Jan 23 2012

Science, Medicine, and Academia

Proponents of so-called complementary and alternative medicine (CAM) are forcing us to answer a question no one has explicitly asked – should there be a scientific basis to medicine? Proponents are generally very coy about this topic, and in most venues want to pretend that they are being scientific, while really promoting “other” forms of evidence and “other” ways of knowing. They promote health care freedom laws designed to weaken the scientific standards of medicine, while simultaneously infiltrating academia with assurances that they are science-based.

Unfortunately most academics and health care professionals are simply naive to the situation (so-called “shruggies”) and too easily accept these assurances without checking out the facts themselves. Their initial reaction to those of us who are calmly but insistently pointing out that the CAM emperor has no clothes is to assume that we must be overreacting, because CAM can’t truly be as bad as we say. Homeopathy can’t really be made of nothing, can it? But it’s a large industry, with entire hospitals in the UK. How can it be as nonsensical as the skeptics are saying?

This naivete extends, unfortunately, to many university administrators, who are used to being egalitarian and accommodating. Proponents of CAM are sincere, and know how to play the game, so they put their best academic foot forward (often lubricated with grants from ideologically dedicated organizations like the Bravewell collaboration) and work their way into academia. They are persistent, and good at dismissing their critics as closed-minded, unfair, or having an axe to grind.

Perhaps the best tool we have in countering this infiltration of abject nonsense into the halls of academia is to simply point out exactly what they are buying. This strategy has had a great deal of success in the UK, and some limited success in the US. Now, defenders of science and reason in Australia are gearing up for their own fight. A new group called the Friends of Science in Medicine has formed to oppose the watering-down of science in academic medicine and the practice of medicine in Australia. A recent article about the group states:

 A new group called “Friends of Science in Medicine” comprising of more than 350 of Australias top scientists, including basic and clinical scientists, medical practitioners, clinical academics and consumer advocates have formed to address what they consider the “diminishing of the standards applied to the teaching of science in our universities”. The group is concerned about the increased teaching of, what they call, “pseudoscience” in Australian universities and its application within our health care system.

Their aims are in line with other groups, like the Institute for Science in Medicine (an international group of which I am Chairman). And of course we tackle this issue frequently at Science-Based Medicine.

Our collective strategy is basically two-fold. The first is to establish what the scientific standard should be. The second is to shine light onto the claims and practices of so-called CAM, to expose the fact that they do not meet this standard. Proponents are coy on the first question, and deceptive (either naively self-deceptive or deliberately so) on the second.

We need to affirm the necessity of having a transparent objective scientific standard for medicine. Otherwise, there is no standard of care. There would be no way of determining which treatments were legitimate and which were not. This question has many practical implications – which professions should be licensed, which treatments covered by insurance, which practices allowed under the scope of practice of each profession, what should be taught in medical, nursing, and other health-related curricula, and which practices constitute malpractice. Without a science-based standard, there are no answers to these questions.

That, of course, is what CAM proponents want. How else can you practice homeopathy, get covered for it, have it be included within your scope of practice, and not be sued blind.

Further – we can’t have a double-standard. Within medicine there is a pretty clear consensus as to what the scientific standard is. It is slowly evolving, if anything becoming more stringent as we root out more and more subtle ways of subverting best scientific practice. CAM as a category exists to weaken this standard, or to create a double standard for themselves so that practices that are not science-based can be taught, used, and covered. But (I hope) CAM is starting to be the victim of their own success, in that as they have successfully promoted CAM it is necessarily coming more and more into the light. As it does it is getting easier to expose CAM for the utter nonsense that most of it is.

Groups like those mentioned above are starting to form – comprised of health care professionals who have bothered to look and see what is happening.

22 responses so far

22 Responses to “Science, Medicine, and Academia”

  1. daijiyobuon 23 Jan 2012 at 12:31 pm

    Re: “simply naive to the situation”…

    I pose that higher education has placed too much emphasis on volume-of-content and its reproduction [drones!], instead of critical thinking and what I’ll hazard to label ‘quality of epistemic methodology’. We are merely seeing the outcomes in that system in the present “academics and health care professionals” mannerisms.

