Aug 22 2014

What’s The Harm – Ebola Edition

A common defense of implausible treatments is the question – “what’s the harm.” In other words, implausible therapies might help and can’t hurt, so there is no harm in trying. Is this a valid argument, however?

In trying to assess which side of a controversy has the better position I look toward logic and evidence. Evidence is critical, of course, but in fields outside my expertise I have to rely upon experts to interpret that evidence and put it into a broad and deep scientific context. In controversies, often the data itself is not the core issue, but which data to trust and how to interpret that data.

Therefore, when evaluating various controversial positions, it is very helpful to determine which side has the better arguments. If there is a dramatic asymmetry with one side relying heavily on logical fallacies, that is often very telling. Further, on any particular point you can follow the exchange through to completion and see which side ultimately has the better position.

For example, creationists argue that evolution violates the second law of thermodynamics which states that in any system entropy should increase. Scientists counter that the second law only applies to closed systems and the Earth is an open system, receiving energy from the sun. Creationists then counter that the universe is a closed system and so entropy should be increasing in the universe. Scientist counter further that entropy is increasing in the universe but this does not preclude local decreases in entropy where energy is available, such as the biosphere of the Earth. Creationists then respond by changing the subject. In other words – they have no response. They are wrong and have lost the argument.

Creationists have essentially lost every argument in this fashion, but they continue to use discredited arguments because that is all that they have. I chose a deliberately very asymmetrical issue to illustrate the point.

The same asymmetry exists in the controversy between science-based medicine and so-called alternative medicine (CAM), in my opinion. CAM proponents have lost every major argument, but they continue to use them because that it all that they have. One of those argument is “what’s the harm?”

I discuss this issue at length in this article on Science-Based Medicine. The quick version: delayed effective treatment, false hope, lost opportunity, using limited resources, instilling distrust in mainstream medicine and bizarre notions of health, disease, and science. Oh, and at times there is direct physical harm.

Even CAM modalities presented as entirely safe, such as acupuncture, have documented risks and adverse events. One such risk is infection, which is largely due to the fact that acupuncturists rarely use proper antiseptic technique (have you ever seen a picture or video of an acupuncturists wearing gloves?). Why don’t they use proper technique? Probably because they are not operating within a science-based and ethical system of medicine. Don’t expect science-based precautions in a magic-based practice.

This leads us directly to the specific topic of this article – it has been reported to AFP (Agence France-Presse) that the current Ebola outbreak spread from Guinea into Sierra Leone, resulting in 365 Ebola deaths so far, through the actions of one herbalist.

The herbalist lived in the remote eastern border village of Sokoma. She claimed that she could cure Ebola with her medicine, prompting infected patients to travel from Guinea to receive her treatment. Of course, her treatments were worthless. But further, she apparently did not practice isolation precautions. Ebola patients traveling to her clinic spread Ebola to Sierra Leone. The herbalist herself caught Ebola and died from the virus. At her funeral, further people were infected.

Sierra Leone is now in the middle of a serious Ebola outbreak, overwhelming their hospital resources and resulting in the death of health care workers among many others.

Even if her herbal drugs were directly harmless, her unscientific practice was not.

This is just one more example of the harm that injecting magical thinking into medicine can cause. This gets filed along with chiropractors and naturopaths who oppose vaccination, acupuncturists who do not practice antiseptic technique, CAM proponents who stigmatize standard cancer treatment, those who deny the reality of mental illness, vague fears of toxins that lead to opposition to fluoridation, communities without wifi or cell phones, and countless other examples.

Belief in magic and opposition to science and reason is endlessly mischievous and pernicious.

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14 responses so far

14 Responses to “What’s The Harm – Ebola Edition”

  1. Mukiwaon 22 Aug 2014 at 9:44 am

    Reminds me of witch doctors peddling condoms made of intestines in Zimbabwe when I was much younger. I don’t remember the exact details, but it was along the same lines, an opposition to science which probably for some time didn’t help in preventing the spread of AIDS or any STD’s or possibly even pregnancy due to being porous.

