Sep 14 2015

Is Fibromyalgia Real?

The question of whether or not fibromyalgia is a real disease is deceptively complex. The answer, therefore, is not a simple yes or no. A thorough answer requires some background, which makes it challenging to discuss any issue related to fibromyalgia without going on a long tangent about its status as a diagnosis.

What’s In a Name?

Before we get to fibromyalgia specifically, I want to review how diagnostic labels are used in medicine. Health care providers, researchers, and also insurance companies and regulators need a common language to refer to what patients have. As our understanding of disease is incomplete, and also disease entities are often complex and fuzzy around the edges, a coherent and thorough diagnostic system is likewise complex.

For simplicity, however, we can divide diagnostic entities into two broad types. First there are discrete diseases, which are pathophysiological entities. This is a specific problem with a specific tissue or physiological process in the body. A disease diagnosis may refer to a specific genetic mutation, for example, or an alteration in a physiological parameter.

A disease diagnosis such as this is often confirmed with specific laboratory findings. This may be so specific that, for example, one particular finding on biopsy equals a specific diagnosis. But of course disease diagnoses exist on a spectrum as well. There may be laboratory markers that are present 60% of the time, or that exist with several diseases. A disease may actually be a category of multiple specific diseases that we have not sorted out yet.

The other type of medical diagnosis can be called a clinical syndrome. Clinical syndromes are defined mostly or entirely by a set of clinical symptoms. Such diagnoses are therefore mostly descriptive. The labels simply recognize that a certain pattern of symptoms tend to cluster together any may have a certain demographic profile or natural history. However, the diagnosis has not yet graduated to a specific disease because we do not understand the underlying pathophysiology.

Historically many clinical syndromes were later discovered to represent a number of specific diseases, and the labels changed as our knowledge changed.

It is imperative, especially for practitioners, to understand the nature of any particular diagnostic label. Is it “real” is too vague a question for many clinical syndromes. They are real in that there are patients who present with the defined set of clinical symptoms, but they may not be real in that they are not a specific pathophysiological entity.

A much better question is whether or not a diagnosis is useful – does it provide any guidance in terms of treatment, prognosis, workup, or research? Some clinical diagnoses are just placeholders for our current ignorance. Others are a useful attempt to capture a real entity and generate hypotheses that can be scientifically tested. Some, such as migraine, are very discrete clinical entities that are perfectly useful as a basis for treatment.

Clinical syndromes are perfectly legitimate, but do create the potential to be misused or even abused. Because they are often vague and rely on non-specific symptoms, without laboratory confirmation, they can easily be used by the lazy or perplexed clinician as a “garbage pail diagnosis.” Everything you don’t understand can be thrown in, just so that you have a label.

We are often forced to use labels, even when we don’t yet understand what is causing the patient’s symptoms. The trick is not to use a label that is more specific than the current understanding of the patient allows.

Fibromyalgia

Fibromyalgia is a controversial clinical diagnosis that suffers from many of these problems as challenges. Here is a description of the diagnosis:

Chronic widespread pain is the hallmark symptom of fibromyalgia and has been proposed to be of neurogenic origin. A central amplified pain perception is linked with allodynia and hyperalgesia. Fatigue and sleep disturbances are also common components of the syndrome. Other key symptoms include tenderness, mood disturbances, and cognitive difficulties. … Anxiety and other mood disorders are common comorbid conditions.

Currently there are no laboratory findings that confirm or exclude the diagnosis of fibromyalgia. It is a clinical diagnosis with a fairly broad description, including many non-specific symptoms, like pain and fatigue. It is also comorbid with other conditions that can potentially cause pain and fatigue, but which in turn can be caused by pain.

This is one of the key challenges of fibromyalgia as a diagnosis – patients with the diagnosis often have a web of interrelated symptoms and it is difficult to impossible to tease apart what is causing what.

When the diagnosis of fibromyalgia was first defined in 1990 it contained as a diagnostic criterion the existence of specific tender points – specific locations on muscles that were tender to the touch. This was really the only specific criterion. Some argue now that this was intended for research purposes, and not for clinical purposes. However, the tender points were frequently ignored. Anyone with diffuse chronic pain and fatigue, with or without specific trigger points, could be given the diagnosis of fibromyalgia.

Interestingly, in response to this common practice, rather than tightening up the use of the fibromyalgia diagnostic label, the American College of Rheumatology simply dropped tender points as a criterion in 2011.

Perhaps the first clue of what might be happening with fibromyalgia is evidence that many patients have what is called central sensitization, or a disorder of pain regulation is which they are more sensitive to pain. What is not known is if this finding is primary or secondary.

In other words, do some patients with fibromyalgia have central sensitization as the primary cause of their symptoms, or is it being caused by some other entity which is the true underlying cause, or is it a result of the chronic pain?

We may need to think of fibromyalgia like fever – it is a physiological process that is a response to many possible underlying causes, but is not a disease unto itself.

For years instead of using the term fibromyalgia I would use other diagnostic labels that I felt were more appropriate, such as myofacial pain syndrome. This label is better, in my opinion, because it focuses on the symptom and describes it as a syndrome. It does not cause confusion by giving the false impression of a specific disease label. However, “fibromyalgia” has essentially come to mean the same thing, especially with the dropping of the specific tender point criterion.

Patients are caught in the middle

Perhaps the biggest problem with the controversy surrounding fibromyalgia as a diagnostic entity is that while scientists and clinicians are debating the utility of this label, how it should be defined and used, there are patients who have chronic pain and other symptoms that need to be treated.

Often times when a patient is given the label of fibromyalgia they take that as validation that their symptoms are real and debilitating. Then when they hear that the diagnosis is questioned, they often take it personally, as if questioning the scientific utility of fibromyalgia as a diagnostic label is an attack on the validation of their symptoms. They interpret questioning the reality of the label as questioning the reality of their symptoms.

This could not be further from the truth, however. Clearly there are many patients who have chronic diffuse pain, fatigue, poor sleep, and other comorbidities. These symptoms often take a great toll on quality of life. Nothing in the scientific discussion about fibromyalgia as a diagnosis calls into question these symptoms. The question is entirely about how we understand the possible cause or causes of these symptoms in order to guide our treatment and research.

