Jul 13 2017

The Fragility of Truth

homeopathy5There is a lot to be horrified about regarding the alternative medicine (CAM) industry. The industry largely trades in fraud and misinformation at the expense of the public’s health. But I often find myself most dismayed by what the industry says about the relationship between humans and reality.

I have discussed over the years the many ways, mostly revealed through psychological research, but also with many specific examples, in which people build their narratives about the world and how these narratives trump reality and often even basic logic. If you ever doubt the ability of people to erect a false narrative and worship it as truth, remember that there are people who believe, in the 21st century, that the Earth is flat.

Humans, however, also have science, philosophy, logic, and reason. We have managed, especially in the last few centuries, to collectively crawl out of a deep pit of self-deception and slowly accumulate real knowledge about the universe and how it works. As a species we have this weird dual nature, at times rigorously rational, and at others hopelessly gullible and ideological.

What is perhaps most concerning about the CAM phenomenon is what it tells us about the balance between reason and deception. Sitting on top of the last few centuries of scientific progress, it certainly seems like science and reason are winning. But perhaps this vantage point gives us a biased perspective. Over this period we have largely shifted from a pre-scientific view of the world to a scientific one. Science then showcased its power by picking a lot of the low-hanging fruit – answering the easiest questions to answer.

We made huge discoveries, like the immune system, the germ theory of infection, and genetics. We discovered the fundamental building blocks of the universe, and the various forms of energy – understanding them well enough to harness them directly. Our technology advanced accordingly, and we have transformed our civilization.

But now it seems that the questions are getting harder, more subtle, more complex, and it is taking more and more effort to make incremental advances in our knowledge. We will probably never again see a situation where someone like Einstein publishes four papers in one year, laying out the foundations of special relativity and quantum theory, while earning his PhD and eventually a Nobel Prize, and all in his spare time. Today teams of people working with equipment like the Large Hadron Collider labor for years to add one tiny piece to the puzzle of particle physics.

As scientific questions get more difficult, we are also seeing how easy it is to subtly distort the process of science in order for it to serve a desired narrative. We are reminded how fragile the truth can be.

Today it is really hard to definitively answer a scientific question. You can’t just do one clever experiment that reveals a fundamental nature of reality. In medicine, for example, it takes 10-20 years and dozens of experiments, with increasing rigor, to reliable conclude if a treatment is effective or not. Further, this process must be explicitly designed to really answer that question – does it work? A certain amount of objectivity and judgment is required, which requires skepticism and critical thinking. Along the way most individual studies will be wrong or misleading. Researchers can easily and even innocently put their thumb on the scale with p-hacking. Publication and citation bias can further distort the findings.

Even in mainstream medicine, dealing with scientifically valid and highly plausible hypotheses, it is damn hard to come up with definitive answers. We can do it, but it takes more time and effort than most people realize. And until we get to that final stage in which we are conducting the most rigorous and objective studies, all bets are off. We really don’t know if the treatment works or not. Preliminary evidence is simply massively misleading.

Enter CAM world. There have been a number of criticisms from the outside and exposes from the inside of the world of CAM showing what happens when bias, narrative, and agenda is more important than scientific rigor and truth. Edzard Ernst is perhaps the most famous CAM whistle-blower. He started his career as a homeopath and physician, enthusiastic about the untapped potential of alternative approaches to medical treatment.

This led him to scientifically research the most popular CAM treatments, to review existing evidence, and to engage with his fellow CAM enthusiasts. He wanted to prove scientifically that some CAM therapies worked, but he was honest to the science, and what he discovered is that it is a scam through and through. He found that practitioners were “like children” who jealously defended their beliefs, and would attack anyone who dared speak the truth. In his book (with Simon Singh), Trick or Treatment, he says:

“Concepts such as the qi of Chinese traditional medicine are myths which enjoy the same status as religious faiths. Believers cling to the myth despite the evidence, reinterpret the myth to suit the evidence, or lie about the evidence to support the myth.”

and

“Integrated medicine promotes CAM no matter what the evidence says.”

He is not the only one. Britt Hermes went into Naturopathy thinking it was real medicine, and discovered that she was just being victimized by a scam. Frank van der Kooy had a similar experience with CAM in Australia, documenting how the industry works to create a false narrative.

I, of course, have done my own exploration of the science and deception of CAM. Homeopathy is a great example – homeopathy is pure magic, with zero scientific plausibility, and now a mountain of clinical evidence showing that it works for absolutely nothing. And yet naturopaths and homeopaths keep the lie of homeopathy alive, distorting the evidence, lying about the evidence, making up crazy justifications, trying to change the rules of evidence, and attacking anyone who dares criticize homeopathy.

Acupuncture is perhaps an even better example of what I am talking about here, because it is less obvious. Acupuncture clearly does not work for anything, and also lacks any plausible mechanism. Proponents, however, have been masterful as creating this entirely false construct of acupuncture research which is designed to promote acupuncture and show that it works, while rarely designing the study to ask “does it work?” Those studies that are actually capable of asking the correct question clearly show that acupuncture is worthless. It is a theatrical placebo.

So proponents have mostly stopped doing the kind of studies that can show acupuncture doesn’t work. They design studies guaranteed to give a positive result, to confusingly mix variables, that are not properly blinded, that use weird outcome measures, and even then give a distorted and biased interpretation of the results.

The acupuncture research is a good representation of CAM world overall. The entire industry is a house of cards, based on bias and scientific distortion. They live in the preliminary phase of evidence, and never get to the rigorous definitive stage, or when they do they ignore or dismiss the results. They are superb at marketing, at spin, at attacking their critics, and their customers parrot their propaganda so thoroughly it’s scary. I get e-mails every week from people vomiting forth the standard pro-CAM apologetics, as if they are reading from a propaganda pamphlet.

As a useful thought experiment, I have an open challenge to anyone to tell me one CAM modality that has been rejected by any CAM profession or institution because of evidence of lack of efficacy. It doesn’t exist. This is powerful evidence that they are unable or unwilling to demonstrate that a treatment does not work, which must mean that they are also unable to demonstrate that any treatment does work.

Even more alarming is the degree to which their self-fulfilling narrative had spread into the popular culture, into regulations, and even into academia. They have erected an alternate reality in which their fraud is legitimate, and they have successfully sold that reality to the world.

There are many other examples of this phenomenon, mostly isolated to specific ideological groups. It is also easier to see when it is another group that embraces a false anti-scientific narrative. There are those who reject evolution, deny climate change, think GMOs are evil, and believe that vaccines are a holocaust. People in these groups believe they have knowledge, think they have the answer, and have a long list of ready-made rationalizations that can use to fend off logic and evidence.

CAM is perhaps more dangerous because it is bipartisan. Proponents have learned to work both sides of the aisle. There are also far too many shruggies in science and academia. Politicians generally don’t have the scientific savvy to see through the scam.

All of this is also enabled by the deficiencies in mainstream science, medicine, and academia.

Science is hard, and it’s getting harder. Perhaps we are entering a post-enlightenment period, where the psychological forces of deception and belief have the upper hand over science and reason. We are being reminded how fragile the truth can be. But I like to stay optimistic – we have already identified lots of specific steps we can take to improve the situation. We just need to have the will to take them.

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