  2. Bruceon 22 Aug 2014 at 11:58 am

    Not to mention their “cures” for AIDS which ranged from “sleep with a virgin” to “rape a white girl”. The immediate consequences and fallout for the latter could really not be put in a “harmless” category. Fear and superstition are very powerful tools… draw someone in with seemingly harmless mumbo jumbo and pretty soon they will be doing the craziest things.

    It is a pity that religion seems to be taking a very big hold in Africa, replacing these traditional ways… even with things like the above happening, I am not convinced Jesus or Allah are much better, especially given the persecution of those who happen to be homosexual.

  3. Teaseron 22 Aug 2014 at 1:47 pm

    Some sources do not consider the AFP as a reputable news source.

    “It’s always a problem when a habitually inaccurate news source says things…….”
    scienceblogs.com/effectmeasure/2008/04/13/afp-newswire-even-less-reliabl/

    Using this questionable herbalist story is special pleading. Typically you just attack! Your position that CAM is a major contributor for this Ebola outbreak is misleading and unfounded according to other outbreak analysis.

    The consensus from reputable news sources and medical journals tell a different story. None of which suggest a herbalist or CAM as a cause for the spread of the disease in this outbreak.

    “The local people thought that the Europeans in control of the isolation units were in a body parts business,” he says. “Their loved ones would go into the isolation units, and they would never see them come out.”

    ww.npr.org/blogs/health/2014/04/02/298369305/why-anthropologists-join-an-ebola-outbreak-team

    Analysis from the South African Centre for Infectious Disease Surveillance (SCAIDS)

    “When response teams arrived in villages to support local health teams, people in the village already knew that Ebola was a deadly disease. There was a high degree of fear and stigmatization. (7) It is important to work with the community and involve local chairmen, religious leaders and council member prior to any activities in the community. Even drastic measures such as quarantine was more successful when imposed by the community – rather than by health authorities or other strangers. (5)”
    ww.sacids.org/oweb/sacids/home/news~and~events/25-595/WHAT_ARE_THE_LESSONS_LEARNED_FROM_A_COORDINATED_NETWORK_RESPONSE_IN_EAST_AFRICA.html

    This article from Wired points to severely degraded infrastructure.
    ww.wired.com/2014/08/ebola-outbreak-causes/

    “Entropy was in full effect: Blood, vomit and urine smeared hospital floors. Without protective gear, some hospital workers treated Ebola patients wearing only scrubs. When nurses got sick, others went on strike, leaving few people left to pick up patients who had fallen out of their beds.
    This health-care breakdown is the main reason why the virus has spread so far this time, Bausch says. It doesn’t just show up, randomly appearing from the forest. Outbreaks happen where the economy and public infrastructure have fallen apart for years.”

    New York Times
    ww.nytimes.com/2014/08/10/world/africa/tracing-ebolas-breakout-to-an-african-2-year-old.html

    New England Journal of Medicine articles.

    Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report
    Sylvain Baize, Ph.D., Delphine Pannetier, Ph.D., Lisa Oestereich, M.Sc., Toni Rieger, Ph.D., Lamine Koivogui, Ph.D., N’Faly Magassouba, Ph.D., Barrè Soropogui, M.Sc., Mamadou Saliou Sow, M.D., Sakoba Keïta, M.D., Hilde De Clerck, M.D., Amanda Tiffany, M.P.H., Gemma Dominguez, B.Sc., Mathieu Loua, M.D., Alexis Traoré, M.D., Moussa Kolié, M.D., Emmanuel Roland Malano, M.D., Emmanuel Heleze, M.D., Anne Bocquin, M.Sc., Stephane Mély, M.Sc., Hervé Raoul, Ph.D., Valérie Caro, Ph.D., Dániel Cadar, D.V.M., Ph.D., Martin Gabriel, M.D., Meike Pahlmann, Ph.D., Dennis Tappe, M.D., Jonas Schmidt-Chanasit, M.D., Benido Impouma, M.D., Abdoul Karim Diallo, M.D., Pierre Formenty, D.V.M., M.P.H., Michel Van Herp, M.D., M.P.H., and Stephan Günther, M.D.
    April 16, 2014DOI: 10.1056/NEJMoa1404505

    Ebola 2014 — New Challenges, New Global Response and Responsibility
    Thomas R. Frieden, M.D., M.P.H., Inger Damon, M.D., Ph.D., Beth P. Bell, M.D., M.P.H., Thomas Kenyon, M.D., M.P.H., and Stuart Nichol, Ph.D.
    August 20, 2014DOI: 10.1056/NEJMp1409903

    Ebola — Underscoring the Global Disparities in Health Care Resources
    Anthony S. Fauci, M.D.
    August 13, 2014DOI: 10.1056/NEJMp1409494

    NOTE: I have intentionally truncated the URL on this entry. Copy and paste the URLs and the links should auto-complete and go to the page.