One very real risk of using vague diagnostic labels is that they can give the false impression of a specific diagnosis, and therefore end further thinking about possible causes. Settling prematurely on a diagnosis can then result in missing the real underlying cause. Good practitioners don’t let this happen, but it does happen and falsely specific labels encourage this behavior.

Conclusion

Fibromyalgia remains a controversial and poorly understood clinical syndrome. We are in the early stages of understanding what is happening physiologically in patients with this syndrome.

If history is any guide, it is likely that as we tease apart the various underlying causes that are currently lumped under the heading of fibromyalgia, the diagnosis will evolve into many sub-syndromes, and may vanish entirely to be replaced by specific disease diagnoses.

 

100 responses so far

100 thoughts on “Is Fibromyalgia Real?”

  1. hardnose says:

    If it is not caused by an infection, genetic defect, or injury, syndromes are not and never will be understood by mainstream medicine as specific diseases. Unless mainstream medicine gets out of its reductionist rut some day in the far off future.

    Most mental disorders, most autoimmune disorders and allergies, most cancer — pretty much anything where the underlying cause involves the immune system — none of these are well understood or curable by mainstream medicine.

    Lyme disease was a mystery for a while and then was found to be caused by a bacteria. Yes that kind of thing has happened, but more often the cause is never understood well enough for effective treatments to be discovered.

    MS and RA, Alzheimer’s, common forms of cancer and heart disease and mental illness — just about anything that involves chronic inflammation — none of these are curable, in general.

    There is prevention and emergency surgery, symptom-suppressing drugs, but seldom any real understanding or cures.

    It is just wishful thinking to believe that steady, if slow, progress will eventually shed light on fibromyalgia, from within the current mainstream perspective.

  2. hardnose – it is amazing how consistently totally wrong you are, on such a wide range of topics.

    We have made incredible progress on multiple sclerosis, for example, and have gone from no ability to modify the disease just 20 years ago to a slew of disease modifying medications that in some subtypes of MS make a dramatic difference.

    There are plenty of other types of medical illness that are well understood and treated outside of your narrow list. Migraine is a perfect example. We have very effective treatments for this syndrome.

    There are disorders of electrical activity, hormonal, toxic, metabolic, environmental, physiological, etc.

    And you talk about cure as if that is the only option. There is a broad spectrum of disease-modifying treatments that are not an outright cure but can put a disease into remission, or control the disease so that it is only a minor nuisance.

    There are scientists trying to tackle these issues from many perspectives. Your persistent narrative about “reductionist” modern science is so boring and predictable, not to mention disconnected from reality.

  3. goldmund52 says:

    SN: Well done post.

    I think some clinicians hesitate to diagnose fibromyalgia because of their sense that the label may not help the patient. It can reinforce sick role behavior. But, in my world, the main reason it is helpful to positively diagnose fibromyalgia is to prevent iatrogenic harm. I commonly see patients who have had multiple procedures along the spine and elsewhere: epidurals, selective nerve root blocks, radiofrequency ablations, prolotherapy (now upgraded to platelet rich plasma). I whip out the fibromyalgia meter (Wagner Force Dial) and if the thresholds are diagnostic I explain to the patient why nothing they have been doing provides durable benefit.

    For me the Wagner Force Dial adds a level discrimination. (I think I might be the only person in the world that uses one clinically—well, in my geographical area at least.) There is a population with exquisitely low thresholds at the tested points. They tend to be the ones with visceral as well as somatic pain—irritable bowel and bladder. Those people I diagnose with fibromyalgia. In contrast, it’s very interesting to evaluate a patient presenting with the diagnosis of fibromyalgia whose thresholds are above the typical range. Those patients I give permission not to embrace the diagnosis, so to speak. Sometimes those people are somewhere on the somatoform spectrum, where sick role behavior is their primary diagnosis.

  4. BillyJoe7 says:

    Hardnose has been around here for years now and remains as ignorant as when he first appeared. This is incredible to me. You’d think at least a bit of the wisdom would eventually rub off. But here he is still spouting the sort of nonsense that we’ve seen on display in the last few threads. No matter how many times things are explained to him, he never seems to get it.

  5. AmateurSkeptic says:

    Hey Hardnose! Ever hear of polio?

  6. hardnose says:

    Polio is an infection and is therefore on my list of the sort of things that mainstream medicine understands.

  7. hammyrex says:

    Which cures have been produced for chronic disease states from alternative scientific methodologies that are strictly non-reductionist in their approach?

  8. AmateurSkeptic says:

    Well I’m so pleased to see that their reductionist rut hasn’t prevented mainstream medicine from virtually eradicating polio.

  9. RickK says:

    New Horizons and Cassini, the Mars explorers, Chaos Theory, quantum effects in photosynthesis, neuroplasticity, epigenetics, the Fermilab Holometer, genetic cancer treatment, the Higgs Boson, WMAP and Kepler, plate tectonics, modern prosthetics, Homo Naledi…

    “Reductionist rut” my ass…

  10. tmac57 says:

    I too would like to hear about all of the cures, breakthroughs, and superior treatment modalities that non-reductionist, non-western, non-ruttist heroes of alternative medicine have blessed the world with to date.
    My guess is if it truly works, it will already be something that we already acknowledge as ‘medicine’.

  11. hardnose says:

    Reductionism and materialism are NOT science, they are ideologies. They are NOT responsible for any scientific or technological advances.

  12. BillyJoe7 says:

    Another content free contribution by the blog’s court jester.

  13. Bruce says:

    Court Jester implies intentional idiocy to garner laughs.

    Unfortunately, I don’t think there is anything intentional in HN’s idiocy.

  14. tmac57 says:

    Yes, I remember well the western scientist’s chant of “Reduce, re-rut, re-materialize!!!”

    Stupid rationalists! Always wanting evidence and testing everything! Can’t they just believe already?

  15. Pete A says:

    “Reductionism and materialism are NOT science, they are ideologies. They are NOT responsible for any scientific or technological advances.”

    Science, technology, and medicine have advanced and continue to advance.
    People working in these fields are responsible for the advances (because science by itself is not a machine/person producing output).

