Sep 26 2013

The Pharma Shill Gambit and Other Nonsense

Those of us who have been writing about science and medicine for a few years or more quickly experience the fact that there is a subculture of people who are greatly hostile to our message. In addition, they tend to use the same fallacious arguments against us over and over again, as if they are reading from the same script.

As a result we answer the same bad arguments repeatedly, at least so that those who are paying attention will be more prepared to deal with such arguments themselves. Earlier this week Harriet Hall wrote an excellent post over at Science-Based Medicine in which she answers 30 common fallacious arguments against SBM.  The next day I received a comment here that parroted some of the same arguments yet again.

I have addressed these common anti-SBM arguments multiple times, mostly in piecemeal, so it’s good to have Harriet’s post as a sort-of SBM FAQ. Before you leave a critical comment, read the FAQ.

Here is the comment, which I will dissect, adding to Harriet’s analysis.

Clearly the Mayo clinic is run by a bunch of quacks and charlatans that have no interest in the health and well being of the public. How dare they even consider something other than surgery or prescription medication to help people heal. More and more I am getting the feeling that articles like this are by fronts for the pharmaceutical companies. This article is clearly written out of fear; fear that there are ideas and practices out there that you don’t understand and your only resort is to lash out against those ideas. In this case you are attacking one of the most respected medical institutions in the world. Do you, mr. author, perhaps think that maybe you are the one that doesn’t get it?
As far as I can tell the premiss being put forth by the author is that doctors should be the ones that tell their patients how to feel. Ms X has had back problems for years, gets some acupuncture then feels better. According to this article an act of fraud as been committed and her doctor should tell her so. Why? By the way Ms.X your pain didn’t go away you just think it did!
My daughter and I suffer from ‘hay fever’ allergies in the spring. I give her those little white sugar pills knowing full well there is no ‘real’ medicine in them. 15 minutes later symptoms gone she feels better. The over the counter solution has terrible side effects that effectively ruin her day. Why choose the poison? What is your point? People should only feel better if YOU say it is ok.
So what is your point? Why publish articles like this when they serve no real purpose. Is it preaching to the choir so that you get a enough hits on your blog so you keep your job? Many people die every year at the hands of incompetent doctors, and the latest big pharm fad.
How many die from acupuncture or sugar pills? I understand meditation helps clear the mind. Maybe you could try it and come up with a helpful article. Get a doctor to prescribe it for you if makes you feel better.

“How dare they even consider something other than surgery or prescription medication to help people heal.”

This comment is based on the false accusation that mainstream medicine only prescribes drugs and surgery. No doubt these are major treatment modalities of science-based medicine, because they work, but we are not limited to them. Every day I prescribe or give a referral for diet, physical therapy or exercise, specific vitamins for insufficiency or deficiency, lifestyle changes, electrical-based interventions, or counseling. Whatever is supported as safe and effective by plausibility and evidence, I will use.

“More and more I am getting the feeling that articles like this are by fronts for the pharmaceutical companies.”

I wonder where that feeling comes from. Perhaps confirmation bias. It’s nice to just assume that someone you disagree with is lying or biased. It removes the burden of trying to understand and address their actual points. You can then erect a convenient straw man and tilt at it to your heart’s content.

For the record – NeuroLogica, the NESS, SBM, the SGU, or any of my social media outlets are not supported in any way by the pharmaceutical industry. I have zero ties to “Big Pharma.” My efforts are mostly member-supported, with some ad revenue thrown in. I make no money off of my blogs, and they are part of the NESS, which is a non-profit educational organization.

“ This article is clearly written out of fear; fear that there are ideas and practices out there that you don’t understand and your only resort is to lash out against those ideas. “

Another convenient straw man assumption. Anyone who has read this blog or SBM to any extent would soon realize that I have a very deep understanding of the ideas and practices that fall under the big umbrella of CAM. I have published peer-reviewed articles on both acupuncture and homeopathy, and many articles as part of a working group that examines unconventional treatments for ALS.

This is not about fear. It’s about defending a single consistent standard of science, evidence, and ethics in the health profession. CAM is all about producing a double standard, lowering the bar for evidence and even common sense for preferred therapies.

“ In this case you are attacking one of the most respected medical institutions in the world. Do you, mr. author, perhaps think that maybe you are the one that doesn’t get it?”

