The following is a response to many comments left on the Skeptic Blog in reply to my previous post on the skeptical battleground of so-called alternative medicine. There are too many comments for me to reply to individually, so I will answer all the main points raised here. Many of the usual points on the pro-CAM side were raised, and even though I have gone over all of them before on NeuroLogica and Science-Based medicine, it is worth reviewing them here.

Doctors are bad

Many of the comments made the basic point that the popularity of CAM is the fault of evil, uncaring, incompetent or dangerous doctors. These comments took one of two forms – using negative claims about doctors and medicine to explain why CAM is popular, and using them to justify CAM. These are similar but distinct claims. The latter claim, that CAM is legitimate because scientific medicine “doesn’t have all the answers” or is uncaring or corrupt, is a non sequitur. The position of CAM critics like myself is that CAM treatments are unscientific, not proven, and often already proven to be unsafe or ineffective. There should be a single science-based standard of care for all medicine – not a double standard where fraud and unscientific claims can flourish. If we are currently not doing an adequate job enforcing the standard of care that is not a justification for abandoning it – it just means we need to figure out how to do a better job.

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I just wanted to wish all of my readers a wonderful holiday season, winter solstice, festivus – whatever excuse you have to celebrate with your loved-ones. I am taking a break over the holiday to spend extra time with my family. I will be back to my usual schedule of posts next week.

The following was cross-posted today on Science-Based Medicine.

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Science-based medicine is more than a website. It is a philosophy of medicine that is actively vying with other philosophies for dominance in the world of medicine. We believe that medicine should be based upon the best science available, according to a single universal standard of rigorous methodology and valid logic and reason. Others desire a double-standard, so that they can be free to practice or market whatever they wish without having to meet strict scientific standards. Still others have a non-scientific ideological world-view and want public policy to accord to, or at least admit, their personal beliefs.

I therefore expect that we will be attacked by proponents of unscientific medicine in all its forms.  Yesterday, however, we were attacked on the Evolution News & Views website of the Discovery Institute by creationist neurosurgeon, Michael Egnor. This may seem incongruous at first, but honestly I suspected that just such an attack was inevitable.

Many science bloggers, David Gorski and me prominent among them, have taken on both the DI and Dr. Egnor specifically over many anti-scientific arguments he has put forward over the last couple of years. We have sparred mostly about evolution in medicine, neuroscience and consciousness, and the materialist underpinnings of modern science. Dr Egnor’s day job, however, is that of a (from what I can tell) respected neurosurgeon, so I always wondered what he thought of his sparring partners’ writings about science-based medicine.

His entry yesterday ends any speculation – he wrote an incoherent, logical fallacy-ridden screed that would make any snake-oil peddler proud. This reinforces a point I have made in other contexts – all anti-scientific philosophies have science as a common enemy, and will tend to band together in an “unholy alliance” against those advocating for scientific rigor or defending science from ideological attack. That is why a website that is ostensibly about the “misreporting of the evolution issue” would post a blog attacking science-based medicine as an “arrogant medical priesthood.”

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Have you ever had the sense that you were not alone, that another person, perhaps menacing, was in the room with you? And yet, when you look around, no one was there? This is a common experience, which researchers call a “sensed presence.” Neuroscientists hypothesize that this common experience likely has a neurological correlate – meaning that activity in some specific part of the brain is responsible for generating the sensation of a presence.

So far, research has validated that hypothesis. And recently the research team of Michael Persinger had the fortune of capturing a sensed presence event on EEG (which measures the electrical activity of the brain).

The subject is a woman who has had numerous episodes of sensed presence after a head injury. Persinger now presents a case report of her EEG, recorded while she experienced the sense of a man in the room with her when none was present. For some reason as yet unknown, 90% of time a sensed presence is of a member of the opposite sex. The EEG shows a burst of electrical activity in her left temporal lobe during the event, and of note she perceived the presence to be on her right side.  (Brain activity corresponds to the contralateral or opposite side of the world.)

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There is a dedicated fringe anti-vaccine movement. They are dedicated to some permutation of the collection of beliefs that vaccines are: 1) not effective; 2) have not reduced or eliminated any infectious disease; 3) are not safe; and 4) are a conspiracy of Big Pharma, the government, and paid-off doctors. Specific claims have wandered over the years, but they have as a central theme that vaccines are bad. When one specific claim collapses, they will move on to the next anti-vaccine claim.

While anti-vaccine cranks have been around as long as vaccines, it is only recently that they have captured the attention of the mainstream media and the skeptical movement and the battle has really been engaged.