    So, your “reductionist rut” argument is self-refuting. These would be better arguments:
    1. Religion is not science, it is a collection of incompatible ideologies, which are NOT responsible for any of the scientific, technological, and medical advances we are making.

    2. Alternative medicine is neither science nor medicine, it is a collection of incompatible ideologies, which are NOT responsible for any of the scientific, technological, and medical advances we are making. The only thing they ‘cure’ is illnesses that don’t actually exist and, of course, fat wallet syndrome.

    I get the impression that you are suggesting fibromyalgia (and many other illnesses) has a supernatural or paranormal cause. Perhaps the cause is a miasm, unbalanced chi, praying to the wrong deity, ancestors who eat a forbidden apple, possession by a spirit entity, the position of the planets at birth, having one’s bed aligned in the wrong direction, a ley line, Wi-Fi, mobile phones, overhead power lines, aliens in their UFOs, or any combination of these things. Without science, everything imaginable becomes magically possible — and easy to sell to people who are vulnerable due to being chronically ill. The correct term is “quackery”.

  16. steve12 says:

    HN:

    Just replace “Marketing” w/ science:

    https://www.youtube.com/watch?v=xIVRvd1g5Jg

    I do find it sort of humorous that someone in a scientific argument cannot even define science.

    The truth about HN is much more tedious: he’s a denier. Not of AGW or vaccines. No, he’s a denier of knowledge period.

    Let me be a good reductionist and simplify HN: he’s a denier. Not of AGW or vaccines. No, he’s a denier of knowledge period. No one knows anything.

    I can just hear the 3 AM conversation about solopsism and the ‘Matrix’….

  17. steve12 says:

    My ‘funny’ edit ruined by my poor proof reading!

  18. hardnose says:

    “Stupid rationalists! Always wanting evidence and testing everything! Can’t they just believe already?”

    There is no connection between rationalism, science and materialism. Materialism is an ideology that makes no sense, and has nothing to do with the scientific method or logic.

    I am not a materialist (whatever that is), but there is no reason non-materialists can’t be scientific. When you feel threatened by an argument all you can do is try to be insulting.

    Many scientific and technological advances occurred before the materialist/atheist fad began taking over mainstream science. And even now, a large percentage of scientists are not materialist/atheists. This blog is a haven for fanatical atheists. You mostly talk to each other so you have no perspective.

  19. mumadadd says:

    “Materialism is an ideology” is not an argument.

  20. mumadadd says:

    Neither is “materialism is stuck in a reductionist rut”.

  21. steve12 says:

    HN: define science for me

  22. hammyrex says:

    Hello, I’m here to sell you a vacuum cleaner. Let me explain for an hour why your current vacuum is completely useless and you should feel dumb for having ever bought it. Just don’t ask about the product I’m selling, because I have no intention of explaining why mine is better or more useful.

  23. tmac57 says:

    HN- “I am not a materialist (whatever that is),…”

    Hmmmm…you don’t know what materialism is but you know that you aren’t one (materialist) , and you are sure that it make no sense?

    Good, solid rationality there HN.

  24. Bruce says:

    “This blog is a haven for fanatical atheists.”

    HA!

    Just go visit other blogs and spew your nonsense, especially ones that are specifically about athiesm. You have no idea how lightly treated you are here.

  25. hardnose says:

    “Hmmmm…you don’t know what materialism is but you know that you aren’t one (materialist) , and you are sure that it make no sense?”

    The idea of materialism makes no sense, the word is never defined logically. I would not describe myself as something that has not been defined and makes no sense.

  26. hardnose says:

    “HN: define science for me”

    Science is a method for determining cause and effect. It’s really a formalization of good old trial and error, which our species (and others) has always practiced.

    The scientific method can lead to definite answers, but it also can be extremely difficult and time-consuming, and would not usually be practical in every day life.

    Science and the philosophy of materialism are not related.

  27. hardnose says:

    But I should add that in certain kinds of work we do generally use the scientific method. For example, in anything that involves trouble-shooting, such as software development.

    In many non-technical things, however, a strictly scientific approach isn’t practical. For example, you can’t do an experiment to see what your life would have been like if your children had never been born, or if you had married a different person.

  28. Pete A says:

    “But I should add that in certain kinds of work we do generally use the scientific method. For example, in anything that involves trouble-shooting, such as software development.”

    And, for example, trouble-shooting things such as fibromyalgia.

  29. hardnose says:

    “And, for example, trouble-shooting things such as fibromyalgia.”

    I never said medicine should not be scientific! I keep saying the opposite. I said that science and materialism are separate things. You can trouble shoot fibromyalgia scientifically without being stuck in materialism. That is my whole point.

  30. RickK says:

    hardnose,

    You keep telling us what you’re against.

    You don’t like atheists. Ok, fine. Name a god that definitively exists and provide your evidence. If you can’t name a god that definitively exists, then explain why atheism isn’t a perfectly valid conclusion based on the evidence.

    You don’t like materialists. Ok, fine. Define “materialism” and explain why it doesn’t work and provide examples where “non-materialism” performs better.

    You don’t like mainstream medicine. Ok, fine. Provide an example of alternative medicine curing a condition and why it cured it, and let’s discuss it.

    What are you in favor of? What do you promote as an alternative? If the scientific method, which I define as trying every way possible (including enlisting others) to prove your own ideas wrong, isn’t an effective way of finding truth, please offer your alternative approach and examples of why it works better.

    We’re not insulting you because your ideas are threatening, we’re insulting you because you’re not presenting any ideas – you’re just crapping on everybody else’s. Your unsupported dismissal of the evidence-based discovery process that has given us every single answer to every mystery of nature that’s ever been solved is worthy of nothing but scorn.

    If you don’t want to be treated like an unruly brat, man up and make a cogent case FOR SOMETHING.

  31. Khym Chanur says:

    @hardnose:

    You can trouble shoot fibromyalgia scientifically without being stuck in materialism. That is my whole point.

    How would one troubleshoot fibromyalgia in a non-materialistic, non-reductionistic manner?