This is nothing but an argument from authority. I know Mayo Clinic is highly respected, as I wrote at the very beginning of my article. That’s why it is so tragic that they are allowing their good name and reputation to be used to shill for pseudoscience and quackery.

This is politics. They have been sold a bill of goods and do not have the expertise to recognize the subtle deception. They have handed decision-making over to people who present themselves as the experts, but who are really industry proponents. While I respect Mayo Clinic generally, this is an institutional failure, one that most academic institutions have fallen for.

As for considering that perhaps I am missing something – that is always my default assumption until I have examined an issued with sufficient depth to feel that I have a solid grasp on it. You should try it.

“As far as I can tell the premiss being put forth by the author is that doctors should be the ones that tell their patients how to feel. “

This is simply wrong, and has been addressed multiple times (this is another common straw man). This is not about not believing patients, or telling them what they experience. It is about how to interpret their experience. Anecdotes are tricky because, by definition, there is no control of variables. Which variables led someone to feel better after a treatment – regression to the mean, the self-limiting aspect of the illness, expectation bias, another simultaneous treatment, simple coincidence, or a specific treatment effect?

Even when I prescribe a treatment for a patient and they come back and tell me their symptoms are better, I do not assume that my treatment made them better. There is no way to know for sure with an individual patient. That is precisely why we need large rigorous trials to control for all those variables.

“My daughter and I suffer from ‘hay fever’ allergies in the spring. I give her those little white sugar pills knowing full well there is no ‘real’ medicine in them. 15 minutes later symptoms gone she feels better. The over the counter solution has terrible side effects that effectively ruin her day. Why choose the poison? What is your point? People should only feel better if YOU say it is ok.”

Again, placebo medicine is a very tricky concept. First, I have to wonder if her symptoms would be gone in 15 minutes if you gave her no intervention, or if there is reporting bias involved. Perhaps simple reassurance and attention would be enough, without the placebo. This is simply a “kissing the boo boo” effect – no one has argued against this, or for medication when it’s not necessary. I do think that deception is problematic, but this is a complex issue. Perhaps you can read one of my many other articles on placebo medicine if you truly wish to understand my nuanced position.

“So what is your point? Why publish articles like this when they serve no real purpose. Is it preaching to the choir so that you get a enough hits on your blog so you keep your job?”

This blog is a hobby, not my job, and I make no money from it. I don’t think impact is solely measured in hits either. The point is to explore science and critical thinking in the context of topics of interest to the broad public (you could have clicked the “About the Author” button if you were really curious).

“Many people die every year at the hands of incompetent doctors, and the latest big pharm fad.”

This is the “death by medicine” gambit that we have also covered extensively. Many people also die from lack of proper medical treatment, often at the hands of so-called CAM practitioners. When considering any medical intervention you have to look at risks vs benefit – not just risks. The evidence clearly shows that modern medicine saves many more people than it harms, and we are always looking for ways to reduce and avoid harm. The way to do that is with science – not wishful thinking and mindless propaganda.

“How many die from acupuncture or sugar pills? I understand meditation helps clear the mind. Maybe you could try it and come up with a helpful article. Get a doctor to prescribe it for you if makes you feel better.”

Acupuncture? Here are some cases (and here), and here is a published study. The risk from acupuncture is small but significant. Given that there is no proven benefit, that is too high a risk for me  - again, you have to consider risk vs benefit.

Sugar pills? That is more difficult to measure, as there is no direct harm. Indirect harm, however, can include instilling bizarre health beliefs that lead to avoiding effective treatments and reliance on ineffective treatments. Again, I refer you to What’s The Harm for a long list of what can happen when you believe in placebos.

Conclusion

E-mails and comments such as this are a daily occurrence. They are the result of not thinking carefully about one’s arguments, making knee-jerk self serving assumptions, and not even bothering to understand the position or the person against which you are arguing. It is intellectually lazy.

Hopefully it will serve as a cautionary tale – think before you comment.

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28 responses so far

28 Responses to “The Pharma Shill Gambit and Other Nonsense”

  1. locutusbrgon 26 Sep 2013 at 9:39 am

    So frustrating how effective these gambits are. The countless deaths from laetrile, antineoplaston, or chronic lyme treatment et al. All the proponents use these gambits extensively. Yet somehow they get a pass, it’s ok to kill people if you are telling people what they want to hear. My personal favorite is when the chronic lyme proponents use the big pharma shill gambit. I mean, because drug and medical device manufactures hate to sell IV supplies and antibiotics right?

