Mar 20 2008

A Golden Age of Quackery and Antiscience

Sometimes it’s useful and instructive to take a step back and look at the big picture. While many who read this blog (and affiliated blogs, and listen to my podcast) may see it only as a source of information (and hopefully at least mild amusement), it is also very consciously and deliberately part of a greater struggle for the very nature of human society and civilization. That may seem grandiose (and I am not making any judgments about the scope or impact of my humble efforts), but this has always been part of public intellectualism – engaging in the broader conversation about the nature of knowledge and the human struggle to grapple with it and ourselves.

The big picture is that homo sapiens is a curious species that is pushed and pulled in divergent directions by psychological and cultural forces both conscious and subconscious. There is a literal struggle for dominance among these various forces – each carving out a niche while often trying to defend and expand its territory. Some of my colleagues have recoiled at this military analogy – but I feel it is apt. It is a struggle for dominance and resources – and that is what all war is about.

My side in this struggle marches under various banners, all imperfect and faded at the edges, leading to internal struggles as to which banner is best, without any clear consensus. Mine is the side of science, scientific skepticism, rationality, reason, and methodological naturalism. No one label captures all of that, and attempts to do so have spectacularly failed, in my opinion (remember the “brights”). But we know who we are and we are increasingly organized and active, thanks largely to the internet.

Arrayed against science and reason are those who advocate for the virtue of faith, spirituality, post-modernism, anti-intellectualism, various ideologies, pseudoscience, and anti-science.

Whenever I interview a guest for my podcast who has been engaged with science and skepticism for decades I invariably ask. “How are we doing?” What’s the long view? I have been doing this for about 13 years so I have some perspective, but I appreciate the insights of those who have been doing this for 30-40 years or more. Here is the feedback I have received:

Paul Kurtz, arguably the founder of the modern skeptical and secular humanist movements, who has been doing this the longest, is also the most positive. He sees the struggle of science vs unreason as going in cycles, and yes we had a bad patch around the turn of the millennium but there is no reason to panic. There is no crisis, just more in an endless series of issues. There will always need to be skeptics to defend science and reason, the pendulum will swing back and forth, but he does not feel there is any larger trend toward anti-science.

In a recent episode of Science Talk, the podcast of Scientific American, Argonne National Laboratory director Robert Rosner has many pessimistic observations to make about science in America. Specifically – the brain drain of talent away from this country, the lack of support for science in the government, and the lack of adequately trained technology workers to maintain our science and technology based infrastructure.

In my field of medicine the outlook is a bit more gloomy. Wallace Sampson wrote today in our Science-Based Medicine blog that the trend in medicine over the last 20-30 years has been frighteningly bad. The FDA no longer aggressively fights against fraud and quackery; they are underfunded (perhaps deliberately), incompetent, and uninterested. Medical schools are being infested with the promoters of woo, corrupting the next generation of physicians. Politicians are largely scientifically illiterate and ideological. The zealots are winning and science-based medicine is suffering – perhaps an endangered species.

By coincidence I interviewed Stephen Barrett last night for this week’s episode of the Skeptics’ Guide to the Universe. He says we are in a “golden age of quackery” created by various forces. He points primarily to the National Center for Complementary and Alternative Medicine (NCCAM) – which he believes has falsely legitimized and promoted pseudoscience in medicine. Quackery has been rebranded as “alternative” creating a safe haven within medicine for quacks and frauds.

To balance this I will say that during a conference at which I spoke along with Marcia Angell, former editor of the New England Journal of Medicine, she expressed her view that science works, the public generally understands and respects this, and over the long haul this advantage of science will win out over nonsense. So we can put her in the optimistic camp.

Where do I stand on all of this? My views have become, if anything, more complex and conflicted. I can see both sides and I am not sure how this will all play out in the future.

Taking the very long term perspective, I think it is undeniably true that in recent centuries the overall trend has been toward enlightenment, toward a larger role for science in society and a diminishing role for faith-based belief systems. I am hopeful that this large trend will continue, and that we should not be overly worried about what may turn out to be a short term reversal lasting only decades. I also agree with Marcia Angell that science has a distinct advantage – it works, its principles are valid, and in the end it seems to work out.

But my long term optimism is tempered by two pessimistic possibilities. The first is more dire, if less likely. It may be true that the long term trend over the last 600 or so years has been positive – reflecting the rise of science and reason in human civilization. But if we take an even longer view we see that at other times in human history the light of science and reason has been extinguished – for example the death of empiricism in ancient Greece and the other historical factors that lead to 1500 years of Dark Ages.

Is it possible that we are seeing the beginning of a new age of darkness? I certainly hope not, and I think this is very unlikely – for various reasons. The first is that science is much more broadly and deeply institutionalized than it was at any time in human history. The second is that cultures are no longer as isolated as they were. If the light of science dies in one location it is certain to survive elsewhere (and in fact the Dark Ages were largely a European phenomenon, while science and reason survived in Persia).

So long term I remain optimistic, but I do think there is a small chance of a major reversal that could have long term implications.

Over the short term – the next few decades – I am less optimistic. While I think that science remains strong and continues to progress at an accelerating pace, there are some scary trends. Scientific literacy in the public is not improving, and remains dangerously low. The institutions of science have been weakened by an infiltration of anti-scientific philosophy – specifically notions that science is a “Western” cultural endeavor, a misplaced desire for “tolerance” of other ways of knowing, and post-modernist philosophy that scientific facts are just aesthetic opinions.

Medicine probably has the worst of it right now. Wally Sampson is essentially correct – every medical institution is under siege by nonsense and now very compromised. The defenders of science in medicine are increasingly on the fringe and made to seem as if they are the ideologues. This is all happening at a time when health care itself is in crisis, burdened by their own success. Technology has given us the ability to deliver more health care than we can afford, and we do not have the infrastructure or political will to deal with this problem. Medicine has also become too complex to effectively regulate. So doctors are largely just trying to survive. During this vulnerable time in the history of medicine, the scientific underpinnings of the standard of care are under coordinated attack by those who wish to be free to practice their faith and ideology (rather than medicine) or simply want the freedom to commit health fraud. Effective enforcement of a scientific standard of care is anathema to quacks and con artists.

I agree with Stephen Barrett that we are in a golden age of quackery. The mechanisms of regulation have broken down. The promoters of nonsense have pulled off one of the greatest cons in modern times – convincing the public that quackery, nonsense, and fraud are legitimate “alternatives” to science-based medicine and that they should be “integrated” into every aspect of health care, from the laboratory to the bedside.

While I think that science and reason will eventually prevail, there will be a great deal of long term damage done in the meantime. Institutions and culture have great inertia, and the infrastructure of pseudoscience being constructed within government, academia and medicine will be around for a long time. It is like a metastatic cancer – ever spreading, almost impossible to eradicate, constantly sapping the energy and resources of society. I think the patient will live but with damaged health.

Meanwhile a growing and increasingly organized and energetic skeptical movement is working diligently to defend the integrity of science and to retard the institutions of anti-science. I do think much depends upon how successful we are in this task. I agree in part with Paul Kurtz that this is an endless struggle and there will always need to be skeptics beating the drum of reason. But I also think we are at a turning point in history when the momentum appears to be shifting. It will up to our generation of skeptics to shift it back.

How are we doing? We will see.

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