  32. Pete A says:

    “I never said medicine should not be scientific!” Indeed, you have claimed that mainstream medicine is unscientific because it is stuck in a reductionist rut.

    But, you refuse to tell us *your* definition of science, *your* definition of non-reductionist medicine; and you endlessly refuse to provide even a jot of evidence for an alternative system that is medically efficacious.

    The only thing that you seem capable of is making endless pathetic stabs at those who ask you to provide evidence of your claims. I will, of course, give you full credit for your exemplary displays of having abject bankruptcy in the fields of 21st Century science and logic — straw-manning your opponents and issuing ad hominem attacks are the lasts resorts of everyone who has zero evidence to back their belief systems.

    Back in 2007, PZ Myers issued a sobering warning that has, most unfortunately, been the truth ever since:
    “Brace yourselves, people. These cranks and religious weirdos are not going to provide better, smarter, more interesting arguments as they work their way through the three fronts I mentioned at the beginning. What we’re going to get is ever more stupid, illogical, and fact-free rationalizations for their religious presuppositions. We have to wrestle with them as they come up — that is the rationalist’s obligation — but we also have to address the root cause directly. And you all know what that is, boys and girls…

    The damned curse of supernatural and religious thinking.”
    http://scienceblogs.com/pharyngula/2007/06/04/egnors-machine-is-uninhabited/

    See also:
    http://rationalwiki.org/wiki/Non-materialist_neuroscience

  33. hardnose says:

    “If the scientific method, which I define as trying every way possible (including enlisting others) to prove your own ideas wrong, isn’t an effective way of finding truth, please offer your alternative approach and examples of why it works better.”

    I have said several times just recently that I am NOT in ANY WAY opposed to the scientific method. How else can I say it so you might be able to understand?

  34. hardnose says:

    “How would one troubleshoot fibromyalgia in a non-materialistic, non-reductionistic manner?:

    By using the scientific method.

  35. hardnose says:

    “you refuse to tell us *your* definition of science”

    You obviously didn’t read my comments.

  36. Pete A says:

    You obviously didn’t properly read my comments or bother to read the references I provided. I’m sure you’ll perform your usual ‘trick’ on this website: trying to bury solid evidence with your multiple outbursts of incoherent noise.

  37. Khym Chanur says:

    @hardnose:

    Could you give some examples of non-materialistic, non-reductionistic application of the scientific method? Within the realm of medicine, would the scientific investigation of things like energy healing and homeopathy count?

  38. RickK says:

    hardnose said: “I have said several times just recently that I am NOT in ANY WAY opposed to the scientific method. How else can I say it so you might be able to understand?”

    OK, fine.

    That’s it? That’s the extent of your response? That’s all you can offer that’s positive or gives us an idea of what you’re “for”?

    hardnose is not opposed to the scientific method.

    hardnose is against materilism, but he can’t define it or give a positive example of “non-materialism” in action.

    hardnose is against reductionism, but can’t given an example of how reductionism is being misapplied or is holding us back.

    hardnose is against atheism, but can’t support the existence of any gods or express why atheism isn’t a valid position given the evidence.

    But… hardnose is not opposed to the scientific method.

    Got it.

  39. RickK says:

    Thanks Pete A for that reference back to a memorable and accurate PZ post.

  40. steve12 says:

    HN’s definition of science:

    “Science is a method for determining cause and effect. It’s really a formalization of good old trial and error, which our species (and others) has always practiced.
    The scientific method can lead to definite answers, but it also can be extremely difficult and time-consuming, and would not usually be practical in every day life.
    Science and the philosophy of materialism are not related.”

    This is somewhere b/w incomplete and wrong. Science has assumptions that are not stated in the high school “scientific method” you keep referring to. One of those is (at least) methodological naturalism. W/o this assumption, how can our experimental manipulations be interpreted? The effects we see could be caused by our manipulation, or the capricious (non material?) whims of who-knows-what. Those capricious whims of who-knows-what might be real and true – but if they are, there’s no point in doing experiments. Our manipulations are pointless. So we must (MUST!) assume methodological naturalism in order for science to have any meaning.

    Now, can we assume methodological naturalism w/o assuming materialism? I don’t see how.

  41. hardnose says:

    Why would non-material causes be capricious? Many things investigated by modern science are not material.

  42. mumadadd says:

    I agree with HN on one count, that materialism is poorly defined. I can see how materialism could be considered circular — there is only matter, and everything that exists is defined as matter; when something new is discovered it is incorporated into this category and there is nothing, even in theory, that could actually exist and wouldn’t be included in this category.

    I casually use term interchangeably with “physicalism” and “naturalism”, but I see all of them as more a shorthand for a form of monism. For me, the key point is that everything we observe can be explained in terms of interactions of “stuff” as determined by consistent and predictable rules; there isn’t something in addition to this or something outside of the system that can act within it. This assumption has worked historically and continues to be the only game in town for making successful predictions about reality and driving technological progress. It seems reasonable to continue with this assumption until we start tripping over anomalies that we can’t explain within this framework.

    People like HN and Ian “clockwork clock” Wardell will point to gaps in our current scientific picture, or the fact that our knowledge isn’t perfect and complete, as though this confirms the existence of phenomena for which there is no reliable evidence, or as though it completely undermines the whole assumption of materialism/naturalism/physicalism. It doesn’t; you don’t just get to introduce magic because we don’t have perfect knowledge that can explain absolutely everything now.

  43. BillyJoe7 says:

    mumadadd: “materialism…I casually use the term interchangeably with “physicalism” and “naturalism””

    I’ve usually resorted to the following in these arguments:
    material/physical/natural VERSUS immaterial/non-physical/supernatural

    This puts the two positions in sharp relief.
    The second trinity is unsupportable from the point of view of science.

  44. Pete A says:

    Carl Sagan explained it in the chapter “The Dragon in My Garage” of his book The Demon-Haunted World: Science as a Candle in the Dark.
    http://rationalwiki.org/wiki/The_Dragon_in_My_Garage

  45. steve12 says:

    HN:

    “Why would non-material causes be capricious? Many things investigated by modern science are not material.”

    That’s just it -how would I know?

