Mark Hoofnagle has a MD and PhD in physiology from the University of Virginia, and is now a general surgery resident. His interest in denialism concerns the use of denialist tactics to confuse public understanding of scientific knowledge.
To wear the mantle of Galileo, it is not enough to be persecuted: you must also be right.
--Robert Park
I used to spend a lot of time on the websites of Joe Mercola and Gary Null, the most influential medical cranks of the internets (to call them "quacks" would imply that they are real doctors, but bad ones---I will no longer dignify them with the title of "quack"). I've kept away from them for a while in the interest of preserving my sanity. Unfortunately, Orac reminded me this week of the level searingly stupid and dangerous idiocy presented by these woo-meisters.
In light of this, it seems reasonable to reexamine the Galileo gambit. When a "discoverer" of some new medical "miracle" is dismissed by the medical establishment, they often invoke the ghosts of Galileo and of Ignaz Semmelweis.
Galileo and Semmelweis are a pair of historical figures that share a common story---they both made significant scientific discoveries, documented the evidence for them, and were reviled by certain authorities, but eventually honored.
Ideas are cheap. I believe that my idea to use a flow sheet to track my diabetics' care leads to better outcomes. I have precisely NO evidence to prove this, but it doesn't harm me or my patients, and there is at least peripheral evidence elsewhere that this is a good idea. There is also a plausible hypothesis behind this---if I have one piece of paper that contains the critical data for a diabetic, I can see right away if their blood pressure or cholesterol are above optimal levels, I can see what their weight is doing, and I can see if they have engaged in proper preventative care, such as eye and foot exams. There is also a small body of data to support the practice. It would not surprise me if someone studies this in the future and finds my method lacking, especially vs. electronic health records. When necessary, I'll happily modify my practice in a way that benefits my patients.
Let me summarize the characteristics of a "good" clinical science thinking, in this context (no, I'm not gonna go all Popper on y'all):
- Relevance: an idea should bear directly on a real clinical problem
- Testability: it should be possible to test the idea to see if it has merit (this includes Popperian falsifiability).
- Plausibility: the idea should have some basis in reality and should not have been birthed de novo from between someone's buttocks. It should not require a "suspension of disbelief" or "open-mindedness".
- Abandonability: the poser of the question should be willing to abandon the idea if it is proved false. Moving the goal posts, invoking a conspiracy, or any other deus ex machina is never necessary for a good idea.
- Modifiability: an idea can be rationally modified and retested if it may still contain a kernel of truth despite failing one or another tests. Any idea that is held so tightly that reality must be modified to fit the idea should be highly suspect.
There is an enormous literature on what constitutes science, etc. This is just a little guide to reading on quackery, crankery, and other idiocy.
When you encounter possible medical crankery, a couple of questions to ask yourself are "cui bono": who benefits? Is the answer "patients", "medical science", or "one dude with a P.O. box"?
The other question is, "where's the evidence?" (remember, no conspiracy theories or you violate Pal's Law).
Or, as Dawkins so acerbically put it:
If you are in possession of this revolutionary secret of science, why not prove it and be hailed as the new Newton? Of course, we know the answer. You can't do it. You are a fake.
Medicine & Health
Comments
I have a complex view of this topic because of the difficulty I am experiencing in my nitric oxide research. Many times people have told me "prove it", but no one is willing to work with me to do so, or to tell me where my ideas are wrong.
Some ideas are common, easy to come by, and so are considered to be cheap. Correct ideas are not common, are not easy to come by and so should not be considered cheap. The value of the ideas that Galileo and Semmelweis had was not in the quantity or quality of the evidence that they had for them, rather the value in the ideas was there because the ideas were correct. They were correct irrespective of the quantity of evidence there was for the idea or against the idea.
It is extremely difficult for anyone to think outside the paradigms that they are accustomed to thinking in, even when those paradigms are wrong. To overturn a paradigm, even a wrong paradigm is considered extraordinary and so requires extraordinary evidence. Acquiring extraordinary evidence is not easy. Often it requires funding and funding of ideas that are considered extraordinary in the absence of extraordinary evidence is usually considered too "high risk". What "high risk" means is that those who decide to fund it might look foolish if the project is not successful.
Correct paradigm-breaking ideas are the most difficult to conceive, fund, research, and publish because before they are the premises are thought to be wrong.
Simply because an idea is proposed by someone who is not capable of raising sufficient funding to "prove" the idea is correct does not mean the idea is wrong, only that the idea has not been tested.
To take an example, every single large, long duration, placebo controlled double blind trial of supplemental antioxidants has shown no health benefit to taking supplemental antioxidants. The hypothesis of the trial was that there would be positive health effects and the trial showed that there wasn't any. If the researchers had as their hypothesis that the trial would show there was no benefit, would they have been able to get funding to do it? I don't think so.
