Dec 12 2011

Fighting CAM – In Australia

One thing that I notice when the issue of so-called complementary and alternative medicine (CAM, although some of my colleagues add the “s” from “so-called” to make is SCAM) is brought up in the media is that many misconceptions will be cited as fact, often by both sides, although far more by the pro-CAM side. CAM advocates seem to rely almost entirely on misconceptions and factual errors.

In Australia recently an ABC program aired that was highly critical of CAM, and now CAM advocates are firing back. The latest exchange was initiated by a group of 34 Australian physicians who are campaigning against pseudoscience in medicine. This is something that should not be controversial, but amazingly there is a large number of practitioners (although a minority) that stand  up to defend pseudoscience in medicine. They report:

Emeritus Professor of Medicine at the University of New South Wales John Dwyer says some courses previously offered at Southern Cross were more “magic” than science.
“We were off to a bad start with Southern Cross University when their founding Professor of Health and Nursing was teaching for years Healing Touch therapy; quite extraordinary nonsense.”

Good for him and his colleagues – we need more professionals who are not afraid to point out that the CAM emperor has no clothes.

Defending nonsense we have:

Professor Iain Graham from Southern Cross University’s School of Health yesterday defended his university, saying the use of alternative therapies, such as homeopathy, can be traced as far back as ancient Greece.

The Argument from Antiquity

I have to give the standard caveat that professor Graham may have been misquoted or misrepresented, but he was quoted making the same argument in a different piece as well. Taken at face value, we have a misstatement of fact combined with a logical fallacy. He probably (if I am being generous) did not mean to state that homeopathy can be traced back to ancient Greece, just that some CAM therapies can. Homeopathy was invented by Samuel Hahnemann about 200 years ago.

But I wonder what CAM modalities he had in mind. Chiropractic? About 100 years. Therapeutic touch? A few decades. Acupuncture is a complex question, but what passes for acupuncture today is less than 100 years old. Perhaps he was thinking about blood letting or trepanation.

It is true, however, that some basic concepts, like the notion of a life energy, can trace it roots to ancient Greece, and other ancient cultures. However, such notions are pre-scientific nonsense. Scientists abandoned the notion of life energy over a century ago because there is no evidence that such a force exists (and there still isn’t) and after figuring out all the basic processes of life there was essentially nothing left for the alleged life force to do.

For some reason, however, professor Graham believes that antiquity in science is a virtue – the “argument from antiquity” logical fallacy. The unstated assumption is that if an idea has survived for hundreds or thousands of years it must be legitimate. This is demonstrably false. Galenic medicine (blood letting, purging, etc. based on the notion of the four humours) survived for thousands of years, and yet it was based on complete an utter primitive nonsense. In fact its tendrils still exists – there is still blood letting, cupping (which is just another form of blood letting) and similar practices going on in the world. It was replaced in the West because of the advent of science in medicine – a trend that Graham apparently wants to reverse.

The Argument from Popularity

Graham’s second swing and a miss is this:

“Eighty per cent of Australians seek alternative therapies,” Prof Graham said.

“Obviously orthodox medicine is not working for everyone,” he said.

I highly doubt that the 80% figure is correct. Most such figures are highly inflated by including all sorts of practices in the CAM category, like exercise, eating organic food, and sometimes prayer is included. US surveys show the percentage of CAM use is around 1/3, but this is mostly things like massage and chiropractic manipulations. Homeopathy is around 3-4%, and acupuncture 6-7%. In fact, only manipulation and massage were in the double digits.

This is all marketing deception – create a false category (CAM), pad it out with commonly used methods, and then claim that the extreme fringes are therefore getting more popular. I don’t know how Graham got to 80% (I doubt such methods are that much more popular in Australia) but it is close to one survey from 2007 that found that 69% of Australians used one of the 17 most popular forms of CAM in the last year. However, they included in their list: martial arts, yoga, massage, meditation, and taking multivitamins. I am not sure what taking multivitamins says about the popularity of homeopathy, but apparently professor Graham thinks that is significant.

