May 03 2010

More Anti-Science at the Huff Po

One of the challenges of trying to be scientific, and an honest intellectual, is that judgment is often required in assessing a claim or topic. The problem with relying upon one’s judgment is that it is fraught, even overwhelmed, with personal bias. The “default mode” of human behavior (which means most people do this most of the time) is to construct an elaborate rationalization for what we already believe, and want to believe. The more intelligent we are, the more sophisticated and elaborate our rationalizations – giving more confidence in our conclusions, but not necessarily deserved.

The solution to this problem is to develop a specific intellectual skill set – knowledge of the many and various ways in which we bias our thinking and the constant application of this knowledge to our own beliefs. In other words, we need to be skeptical, especially of ourselves. But not just skeptical in attitude, systematically skeptical of the process of our own thought. But since this is necessarily self-referential (we can bias our assessment of our biases) it is also necessary to check your beliefs and thinking against other people, people with different perspectives – from different backgrounds, areas of expertise, and cultures.

The opposite of this approach is to be insular, to have a self-contained belief system that feeds on itself but which is completely disconnected from logic and reality. Humans seem to have an unfortunate penchant for falling into such self-contained belief systems, cults being the ultimate expression of this tendency. Conspiracy theories are another manifestation.

One manifestation in particular I want to discuss today is the “demonization” of a person, belief, or system that we don’t like. You can make anything sound sinister and broken, if you exaggerate and emphasize the flaws and weaknesses of a system and ignore or downplay the virtues. For example, if you really wanted to make a case that democracy is broken, you could point out the corruption in the system, the power of lobbyists, the failures of the election system and the electoral college. The 2000 election would stand as a prime example. You could then conclude that we need to reject democracy for something else – anarchy, or perhaps a benign dictator.

This is exactly what Dana Ullman has done to science at the Huffington Post. He essentially says that science is broken and not to be trusted – therefore trust my pseudoscience (homeopathy) and help this new medical science to replace what we have now. It is a remarkable piece of propaganda.

His primary strategy is to point out weaknesses in the practice of science (not the underlying philosophy or methods), as if this is news to anyone. Science is a human endeavor, and is subject to all the frailty of humans. Skeptics and science educators (like Carl Sagan) are the first to point this out. The application of science can fail in a hundred ways, which is why we need to be vigilant, exacting in our evaluations, and rely upon consensus of evidence and consensus of interpretation. Ullman, of course, simply does not like the consensus of logic, evidence, and opinion that homeopathy is pure bunk, and so he rails against the practice of science as if it will save him and his preferred belief.

There are too many examples for me to dissect every one here, so I will give some salient examples. He writes:

Modern medicine uses the double-blind and placebo-controlled trial as the gold standard by which the effectiveness of a treatment is determined. On the surface, this scientific method is very reasonable. However, serious problems in these studies are widely acknowledged by academics but remain unknown to the general public. Fundamental questions about the meaning of the word “efficacy” are rarely raised.

He contradicts himself here – academics acknowledge this problem but it is also rarely raised? This is a case of what we call – making shit up. Ullman clearly has insufficient direct familiarity with clinical research, where fundamental questions about efficacy are constantly raised and discussed. I have actually been involved with designing clinical trials, and a great deal of time, thought, and care has always been given to exactly what we would measure, and what it means. Do we follow a clinical marker of disease, net clinical outcomes, overall quality of life, or all of these things? In most trials multiple endpoints are followed in order to blanket the notion of “efficacy” as much as possible. We want objective measures to know that something biological is happening, clinical measures to know that there is relevant benefit, and quality of life measure to know that patients will actually feel better. We also consider how long we need to follow subjects – are benefits sustained or temporary? Frankly, saying that clinical scientists do not question the notion of efficacy is profoundly ignorant and naive – the kind of thing someone writes when they are trying to build a case against science, not fairly assess it.

Then we discover what Ullman is really getting at.

For instance, just because a drug treatment seems to eliminate a specific symptom does not necessarily mean that it is “effective.” In fact, getting rid of a specific symptom can be the bad news. Aspirin may lower your fever, but physiologists recognize that fever is an important defense of the body in its efforts to fight infection. Sleep-inducing drugs may lead you to fall asleep, but they do not lead to refreshed sleep, and these drugs ultimately tend to aggravate the cycle of insomnia and fatigue, while conveniently (for the drug companies) tend to create addiction. Long-term safety and efficacy of many modern drugs for common ailments remains unknown, despite the high hopes and sincere expectations from the medical community and the rest of us for greater certainty.

