Mar 22 2007

UK Fight Over Anti-Science in Medicine

I’m outraged, and I am both distressed and puzzled over why more of my scientific colleagues are not similarly outraged. The institution of science has transformed our world, proven its validity and value, and stood the test of time. The rigorous methods, transparency, and aggressive self-criticism of science are nowhere more needed than in the applied science of medicine. And yet the scientific underpinnings of modern medicine are under relentless attack by ideologues, charlatans, cranks, and frauds – and the public and their elected representatives are largely buying it. It’s like watching a train wreck in slow motion.

Occasionally there are shots fired by those scientists who bother to pick up their head for a moment and see what’s going on in the world around them – as with a recent article published this week in Nature. In the UK over the past decade British universities have started offering bachelor of science (BSc) degrees in subject areas that are not so scientific – including 45 degrees in so-called complementary and alternative medicine (CAM). Six universities offer BSc degrees in homeopathy. Offering a science degree in a pseudoscience is nothing short of a scandal, akin to teaching intelligent design (ID) as science in the classroom.

Professor Colquhoun, a professor of pharmacology at University College London , is quoted as saying, regarding homeopathy, “That is quite different from awarding BSc degrees in subjects that are not science at all, but are positively anti-science. Yet this sort of gobbledygook is being taught in some UK universities as though it were science.”

The Nature article writes: “Ben Goldacre, a London-based medical doctor, journalist and frequent critic of homeopathy, says that several universities have refused to let him see their course materials. ‘I can’t imagine what they’re teaching,’ he says. ‘I can only imagine that they teach that it’s OK to cherry-pick evidence. That’s totally unacceptable.’”

Colquhoun and Goldacre are right on, but their rational voices seem to be drowned out by the din of nonsense on the other side. First, it is very telling that the universities in question are hiding their course material – many even refusing to show their material or even speak with Nature. What are they hiding? Science is supposed to be transparent – how can they possibly justify keeping the details of what they are teaching as science a secret? Such secrecy is a red flag for pseudoscience.

Defenders of anti-science in medicine make several specific claims in their own defense, all hopelessly bogus. Brian Isbell, head of Westminster’s department of complementary therapies, defended teaching homeopathy as science by saying that students will also learn the “health-sciences model of disease.” The phrasing, again, is very revealing. Creationists like to use the word “model” to refer to both creationism and evolution, because it blurs the distinction between a scientific theory and a religious belief. Are their other “models” of disease? In practice such programs teach bad science and token science along side their preferred pseudoscience. The token science is diluted and directly contradicted by nonsense, and so should not earn them a science degree.

The Nature article includes the example of an uncontrolled study in homeopathy – basically patients were just asked how they were doing without objective measures or any control group. Surprise, surprise – many of them said they were doing well. A real science class should teach that such studies are worthless as evidence. Isbell, rather, explained the weaknesses, but then defended the results and still useful. He said, “It doesn’t have the rigour of other methods, but it is part of the picture.”

Clare Relton, a practicing homeopath, is quoted in the study as making the standard defense of lack of evidence for homeopathy – that it cannot be studied by traditional scientific methods. Homeopathic treatments are too individualized, and giving a placebo would interfere with the therapeutic relationship, she argues (which is ironic, given that all homeopathic remedies are nothing more than placebos). Therefore blinded controlled trials in homeopathy are not possible. Of course, this is just the excuse homeopaths give after such trials show that homeopathic remedies do not work. But even if this were true and not the transparent rationalization that it is, it is a logical fallacy to conclude that therefore we can depend on uncontrolled observations. Uncontrolled studies are still worthless, even if that’s all that we have.

Of course, this all has to be viewed in the context that homeopathic remedies cannot possibly work because they contain literally nothing – no active ingredient, just the water in which they are diluted. I do not believe it is an astounding cosmic coincidence that all CAM treatments that are theoretically impossible also are, by their nature, immune to standard scientific study. This is just self deception by the profoundly naïve and scientifically illiterate.

In an interview, “The Prince’s Foundation for Integrated Health, a group set up by Prince Charles to promote complementary therapy, said there was increasing evidence alternative therapies worked and where there was no proof it did not necessarily mean that there would never be.”

We have been hearing this from the CAM crowd for decades now. Proof is coming, it’s coming. The fact is, after renewed interest (political not scientific), years of research, new journals dedicated to CAM, countless studies, millions of dollars spent, and research organizations dedicated to CAM – there is still little to no evidence to support any CAM modality. The evidence is just not there, and it’s not coming. Many modalities have been thoroughly proven to be worthless, like homeopathy, but proponents just dismiss the negative evidence and cherry pick bad studies that appear to support their faith. It’s no different than ESP, Sasquatch, or Astrology. The same pattern of research can be seen in all these areas, and the same lame excuses by proponents. Research in these areas just goes around in circles, never providing compelling or definitive evidence, never teaching us anything about the nature of reality or human disease. The simplest explanation is that the claimed phenomena are just not real.

Defenders criticized Colquhoun and Goldacre for making “sweeping generalizations.” But in this case generalizations are justified. CAM is an extremely diverse set of beliefs and methods with only one thing truly in common – lack of scientific rational or evidence. Basically, everything that falls below the bar of good science gets lumped into this vague category. All defenders of science are saying is that we need to defend quality control in science; we should not have a double standard. Pointing out that everything below the bar is below the bar is not only fair, it’s insanity to pretend otherwise. And it’s malfeasance to confer a science degree on it. (The old cliché of putting lipstick on a pig comes to mind.)

Foundation chief executive Kim Lavely is quoted as saying, “The enormous demand from the public for complementary treatments means that we need more research into why and how patients are benefiting. Scientists should want to explore this rather than make sweeping, absolutist generalisations arising from deeply held prejudice as David Colquhoun does in this article.”

In addition to committing the ad populi logical fallacy, Lavely makes the same mistake that most CAM proponents make when she says that we should research “why and how patients are benefiting.” Wrong. We should be researching IF patients are benefiting. This is precisely why most CAM research is worthless and wasted money and resources – they aren’t designed to answer the only important question: does this stuff work? They start with the assumption that they do work (convinced as they are by anecdotal experience) and are merely trying to find ways to promote CAM.

She also dismisses Colquhoun’s skepticism as “arising from deeply held prejudice.” Wrong again. This is an ad hominem logical fallacy – Colquhoun’s points are perfectly legitimate, and Lavely cannot counter them, so she tries to dismiss them as bias. It is not bias to understand the scientific method and how to apply it to medicine, to champion reason and logic and high standards of scientific quality and academic rigor in this vital discipline.

But to many CAM proponents, steeped in post-modernist relativism, science is a bias. They want something else – they want a different kind of science, one that allows for very unscientific methods (much the same way that ID proponents want to change the definition of science to allow for supernaturalism). They want to undermine the scientific roots of medicine – to treat anecdotal evidence as if it were scientific, to treat uncontrolled studies with the same weight as blinded and placebo-controlled trials, to eliminate any consideration of scientific plausibility, and to remove any enforcement of a standard of care.

Part of this assault on scientific medicine is to render the label “science” meaningless by applying it to pseudoscience and abject nonsense. You bet I’m outraged.

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