    Common deceit tactic if you have no evidence and no argument attack the messenger.

  2. ccbowerson 26 Sep 2013 at 9:58 am

    “In addition, they tend to use the same fallacious arguments against us over and over again, as if they are reading from the same script.”

    It reminds me of how the internet is not just a place that allows for the easy transfer of information, but this information is clustered, which allows for an echo chamber effect. These small clusters can create their own ‘facts,’ and ideas that would have been urban legends in the past get passed around to a much higher level.

    Because most people do not fact check everything they here (skeptics aside) when a person encounters an idea repeatedly, they tend to lend it legitimacy whether it is warranted or not. This results in many people within that cluster believing the same things, which are a mix of truth and fiction. I think it is also important to remember that many of these topics are specialized ones, and the average person does not have the knowledge to properly and fully evaluate each topic. That is one reason why critical thinking is important because it cuts across topics, and it can allow an individual to better evaluate information in topics for which specialized information is not needed.

  3. oldmanjenkinson 26 Sep 2013 at 11:42 am

    How I see alt med apologists:

    AltMed: If A then B. A therefore B

    Medicine: What is your evidence?

    AltMed: Strawman! Ad hominem! Circular logic! Wash, rinse, repeat.

    http://upload.wikimedia.org/wikipedia/commons/a/a7/Graham%27s_Hierarchy_of_Disagreement1.svg

  4. acm37on 26 Sep 2013 at 12:21 pm

    Hi Dr. Novella — I’m an MD/PhD student at your school, currently working on my neuroscience PhD. It’s been amazing how many bizarre conversations I have had since starting med school with family members and friends that show terrible misconceptions about how their body works. Granted, that isn’t their field, so I totally understand why — but your writing has been really helpful in allowing me to have tactful, sensible conversations with them about why certain things work and why other things may not.

    I appreciate it and will continue to follow! Work like this helps me construct better arguments against the crazy…

  5. jim barclayon 26 Sep 2013 at 12:52 pm

    These people baffle me…your argument is so bulletproof its astounding that anyone wouldn’t be swayed by reading it

  6. BillyJoe7on 26 Sep 2013 at 4:46 pm

    acm37: “… since starting med school with family members and friends”

    You and your family and friends must be a talented lot (:

  7. tmac57on 26 Sep 2013 at 8:42 pm

    Sadly,it is not just that we are living in a world of alternative ‘medicine’.

    It is now very clear to me that we are living in a world of alternative ‘facts’.

    Social media has clearly exposed the dark recesses of what comes from the manipulation of the frailties of human cognition.

    Maybe I am too pessimistic,but I don’t see that rationality is winning the day.

    I hope that I am wrong.

  8. Brad Smithon 26 Sep 2013 at 11:06 pm

    I see the same types of arguments made not just by CAM proponents, but by those belonging to the anti-GMO, anti-Vaccine, climate change deniers and conspiracy theorists. It’s exactly the same type of rhetoric and fallacious arguments that get repeated time and time again by all of those groups.

    The pattern of it all is absolutely astounding.

    tmac57: Spot on. My friends back home had never really been interested in skepticism, or the position from the other side. It wasn’t until I moved to Oz and met another Brit (who has incidentally become my best friend) that I realized how widespread all this misinformation actually is. He was constantly liking and commenting on all the anti-GMO, anti-Monsanto, Sandy Hook/911 conspiracy theory and other wacky Facebook pages. Thankfully, I managed to change his mind on a few issues by writing some blog posts for him.

    The internet is an amazing place in which information can be retrieved, but we have to approach absolutely everything with at least a little bit of skepticism if we are to sort the truth from the utter crap.

  9. Kawarthajonon 27 Sep 2013 at 4:17 pm

    It seems as though many of the people who write in to complain about your writing, Steve, are quite angry about what you have written and are quite passionate about their opposing point of view, regardless of how ridiculous their logic can be and how solid your arguments are. I have faced a very small version of that in my community, where I have criticized local council members who are promoting pseudoscience about wind turbines. I must say, I was taken aback at the ferocity of my opponents and I only had to experience this about one, small issue.

