Effect Measure

Orac is upset with me

There are over sixty blogs under the Scienceblogs umbrella. There is an impression we are all “progressives” (aka left-leaning) and must agree on matters social and political. While we probably are more to the left than the average (we are reality-based and rational, after all) there is a wide spectrum of views amongst ourselves. While I have no hesitation declaring myself a Person of the Left (whatever that means), I am also a scientist and put a premium on critical thinking and rationality, values I share with other Sciencebloggers. This tends to reduce differences between us. But there are real and sometimes big differences nonetheless.

Readers of Scienceblogs know this. The debates sometimes become acrimonious (I won’t link to the posts and wasn’t involved, but suffice to say the word “asshole” was used). More often those differences poke their head above water in more moderate form, and so it is with a personal attack on me by my esteemed Scibling, Orac at Respectful Insolence. Today he responded to this mention of his name in one of my posts a couple of days ago:

ScienceBlogs likes to take on quacks. Orac, over at Respectful Insolence, does it every Friday and does it well. It’s a good project and I’m not against it. But there are a lot of quacks around that aren’t called quacks. They have corporate suits and research departments. And advertising and marketing departments. Big companies. Like Nestle. (Effect Measure, “Quacks in business suits“)

That’s it. My only mention of Orac (although in explanation of his reaction, he seems to think my whole post was about him). One sentence. If that’s his idea of a criticism, I should be so lucky about my critics. In response to my withering critique, he posted an 1800 plus word straw man, implying I am akin to a smear artist:

I’ve written before about how one of the favorite tactics of those who do not like my insistence on applying skepticism, science, and critical thinking to the claims of alternative medicine or my refusal to accept a dichotomy between “alternative” and “conventional” medicine is to try to smear me as some sort of “pharma shill.”

[snip]

There’s a more subtle form of the pharma shill gambit. Indeed, it’s so subtle that it’s likely that the person using it will not admit that, at its heart, that’s what it is. I may well be that I might get a fairly vociferous reaction to making this statement. So be it. I’m a bit tired of and more than a little annoyed by this sort of insinuation. Basically, this subtle variation on the pharma shill gambit takes the form of asking me why I spend so much time deconstructing woo and so little time taking on the abuses of science by big pharma and the corporate world.

[snip, after saying I’m an example]

Note the obvious implication: That I am somehow insufficiently vocal about corporate malfeasance (“quacks with business suits”) compared to those poor, little picked upon quacks whose woo I take such delight in deconstructing–you know, the little guys (or “little quacks,” if you will). And what’s the further insinuation behind that, I wonder? I’ll leave that one for you to contemplate for a moment. Decide for yourself if I’m reading too much into Revere’s criticism and leave a comment if you think I am. In the meantime, let’s continue.

Wow. And continue he does:

When faced with such a criticism, I can’t help but notice how much it resembles the infamous “concern troll” of progressive politics. In essence, I’m being told that I’m not sufficiently interested in or vocal about what the person complaining thinks that I should be interested in or vocal about. I will concede that it’s not a perfect analogy. For one thing, if you buy the usual definition of the term, concern trolls are actively working to undermine the cause that they express “concern” about, and I don’t think for a minute think that’s what’s going on here. I do, however, think that the end result can be the same: Fostering divisions in skeptics and critical thinkers who should in fact be of one piece on the question of assaults on evidence-based medicine, regardless of whether they come from quacks with or without business suits. There’s no reason that one should be condemned for choosing to emphasize one over the other, as long as one is not consistently defending one while attacking the other. The only reason for making such an attack is, as far as I can tell, to question the motivations of the one at whom the attack is directed and suggest hypocrisy.

Again, Orac (incorrectly and without basis) assumes my motivation was to attack him and call him a hypocrite. I have never suggested, nor do I believe, he is a hypocrite. A bit hypersensitive and hypercompetitive, maybe, not a hypocrite. However after conceding his analogy with a “concern troll” is imperfect, he proceeds to apply it to me:

When faced with a concern troll-like complaint like this, my first reaction is often to point out that the person making the complaint clearly isn’t a regular reader of this blog.