Again – more nonsense.  A great deal of ink, as they say, has been spilled exploring all of these questions in the medical literature.  A low grade fever is not a problem, but a high fever can cause damage to the brain, lead to seizures in young children, and should absolutely be treated. Fever is not essential for the body to fight off an infection.

Sleep inducing drugs are tricky to use well. First we need to distinguish sleep onset problems vs sleep maintenance problems. For sleep onset problems a sedative may be effective, and in fact will restore the sleep cycle. But it must be done in conjunction with what we call sleep hygiene – no napping during the day, avoid eating late at night, etc. Sure, some primary care doctors with insufficient training and experience with sleep disorders may just prescribe a sedative. That is a reason to improve education and practice, not chuck the whole system. Because those with more experience and training take a very sophisticated approach to sleep. Start with sleep hygiene. Then treat either sleep onset, maintenance, or both as needed. The goal is to reestablish a normal circadian rhythm and then wean off the medications. Addictive medications are to be avoided – some sleep medications are not addictive, but patients may become dependent upon them if they do not also work on sleep hygiene, or if they have another unidentified sleep problem. So if this approach does not work – then order a sleep study or perhaps consult with a sleep expert.

The point of going over sleep medicine is to contrast the reality to Ullman’s cardboard cartoon. His goal is not to understand or elucidate, but to confuse and poison the well. But also to support an alternative to the scientific view – the homeopathic view that all symptoms are good – they are the body’s way of fighting disease. Treating symptoms is therefore counterproductive. While this may be true is a minority of cases, this is not a general rule of medicine or biology. It is a homeopathic philosophy, nothing else, and is not based upon evidence. Pain does not help the body fight off any ailment that causes pain. Pain only warns us of a problem. So you would not want to numb someone to all pain, because then you cannot follow it as an outcome. But you do want to provide relief to improve quality of life. Pain should be treated – just with care and thought.

Further, there are two kinds of pain: nociceptive and neuropathic. Nociceptive pain is the body sensing tissue damage, and provides a protective and warning function. It should be alleviated, but not masked. Neuropathic pain serves no function, it is a malfunction of the nervous system, caused by trauma, disease, and sometimes even genetic mutations that alter nerve function. With neuropathic pain, the pain is the disease. There are specific medications that may reduce neuropathic pain – not regular pain medication, but neurologically active medication that suppress the abnormal pain generation or pathways.

Homeopaths like Ullman whitewash over all this nuance and complexity. To them, symptoms are good, and all symptomatic treatment is bad. And then they criticize science-based medicine from their own childish perspective.

Later on comes this gem:

Conventional drugs used today are so new that there is very little long-term research on them. There are good reasons why a vast majority of modern drugs used just a couple of decades ago are no longer prescribed: they don’t work as well as previously assumed, and/or they cause more harm than good.

Drugs used today have been available for a variety of time. Some drugs in common use have been used for decades. I routinely prescribe drugs that have been around for 40-50 years – so-called tried and true drugs. There are few surprises in store when using such drugs. Others have been around for 10 or so years – enough time for post-marketing experience to have been tracked and for doctors to have a good fix on long term efficacy and safety.

And sure, there are also new drugs always coming on the market. It is acknowledged that with such drugs we, by necessity, lack long term experience. And so they are used with more caution, while their effects in the real world are tracked and studied. Some drugs ultimately fail at this stage, while others go on to become established drugs.

Again we see the complex reality, and Ullman’s self-serving cartoon. I would also like to hear what an alternative to this system would be – how do we gain decades of experience with large numbers of patients without, you know, using drugs for decades in large numbers of patients. Ullman has his alternative – chuck the whole system and replace it with nonsense and pseudoscience – his particular flavor of pseudoscience. Trust in the gurus, not science.

Conclusion

To a physician, Ullman’s rant is a transparent and naive polemic. But to someone not personally familiar with the intricacies of modern medicine, who cannot put his claims into perspective, his case can seem superficially compelling. Reading his article is like watching Loose Change without any further background knowledge about 9/11. If you pile up a bunch of biased misinformation in one place, the shear size can seem impressive.

Ullman also entirely misses the big picture that medical science is self-critical and self-corrective (unlike, say, homeopathy which is insular and protective). All of the criticism he exploits to attack medicine are self-criticisms that academic physicians and scientists have and continue to raise. We are asking the questions – how long do we need to study a drug before we can confidently extrapolate its long term effects? Then we look back and ask – how is this working? Maybe we need to follow these drugs longer before approval. Maybe we need to follow different outcomes. Maybe we need a different strategy.