  4. rezistnzisfutlon 22 Aug 2014 at 2:31 pm

    Not only was her practice unscientific, but she didn’t draw on the body of knowledge and experience of the scientific and medical community in dealing with a lethal contagion. That’s where the training gained from centuries of hard experience comes into play. Even if the “remedy” she used was worthless, if she’d employed proper isolation and quarantine procedures, perhaps some lives would have been saved.

    And that’s the rub with people like this is that they are basing work on their own ignorance.

    Not going to bother engaging Teaser, just being the typical contrarian just for the sake of being contrary.

  5. Steven Novellaon 22 Aug 2014 at 8:30 pm

    I never claimed CAM was a major source of this outbreak. I repeated the report that the transfer specifically to Sierra Leone was traced to one healer. Your links don’t address this.

    So far, the story checks out. https://uk.news.yahoo.com/ebola-outbreak-womans-healing-powers-claim-caused-deadly-104407107.html#caZG8i9

    Of course, I am depending on international news outlets. If the story changes significantly, I’ll update.

  6. jsterritton 22 Aug 2014 at 9:32 pm

    Teaser…

    WTF are you talking about?

    “Using this questionable herbalist story is special pleading. … Your position that CAM is a major contributor for this Ebola outbreak is misleading and unfounded according to other outbreak analysis. … The consensus from reputable news sources and medical journals tell a different story. None of which suggest a herbalist or CAM as a cause for the spread of the disease in this outbreak.”

    Nobody is suggesting that CAM or a herbalist are responsible for the Ebola outbreak in west Africa. However, informed sources like Mohamed Vandi, “a medical official in the district of Kenema, Sierra Leone” are saying that CAM — in the form of a single herbalist practitioner — helped the outbreak to spread to Sierra Leone by attracting credulous sick people to that country. That’s what we’re talking about here. You need to read better and work on your comprehension skills. It appears that you have mistaken this news item for something it isn’t. Repeat: no one is saying that CAM caused — or is a major contributor to — the Ebola outbreak in west Africa. Not Neurologica, not the AFP, no one.

  7. BBBlueon 22 Aug 2014 at 9:51 pm

    From ScienceBlogs:

    AFP has shown itself to be an unreliable, inaccurate and often sensationalistic wire service when it comes to medical reporting. They simply aren’t in the same league as AP, Bloomberg, Reuters and the others.

    From Reuters:

    Sierra Leone’s first Ebola case was a so-called ‘sowei’, a traditional women’s leader and healer who treated the sick crossing over from Guinea, according to Dr Mohamed Vandi, the chief medical officer for Kenema district.

    At the Moala checkpoint on the road to Liberia, masked health workers take the temperature of all travelers to monitor for anyone who might be carrying a fever.

    But many still put faith in traditional methods.

    At the same Moala checkpoint, police and soldiers tied herbal rope bracelets around travellers’ wrists, telling them a local traditional healer had been told in a dream that doing so could ward off Ebola

    http://reut.rs/1vtrMmQ

    If one wants their challenge to be taken seriously, they would not just provide a link related to a 6-year-old story by a different reporter, they would do what ScienceBlogs did in that particular instance: provide evidence.

  8. tmac57on 23 Aug 2014 at 10:35 am

    From the WHO website:

    A month after the government announced the outbreak, the need for information remains high. To disseminate the messages more rapidly and reinforce their content, WHO and its partners have been engaging religious leaders, tribal leaders, traditional healers and community leaders to help with the outreach.