Since I am not a troll on his blog, I don’t know what this has to do with anything. I don’t read his blog regularly, not because it isn’t good, but because he doesn’t write about things that interest me. I have limited time and I don’t read many blogs. So what? His subsequent recitation of all the times he wrote about quacks in business suits is irrelevant. Again his assumption it was all about him. Not everything is.

After saying that “anti-corporate” types (moi?) like to beat up on Big Pharma but won’t call out the “altie” infiltration of medical schools, he goes on to associate himself with the idea my complaint is akin to alternative medicine defenders who criticize quack busters by saying they don’t equally condemn Big Pharma. Orac acknowledges that’s not my position. But he feels free to associate me with it anyway.

Orac concludes by predicting the teaching of alternative medicine viewpoints in medical school will make future physicians helpless before the blandishments of the quacks in business suits. He is trying to stop this nonsense. This is hyperbole and it’s ridiculous. Our profession and the general public have been falling for quacks both in business suits and jester costumes for a long time. We will undoubtedly continue to do so, independently of and not influenced by what happens in medical school education. Scientific medicine won’t come a cropper because medical students learn about acupuncture or whatever.

Finally, let me state what the post was about. It was about recognizing, and even using, the word quackery for things more pervasive (and in my view more harmful) than the “alties” that quack busters like to write about. It was a point about misplaced priorities, as Blake Stacey of Sunclipse wrote in a comment to Orac’s post. Given the amount of corporate quackery compared to other kinds, I felt there was insufficient attention by scientists to it. The post was actually about a group of young scientists in the UK who felt the same and were acting on it. I approved. If it’s not where your passion lies, that’s OK with me. But I think it is a legitimate topic of conversation and it should be possible to voice such an opinion without being accused of being like a smear artist or a concern troll.

Even though Orac may see himself as a noble Don Quixote (“seemingly increasingly quixotic crusade”), I suggest he view himself more realistically: A blogger, like me, who has a platform to rant about what interests him and what he cares about. One of the few things I agreed with in his petulant post is this:

In the meantime, with all due respect, I’ll rant about what I want to rant about, not what anyone else thinks I should rant about.

Comments

  1. #1 MarkH
    October 17, 2007

    Finally, let me state what the post was about. It was about recognizing, and even using, the word quackery for things more pervasive (and in my view more harmful) than the “alties” that quack busters like to write about.

    You mean like recognizing denialism?

  2. #2 MarkH
    October 17, 2007

    Let me try that again:

    Finally, let me state what the post was about. It was about recognizing, and even using, the word quackery for things more pervasive (and in my view more harmful) than the “alties” that quack busters like to write about.

    You mean like recognizing denialism.

    That’s better.

  3. #3 revere
    October 17, 2007

    Mark: Could be. Depends on what you are denying, I guess. In my field we are beset with various kinds of denialism from industry, which mainly is about manufacturing doubt. If that’s what you mean, yes. Like recognizing some denialism as quackery.

  4. #4 MarkH
    October 17, 2007

    Have you read my brother’s Deck of Cards?

  5. #5 revere
    October 17, 2007

    Mark: Actually, I hadn’t, but it’s great. Everyone here who hasn’t looked at it should. Now.

  6. #6 Hank Roberts
    October 17, 2007

    I wonder if you accidentally stepped on his shadow?
    As far as I’m aware he doesn’t ever say where he works.
    Nestle’s a big pharmaceutical company these days.

  7. #7 Orac
    October 17, 2007

    Our profession and the general public have been falling for quacks both in business suits and jester costumes for a long time. We will undoubtedly continue to do so, independently of and not influenced by what happens in medical school education. Scientific medicine won’t come a cropper because medical students learn about acupuncture or whatever.

    You must be fortunate enough to be at a school not affected by this problem if you believe that. (In which case let me send out an application to join your school’s cancer center, if it has one, and its Department of Surgery!) Either that, or you’re out of touch with what’s happening in academic medicine other than epidemiology. My guess is that it’s probably both. I’m also worried that you seem to think the problem is so longstanding and pervasive that there’s little hope of ever changing it. Your comment reeks of a “why bother?” attitude that disturbs me. Be that as it may, if we’re not going to start with medical students who are at the very beginning of their education, where else can academic physicians start? That’s the first time we get access to young people who want to become doctors. As a profession we can’t do much more on this score, unless we somehow find a way to instill the skills of skepticism and critical thinking from a much earlier age, a task that will require far more from society at large than what just academic medicine can do.