Anti-vaccinationists have focused much of their recent efforts on the claim that vaccines cause autism. At first the MMR vaccine was blamed, sparked by a now-discredited study performed by Andrew Wakefield. This led to declining vaccination rates in the UK and a resurgence of measles.

As the MMR claim was in decline (although by no means abandoned), attention shifted to thimerosal – a mercury-based preservative in some vaccines. There are many flaws with the thimerosal hypothesis, and numerous studies have shown no link between thimerosal and autism or any neurological disorder. But the fatal blow to the thimerosal hypothesis was struck when thimerosal was removed from the routine childhood vaccine schedule (thimerosal, incidentally, was never in the MMR vaccine) in the US by 2002. In the subsequent 6 years the rate of autism diagnoses kept increasing at their previous rate, without even a blip. Only the most rabid (or scientifically illiterate)  anti-vaccine fanatics still cling to the thimerosal claim.

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In the 1960s and 70s Stanley Milgram performed a series of now famous obedience studies. The most famous of which, experiment 5, involved a subject being asked to deliver shocks to a confederate (someone who was in on the experiment) in what they were told was a learning experiment. Surprisingly, 65% of subjects continued to deliver shocks all the way to the end, even over the increasingly vehement protests and even medical complaints of the confederate. Prior to Milgram most people, and even psychiatrists, did not predict such an outcome. Almost no one thinks they personaly would behave like the subjects in experiment 5, but apparently 65% of us are wrong. These experiments stand as a dramatic demonstration of the power of authority and other situational factors in human behavior.

Milgram’s experiments, however, have been controversial. There is always, of course, controversy over exactly how to interpret social psychology experiments. Human behavior is extremely complex, and so there are always numerous variables to consider when interpreting such studies. But even more controversial than the interpretation are the ethical considerations raised by the study. Specifically, the subjects were exposed to significant short term stress during the study. Ethical guidelines since Milgram have made it impossible for anyone to replicate his studies over the last 30 years, which means there is no way to end the controversy over interpretation.

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A few months ago I blogged about so-called “good” bacteria. We are colonized by friendly bacteria that do not cause infections or harm, and in fact serve vital functions.

One of the specific topics I covered was probiotics – use of friendly bacteria species to improve the bacteria in our guts to help stave off infection or otherwise promote GI (gastrointestinal) health. Based on the evidence at the time I was luke warm on probiotics – the concept is sound, but the evidence for specific benefits is preliminary.

A new study, actually a meta-analysis and review of existing studies, published in the American Family Physician, has altered my assessment to be more positive.

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This is a website I should have plugged before – it’s called whatstheharm.net. As the name implies, it is an answer to those “shruggies” who do not see unscientific or fraudulent medicine as a problem. The site catalogues cases of people harmed by so-called alternative medicine treatments. Most of the cases are due to refusing standard treatment as a result of misplaced faith in unconventional treatment.

For example, Jacqueline Alderslade was told by a homeopath to give up her asthma medication. She subsequently died of an asthma attack. This was a completely avoidable death.

I was reminded of this site by a recent case of a man who was convicted and will spend 6 month in jail for injuring his daughter. He decided to treat her with bogus supplements rather than seek appropriate medical care, resulting in her suffering heart and brain damage.

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Headlines declare, “Mind-Reading software could record your dreams.” Of course, those in the business of writing headlines for news articles are notorious pathological liars.

The technology being reported on is indeed very intriguing, but it actually has nothing directly to do with recording dreams. This is just one speculative future application when and if the technology significantly matures. But that’s what the headline writer pulled out.

This is similar to the reporting of advances in so-called metamaterials that have a negative refractice index. These materials have many possible and plausible applications. Perhaps the least plausible and most highly speculative application would be the creation of an invisibility cloak. So of course, the headlines read that scientists make breakthrough in creating an invisibility cloak.

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Being both a skeptic and a physician I have focused a great deal of my skeptical efforts towards science and medicine. While I endeavor to be a full-service skeptic, pseudoscience in medicine is definitely my specialty. It is therefore especially painful for me to admit that in this arena, more than any other, we are getting our butts kicked. We are almost at the point of being routed, with the defenders of scientific medicine being relegated to the role of insurgency. How did this happen?

What is Alternative Medicine?

I think the biggest victory scored by the promoters of complementary and alternative medicine (CAM) was the name itself. Fifty years ago what passes today as CAM was snake oil, fraud, folk medicine, and quackery. The promoters of dubious health claims were charlatans, quacks, and con artists. Somehow they managed to pull off the greatest con of all – a culture change in which fraud became a legitimate alternative to scientific medicine, the line between science and pseudoscience was deliberate blurred, regulations designed to protect the public from quackery were weakened or eliminated, and it became politically incorrect to defend scientific standards in medicine.

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