    I must say, I am impressed with how logical and calm you continue to be, regardless of what nonsense is written about you (i.e. btw, are you going to be eating babies for thanksgiving again this year? Or was it Christmas?). You do not respond to their emotional ferocity in kind, which makes you incredibly frustrating for your opponents, but also makes you an excellent advocate for logic and science. I know that I would not be able to maintain my calm under the pressure that you face! I’m not sure how you do it, but I appreciate your work.

  10. skeptasmicon 28 Sep 2013 at 6:04 pm

    I’d just like to say that I really dislike recommending people use the “What’s the harm” website as a reference. It’s not that the stories are anecdotal and unscientific. I do understand that sometimes anecdotes are the best way to get through to people, and I originally thought the website was a good idea.

    But in categories such as “evolution denial” and “moon landing denial” the harm listed is people getting attacked for their views. It seems like they are implying that people should change their controversial views to avoid being attacked, or even that these people deserved to be attacked for their beliefs. The message seems to be the exact opposite of what the website was designed to promote: forget the scientific evidence, some passionate vigilante scientists are going to injure you if you don’t change your views. How does this promote critical thinking? If they put these examples forward as examples of the harm of believing in creationism, what does that say about the harm of being homosexual/transgendered?

    Furthermore, how can you accuse anyone else of cherry picking examples when you use this as a reference? I can’t find any statistics, but I doubt that there are more people attacked for believing in unscientific views than there are for believing in scientific ones.

    I have written the website asking about these statements but have received no reply. Given that 1/4 of the links on the site seem to be dead, I don’t think the website is maintained anymore.

  11. sonicon 30 Sep 2013 at 12:46 pm

    In the interest of furthering understanding, I will attempt to explain why part of this response might be unacceptable to some outside the medical profession. Perhaps this will help make it possible to address this attack in a manner that will cause it to cease.

    I have had it explained to me this way (I left out a few curse words)—

    Every time I turn on the television, I am told “Ask your doctor… See your doctor…”
    These ads run over and over– I’m told to ‘see my doctor’ every few minutes during the sporting events that I watch.

    The companies spending the large amount of money to run those ads are directing me to the dealers of their products. “See your Ford dealer today,” is another example of this phrase in action.

    I don’t go to the Ford dealer expecting him to tell me how the other cars are better- and I expect that even his most honest opinion is colored in favor of his brand.

    When a doctor claims ‘no ties to big pharma’– oh my…

    Well, the drug companies are spending billions of dollars telling me to come see this guy. I’m pretty sure the manufacturer is sending me to his salesman with the pitch I hear on TV over and over.
    So is this guy claiming he doesn’t know he is a salesman for the drug companies? He has to know he is. Nobody smart enough to be a doctor could be that stupid.

    Is he claiming that he is not influenced by the people spending billions of dollars on his behalf?

    At this point I’d like to point out that when it comes to trying to understand a person’s motives, ‘Follow the money’ is a basic investigative technique people seem to use instinctively.
    I often read that someone who takes money from an oil company shouldn’t be trusted about AGW, for example.

    Anyway, that’s the way this situation has been described to me.
    I hope this explains why this keeps coming up–

    And I hope this helps to make it possible for a communication to occur so that this particular attack can be addressed in a manner that will cause it to cease.

  12. SteveAon 30 Sep 2013 at 2:45 pm

    Sonic: ““Ask your doctor… See your doctor…”

    Drug companies make drugs. Doctors prescribe drugs. Who else should they be telling people to go to? The local bishop? Their mailman?

    The argument presupposes that a doctor, pharmacist or any other medical professional will ‘follow the money’ to the exclusion of every other consideration, the welfare of their patients for example. Is this the real world? No, it’s not.

    The argument also ignores the fact that many drugs are marketed in competition with each other. Doctors are not car dealerships. Doctors are not tied to brands or companies. Unless we think that medical professionals are simply money-grubbing hacks who somehow auction their services to the highest bidder. Again. Not the real world.

  13. sonicon 01 Oct 2013 at 1:40 am

    SteveA-
    I think the problem is that the claim of ‘no ties…’ seems obviously false.
    Without drugs, doctors wouldn’t be nearly as valuable as they are. And the drug companies do spend billions directing people to doctors.