In any case – I will grant that CAM as a marketing concept has been somewhat successful, and even that it has gained popularity recently (although not as much as advocates would have you think). That is entirely irrelevant, however, to the question of whether or not any particular CAM modality is science-based and appropriate for a university curriculum (the question at hand).

Universities are supposed to be thought-leaders, to have intellectual standards that rise above the mere notion of popularity. They are supposed to uphold academic standards of scholarship, and in scientific disciplines of high standards in science. It is therefore very odd and disturbing to defend a university policy based upon popularity. Should we allow surveys of public opinion to determine whether or not we teach creationism or astrology in our universities?

Conclusion

These same two arguments keep coming up in the defense of CAM, despite the fact that they are factually dubious and logically fallacious. That, however, is the nature of CAM – it is an intellectually dubious enterprise. We need more professionals like John Dwyer who are not afraid to say so.

In the comments to the above article another very common CAM canard was presented. Commenter “shotinfo” wrote:

According to articles published in both the British Medical Journal and the New England Journal of Medicine, between 85% and 90% of all mainstream medical drugs and procedures have never been scientifically proven to either work or be effective.

I love the fake references – of course no such articles in BMJ or NEJM exist, and no references were offered, but it certainly makes the fake factoid sound legitimate. I have already discussed this issue in detail. The bottom line is that surveys of medical practice find that about 78% of them are reasonably evidence-based. Yet again we have a factual misstatement used to support a logical fallacy (tu quoque). All medical practice should strive to be more science and evidence-based. Pointing out the deficiencies in one discipline does not justify deficiencies in another.

The commenter, however, also misses the real point of criticism of CAM. Mainstream medicine is based upon a culture and institution of science, and a science-based standard of care. The execution of this standard is flawed, but the principle is clear. CAM is not based on a science-based standard. It, in fact, seeks to subvert and even remove the science-based standard of care. And CAM proponents live in a culture of pseudoscience, not legitimate science.

We need to keep pointing this out – and the defenders of CAM will keep making our point for us by quoting the same factual errors and logical fallacies over and over again.

Share

8 responses so far

8 Responses to “Fighting CAM – In Australia”

  1. Weson 12 Dec 2011 at 3:27 pm

    Steven,
    Thank you for the research and education. I am an ER doc in Alberta, Canada and find myself, almost on every shift, dealing with magical thinking and pseudoscience. I appreciate your blogs and essays on here to keep me up-to-date and informed. I quite often use the information and ideas you provide and review to try to educate patients and co-workers when such topics come up.
    This blog is another example of one that I am sure will come in handy.
    Thanks again,
    Wes

  2. desparozon 12 Dec 2011 at 4:26 pm

    As an Australian, skeptic and martial artist, I was intrigued by the reference to “martial arts” in their list.

    I thought (perhaps hoped) that you were making a generalisation on arts like T’ai Chi, which may once have been martial, but are now for the most part simply therapeutic in nature, and often based on the concept of Chi… Surely a paper like this couldn’t make over-generalisations and get away with it?

    Unfortunately the article is worse than simply saying martial arts, because it sandwiches martial arts in a single item: “Chi Gong, martial arts and Tai Chi”. Not only is the generic term sandwiched, the use of capitals on tai chi and chi gong draws attention away from the generic.

    With some notable exceptions, the vast majority of Tai Chi practitioners are no longer practicing a martial art as such. To an even greater extent, most Chi Gong practice is now “therapy”, “movement exercise” or sometimes simply mystical in nature.

    This classification would be like saying something like “drinking is uneqivocally bad for you, because almost 100% of autopsy patients had drunk Beer, liquid or Whisky in the past 24 hours”. There may be a relationship between alcohol and liquids, but the over-generalisation doesn’t prove the point. (BTW: I am not condoning excessive alcohol consumption, it was just the best analogy I could come up with first thing in the morning).

    As a martial artist of many years, I have seen a lot of BS in the arts. I am one of an increasingly large group of practitioners who looks for scientific explanation of why things happen the way they do. I am keenly interested, for example, in the body’s vulnerable points. I am uninterested in explanations of those vulnerabilities that involve pseudo-science (chi, meridians, etc). I am intrigued by the physiologically valid reasons.