    As a teacher, it’s quite a conundrum: I have specific factual content and national exam performances I have to spend my time with students toward, and therein the ‘remedy’ is quite earlier on in the process of curriculum authorship and all I can do is some marginal representation of something more reflective and comparative.

    And it is unfortunate that the written-communication academic areas — like Literature and English — in this country at least, presently don’t have much care for science and its utility.

    Post-modernism, and kind, are quite hostile to science, and the volume-of-content demands leave science often as merely memorization and not a more reflective methodology.

    -r.c.

  2. BobbyGon 23 Jan 2012 at 2:02 pm

    @daijiyobu-

    “I pose that higher education has placed too much emphasis on volume-of-content and its reproduction”

    See Weed & Weed, “Medicine in Denial.”

  3. PharmD28on 23 Jan 2012 at 3:09 pm

    A physician that a know a bit at my facility, before I knew that he was “pro-CAM” – we got to talking about the topic just a bit…his opening statements were something to the degree of “well, 90% of what we do is not evidence based”……

    Oh, ok, sure, then my pointing out that X strategy is not evidence based is no different than any ol’ treatment we use….??? What a load of crap.

    I have said this before, but I have had something like 4 occurrences of this in the past year – it all starts with me discussing with a patient or someone a bit of a CAM apologist friend or something…I will make my points, and keep coming back to a lack of data, or pointing out data that is negative data…and of course they bring up anectdotes and I talk about that for a bit…and eventually, OUT OF NOWHERE, I am asked if I am religious….I swear this happened just last week with a patient of mine…it happened 2 months ago in talking with a couple about vaccinations for their child – again out of nowhere with no mention of religion AT ALL…and about 5 months ago it happened with me talking to a pharmacy student….

    Once some of these folks figure out that you are unwilling to step away from evidence based medicine for even a moment…they figure you are “not religious”….

    I guess you need to have faith to be a proponent or a CAM apologist….faith in a god is one thing…faith in homeopathic medicine is another thing….

    _______

    I think Dr. Novella this is a great post…I had to do this with the parents about vaccines a month ago…it actually went pretty well I think….she had some crap book like “things your doctor wont tell you about vaccinations” – author was something stone…forgot now, but anyway…I opened up the book, and went to the chapter on thiomersal….and before reading it…I asked her what sort of evidence should this author cite to support the theory that this substance has been causitive for autism….she had before stately vaguely that there was evidence to such effects…and she could not recall the details of the citations, but “they were there”…well, we read through the highlights of the chapter, and at the end of the chapter there were a list of references…within them were 2 studies…one was some strange sounding observational small study…the other one involved levels of something or the other in monkey brains….I asked her if she thought that this data cited was “robust” to support this conclusion…and also asked her why this author did not feel the need to address the published other research, all like 18 studies that compel one to come to the conclusion that it is in fact NOT causitive….

    Luckily she was not dye in the wool about it all….and I think much of what we talked about sunk…but I think you are absolutely right…before the debate on such matters starts…one has to establish the standard of how we will base our conclusions!! Of course, I have tried to do this in conversations and it has been total failure from the get go with denialists…ugh. And of course in such instances I am just a “sheeple”

  4. ccbowerson 23 Jan 2012 at 4:01 pm

    PharmD28-

    If you have any “compounding pharmacies” in your area, you can usually hear a lot of mental gymnastics for rationalizing (and often promoting) the types of non-evidence based products often made there. I have heard some commercials where I live that are downright painful to listen to.

    “faith in a god is one thing…faith in homeopathic medicine is another thing…” Hmm. At least for some those things are probably not that different from each other.

  5. nybgruson 23 Jan 2012 at 6:50 pm

    At least for some those things are probably not that different from each other.

    Bingo!

    As for myself I am currently in a protracted discussion about good vs bad science with a student a year behind me. I don’t have time to get into all the details now, but I feel that my experience lends significant creedence to dajiyabou’s comment. He seems incapable of understanding things like the notion of “tooth fairy science” (as coined by Dr. Hall and explained by me), nor that what question one asks is just as vital as the methodology one uses to answer it.