    If there is this whole other non-natural causation that may have caused the effects I’m seeing in my experiment instead of what I naturally manipulated (a limitation of science to be sure), how can I interpret my experimental results?

    Why engage in science when the effects I’m observing can’t be interpreted?

    They may be caused by:

    A. my natural manipulation

    OR

    B. some non-natural intervention that I *by definition* cannot control in an experiment.

  46. hardnose says:

    “everything we observe can be explained in terms of interactions of “stuff” as determined by consistent and predictable rules; there isn’t something in addition to this or something outside of the system that can act within it.”

    I can’t imagine why you think I would not agree with that.

  47. mumadadd says:

    You said there was strong evidence of the supernatural. That is in direct contradiction to what you just agreed with. So which is it?

  48. mumadadd says:

    # hardnoseon 03 Sep 2015 at 6:58 pm

    “Believers are not necessarily more scientifically illiterate – even highly educated individuals can be believers – but they are bothered less by apparent contradictions between their paranormal beliefs and logic and evidence.”

    Nonsense. There is no logic or evidence that contradicts the supernatural. Even if you refuse to consider the enormous quantity of evidence for the supernatural, you still can’t claim to have any negative evidence.

    http://theness.com/neurologicablog/index.php/thinking-style-and-paranormal-belief/#comment-101517

  49. steve12 says:

    Prepare yourself, Mumadadd, for a one-liner that clarifies nothing.

    The one thing that HN actually IS an expert in – his own thoughts – he’s quite stingy with.

    I suspect he hasn’t really thought about the natural / supernatural distinction much. He thinks an orderly universe that follows rules and can be explained by science could still be supernatural. Which is of course logically absurd.

  50. mumadadd says:

    HN,

    You also said that extra spatial dimensions and parallel universes might account for common paranormal experiences. WTF, seriously?! Explain how this follows; then explain how it doesn’t contradict my statement that you previously quoted and (heavily) implied that you agreed with.

    Or ignore me – it’s just my indoctrination talking…

  51. mumadadd says:

    Steve12,

    “Prepare yourself, Mumadadd, for a one-liner that clarifies nothing.”

    I live in hope…

  52. AmateurSkeptic says:

    # hardnose on 03 Jun 2015 at 1:20 pm

    2. Most anti-GMO arguments I have seen are stupid and/or unconvincing.

    3. I think there are very good reasons to be concerned about GMOs. One good reason is that DNA is not at all well understood. Another is that allergies and the immune system are not at all well understood. How can you test something and confidently verify its safety if you don’t really understand the thing you are testing?

    # Ekko on 03 Jun 2015 at 1:34 pm

    hardnose,
    I like how your point #3 reinforces your point #2.
    Luckily, your personal lack of knowledge and understanding are not relevant in the larger scheme of things.

  53. hardnose says:

    If you were able to read and think carefully, you would have seen that 2 and 3 do not contradict each other.

  54. hardnose says:

    mumadad,

    Everything is made out of stuff and everything is part of nature. But that doesn’t mean it’s simple or that science has a good understanding of nature.

    I believe there is probably stuff that is not yet understood or recognized by science. The particles, energies and fields that are currently known are probably not all there is. Very far from it, I think.

    I also believe, as I have admitted, that the universe is made out of information, and that it is intelligent. Materialists believe that mind has evolved out of unintelligent non-living stuff. I think the opposite — that stuff evolved as a product of universal intelligence.

    I do not believe in the “supernatural,” because I think everything by definition must be part of nature. The nature/supernature dichotomy originally referred to what can or cannot be perceived by the physical senses.

    Now we know that there are many things that can’t be perceived with the physical senses, yet we know they are all part of nature anyway.

  55. hardnose says:

    And sometimes I used the word “supernatural” here, but I really meant things not yet understood by science.

  56. AmateurSkeptic says:

    Hardnose, you are confirming Ekko’s point since #2 and #3 do not contradict each other.

    #3 is both stupid and unconvincing as you so eloquently suggested in #2.

  57. RickK says:

    Actually, I’m rather proud of hardnose. He took a break from disparaging everything to say what he actually believes. Let’s giv him credit and engage with what he’s said. I will, when I’m not typing on an iPad on a moving train.

  58. Pete A says:

    Hardnose,

    “If you were able to read and think carefully, you would have seen that 2 and 3 do not contradict each other.”

    If you were able to think logically and coherently, you wouldn’t have written such an egnorant [two sandwiches short of a picnic] comment for the world to see and to indelibly record.

    “And sometimes I used the word ‘supernatural’ here, but I really meant things not yet understood by science.”

    No, you use words to mean whatever you want them to mean, aka wilful obscurantism.

    It is always hilarious to watch an ideologist, who doesn’t begin to understand logic and science, endlessly attack not just science, but also anyone and everyone who does actually understand 21st Century logic and science.

    Regarding your frequent bandying around of the word “supernatural”, I called you to task for it on 13 Sep 2015:
    http://theness.com/neurologicablog/index.php/thinking-style-and-paranormal-belief/#comment-101812

  59. steve12 says:

    HN:on 16 Sep 2015 at 6:44 pm

    All of this is great – a clear spelling out of what you think, whether we agree or not. Especially here:

    “And sometimes I used the word “supernatural” here, but I really meant things not yet understood by science.”

    This is a common semantic confusion that can enter discussions like these and wreak havoc, but it’s now clear. Thanks for that clarification.

  60. tmac57 says:

    HN- “Now we know that there are many things that can’t be perceived with the physical senses, yet we know they are all part of nature anyway.”

    Can you supply an example?

    Even invisible light waves and sound waves beyond human hearing are known to our senses by proxy of our tools, and were predicted by theory, so those kind of things do not count.

  61. hardnose says:

    “Even invisible light waves and sound waves beyond human hearing are known to our senses by proxy of our tools, and were predicted by theory, so those kind of things do not count.”

    The things that we can perceive through technology are things that science already understands. We now know that things can exist that we cannot naturally perceive. People had no idea that microbes or x-rays or protons, for example, existed, before we had technology to detect them.

    There is absolutely no reason to assume that the things nainstream science already knows about are all that exists.

