 2 – back to Sunday school”.

  9. DanaUllmanon 24 Mar 2008 at 9:38 am

    The “team” on which I play is the Hippocratic team, for I honor his “First, do no harm” dictum. I also play on the evidence-based medicine team, not just evaluating short-term but long-term results. I am critical of the use of polypharmacy unless there is evidence that multiple drug regiments have evidence (99% of the time, they don’t).

    There is a good reason that homeopathic medicines are used by hundreds of millions of people today and that historically, it has been used by many of the most respected physicians, scientists, and cultural heroes of the past 200 years.

  10. Steven Novellaon 24 Mar 2008 at 10:05 am

    Dana,

    Your accusations are unfounded and unfair. This is not to say there is nothing legitimate to criticize in mainstream medicine, but there is a science-based standard of care. There are also ethical standards for informed consent – so it is absolutely not routine to make claims that go beyond the evidence.

    Many procedures do lack placebo controls, but that does not mean that they have not been studied scientifically. It is no ethical to do sham surgery – that does not mean that surgery is forever unscientific. You can compare surgical management to medical management, for example.

    Also, there are many procedures – like stopping someone from massive bleeding, or replacing lost blood – that are so obvious based upon our basic understanding of physiology that again it would be absurdly unethical to do a controlled trial.

    CAM is the ultimate double-standard. It is all about skirting reasonable requirements for scientific validity and regulations that seek to establish a standard of care.

  11. [...] response to my blog entry on A Golden Age of Quackery and Antiscience, Dana Ullman wrote: Quackery is commonly defined as the use of unproven methods by practitioners [...]

  12. b_calderon 24 Mar 2008 at 8:52 pm

    What about addressing the issue of cost? When you need virtually anything, cost is a huge factor and it is one place where quacks can always beat medicine. At least when it comes to delivering imaginary cures that have a low cost, that is.

    Skeptics can’t address people’s beliefs as being a single issue when they are not.

  13. DanaUllmanon 24 Mar 2008 at 9:07 pm

    Steven,
    Like I said, I honor surgery, and I’m glad that we both recognize there ARE other means to assessing “scientifically” whether a treatment is effective other than randomized placebo controlled trials. Such are the challenges facing many CAM therapies: how does one create a placebo mantra, a placebo massage, and even placebo acupuncture is quite challenging. (Please don’t get me wrong: I do not disbelieve in the value of surgery just because there are few placebo-controlled trials. My point is that even serious scientists respect various means to accumulating and confirming therapeutic value).
    It is much easier to conduct placebo-controlled trials with homeopathy, but good trials must also be sensitive to the homeopathic method which requires individualization of treatment, except in a small number of medical situations where one medicine can routinely be given effectively (as has been seen in four large trials testing Oscillococcinum in the treatment of influenza, and recently, in the use of Kali bichromicum in treatment of COPD).
    For those people who have any sense of medical history, we know that conventional medicine over the past 150 years or so has always insisted that their methods were “scientifically confirmed,” and yet, consistently, their treatments have been found to work only temporarily or not at all and that the side-effects are often worse than the benefits provided. This is why I hope that we ALL become more HUMBLE.
    Sadly, conventional medicine tends to be extremely competitive and seeks to thwart research into modalities that are new and/or unconventional. Such is the continual and predictable history of medicine and science.

  14. Mojoon 25 Mar 2008 at 8:33 am

    Dana Ullman wrote, “The “team” on which I play is the Hippocratic team, for I honor his “First, do no harm” dictum.”

    The trouble is that that’s all homoeopathy does.

  15. Steven Novellaon 25 Mar 2008 at 9:32 am

    Dana Ullman wrote: “Sadly, conventional medicine tends to be extremely competitive and seeks to thwart research into modalities that are new and/or unconventional. Such is the continual and predictable history of medicine and science.”

    This is an unsubstantiated assertion. The whole point of scientific research is to find new and unconventional treatments. This is happening all the time in scientific medicine. In my opinion, this is just standard CAM apologist propaganda.

    You also stated that there are other legitimate ways (other than placebo-controlled trials) to scientifically investigate treatment. I agree, as I stated, and mainstream medicine uses a variety of scientific methods to assess new treatments and ideas. This is why I advocate for “science-based medicine” and not merely “evidence-based medicine.”

    But the part of science that the homeopaths (and CAM proponents in general) miss is the very critical one of scientific plausibility, which is a way of assessing prior probability. If you have a modality that is difficult to study, that has ambiguous clinical evidence, and a prior probability of essentially zero due to an utter lack of any scientific plausibility – this modality is probably not real. Simply appealing to ignorance is insufficient defense – we are not talking about uncertainty as to the precise physiological mechanism of a treatment, but a complete lack of physical plausibility. You cannot overlook this and claim to be science-based.

  16. DanaUllmanon 25 Mar 2008 at 9:59 am

    According to dictionaries, “implausible” means “unlikely” or “not plausible” (which is defined “seemingly valid”).

    What would happen to science and medicine if researchers chose not to study things that were “seemingly invalid” or simply “unlikely”?