    I’m actually starting to get exasperated and feeling a bit defeatist since his mentality – all well intentioned of course! – is precisely what is allowing such an abundance of bad science to go unchecked and often unnoticed. I’ll check back here tomorrow and see what others have posted and perhaps add in a bit more. Now, time to go to a free NBA game gratis my clinical institution 😀

  6. ccbowerson 24 Jan 2012 at 10:54 am

    Nybgrus –

    The connection that I’ve notice that some (many?) people connecting religious belief/faith and pseudoscience is the idea/ comment I’ve heard: “Don’t you just believe in anything?!” The answer is no, but I usually provide an explanation since simply “no” might be misleading for some people.

  7. PharmD28on 24 Jan 2012 at 10:55 am

    an update as it relates….it turns out the couple that asked me about vaccines, went on with some form of alternative vaccine schedule “one at a time”…and she re-iterated that she still “had concerns” despite my “logical and persuasive argument, and that of her pediatrician as well”….not sure about the schedule…I think at this point she is going to do what she is going to do…once those anti-vaxxers get the fear into these parents about aborted fetuses, autism, adhd, mental retardation, the evidence seems to matter much less…at least it “appears” as though they will get all of the vaccines…why on earth they feel this alternative schedule is helpful and not potentially harmful is beyond me….its absurd.

    Lately I have wondered if it is a form of egotism/pride…something like “well I have done all of this research, I read this book, and spoke with alot of people about it, I know there is evidence to support these concerns…”

    It cant be that they are just wrong…no it must be as Dr. Oz said to Dr. Novella – “that mainstream science just can’t seem to get its arms around it [reference to CAM]”…..special pleading to again blindly protect the ego despite otherwise being an illogical non-evidence based position…sigh.

  8. PharmD28on 24 Jan 2012 at 11:10 am

    “At least for some those things are probably not that different from each other.”
    yeah, I know…to me it is indeed the same as the tooth fairy, easter bunny, santa clause, and yeah, CAM lol – but I guess I was being a bit genourous in distinguishing a bit as I am pretty sure there are also many? that “appropriately” compartmentalize the two…

    @ccbowers – yeah, exactly – I did not see it coming to be honest….I am still not entirely sure how to handle this angle going forward best…

  9. nybgruson 24 Jan 2012 at 12:02 pm

    “Don’t you just believe in anything?!” The answer is no, but I usually provide an explanation since simply “no” might be misleading for some people.

    I think you’ve hit the nail on the head. Even people distinctly more rational than the average person (I know, not saying terribly much there) often harbor a belief that they will refuse to get rid of. Converse with them on any other topic and they will employ graceful logic and elegant application of evidence and even – -=gasp=- – change their minds. But hit that one topic of belief and the reaction is like talking to a creationist.

    And of course, for those whom belief rather than understanding predominates their worldview it is simply incomprehensible that someone (such as myself) could never just believe in something. Of course, I suppose that is fair, since it is equally (perhaps more?) incomprehensible to me that someone would genuinely “just believe” in anything.

  10. ccbowerson 24 Jan 2012 at 1:23 pm

    “But hit that one topic of belief and the reaction is like talking to a creationist.”

    I think you are describing a situation in which a person has a commitment to an ideology, which results in a suite of ‘thinking problems’- motivated reasoning. Its a hard nut to crack, because individuals are often unaware of their own biases in this regard, even skeptics who try to be intellectually honest in other areas

  11. BobbyGon 24 Jan 2012 at 2:02 pm

    @ccbowers –

    Indeed. See Daniel Kahneman’s new book “Thinking, Fast and Slow.”

    Also, the Sperber / Mercier paper “Why Do Humans Reason?” is excellent. (Why? To win the argument, not to get at objective truth.)