    For example, if someone is struck in an appropriate manner on the neck there is a good chance of them becoming unconscious. I don’t care that a point called “Stomach 9″ was struck, because it is irrelevant (and fictional). The underlying structures of the vagus nerve, carotid artery, carotid sinus, etc, and the autonomous responses by the body provide a scientific explanation for the effect. This knowledge allows us to structure training for safety (ie. don’t strike that point), and also to structure practice for (justified) self-defence, accordingly.

    As a skeptic, I’ve long liked the phrase “medicine that is known to work is called medicine, everything else is alternative medicine”. In the martial arts, many have started adding the name “functional” or “reality based” to the term martial arts. It seems wrong that the “realists” have had to redefine our practice to differentiate from the “woo” arts.

  3. Guy Chapmanon 12 Dec 2011 at 5:13 pm

    The problem lies in the term CAM itself. It combines two entirely distinct categories: complementary therapies and alternatives-to-medicine.

    Complementary therapies is a broad category including all sorts of things, some of which have a decent evidence base (good diet, massage for muscle pain and so on).

    Alternatives-to-medicine, however, is pretty much universally fraudulent – the correct technical term for an “alternative” medicine that can be shown to work is, of course, medicine, and science shows no obvious reluctance to adopt treatments isolated tree bark, to name one well known example.

    The term “complementary and alternative medicine” as used to justify fraudulent alternative-to-medicine practices is the medical equivalent of claiming that flying carpets are a viable alternative to cars because they are part of the category of “alternative transport” which includes bicycles and rowing boats.

  4. ccbowerson 12 Dec 2011 at 5:53 pm

    But “The Argument from Popularity” is used by people in cultures all over the world, and the “argument from antiquity” has been used for thousands of years!

  5. thequiet1on 12 Dec 2011 at 7:49 pm

    It’s very good to see a group of MD’s here taking the initiative and going on the offensive. We don’t need more ‘shruggies.’

    John Dwyer also had an article published on The Conversation recently titled “There’s no place for pseudo-scientific chiropractic in Australian universities” (http://theconversation.edu.au/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576).

    I like the cut of his jib.

  6. DrainBamagedon 12 Dec 2011 at 8:56 pm

    “shotinfo” is a popular pseudonym of Meryl Dorey (of the Australian Vaccination Network), so it’s most likely that the author of the “shotinfo” comment cited above is Meryl.

  7. micwaton 13 Dec 2011 at 4:03 am

    Hi Steve, just want to point out a technical error. The link to Professor Graham’s “different piece as well” in your post above is a second link to the same story as the first one.

    I think it’s a really interesting point that some of these so called ancient therapies and that old after all. Presumably there are some things that worked all along (even in Ancient Greece) and still work because they contained effective active ingredients. So we don’t call that alternative medicine any more, just medicine. And presumably it can be refined and delivered better pharmacologically these days. Can you give some examples of medicines whose origins were in ancient times – ie those that really have stood the test of time not because they are old but because they work?

    Unfortunately, the study of naturopathy etc at Southern Cross Uni is a symptom of its academic laxity and Kow-towing to its local hippy fringe community (in my personal opinion). This is based on its location on the North Coast of NSW – also a hotbed of anti-vaccination sentiment on Australia’s East coast. It is not a faculty of medicine since the university has no such faculty. Unfortunately its offering of CAM type ‘university’ courses – where someone can get a university Masters degree in complimentary medicine is a symptom of market driven rather than science driven faculty offerings.

  8. norrisLon 27 Dec 2011 at 12:07 am

    Almost embarrassing to be an Australian when so called universities are peddling such nonsense. But we are working on it over here. But then we have this twit in my own country and in my profession. pawstoheal.com.au/
    unbelievable garbage from this person in the guise of veterinary medicine and surgery. She even allows her patients the right to die when THEY feel ready, rather than being compassionate and euthanasing them when euthanasia is obviously required on compassionate grounds. What’s wrong with the Victorian Board of veterinary Surgeons that they allow this person to practice as a veterinarian?

    Stuart

Trackback URI | Comments RSS

Leave a Reply

You must be logged in to post a comment.