    There is a big difference between being a shill and having ties.
    But the claim of ‘no ties…’ is exactly what one expects from a shill.

    Perhaps this helps explain the perception.

  14. Bruceon 01 Oct 2013 at 5:10 am

    Sonic,

    You have two major issues with your reasoning:

    Firstly: Steve Novella has often said he has no ties to Big Pharma. I guess that means he is a shill?

    I have no ties to big pharma either… that must make me a shill. How about you? I bet you would say you have no ties to big pharma, does that make you a shill too?

    Secondly: What do you define as “no ties”? If I buy a drug made by one of the companies, does that mean I have no ties? What if I give that drug to my son, or tell my mother-in-law to buy it because it works? Does that mean I have ties? What happens if my wife works for the company? What if my cousin works for the company? What if my cousin’s room-mate’s dog’s mother’s owner works for the company?

    I think it is implicit when people say they have no ties to the company that they are saying they are not a shill and their only contact with the drug or company will be incidental and not influential in them promoting the product in any way.

    You are arguing semantics which is really quite tedious.

  15. sonicon 01 Oct 2013 at 1:00 pm

    Bruce-
    A shill is defined this way-
    A shill is a person who publicly helps a person or organization without disclosing that they have a close relationship with the person or organization.

    So the claim of ‘no ties’ is exactly what one expects a shill to say– that’s part of what makes them a shill.
    People who do have a relationship with a business and disclose this fact are called ‘associates’ or ‘spokesmen’ or ‘in the same business’ or other- depending on the actual relationship.

    A tie is something that-
    brings together in relationship; connects or unites

    There is a relationship between the drug companies and doctors. Drug companies make discoveries and new products that make the doctor more able to help a patient– making the doctor’s treatments more effective and valuable. Drug companies spend billions advertising for the doctors.

    And doctors keep up with what the drug companies have available so they can prescribe the best.

    I am not saying this relationship is evil or wrong or that any specific doctor is unduly influenced by the drug companies (although some doctors are- right?).

    But when someone who obviously has ties to an industry claims ‘no’.. well, that is shill behavior, plain and simple.

    I really do think this is a problem in perception.

    I’m beginning to think the problem lies at least partly with a doctor who doesn’t know he has ties to ‘big pharma’.

    Perhaps this conversation needs to continue…

  16. Hosson 01 Oct 2013 at 3:11 pm

    Sonic
    http://www.thefreedictionary.com

    tie (t)
    v. tied, ty·ing (tng), ties
    v.tr.

    5. To bring together in relationship; connect or unite: friends who were tied by common interests; people who are tied by blood or marriage.

    shill (shl) Slang
    n.
    One who poses as a satisfied customer or an enthusiastic gambler to dupe bystanders into participating in a swindle.
    v. shilled, shill·ing, shills
    v.intr.
    To act as a shill.
    v.tr.
    1. To act as a shill for (a deceitful enterprise).
    2. To lure (a person) into a swindle.

    I find it very interesting that you chose to use thefreedictionary.com as a source for the definition of tie, but you decided to make up your own definition for shill to prove your point. I don’t have enough evidence to claim that you did what I’m suggesting with certainty, but I think it’s probably the case.

    Reductio ad absurdum has demonstrated that your position is false in Bruce’s previous comment.
    You want another example…I’m happy to help.

    “A tie is something that – brings together in relationship; connects or unites”
    “A shill is a person who publicly helps a person or organization without disclosing that they have a close relationship with the person or organization.”
    Big Pharma makes pharmaceutical drugs
    Some people use pharmaceutical drugs
    Pharmaceutical drug users fiscally help Big Pharma
    There is a relationship between the pharmaceutical drug user and pharmaceutical drug maker
    People who use pharmaceutical drugs have ties to Big Pharma
    Some pharmaceutical drug users publicly tell others how drugs help them
    Pharmaceutical drugs users who publicly tell others how drugs help them and who don’t disclose their ties to Big Pharma, are shills

    *slow clap*

  17. Mlemaon 02 Oct 2013 at 5:48 am

    I wonder if one reason behind these sorts of attacks is that Dr. Novella hasn’t really ever turned his skeptical eye to the problem of big pharma and how it influences research, medicine and academia. I respect his integrity as a physician, and I happen to know that lots of docs don’t really like patients coming to them, asking for drugs because they saw an ad that made them believe that they might be in need of a certain drug to improve their lives. I’m thinking of a cholesterol drug, not shown to reduce stroke or heart attack, but advertised as “getting your numbers where you want them”. The docs don’t like that the drive to develop and market profitable drugs often puts their patients at risk. More than a few doctors find themselves disillusioned when a drug marketed to THEM turns out to be a bad one, having trusted the industry and regulators to ensure their safety. Also, medicines for less-profitable but more real illnesses are unattractive to developers.