In that way medicine continues to scratch and claw forward. It’s a messy process, fraught with error, missteps, even bias and fraud. But just like democracy, it may be a frustratingly flawed system, but it is the best we have. And I would no more want to chuck science-based medicine for the wishful thinking and magic Dana Ullman is selling, than I would want to chuck democracy and accept a dictator.

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19 responses so far

19 Responses to “More Anti-Science at the Huff Po”

  1. BelJonason 03 May 2010 at 10:04 am

    I think this is my new favorite article of yours. It gives such a great mental illustration of why science is better than non-science, and how things are so much more complicated than saying “these are good for you, and these are bad for you.” And I love how eloquently everything is written up until “This is a case of what we call – making shit up.”

    Now, pardon me, while I link this on all the FaceSpaces I can find.

  2. superdaveon 03 May 2010 at 10:33 am

    Why hasn’t someone from SBM posted on huffpo yet?

  3. Alison Cumminson 03 May 2010 at 10:55 am

    Nice critique of Dana Ullman, but I’m going to critique an analogy and an example.

    Democracy vs benevolent dictatorships is not a good analogy for science vs fantasy. Democracies and dictatorships both exist and both can be effective at maintaining a country, so I would use them as an analogy for, say, chemotherapy vs radiation for post-surgical treatment of cancer. Both exist and both have pros and cons.

    A better analogy for science vs homeopathy might be democracy vs the benevolent dictatorship of the tooth fairy. The first exists, warts and all; the second is a completely irrelevant nice idea.

    Also, I think that it’s been shown that while it is completely logical that giving acetominophen for routine prophylaxis of fever with vaccination should reduce febrile seizures, it is in fact ineffective… and it may even reduce the vaccine response. I think that these days children with a history of febrile seizure are given phenobarbital suppositories to prevent the seizure, not acetaminophen to prevent the fever.

    Please correct me if I’m wrong.

  4. Steven Novellaon 03 May 2010 at 11:14 am

    Alison,

    OK – I just updated my knowledge of febrile seizures (I don’t treat kids and what I learned as a resident has been modified). There is no evidence that treating the fever reduces risk of seizures, but it is still recommended for comfort and possible benefit.

    Anti-epileptics, either continuously or intermittently, reduce seizures but are not recommended because the side effects outweigh the benefit, and febrile seizures are generally benign. So reassurance is the current standard – except in a select minority of cases where seizures are more serious.

    But the broader point is – treating symptoms is a case by case decision of risk vs benefit. Meanwhile Ullman takes a blanket philosophical approach, and cherry picks examples to support it.

    Also – I figured someone would object to the analogy – although I do like that you took it a step further and I probably would have gone there if I thought about it.

    The point of my analogy was this – democracy and science are open and transparent. Dictatorships and pseudoscience are closed, insular, and protective. So as far as that goes, the analogy is apt and relevant to my points.

    But I do like the image of a fairy dictator.

  5. SpicyCupcakeon 03 May 2010 at 11:40 am

    From the Article,:

    “To get FDA approval to market a drug, most of the studies for psychiatric conditions last only six weeks (Angell, 2004, 112). In view of the fact that most people take anti-depressant or anti-anxiety medicines for years, can these short studies be scientifically valid? What is so little known and so sobering is that research to date has found that placebos are 80 percent as effective and have fewer side effects and a lot cheaper (Angell, 2004, 113).”

    Is this just an attrocious example of quote mining or was this as incoherient as I’m reading it? What I am lifting from this is that he has taken two out of context peices of information and put his own bridge to give them a false context. I do not know about this Dr. Angell or what the intention of the Doctor’s writing was. I do feel like this is likely a poor representation of it.

    Also, is there any way to handle these missinformation arguements, quote minings, and etc. out side of just being far more informed than the person making them (the only way i’ve been able to handle them up to this point)?

  6. Lucianon 03 May 2010 at 11:58 am

    SpiceyCupcake, when looking at any of these articles, especialy when it’s from the Huff Post, I’d tell you to use Carl Sagan’s Baloney Detection Kit. I recently suscribed to the video podcast RDF tv, and in their first video Michael Shermer, of Skeptic Magazine, describes this manner of confronting claims from a scientific stance in a step-by-step fashion. Here’s a link if you’re interested.

    http://richarddawkins.net/articles/3986

  7. Steven Novellaon 03 May 2010 at 12:12 pm

    Regarding that claim by Ullman – here is a good review that shows how out of context and cherry picked his statement is: http://www.psychiatrist.com/private/article_wrapper.asp?art=2010/v71e01/v71e0102/v71e0102.htm

    European countries require 6 months of data, and post marketing there is 2-4 year follow ups. They show the long term efficacy and safety of anti-depressant medications. Ullman attempted to deceive his readers that we only have data for 6 weeks.