  62. mumadadd says:

    HN,

    Thanks for clarifying what you believe. So now the question becomes, why do you believe this?

    “I believe there is probably stuff that is not yet understood or recognized by science. The particles, energies and fields that are currently known are probably not all there is. Very far from it, I think.”

    Maybe, maybe not. But how do you get from that to anything specific? As an example, we have dark matter – we know it’s there but we don’t know what it is. The basis for concluding that it is there is solidly science based, and we can at least make sensible speculations about what it is we’re looking for. So, based on our best current understanding, what other *specific* gaps are there that suggest completely new particles/forces/something else? On what basis can you speculate about specifically what these will be, or which well established, well evidenced theories might be overturned? Surely you would need counter-theories with comparable evidence — what are these?

  63. mumadadd says:

    HN,

    “People had no idea that microbes or x-rays or protons, for example, existed, before we had technology to detect them.

    There is absolutely no reason to assume that the things nainstream science already knows about are all that exists.”

    But there were observable effects before we had the capability to directly observe what was causing them. Obviously we can’t rule out stumbling across something completely novel and unforeseen because we invented a new gadget that could (incidentally) detect it, but this isn’t generally how science progresses; you need an observable effect before you can speculate about a cause and how to verify this cause.

    So, start at the beginning — what observable effects aren’t sufficiently explained by current scientific models?

  64. Pete A says:

    He’s just playing the tired old game “Science doesn’t know everything.”:
    http://rationalwiki.org/wiki/Science_doesn%27t_know_everything

    It’s frequently used in apologetics — especially the Argument from design aka God of the gaps. “This is by far the most popular argument because it almost sounds like science.”:
    http://rationalwiki.org/wiki/Apologetics

    We’ve already had the Argument from morality.
    http://rationalwiki.org/wiki/Fun:Arguments_for_the_existence_of_God

  65. BillyJoe7 says:

    hardnose,

    “I believe there is probably stuff that is not yet understood or recognized by science. The particles, energies and fields that are currently known are probably not all there is. Very far from it, I think”

    You might be interested in the views of an actual physicist:

    http://www.preposterousuniverse.com/blog/2010/09/23/the-laws-underlying-the-physics-of-everyday-life-are-completely-understood/

    http://www.preposterousuniverse.com/blog/2010/09/29/seriously-the-laws-underlying-the-physics-of-everyday-life-really-are-completely-understood/

    http://www.preposterousuniverse.com/blog/2010/10/01/one-last-stab/

  66. Pete A says:

    HN’s first sentence on this article was: “If it is not caused by an infection, genetic defect, or injury, syndromes are not and never will be understood by mainstream medicine as specific diseases.”

    Which is the God of the gaps argument:
    P1: Science doesn’t know X (syndromes such as fibromyalgia in this instance).
    P2: Anything science doesn’t know it will never know.
    C1: Science will never know X.
    C2: God did it (or the intelligent designer, original sin, the supernatural, the paranormal, etc.).

  67. tmac57 says:

    All of this wasted time just to be told science doesn’t know everything, as if anyone ever said or inferred such a thing. It was all just a strawman argument from the get go. Sigh….

  68. hammyrex says:

    Yeah, the whole bait-and-switch is kind of obnoxious. I was hoping there might be some collateral that results in learning something new about philosophy of science; instead it was just a time machine back to high school intro to philosophy.

  69. Pete A says:

    tmac57, I think it essential to understand and to recognise negative apologetics when it is being deployed.

    QUOTE (retrieved 2015-09-17)
    Purely defensive apologetics, or negative apologetics, “is concerned with responding to direct attacks upon the truth or rationality of Christian faith, trying to show that such criticisms are unjustified. This apologetic method is commonly associated with Reformed Epistemology. The objective is to show that the believer is justified or is not in violation of any rationality norms or is within his or her ‘epistemic rights’ in accepting Christian beliefs.”[7] Negative apologetics may attempt to refute arguments perceived as contrary to Christian faith by showing them to be internally inconsistent or by showing them to be irrational according to Christian presumptions.[8] As negative apologetics is framed in terms of permission to maintain a belief despite objections, it makes no attempt to justify the belief as warranted. Thus, where negative apologetics is the sole apologetics presented, as is common among young earth creationists, the apologist implicitly makes an argument for the existence of a god or some other religious proposition that remains unvalidated.
    http://rationalwiki.org/wiki/Christian_apologetics#Negative_apologetics

  70. hardnose says:

    Oh yes Sean Carroll, we are so fortunate that there is someone in the world who understands it all. And if you don’t believe he knows it all, just ask him and he’ll tell you that he does. Case closed.

    And of course the laws of physics of every day life are all there is, so we can stop worrying about everything else. Close down subatomic physics and astromony, we don’t need them any more.

  71. Pete A says:

    As I’ve mentioned before, there are two methods to bury a signal in noise: reduce the power of the signal; increase the level of noise.

    Egnor/hardnose is unable to reduce the power of the signal on this website, therefore his only option is to ramp up the level of incoherent noise — by using both short bursts of (Poisson) noise and long-term incessant random (Gaussian) noise.

    Only on his IDiot website (and in other domains over which he has acquired a level of control) is he able to silence a few of his critics.

  72. AmateurSkeptic says:

    Sean Carroll: “Obviously there are plenty of things we don’t understand. We don’t know how to quantize gravity, or what the dark matter is, or what breaks electroweak symmetry. But we don’t need to know any of those things to account for the world that is immediately apparent to us. We certainly don’t have anything close to a complete understanding of how the basic laws actually play out in the real world — we don’t understand high-temperature superconductivity, or for that matter human consciousness, or a cure for cancer, or predicting the weather, or how best to regulate our financial system”

    “Science will certainly push forward along the frontier of phenomena that are too big or small or subtle to be detected without delicate instruments, as well as along the much more jagged and unpredictable frontier of how the basic laws play out in complicated ways.”

    Hardnose interpretation: “And of course the laws of physics of every day life are all there is, so we can stop worrying about everything else. Close down subatomic physics and astromony, we don’t need them any more.”