    I have no doubt that Dr. Novella has an appropriately critical attitude toward the problem, but he doesn’t really talk about it because he finds he must defend the pharmaceutical industry in general, against the attacks of those who would say that the whole thing is evil? Just a thought.

  18. sonicon 02 Oct 2013 at 2:58 pm

    Hoss-
    I used the wikipedia for the definition of ‘shill’.
    (when I google ‘shill’ that’s what comes up first and it seems appropriate.)

    I would agree that if someone claimed a drug helped them and at the same time claimed they had no interest in or relationship with the company that made the drug that person would either be:
    a) misunderstanding what it means to have a relationship
    b) acting as a shill would
    c) both a and b.

    Don’t you agree?

  19. Hosson 02 Oct 2013 at 4:42 pm

    Sonic

    “A shill is a person who publicly helps a person or organization without disclosing that they have a close relationship with the person or organization.”

    You’re not analyzing the nature of the relationship at all. All you’re doing is establishing a thin relationship(although any type would do) and applying the rest of the definition. The way you’re using definitions there is no such thing as an independent consumer or independent advocacy.

    Also you really need to add deceit to the definition of shill you’re using, which I think is one of the important defining attributes of shill.

    I’m surprised you didn’t recognize my previous example as being absurd, which I thought was obvious.
    Person uses a pharmaceutical drug
    Person tells friends the awesomeness of pharmaceutical drug without any detail about the consumer producer relationship
    Person, by your usage of the definition, is a shill

    The loose usage of the word shill you’re using(which is different from the definition you gave) makes you apply it to people who are not shills.

  20. sonicon 02 Oct 2013 at 10:23 pm

    Hoss-
    I’m laughing out loud– I just thought of this–

    All we have to do to prove we have no ties with something is to stop using it completely.
    Let’s make it illegal for doctors to prescribe drugs– we’ll let the drug companies hire people to do that directly– and they can’t hire any MD’s.

    Still think ‘no ties’? (I think this is a terrible idea- I bring it to make the point).

    Understand– I am not saying that doctors in general or that Dr. N. specifically are shills. (Let’s admit that some are, OK?) I am suggesting that if one weren’t convinced of that, then the obviously mistaken claim of ‘no ties’ might lead one to believe that the person is being less than honest– and perhaps this less than honest answer is an attempt to hide the truth.

    The relationship exists– there are ways to describe the relationship so that one can understand that a doctor is not a shill for the drug companies.

    But to deny the relationship when it id so obviously there– I don’t get it.

  21. BillyJoe7on 03 Oct 2013 at 12:50 am

    I think there are very few doctors who do not have ties to the drug companies.

    Even just seeing a drug rep is a tie to the drug company, because drug reps see doctors for the specific purpose of influencing them and doctors who see drug reps have been shown to be influenced even when they are adamant that they aren’t influenced and even when all they receive as kickbacks are pens or even no kickbacks at all.

    But a doctor who diagnoses hypothyroidism and prescribes thyroxin does not, by that act, have a tie to a drug company just because that patient will be dispensed thyroxin from a particular drug company.
    To believe so is to take this discussion down a deep dark hole from which there is no return.

  22. Bruceon 03 Oct 2013 at 5:09 am

    Mlema,

    There was a very good program on BBC last night by Dr Brian Cox called Science Britannica where he discusses the issue of “Freethinking” or “Blue Sky” science vs targetted research.

    It is certainly not an easy problem to solve and a very fine line to walk, but the “equation” is actually very simple… science costs money. Research needs to be funded, and a great part of this funding needs to come from what it produces. The ideological purity of free thinking and free flowing science is really almost impossible to maintain.