    Regarding Angell – she is complicated. My impression is that she is far left in her ideology, and very anti-corporate. I think this biases her evaluation. She, for example, advocates completely socializing the pharmaceutical industry. So she tried to build a case against the pharmaceutical industry for political reasons. Her view is hardly a consensus view.

  8. Elisheva Levinon 03 May 2010 at 12:14 pm

    Very good critique and your general statement in the first three paragraphs is an excellent analysis of most of what passes for intellectual discourse at present.

    I also found myself arguing with your democracy vs. dictatorship analogy, and what you said in comments did not clear up the argument for me. A democracy is simply majority rule by whatever group of people are considered to be citizens (in the Athenian Democracy it was men who were freeholders in the city). Therefore, a democracy without the protection of individual rights– especially including the rights protected by the First Amendment–can be just as closed as a dictatorship. A majority can easily overrun and trample skepticism as does a dictator, although the process of doing so may be less orderly.

    I believe that this is exactly what has happened in the current culture of the United States, where skepticism is taken to be an attitude of refusal to accept even the most basic scientific knowledge, and where people believe that scientific questions can be decided by the “consensus” of the majority of scientists and/or politicians.

  9. Steven Novellaon 03 May 2010 at 12:21 pm

    Elisheva – what you are saying, which is consistent with my point, is that some systems of democracy work, and some don’t. This is also analogous to science – some institutions of science work, and historically there have been those that do not.

    My point is, you can look at a system that basically works, point out all the flaws, and build a bogus case that the system is broken and needs to be trashed. I would not say that American democracy is broken and should be trashed. It basically works, at least better than anything else, and we can work within the system to improve the problems. The same is true of science-based medicine.

    That is the essential thing to consider – can you work within a system to improve it, or is it inherently broken. Some systems need to be trashed or overhauled.

  10. banyanon 03 May 2010 at 12:45 pm

    It looks like Ullman is criticizing one modality without comparing it to any alternatives, then promoting another without comparing it to any alternatives. If he’s going to apply a set of criteria to scientific medicine, he should use the same criteria for homeopathy.

    For example he says the following:
    * According to 2006 data, the infant mortality rate in the United States was ranked twenty-first in the world, worse than South Korea and Greece and only slightly better than Poland.
    * Data from 2006 also showed that the life expectancy rate in the United States was ranked seventeenth in the world, tied with Cyprus and only slightly ahead of Albania (InfoPlease, 2007).

    To really know if this is helpful data for determining whether alternative medicine would be a good alternative, we need to know whether a country that extensively uses alternative medicine, and differs as little as possible in other ways, would have better infant mortality and life expectancy rates. Not only does he not do this, he provides no argument whatsoever that homeopathy or any other alternative modality would increase life expectancy or lower infant mortality rates. Probably because he knows full well that it wouldn’t.

  11. SpicyCupcakeon 03 May 2010 at 1:13 pm

    Dr. Novella,
    Thank you for the link. I have not thoroughly digested it yet. It does quickly become clear what you are demonstrating. I can also tell you that if it is not mentioned in the study (was skimming it) the idea that someone is trying to profiteer off of your illness is something that gets in the way a lot. My own parents thought the psychiatrist were trying to take advantage of us when I was younger and refused to do visits along with medication (found to be a mistake). A number of people that consider themselves “better” think that people are just trying to profit off their perscription. The distrust sewn by people like Mr. Ullman can (in my anicdote based opinion) affect these treatments to potientially devastating ends.

    Lucian,
    Thank you for the link. The video puts a more cogent explanation that what I can muster on the fly! I guess the natural progression of the question is, I use many of these tools already. It is difficult to demonstrate why these make an argument suspect the naïve third party that sitting in on the discussion of my coffee shop soapbox. Do you have any resources or personal advice on how to not just detect bologna but to clearly warn others? (input from Steve always welcome as well!)
    I have some methods that I use already. One I would like to be able to move away from is naming out loud certain logical fallacies. Most people do not know the specific meaning, but they understand that something in the argument is fallacious. However, it tends to put the person making the claim into attack mode or at least anger them. In the mean time it’s more of an emotional appeal than a logical one if the third party does not actually know what it means other than its bad, and that is why biggest reason I’m not comfortable with the tactic.