    Also highly recommended, Kathryn Schulz’s “Being Wrong: Adventures in the margin of error”

  12. BillyJoe7on 24 Jan 2012 at 3:43 pm

    “motivated reasoning. Its a hard nut to crack”

    Maybe it will help to give it that name – Motivated Reasoning – and then defining or explaining what that means: starting off believing something (because you dearly wish to be true) and then finding all the reasons to continue believing it is true (because you dearly wish to be true) whilst denying or ignoring all the reasons why it might be false (because you dearly wish to be true).

  13. sonicon 24 Jan 2012 at 4:21 pm

    PharmD28-
    When they ask about you being religious– are they being sarcastic?
    Sometimes a person being didactic (and it sounds like you get that way) comes across religious is why I’m asking.
    I will have more time later– drats!

    ccbowers-
    In the past it seems you and I start at seeming odds, but upon further discussion I agree with you more than it seemed at first.
    When someone says they ‘don’t believe anything,’ I think the person is delusional beyond most.
    You mentioned that your statement requires some further discussion.
    I would like a bit more.
    It is an area that I find distressing (people who claim to believe nothing, I mean).
    Anyway- your further explanation would be greatly appreciated.

  14. ccbowerson 24 Jan 2012 at 4:56 pm

    “Maybe it will help to give it that name – Motivated Reasoning”

    Sure, it may help to identify a phenomenon, but of course motivated reasoning would make the term ‘motivated reasoning’ something other people do when they disagree.

  15. ccbowerson 24 Jan 2012 at 5:06 pm

    sonic –

    I think removing the word “just” from what I wrote changes the meaning too much. I am quoting a hypothetical person (based upon actual people) who is putting forth a “belief” that either has no evidence or has evidence against it. Its this senario, I do not want to just believe because I wish it to be true. That is not to say that I am impervious to doing so, but if I catch myself doing such a thing… I attempt to correct my thinking, while this hypothetical person sees no reason to do so

  16. PharmD28on 24 Jan 2012 at 5:27 pm

    @sonic…

    no I do not think that in any of the cases I specified, including this most recent one about the vaccines, did they mean to be sarcastic…in the most recent case..he went on to qualify why he said that…that “only looking for evidence [for various truths] can lead to bad things”…..

    regarding “believing in nothing”…I think? this was a reference to responding to the likely underlying question(s) intended from the believer just discovering the friend/colleague that turns out to be atheist: “do you believe in a creator, a higher purpose or order? or will you “believe” in something at times that simply has no evidence to support that belief?….my response (and I only assume ccbowers response) is “no”…I simply rather do not like the word believe! What does it mean? It carries all sorts of implications when you state it…I rather like ccbowers use of the word “understand”…Dawkins in his book “the greatest show on earth” (just finished it) made this point (as Im sure others have)…that its awkward to say “I believe in evolution”…rather “I understand the evidence of evolution”…believe implies all by itself a sort of leap of faith with less than stellar evidence to support the claim….hopefully I am not off base…

    Anyway…I suppose this all points out the foundation of figuring out what we know and what we do not know, and being critical of what we think we know in an evidence based manner…that indeed is a challenge up front before proceeding with these folks…

    Thanks for the reading recommendations…Ill have to check those books out…

    I keep seeing this book pop up in my various reading “how we know what isn’t so: The Fallibility of Human Reason in Everyday Life….anyone read it…is it worth reading?

  17. BobbyGon 24 Jan 2012 at 8:46 pm

    “I keep seeing this book pop up in my various reading “how we know what isn’t so: The Fallibility of Human Reason in Everyday Life….anyone read it…is it worth reading?”
    __

    Yes. I have all of such books, and have read them. That one (#20 on my list) is worthy.

    http://vegasboomer.blogspot.com/2009/11/book-research-citations.html

  18. sonicon 24 Jan 2012 at 11:08 pm

    ccbowers-
    You are right- leaving out the ‘just’ does change meaning.
    To believe something has numerous meanings– all the way from ‘firm religious faith’ to ‘suppose’.
    I think what you are talking about is ‘blind faith’– as in “I just believe it- don’t talk to me about facts…”
    Does that seem about right?
    And it is true that some find faith to be its own reward. Or so I’ve heard.
    BTW- I’ve noticed that about ‘motivated reasoning’ myself.

