Sep 26 2013

The Pharma Shill Gambit and Other Nonsense

Those of us who have been writing about science and medicine for a few years or more quickly experience the fact that there is a subculture of people who are greatly hostile to our message. In addition, they tend to use the same fallacious arguments against us over and over again, as if they are reading from the same script.

As a result we answer the same bad arguments repeatedly, at least so that those who are paying attention will be more prepared to deal with such arguments themselves. Earlier this week Harriet Hall wrote an excellent post over at Science-Based Medicine in which she answers 30 common fallacious arguments against SBM.  The next day I received a comment here that parroted some of the same arguments yet again.

I have addressed these common anti-SBM arguments multiple times, mostly in piecemeal, so it’s good to have Harriet’s post as a sort-of SBM FAQ. Before you leave a critical comment, read the FAQ.

Here is the comment, which I will dissect, adding to Harriet’s analysis.

Clearly the Mayo clinic is run by a bunch of quacks and charlatans that have no interest in the health and well being of the public. How dare they even consider something other than surgery or prescription medication to help people heal. More and more I am getting the feeling that articles like this are by fronts for the pharmaceutical companies. This article is clearly written out of fear; fear that there are ideas and practices out there that you don’t understand and your only resort is to lash out against those ideas. In this case you are attacking one of the most respected medical institutions in the world. Do you, mr. author, perhaps think that maybe you are the one that doesn’t get it?
As far as I can tell the premiss being put forth by the author is that doctors should be the ones that tell their patients how to feel. Ms X has had back problems for years, gets some acupuncture then feels better. According to this article an act of fraud as been committed and her doctor should tell her so. Why? By the way Ms.X your pain didn’t go away you just think it did!
My daughter and I suffer from ‘hay fever’ allergies in the spring. I give her those little white sugar pills knowing full well there is no ‘real’ medicine in them. 15 minutes later symptoms gone she feels better. The over the counter solution has terrible side effects that effectively ruin her day. Why choose the poison? What is your point? People should only feel better if YOU say it is ok.
So what is your point? Why publish articles like this when they serve no real purpose. Is it preaching to the choir so that you get a enough hits on your blog so you keep your job? Many people die every year at the hands of incompetent doctors, and the latest big pharm fad.
How many die from acupuncture or sugar pills? I understand meditation helps clear the mind. Maybe you could try it and come up with a helpful article. Get a doctor to prescribe it for you if makes you feel better.

“How dare they even consider something other than surgery or prescription medication to help people heal.”

This comment is based on the false accusation that mainstream medicine only prescribes drugs and surgery. No doubt these are major treatment modalities of science-based medicine, because they work, but we are not limited to them. Every day I prescribe or give a referral for diet, physical therapy or exercise, specific vitamins for insufficiency or deficiency, lifestyle changes, electrical-based interventions, or counseling. Whatever is supported as safe and effective by plausibility and evidence, I will use.

“More and more I am getting the feeling that articles like this are by fronts for the pharmaceutical companies.”

I wonder where that feeling comes from. Perhaps confirmation bias. It’s nice to just assume that someone you disagree with is lying or biased. It removes the burden of trying to understand and address their actual points. You can then erect a convenient straw man and tilt at it to your heart’s content.

For the record – NeuroLogica, the NESS, SBM, the SGU, or any of my social media outlets are not supported in any way by the pharmaceutical industry. I have zero ties to “Big Pharma.” My efforts are mostly member-supported, with some ad revenue thrown in. I make no money off of my blogs, and they are part of the NESS, which is a non-profit educational organization.

” This article is clearly written out of fear; fear that there are ideas and practices out there that you don’t understand and your only resort is to lash out against those ideas. “

Another convenient straw man assumption. Anyone who has read this blog or SBM to any extent would soon realize that I have a very deep understanding of the ideas and practices that fall under the big umbrella of CAM. I have published peer-reviewed articles on both acupuncture and homeopathy, and many articles as part of a working group that examines unconventional treatments for ALS.

This is not about fear. It’s about defending a single consistent standard of science, evidence, and ethics in the health profession. CAM is all about producing a double standard, lowering the bar for evidence and even common sense for preferred therapies.