    Whether you happen to perceive it as a problem or not, though, in academic medical centers all over the country, woo is indeed steadily infiltrating; I’ve documented it extensively over the last year or so, as have Dr. RW and others. Scientific medicine is under increasing assault in what should be its very bastions by an increasingly uncritical acceptance of non-evidence-based “alternative” therapies as being on par with scientific medicine. And it’s not just herbal medicine or other modalities that at least have a degree of plausibility. (If it were only that, this infiltration wouldn’t bother me that much; after all, many highly useful drugs are derived from plants and herbs.) Oh, no. We also have reiki being used in arguably the most prestigious trauma center in the U.S., medical students at another prestigious medical center being taught alternative medicine as part of the mandatory curriculum from year one, the largest medical student group in the country actively promoting woo, and large swaths of curriculum being given over to it in several major medical schools. If you don’t think this is a problem that will degrade over time the critical thinking skills of young physicians in evaluating dubious claims, whether these claims come from quacks or industry, you’ve been paying as little attention to this problem as you accuse me of paying to “quacks in business suits.”

    All of which makes it occur to me: Your accusations of my supposedly attacking a strawman aside, you appear not to be above flirting with the occasional strawman yourself, particularly your remark about my supposedly saying that I predicted that “the teaching of alternative medicine viewpoints in medical school will make future physicians helpless before the blandishments of the quacks in business suits.” What I said is that I feared future physicians will be more susceptible to the blandishments of both alties and your “quacks in business suits.” I suppose you could exaggerate, you know, tart it up a bit, by using the word “helpless” and ignoring that I was treating both sets of “blandishments” as being of a piece, but that would be a bit of a strawman.

    IMHO, of course.

    A bit hypersensitive and hypercompetitive, maybe, not a hypocrite.

    Nice to know. I’ll try to keep that in mind the next time you decide to take an off-handed little swipe at me.

    But, then, being “bit hypersensitive and hypercompetitive” (according to you), I might not be able to help myself next time any better than I did this time.

  8. #8 Orac
    October 17, 2007

    I wonder if you accidentally stepped on his shadow?
    As far as I’m aware he doesn’t ever say where he works.
    Nestle’s a big pharmaceutical company these days.

    Heh. If I accept revere’s explanation that he wasn’t using a variant of the “pharma shill” gambit, at least I can with all confidence point out that you have indulged in not a subtle variant of that gambit but rather a blatant and obvious version of it.

    Nice going, there, Hank!

    By the way, revere (or at least one of the reveres) does know who I am and where I work. I’m sure he’d be more than happy to vouch for the fact that I do not work for big pharma.

  9. #9 huh
    October 17, 2007

    Whoa, you guys are all way over my head here. I just took revere’s original comment as almost a turn of phrase.

  10. #10 revere
    October 17, 2007

    I will gladly vouch for Orac’s bona fides in that regard. Moreover I once myself wondered if he had contract with drug companies to do clinical trials and he assured me he didn’t , which is more than good enough for me. What brought on the suspicion, however, was the strength of your response to a post that was not about what you seemed to think or, in my view, should have thought. As you say, people can judge for themselves by reading it.

    Regarding your comment about the grave danger we face in how we are educating the new generation of medical students, all I can say is we disagree. When I was a medical student no one heard of e”evidence based medicine.” Today we teach it to medical students. As well as other things. We differ on how they will come out. I feel quite confident that however we teach them their behavior will be overwhelmed by the practical exigencies of medical practice in 20 years, whatever that may look like (and I am not brave enough to predict).

  11. #11 Nat
    October 17, 2007

    I read both of your blogs every day and I cannot work out why you’re fighting with one another.

  12. #12 Blake Stacey
    October 17, 2007

    Ditto what Nat said. I’m reminded of a comment left somewhere at ScienceBlogs during the big dust-up last Thanksgiving, the one with PZ Myers on one side and Ed Brayton on the other (with lots of posts flying every which way — nothing like it until Matt Nisbet came along!). I think it was at Brayton’s blog where a commenter said, “I love you both! Won’t you please stop fighting?”