    I suspect Steve has not gone into the whole big pharma thing because it is probably almost impossible to untangle and is most certainly not clear cut black and white. Science has to engage in business to fund itself, and while there might be many out there who take advantage of it, without the money, no research would take place at all. At least not to the levels we have had over the past 150 years. It is not a perfect system at all, and I don’t think it is possible for it to ever be perfect and for there to never be anyone out there willing to make a quick buck off something they or someone else has discovered.

  23. Mlemaon 03 Oct 2013 at 6:41 am

    Bruce, that sounds interesting. But it’s not about free science vs targeted research. It’s about science for big profit as opposed to the advancement of human health. Now if it were just science for profit and the advancement of human health – no problem. Do you see the difference? Medical school teachers, and even deans sit on pharma boards. Schools earn royalties off drugs they help develop. Even journals can be influenced. The industry has powerful lobbyists and holds sway with the FDA through a revolving door hiring policy. It’s called conflict of interest. For every $1 spent on research, big pharma spends $19 on advertising and other promotion. Are these things not worthy of skepticism?

    I think science/medical skeptics could maybe look at some of the drugs and medical devices and the companies that have generated them and critique the scientific rationale and implementation behind them. Some of them are just as bad as the pseudoscience you see in Alt Med advertising. Check the class action suits for ideas.

  24. Mlemaon 03 Oct 2013 at 6:44 am

    I’m also skeptical about big pharma paying fines that amount to nothing more than “cost of business” when they kill a bunch of people because they didn’t properly research a drug but sold the hell out of it.

  25. Bruceon 03 Oct 2013 at 7:13 am

    Mlema,

    I have no doubt there are all kinds of shady practices, but ultimately, when you boil it down it does actually come to science for money (which is almost always targetted research) vs science for knowledge (which is almost always free thinking). Science for profit is always going to be a thorny issue and while there are many very shady practices, the fact that science gets $1 out of $20 for research still beats $0 from $0.

    I think you also miss the point that Steve and others on this blog will actually attack big pharma on their pseudoscience. Many of these drug companies are huge sprawling masses and they will have wings that produce homeopathic remedies and supplements. In my view it is really not productive to attack the very conspiracy sounding “Big Pharma” as a whole. Just because one company sells Fixitus Anythingus C30 alongside the latest drug that is clinically proven to work does not make that drug and the research behind it invalid. We are much better off spending our time looking at each drug/remedy/issue that comes from them and assessing them critically.

    What you might be better off doing is finding one of these drugs or medical devices that you think might be dodgy and post in the topic suggestions part of this site.

  26. Mlemaon 03 Oct 2013 at 3:43 pm

    Bruce, I think targeted research is good. If you are familiar with the kind of baloney research that often goes on which is justified with “freethinking” science just to acquire public grant money, you’ll realize that the restriction of “target” can be a tool of focus on what’s legitimate. What’s happening now, because of the fact that the profit motive and US law has given us gigantic profits and aggressive advertising, on top of weakening oversight – we DO have freethinking – it’s freethinking about “how many billions can we make with this?” Instead of being a targeted goal of discovery, the target is the profit itself. Comparing 1 out of 20 in dollars to 0 out of 0 is a false comparison. Targeted science is still science for knowledge, it just has the goal of solving a problem that will reap financial rewards. The financial rewards should reflect the human value of the discovery. And it’s not like “freethinking” science for knowledge doesn’t cost anything. So, again, that’s a false comparison.

    “Just because one company sells Fixitus Anythingus C30 alongside the latest drug that is clinically proven to work does not make that drug and the research behind it invalid.”

    I’m talking about the “clinically proven to work” drugs, which have reached that status through a profit-biased system that influences the direction and conduct of the direction of research, the nature of development and the publication around them.

  27. OlegShon 09 Oct 2013 at 1:08 pm

    For ordinal people an anecdotal fact from a person they know means more than any evidence-based researches. In addition, many doctors don’t have enough time or desire to educate their patients about treatment options in understandable and convincible manner.

    For example, when I got my child to physician for fever and cough the doc prescribes antibiotics and tells me to use it if after two days if my child doesn’t get better. I understand that doc tries to cover viral and bacterial infection at once.
    However, the most of people will think the doctor knows nothing about the disease and start losing their confidence in conventional medicine and turning toward CAM.

  28. Francesca Allanon 14 Oct 2013 at 12:08 am

    “electrical-based interventions”?

    Could you expand on this, please?

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