Who would get the funding, a researcher who proposes a $10 million trial to show that supplemental antioxidants are a complete waste, or a different researcher who proposes the same $10 million trial to show supplemental antioxidants save lives? The design of the trials would be identical, the data gathered identical, the conclusions reached from the data identical, the only difference is that one researcher has the hypothesis the research will show the supplements to be useless, the other that they will save lives.
Posted by: daedalus2u | August 10, 2008 1:35 PM
But you missed the conspiracy. The [pick one of more: big pharm, AMA, CDC, NIH, journal editors, referees, etc.] are conspiring to keep my PROOF away from the public. All I'm doing is trying to benefit mankind while those evil organizations and people are trying to protect their [pick one or more: turf, profits, academic positions, malpractice insurance, godless science, government agencies etc.].
Posted by: natural cynic | August 10, 2008 1:41 PM
Good points in blog. I do something similar in "debugging" computer technical issues. (not as important as diabetic issues) On our end we do allow for some ideas to be pulled from the ether. We may not try them until we have a test to prove or disprove them. It also depends on how difficult or destructive the test is. (sort of like funding, a $10 trial is more likely to be done than a $10 million trial. )
Too often we do the "wave rubber chicken" solution.
I was watching the Olympics yesterday the women's beach volleyball, USA vs Japan. The Japanese women were wearing titanium necklaces to help them relax and sleep better. (evidence, probably placebo effect)
Posted by: Jim | August 10, 2008 3:43 PM
#1
The person most likely to win will be the one with a reputation for submitting good, fact-checked results on other subjects in that field. Especially if they have enough initial data to show that their proposal has merit.
The problem with folks like Mercola and Null is that they have earned bad reputations in the related fields, and their proposals show no merit based on what we do already know.
Posted by: Bluegrass Geek | August 10, 2008 4:48 PM
"Often it requires funding and funding of ideas that are considered extraordinary in the absence of extraordinary evidence is usually considered too "high risk". What "high risk" means is that those who decide to fund it might look foolish if the project is not successful."
I've been out of academics for about 17 years now, but there used to be grants available from the NIH for the express purpose of generating preliminary data for novel ideas. Are these no longer available?
Posted by: SES | August 10, 2008 7:22 PM
(to call them "quacks" would imply that they are real doctors, but bad ones---I will no longer dignify them with the title of "quack").
I always thought quacks were fake doctors, so the lable fits those guys. The term for a real doctor but a bad one is MALPRACTICE LAWSUIT DEFENDANT.
LOL!
Posted by: Anonymous | August 11, 2008 2:30 AM
(to call them "quacks" would imply that they are real doctors, but bad ones---I will no longer dignify them with the title of "quack").
I always thought quacks were fake doctors, so the lable fits those guys. The term for a real doctor but a bad one is MALPRACTICE LAWSUIT DEFENDANT.
LOL!
Posted by: Dale Husband | August 11, 2008 2:32 AM
Hey, why did my comment post TWICE? And anonymous the first time???
Posted by: Dale Husband | August 11, 2008 2:34 AM
There is some discussion of the term "quack" here: http://www.quackwatch.org/01QuackeryRelatedTopics/quackdef.html "All things considered, I find it most useful to define quackery as the promotion of unsubstantiated methods that lack a scientifically plausible rationale."
I never thought "quack" implies the possession of a medical degree.
Posted by: Joe | August 11, 2008 9:48 AM
I find this whole phenomenon of AIDS denial to be really saddening. The sad thing is that the populations that are heaviest hit by AIDS and HIV are the most likely to believe it, because they have been so disenfranchised by the American Educational System that they do not have the mental self-defense capabilities to protect themselves from pseudoscientific and unscientific claims. Something has to be done about this.
Say what you want about the Cuban government, as they are certainly not a perfect government. But Castro's government has done a better job dealing with AIDS than any other Latin American country, and they would take people like Gary Null and put them in prison in a heartbeat. What Gary Null is doing is a war crime against the uneducated.
Posted by: Gary C. Booker | August 11, 2008 3:00 PM
I tend to use the word "quack" to describe a bad doctor, rather than to describe a dangerous person who *poses* as a doctor.However, I really like to use some compound word with "woo" in it(e.g. "woo-meister", "woo-slinger",etc.)because: 1."woo" rhymes with "poo" (so it's very appropo),and with "foo" ,as in "phooey"(which it is); and 2. it connotes a "wooing", or a courting, of the potential customer,(I mean patient/ client).But that's just me.
Posted by: Denice Walter | August 12, 2008 5:39 PM