    A typical stand of a traditional healer on a market in Conakry, Guinea.WHO/J AnokoA typical stand of a traditional healer on a market in Conakry, Guinea.
    “It was particularly important to start a dialogue with the traditional healers early as some patients prefer to see them instead of consulting the staff at a nearby health centre,” says Julienne Anoko, an anthropologist from Cameroon who has been hired by WHO to help with the response to the outbreak. “As they see and touch many people with different symptoms, they are at high risk. They need to know how they and their patients can protect themselves and that quack cures can put lives in danger.”

    http://www.who.int/features/2014/ebola-myths/en/

    I think it is quite plausible that traditional healers in West Africa have been a key factor in both spreading the disease,and adding to misinformation and avoidance of supportive care that can help improve survival,and isolate infected patients from the general population.

  9. Teaseron 23 Aug 2014 at 3:46 pm

    The premise of this entry is CAM does cause harm. Steven uses the Ebola epidemic and the unverified reports that one herbalist is directly responsible for 365 deaths to make his point.

    “This leads us directly to the specific topic of this article – it has been reported to AFP (Agence France-Presse) that the current Ebola outbreak spread from Guinea into Sierra Leone, resulting in 365 Ebola deaths so far, through the actions of one herbalist.”

    My objection is the lack of evidence to back this claim. Steven has offered nothing scientifically concrete to back this claim other than a sketchy AFP story. Typically this sort of proof is shredded in this forum.

  10. jsterritton 23 Aug 2014 at 4:43 pm

    Um, Ebola virus is responsible for the deaths in Sierra Leone. The report is that the outbreak spread to that country when credulous sick people travelled there seeking bogus remedy. This is an example of a way that CAM does cause harm. As far as confirmation that the news story is as reported, that will come in the form of further reporting. I suppose Dr Novella could have waited for overwhelming, “scientifically concrete” evidence that the story is true, but I see no reason to doubt its veracity. The story is being picked up all over the place (e.g.: http://rt.com/news/181616-sierra-leone-ebola-healer/). I’d say this blog post is timely and topical. If the story turns out to be some kind of rumor or fraud, Novella’s conclusion that “belief in magic and opposition to science and reason is endlessly mischievous and pernicious” will still be valid. I’d worry more about putting all the eggs into one speculative and unlikely the-story-is-a-fake basket.

  11. BBBlueon 23 Aug 2014 at 9:31 pm

    Mr. Teaser,

    Okay, we only have Mohamed Vandi’s opinion about what is probable, so absent a credible epidemiological study, we can’t be certain of how the herbalist and those around her got sick and died, we can only talk about what seems plausible and likely.

    Beyond that, I am curious to know if you disagree with the more general claim that some people have been harmed by pursuing alternative therapies to the exclusion of those which have been scientifically proven? (I define the word “alternative” in this context to mean therapies based on pseudoscience or magic.)

  12. grabulaon 24 Aug 2014 at 9:35 pm

    @Teaser

    You’re misunderstanding of logic is astounding sometimes.

    “Using this questionable herbalist story is special pleading. Typically you just attack! Your position that CAM is a major contributor for this Ebola outbreak is misleading and unfounded according to other outbreak analysis.

    The consensus from reputable news sources and medical journals tell a different story. None of which suggest a herbalist or CAM as a cause for the spread of the disease in this outbreak.”

    There’s no special pleading going on here, her practice contributed to the outbreak. Speaking of terrible understanding of logic, you build a strawman implying Dr.Novella claimed this was the cause of the outbreak or is alone in making it worse. It’s a contributing factor but that certainly wouldn’t fit your CAM based narrative would it?

    “The premise of this entry is CAM does cause harm”

    Boom, see even you get it.

    “My objection is the lack of evidence to back this claim.”

    Oh also your sacred cow.

  13. jsterritton 05 Sep 2014 at 4:10 pm

    @Dr Novella

    “creationists argue that evolution violates the second law of thermodynamics which states that in any system entropy should increase.”

    I call these people “sun deniers.” And then I point out that even if Earth were a closed system, we would be reevaluating the second law and not evolution.

  14. Bronze Dogon 05 Sep 2014 at 4:22 pm

    I call these people “sun deniers.”

    Nice. If I encounter one that says entropy can’t go down, no ifs, ands, or buts, I think I might call that person an “air conditioning denialist.” There’s a reason why you put window-mounted air conditioners in a window and not in the middle of the house.

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