    In actual fact, there is a body of in vitro studies testing homeopathic medicines: A group of German and Swiss physicians, scientists, and professors conducted a systematic review of the in vitro evidence of homeopathic high potencies (Witt, Bluth, Albrecht, et al, 2007). From 75 publications, 67 experiments (1/3 of them replications) were evaluated. Nearly 3/4 of them found a high potency effect, and 2/3 of those 18 that scored 6 points or more and controlled contamination. Nearly 3/4 of all replications were positive. Design and experimental models of the reviewed experiments were inhomogenous, most were performed on basophiles. These researchers concluded that even experiments with a high methodological standard could demonstrate an effect of high potencies. [Witt, CM, Bluth, M, Albrecht, H, WeiƟhuhn, TER, Baumgartner, S, and Willich, SN, The in vitro evidence for an effect of high homeopathic potencies-A systematic review of the literature, Complementary Therapies in Medicine, 15,2, June 2007: 128-138]

    The July 2007 issue of the journal HOMEOPATHY devoted itself to “plausible” mechanisms of action, including several researchers showing replicated data and some showing new data that awaits replication.

    I have no serious problem with people questioning homeopathy, though I hope that we can agree that the case for homeopathy is not closed. Those who do feel that way, IMO, are not good scientific thinkers.

  17. Steven Novellaon 25 Mar 2008 at 7:58 pm

    Dana Ullman wrote: “What would happen to science and medicine if researchers chose not to study things that were “seemingly invalid” or simply “unlikely”?”

    This is a common straw man. “Implausible” is a matter of degree. Science needs to push beyond the edge of current knowledge. There is a sweet spot where we are reaching far enough to discover new stuff about the world, but not so far that the probability of success becomes negligible. It’s like making sound investments vs playing the lottery.

    Extreme scientific implausibility is a waste of time. In order to counter extreme implausibility there would have to be rock solid evidence, which is lacking in homeopathy. There is a great deal of bad research in homeopathy (there is a great deal of bad research in all of medicine) so we need plausibility to guide us through the complex maze of poor methodology, publication bias, placebo effect, etc.

    Also – medicine is an applied science. We have to make decisions that effect real people’s lives. This is not just abstract knowledge.

    What we have not had in homeopathy is a consensus trial – one designed and monitored by skeptics as well as believers, that is replicable by anyone. Positive effects tend to go away under replication.

  18. DanaUllmanon 25 Mar 2008 at 10:31 pm

    Yes, Steven, “positive effects tend to go away under replication,” but the evidence for replication of in vitro studies is impressive. The Oscillo trials have now been replicated four times; childhood diarrhea trials three times; the Reilly trials on allergies have had four different but similar trials; and there’s more.

    What is additionally impressive is that there have been “negative” results from scientists who have shown positive results from other studies. My point is that I do not know any “homeopathic researchers”; that is, these people are “researchers” who are doing all that they can to evaluate objective various phenomena. These researchers are simply

    It is strange that French reseacher, Jacques Benveniste, and Irish biochemist, Madeleine Ennis, have been called “homeopathic researchers” just because they found some positive results from homeopathic doses. The bottomline is that these people have/had integrity and a backbone.

    Finally, one thing that I agree with you: extremely small doses of anything may not have any effect; however, there may indeed be something significantly different about how homeopathic medicines are made. That is, the process of making serial dilution, with vigorous shaking, in a double-distilled water and in glass bottles, may create something other than “small” doses. The “silica hypothesis”, that is, the “silica fragments that fall off the glass walls of the bottle, may interact with the medicinal substance, thereby changing the structure of the water in unique ways for each substance that interacts with the silica chips. Implausible becomes plausible.

  19. superdaveon 26 Mar 2008 at 9:50 am

    silica hypothesis? are you kidding?

  20. DanaUllmanon 26 Mar 2008 at 10:59 pm

    Yeah superdave, the silica hypothesis…and why do I have this sneaking suspicion that you know nothing about it. Hmmm…but let’s cure that.

    Here’s a link to an introduction to it by a Harvard doc and another respected scientist:

    http://www.badscience.net//?p=498

  21. [...] If Dr. Weil succeeds, every new family practice physician will graduate from his or her residency program with a knowledge of CAM. This would not be a bad thing if it were truly a science- and evidence-based approach to CAM and a knowledge of what herbal remedies might interact with “conventional” pharmaceuticals. The optimist in me would like to believe that that’s what would happen, but the realist in me knows that it’s not. Given the history of CAM programs in medical schools and academic medical centers thus far, where credulous promotion of quackery–yes, I say quackery–such as reiki, therapeutic touch, and even that quackery of quackeries, homeopathy, somehow manage to be “integrated” into science-based offerings with nary a word of skepticism about the extreme (and I do mean extreme) lack of scientific plausibility and the preponderance of scientific studies demonstrating no greater efficacy for these modalities than placebo, I fear that when I visualize myself in the hospital 20 or 30 years being subjected to therapies parodied in this video, I may look back at it as prophetic, not funny. Steve Novella was right to wonder whether a golden age of quackery and antiscience is upon us. [...]

  22. [...] agreed when Quackwatch webmaster Stephen Barrett characterized the era we live in as the “golden age of quackery and antiscience.” There’s nothing to be gained for us by pretending otherwise other than perhaps the [...]

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