  73. BillyJoe7 says:

    hardnose,

    How can you expect to learn anything if you cannot understand what you read.
    I invite you to read – and understand – what Sean Carroll is saying in those articles, the second two of which are responses to criticism of what he said by those like yourself who either don’t understand what he said or don’t want to.

    The Laws Underlying The Physics of Everyday Life Are Completely Understood.
    Seriously, The Laws Underlying The Physics of Everyday Life Really Are Completely Understood.
    One Last Stab:

    “And of course the laws of physics of every day life are all there is, so we can stop worrying about everything else. Close down subatomic physics and astromony, we don’t need them any more”

    What an ignorant response to those articles.
    I refuse to believe that you are a retired scientist.

  74. BillyJoe7 says:

    hardnose,

    There’s even a refutation of your “modern science is in a reductionist rut” crap:

    “we can think of everyday objects as being composed of individual pieces, such that those pieces obey laws that are the same independently of the larger context. Electrons obey the same equations of motion whether they are in a rock or in a human heart. That’s the reductionist step. Again, for people who enjoy taking offense: this is not to say that the reductionist description is the only interesting one, or to imply that the right way to attack macroscopic problems is to reduce them to microscopic ones; only that the microscopic laws exist, and work, and are complete within their realms of validity”

  75. hardnose says:

    “The Laws Underlying The Physics of Everyday Life Are Completely Understood.”

    But that’s an insane statement. We don’t even know what matter is.

  76. Pete A says:

    “But that’s an insane statement. We don’t even know what matter is.”

    Thank you clarifying that it is you and your ilk [your fellow ideologists] who don’t know what matter is.

  77. tmac57 says:

    hardnose- Just because the complexity of the universe is not completely understood, and the rules that govern it are currently only partly (tentatively) defined, does, in no way allow any hack that comes along to change those existing rules to Calvinball, and be taken seriously.

    Do you have even the remotest idea of how much work it would take to truly change the existing paradigm of physics, and biological sciences? Those concepts will undoubtedly change with time, but it won’t be easily stumbled upon by mere navel gazing or naive hunches and gut feelings.

    If you truly do respect the scientific method, then give it, it’s practitioners, and the process a lot more credit and respect too, and be a bit more humble, because as Ben Goldacre has said: “I Think You’ll Find it’s a Bit More Complicated Than That”.

  78. BillyJoe7 says:

    hardnose:

    “We don’t even know what matter is”

    You’ve either not read the article or you’ve not understood it.
    Which is it?

    Sean Carroll:

    “But — here’s the important part — one thousand years from now, you will still hear precisely that same story…What there won’t be is some dramatic paradigm shift…Nor will we have discovered new fundamental particles and forces that are crucial to telling the story of everyday phenomena. If those existed, we would have found them by now. The view of electrons and protons and neutrons interacting through the Standard Model and gravity will stay with us forever — added to and better understood, but never replaced or drastically modified”

  79. hardnose says:

    You think that because physicists have observed electrons and protons and neutrons they understand what matter is?

  80. BillyJoe7 says:

    hardnose:

    “You think that because physicists have observed electrons and protons and neutrons they understand what matter is?”

    Sean Carroll:

    “I’m not trying to make a deep philosophical point about the meaning of “understanding”; just noting that things obey laws, and in the everyday regime we know what those laws are”

  81. hardnose says:

    “complexity of the universe is not completely understood”

    Materialists always do that. Pretending to admit not everything is understood, while implying that almost everything is understood.

    You have absolutely no idea how much is understood or not. It is not possible to know how much you don’t know.

  82. tmac57 says:

    “You have absolutely no idea how much is understood or not. It is not possible to know how much you don’t know.”

    I know that we know millions of things that we did not know 10,000 years ago, and we know more (as a species) every year, every day, every second, every millisecond. That we uncover new mysteries means nothing more than that we are making progress, while you see it as regression or stalemate apparently.
    For your own sake man, get some perspective!

  83. mumadadd says:

    “You have absolutely no idea how much is understood or not. It is not possible to know how much you don’t know.”

    I sympathise, HN, really. But there are degrees of confidence about very specific effects, their causes, and the theoretical framework that accounts for said effects, then makes predictions about future effects which can then be validated (or otherwise) through empirical inquiry.

    Explain to us a better way of interrogating reality for answers. Then see PeteA’s previous post about known unknowns / unknown unknowns (I think it was addressed to you, so you probably remember it). Then provide even a sliver of reasonable evidence or theoretical merit for your own assertions.

    We don’t know whether matter is made of little indestructible, irreducible balls of ultimuterealitium or excitations in quantum fields; whether we’re in an infinite regress of black holes, like a cosmic set of Russian dolls; a holographic universe; a multiverse (and if we are, or what variety?).

    So. F*cking. What.

    What the hell else can we do do but what we are doing now? You have a surface level understanding of the intricate and well evidenced theories you so casually dismiss (as do I, but I know my limitations). Then you feel free to substitute them with whatever feels right to you based on your own understanding.

  84. mumadadd says:

    PeteA,

    Thank you for linking back to that comment. It would have taken me a while to find it! I did not see your last comment on this thread before referencing it, by the way — just remembered it and thought it was apropos.

    Cheers. 🙂

  85. mumadadd says:

    Me:

    “We don’t know whether matter is made of little indestructible, irreducible balls of ultimuterealitium or excitations in quantum fields;”

    I am willing to withdraw that. I will just say that as far as I am aware “blah blah blah…”

  86. mumadadd says:

    I just saw HN’s comment on another thread:

    “Extensive clinical studies show that homeopathy, unsurprisingly, does not work for anything.”

    If they are so extensive, why don’t you provide even one reference?

    Obviously the homeopathy journals are full of the opposite of whatever studies you know about but won’t refer to.

    I have to conclude: troll.

    My reasons/excuses for all the long responses I posted to his one-liners are all on me — I wanted to say what I said, but I read much more into what he (or she, possibly but unlikely) said than was actually there.

    Hi, I’m mumadadd, and I’m a someoneiswrongontheInternetaholic (as in I just can’t live without someoneiswrongontheInternet). I’m going to make a serious effort to not bother with this particular wrongontheInternet person again.