    pharmD28-
    I have never seen a double blind experiment to discover if firing a loaded shotgun into one’s mouth will cause death- have you?
    See, just looking for evidence could be problematic. 😉

    “I believe the Giants beat the 49ers this last week,” is a good use for the term.
    “I believe that if there was a rematch the 49ers would win,” seems good to me too.
    (Motivated reasoning perhaps, but I believe you know…)

    In my experience people have reasons for what they believe. The reasons might seem irrational or whatever, but there is a reason (“If I admitted my doubts about the church my wife would leave me,” might be an example- and yes, I’ve known people like that).
    Why would it be better to have the vaccines given over time? could lead to many interesting answers including– ‘well obviously if you shot someone with enough stuff there would be problems.’ (An idea I’ve heard and had to agree with).
    But now with that reason exposed we can ask– is the schedule the doctor recommended too many at once? and this leads to an evidence based inquiry.
    (Just an idea).

    Of course there are always people who will stick with the program regardless of the evidence.
    And as I pointed out before- the claim that faith is its own reward is one that I can’t argue with– as I don’t have enough evidence to determine the truth of that… 🙂

  19. PharmD28on 26 Jan 2012 at 12:36 pm

    @ccbowers

    Yes, exactly, well, I did cite to them a couple studies I found about this concern of “too many at the same time”…and the evidence does not support this conern as it relates to the CDC’s vaccine schedule….The CDC and the AAP’s website both discuss this issue within their patient information and describe the reasoning plainly….

    Now ask me if pointing out the evidence contrary to this “one at a time” schedule (whatever that means exactly and in what order I dont know) had on their decision…as well as the pediatrician re-inforcing the same talking point and evidence? Nada. Once the anti-vaxxer fear sets in, they feel the need to listen to both sides of the story, no matter the evidence…or so it appeared in this case…at least they are getting the vaccines…I think…

  20. PharmD28on 26 Jan 2012 at 12:45 pm

    I think after you read such a book as this one written by this Stephanie Stone that spends all of it’s pages shamelessley ignoring the evidence and only building up boogy men to scare average people with “oh so concerning sounding issues that you’re doctor does’nt want to tell you about”…the whole premise of the book is to break down confidence in your pediatrician, the person you should expect to offer you a meaningful expert opinion of the complicated information at large…”

    Some part of me hopes that once they are over this vaccine thing…that going forward they will be a bit more skeptical about such content moving forward after our discussion….sounds like motivated reasoning to prop up my ego eh? lol

  21. sonicon 26 Jan 2012 at 1:54 pm

    PharmD28-
    I haven’t read the book- so I’ll just take your word for it.
    Some people are harder to reach than others.
    Take me, for example 😉
    Don’t forget to count your victories as well as loses.
    Good luck.

  22. nybgruson 26 Jan 2012 at 9:31 pm

    have never seen a double blind experiment to discover if firing a loaded shotgun into one’s mouth will cause death- have you?
    See, just looking for evidence could be problematic.

    I know this was tongue-in-cheek sonic, but completely and utterly off base. Double blind RCT is not the only form of evidence. It is along that line of the “paper” written to the same effect regarding parachutes and skydiving. It is an inane attempt to demonize methodolatry – which is something that actual scientists (at least good ones) never do. There exists mountains of evidence that firing a loaded shotgun into your mouth will cause death. The fact that it doesn’t come from an RCT is a straw man that is used by many pseudoscientists and sCAMsters as a way of saying, “It’s so obvious that my woo works, why would you need an RCT.”

    I realize that wasn’t exactly your point, but it is such a poor analogy to draw that I think it should not be used, even tongue in cheek.

    And as for the “just believe” point – yes, it is exactly as ccbowers stated. There are indeed things I “just believe” – the majority because I don’t realize it, and many because I don’t care enough and it isn’t important enough to really find the evidence for it. However, in discussions where the latter comes up I always make it a point to preface my statements as such. And in the former, if I ever learn otherwise, I am quick to change my “belief” to and “understanding.”

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