  12. Gallenodon 03 May 2010 at 3:02 pm

    Steve: Speaking of The HuffPo, have you seen this month’s “Anti-Gravity” in Scientific American (http://www.scientificamerican.com/article.cfm?id=140-character-study) and is “InAHuff” by any chance a shot at the HuffPo?

    Spicy: Best tactic I know is to keep asking innocent-sounding questions of the true-believer that require explanations rather than opinions. (Sort of a Socratic method of letting fools expose themselves.) This usually generates all sorts of interesting rationales with a host of logical inconsistencies which any rational third-pary observer should pick up on fairly quickly.

  13. CivilUnreston 03 May 2010 at 4:26 pm

    I agree with Gallenod — if you’re arguing against someone’s opinion, their role becomes the Defender of Said Opinion. Unless someone is already open-minded, they will be quite unwilling to change their opinion because it will mean that they lose the argument.

    For example:
    “The government planned 9/11″

    is best confronted with:
    “But why? There are cheaper ways to get us to go to war…”
    “Then how come they weren’t able to plant WMDs in Iraq?”

    as opposed to:
    “That’s stupid and you have no evidence to support it”

  14. Nitpickingon 03 May 2010 at 10:14 pm

    Sleep-inducing drugs may lead you to fall asleep, but they do not lead to refreshed sleep, and these drugs ultimately tend to aggravate the cycle of insomnia and fatigue, while conveniently (for the drug companies) tend to create addiction.

    What fascinates me about Ullman’s quote above is its source–and the source of much of the rest of his argument.

    That source is the scientific literature. It would seem that Ullman is OK with science as long as it agrees with his positions.

    I’m not saying that he got it right, he clearly distorted and/or misunderstood the science, but in much of his writing he sure seems to be using science as long as it’s “on his side.”

  15. weingon 03 May 2010 at 11:44 pm

    “Also, is there any way to handle these missinformation arguements, quote minings, and etc. out side of just being far more informed than the person making them (the only way i’ve been able to handle them up to this point)?”

    Check out Nonsense on Stilts by Massimo Pigliucci.

  16. zoe237on 04 May 2010 at 12:06 am

    Speaking of trust, there was a story in the NYT today: Tylenol, Generics, and Trust.

    http://www.nytimes.com/2010/05/03/business/03drug.html?ref=business

    You know, I’m trying to reconcile the fact that I agree with some of what Ullman says (particularly about fevers and sleep medicine) with his complete rejection of a system I do indeed “trust.” Is trust the same as faith the same as belief? Anyway, I do believe that the scientific method works in the end, but that sometimes it takes decades, when I as a parent have to make a decision now. Scientists have biases (the power of stories over statistics and confirmation bias and file drawer effect). Sometimes money corrupts (faux journals, pharma kickbacks). Historically, even consensus has been wrong multiple times. To me, the greatest scientific “patriots” are those working within the system even if most of their collegues disagree (e.g. Tom Jefferson). People like Wakefield and Jay Gordon work outside the system by either cheating or relying on anecdotes instead of research.

    However, as an educator, when stories come out like the recent recalls, it bothers me that many people just throw out the entire world view of science because they don’t understand the messiness of the process. Intellectual laziness precludes a nuanced look at data and people would rather someone tell them what to think. I thought the democracy was a pretty good analogy, because I also am a huge critic of certain practices in our republic (two party system, campaign financing), I do think it’s better than the alternative.

    Anyway, I thank this blog and SBM for aiding me in my own discovery process. And I totally agree with the poster who recommended the socratic method for exposing fact and fiction. It works, albeit more slowly.

  17. weingon 04 May 2010 at 8:22 am

    “You know, I’m trying to reconcile the fact that I agree with some of what Ullman says (particularly about fevers and sleep medicine) with his complete rejection of a system I do indeed “trust.””

    He is not really saying that. He is just repeating what real doctors have been saying. It’s a ploy. A broken clock gives the correct time twice a day.

  18. zoe237on 04 May 2010 at 9:44 am

    ““You know, I’m trying to reconcile the fact that I agree with some of what Ullman says (particularly about fevers and sleep medicine) with his complete rejection of a system I do indeed “trust.””

    He is not really saying that. He is just repeating what real doctors have been saying. It’s a ploy. A broken clock gives the correct time twice a day.”

    Yes, that’s true.

  19. borealyson 05 May 2010 at 2:31 pm

    Gallenod – I assumed “InAHuff” was a reference to Senator Inhofe, who’s well-known for making particularly lame comments about global warming.

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