  87. mumadadd says:

    And in my haste, I f*cked up the joke. Here we go again:

    Hi, I’m mumadadd, and I’m a someoneiswrongontheInternetaholic (as in I just can’t live without someoneiswrongontheInternetahol).

  88. mumadadd says:

    IOW: HN, f*ck you and the horse you rode in on. I conclude that any merit I perceived in what you were saying was only in my own head.

  89. Pete A says:

    “This is where one of the iron laws of internet trolldom needs to be invoked, and it goes like this: if you spend a great deal of your time pretending to be an asshole to get a reaction from people…you aren’t pretending. You *are* an asshole.” — Ed Brayton.

  90. mumadadd says:

    Ha!

    # Steven Novellaon 29 Apr 2015 at 11:11 am

    Hardnose wrote: “And the knowledge acquired becomes harder and harder to fit into any kind of system, or to make sense out of.”

    This was, I think, the worst statement out of a long list of terrible statements. It seems to me he is simply trying to trump up how much we don’t know as a general strategy of poking “materialists” and saying “nah, nah” at science. Philosophically and empirically, any coherent position you can tease out of his statements is absurd.

    As others have pointed out, a fair and complete assessment of scientific progress is very different than Hardose’s self-serving cartoon.

    Actually, we are getting better and better at putting our knowledge into a system or framework. The standard model of particle physics is a great example. This model has had great predictive value, the Higgs just being the latest success story.

    But physicists know this is not the whole story, and so they are working to deepen our understanding of particle physics. Yes, this includes periods of increasing the “known unknowns.” Many would argue that the most useful science does this – points the way to the next mystery to be solved.

    The big picture, however, is one of dramatic progress in our understanding of the universe, expanding our view, making sense of everything, and also expanding our knowledge of how much remains unknown. No one serious today is talking about a “complete” understanding. That is a silly straw man. Scientists are just trying to fill in the gaps, and perhaps get to the next level deeper of understanding, without any pretense that it will be the bottom.

    Part of the problem is that it is easy to take modern knowledge for granted. Compare what physicists and chemists know today about matter with the beliefs of alchemists from a few hundred years ago.

    You can always focus on anything (any institution, any person, any discipline) and exaggerate the negatives while minimizing the positives to make it seem worse than it is, or even hopeless or worthless. Hardnose’s attempt to do this to science is particularly transparent and juvenile, but that is his MO.

  91. BillyJoe7 says:

    hardnose:

    ““complexity of the universe is not completely understood”
    Materialists always do that. Pretending to admit not everything is understood, while implying that almost everything is understood.”

    The irony.

    You used the word “understood” three times in the above quote from your last post, but you have shown that you have undertood nothing.

    Physicist are not saying everything is understood, they are saying that all the fundamental laws, particles and forces that affect our every day lives are known. There is not going to be a paradigm shift, no new physics, no new laws, particles or forces waiting to be discovered that affect our every day lives. That process is complete. There is not going to be a new force that could explain remote viewing, telekinesis, or telepathy. In fact, these phenomena cannot exist because there are no forces unaccounted for that could explain them.

    What is not completely understood is how these laws are played out – hence (to quote your quote) the “complexity of the universe is not completely understood”. In fact, it is possible that the complexity of the universe will be completely understood.

    In other words, to use an analogy from one of those links, we know the rules of chess but we are not chess masters.

    “You have absolutely no idea how much is understood or not. It is not possible to know how much you don’t know”

    And you have absolutely no idea how much you’ve misunderstood what one physicist means when he says:
    The Laws Underlying The Physics of Everyday Life Are Completely Understood.
    Seriously, The Laws Underlying The Physics of Everyday Life Really Are Completely Understood.
    I’m not even saying he is correct, just that you have misunderstood what he is saying and therefore are in no position to criticise what he says.

  92. BillyJoe7 says:

    …damn…In fact, it is possible that the complexity of the universe will NEVER be completely understood.

  93. mumadadd says:

    “IOW: HN, f*ck you and the horse you rode in on”

    Sorry for lowering the tone with that — it was a bit over the top.

  94. hardnose says:

    “You have a surface level understanding of the intricate and well evidenced theories you so casually dismiss”

    What theories did I dismiss???

    I disagree with materialism, which is a philosophy not a scientific theory. We don’t know what matter is, therefore we do not understand the foundation of our world. No matter how many different particles are discovered and observed, we still do not have a basic understanding.

    And within the framework of materialism, that basic understanding will never arrive.

    We don’t need to know what matter is to build better computer circuits and for technology to continue advancing. That is unrelated to whether science is dominated by materialism or not.

    But we do need a better understanding of biology, going beyond beyond materialism, or medical science will remain stuck.

    Yes medical science is stuck. Medical technology advances, as technology in general advances. But mainstream medical science needs to acknowledge and investigate some of the things that alternative science is concerned with.

  95. Willy says:

    Hardnose references “alternative science”. Good grief.

  96. BillyJoe7 says:

    hardnose,

    There is no “alternative science” just science.
    Fortunately, science is based on plausibility and evidence, not the “gut feels” and wild speculations of fringe dwellers who force their “science” to follow their preconceived world view.

    You do indeed have a surface level understanding of science, because that’s all you need to use it to drive your aggenda of supporting your pre-conceived world view.
    A deeper understanding would destroy you.
    You are like a little child still holding onto the apron strings.
    You need to let go and boldly stride out into the brave new world created by science.

  97. Pete A says:

    BJ7 wrote: “There is no ‘alternative science’ just science.”

    Likewise, “alternative medicine” is not medicine: it is an alternative-to-medicine that doesn’t actually work for anyone other its practitioners. Alternative medicine that has been demonstrated to be medically efficacious is called medicine.

    Alternative science has two branches: pseudoscience and anti-science. The former is pathetically silly nonsense; the latter is widespread dangerous nonsense.

  98. Paulz says:

    @ hardnose

    ” And even now, a large percentage of scientists are not materialist/atheists. ”

    Bull.

    Back that up, or you’re talking out of your ass.

  99. mumadadd says:

    I think this is the money-shot, from our host:

    Philosophically and empirically, any coherent position you can tease out of his statements is absurd.

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