” In this case you are attacking one of the most respected medical institutions in the world. Do you, mr. author, perhaps think that maybe you are the one that doesn’t get it?”

This is nothing but an argument from authority. I know Mayo Clinic is highly respected, as I wrote at the very beginning of my article. That’s why it is so tragic that they are allowing their good name and reputation to be used to shill for pseudoscience and quackery.

This is politics. They have been sold a bill of goods and do not have the expertise to recognize the subtle deception. They have handed decision-making over to people who present themselves as the experts, but who are really industry proponents. While I respect Mayo Clinic generally, this is an institutional failure, one that most academic institutions have fallen for.

As for considering that perhaps I am missing something – that is always my default assumption until I have examined an issued with sufficient depth to feel that I have a solid grasp on it. You should try it.

“As far as I can tell the premiss being put forth by the author is that doctors should be the ones that tell their patients how to feel. “

This is simply wrong, and has been addressed multiple times (this is another common straw man). This is not about not believing patients, or telling them what they experience. It is about how to interpret their experience. Anecdotes are tricky because, by definition, there is no control of variables. Which variables led someone to feel better after a treatment – regression to the mean, the self-limiting aspect of the illness, expectation bias, another simultaneous treatment, simple coincidence, or a specific treatment effect?

Even when I prescribe a treatment for a patient and they come back and tell me their symptoms are better, I do not assume that my treatment made them better. There is no way to know for sure with an individual patient. That is precisely why we need large rigorous trials to control for all those variables.

“My daughter and I suffer from ‘hay fever’ allergies in the spring. I give her those little white sugar pills knowing full well there is no ‘real’ medicine in them. 15 minutes later symptoms gone she feels better. The over the counter solution has terrible side effects that effectively ruin her day. Why choose the poison? What is your point? People should only feel better if YOU say it is ok.”

Again, placebo medicine is a very tricky concept. First, I have to wonder if her symptoms would be gone in 15 minutes if you gave her no intervention, or if there is reporting bias involved. Perhaps simple reassurance and attention would be enough, without the placebo. This is simply a “kissing the boo boo” effect – no one has argued against this, or for medication when it’s not necessary. I do think that deception is problematic, but this is a complex issue. Perhaps you can read one of my many other articles on placebo medicine if you truly wish to understand my nuanced position.

“So what is your point? Why publish articles like this when they serve no real purpose. Is it preaching to the choir so that you get a enough hits on your blog so you keep your job?”

This blog is a hobby, not my job, and I make no money from it. I don’t think impact is solely measured in hits either. The point is to explore science and critical thinking in the context of topics of interest to the broad public (you could have clicked the “About the Author” button if you were really curious).

“Many people die every year at the hands of incompetent doctors, and the latest big pharm fad.”

This is the “death by medicine” gambit that we have also covered extensively. Many people also die from lack of proper medical treatment, often at the hands of so-called CAM practitioners. When considering any medical intervention you have to look at risks vs benefit – not just risks. The evidence clearly shows that modern medicine saves many more people than it harms, and we are always looking for ways to reduce and avoid harm. The way to do that is with science – not wishful thinking and mindless propaganda.

“How many die from acupuncture or sugar pills? I understand meditation helps clear the mind. Maybe you could try it and come up with a helpful article. Get a doctor to prescribe it for you if makes you feel better.”

Acupuncture? Here are some cases (and here), and here is a published study. The risk from acupuncture is small but significant. Given that there is no proven benefit, that is too high a risk for me  – again, you have to consider risk vs benefit.

Sugar pills? That is more difficult to measure, as there is no direct harm. Indirect harm, however, can include instilling bizarre health beliefs that lead to avoiding effective treatments and reliance on ineffective treatments. Again, I refer you to What’s The Harm for a long list of what can happen when you believe in placebos.

Conclusion

E-mails and comments such as this are a daily occurrence. They are the result of not thinking carefully about one’s arguments, making knee-jerk self serving assumptions, and not even bothering to understand the position or the person against which you are arguing. It is intellectually lazy.

Hopefully it will serve as a cautionary tale – think before you comment.

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