    I happen to think that reasonable people can differ about where the priorities should be placed for criticizing woo and quackery. Genuine science benefits from diversity, after all, just as a democracy thrives upon difference of opinion. Complex problems require complex solutions, etc.

    Intelligent people from differing backgrounds whose interests have a certain amount of overlap disagree with one another — film at 11!

  13. #13 Orac
    October 17, 2007

    I read both of your blogs every day and I cannot work out why you’re fighting with one another.

    “Fighting” may be too strong a word. “Arguing” or perhaps “tweaking each other” mightily is probably closer to the mark.

    Perhaps a clearer explanation (which perhaps I should have mentioned in addition to my post or even instead of what I did mention) can be found in this comment on my blog by a commenter going under the ‘nym “Dangerous Bacon.”

    I accept revere’s word that he wasn’t implying hypocrisy on my part, although at one time he clearly seemed to think that I was somehow associated with or bought off by big pharma. He may not believe that now, but even so revere still does not appear to understand why (other than “hypersensitivity”) I might reasonably interpret his apparently off-handed comment as an attack. There’s a simple reason. His comment very much resembles one common attack that alties direct at me: Why do you go after “alternative” medicine practitioners when “conventional” medicine claims so many lives through medical errors? Whether revere realized it or not, his comment was very similar, along the lines of “Why do you go after quackery when corporate malfeasance is so much worse?”

    Clearly, I dispute his premise, although I am not likely to change his mind, nor he mine.

    As for whether future physicians’ behavior will be “overwhelmed by the practical exigencies of medical practice,” that may or may not be true, depending upon the physician. One thing’s for sure, though. If we let non-evidence-based treatments that don’t have even a modicum of biological plausibility (reiki, homeopathy, etc.) infiltrate academic medicine, which is entrusted with training the next generation of physicians, the game’s over before it’s even begun. If physicians are steeped in evidence-based medicine from the beginning then the “exigencies of medical practice” will over time assume evidence-based medicine as the default. There’s no hope of that happening, though, if we surrender academia to woo now.

  14. #14 VJB
    October 17, 2007

    ‘Can’t we all just get along?’ Famous saying by horrified victim. Come on guys, you’re on the same side.

  15. #15 jk
    October 17, 2007

    A bit of an overreaction on Orac’s part I would say. If anything, the comment was an acknowlegement of work well done.

    Orac exposed his current mindset by reading into the comment the perceived “bait” planted by revere. So we get the piece entitled “Why don’t you rant about what I think you should rant about?” by Orac. Good. This seems to be a healthy perspective on pseudoscience’s weak attmepts at playing what Orac calls the shill or “concern troll.”

    So we know Orac can be self-deprecating as in his intro on his blog (Who (or what) is Orac?), and now we know he can be egocentric by taking an innocuous comment and using it to feed the flames of his fire. It was inspirational for him.

    So, Orac is human. Shall we move on?

  16. #16 Hank Roberts
    October 17, 2007

    Hey, I apologize, Orac. I speculated, wrongly, that ‘Nestle’ might be the trigger for Your heated response. Based on your sidebar description alone, not on anything Revere wrote earlier. I missed some irony there.

    Your text — just text, missing most of what communicates between people — did read to me like you were angry, so I wondered if some “shadow” got stepped on, but my bad, I couldn’t figure out why the _public_ exchange seemed so angry. And as you say above, that’s in the eye of the reader, not what you were feeling.

    You’ve made it a lot clearer. Both academia and pharma are places to watch out for wishful thinking leading to conclusions that aren’t based on evidence, and evidence that’s set down and not continually being tested.

  17. #17 revere
    October 17, 2007

    “Fighting” may be too strong a word. “Arguing” or perhaps “tweaking each other” mightily is probably closer to the mark.

    I agree. We are much alike in some respects that are less than desirable.

    I accept revere’s word that he wasn’t implying hypocrisy on my part, although at one time he clearly seemed to think that I was somehow associated with or bought off by big pharma.

    Jeez, well I hope so. I just said again I knew you weren’t, in the same comment you were replying to (at 6:10 pm).

    Finally, on the subject of EBM and what we teach. We teach students many things with no evidence based support or worse: evidence they don’t work. I won’t go after surgery too much for that, although surgical practice is a bastion of that kind of thing. But so are many other specialties. Many, probably most, of our clinical practices have no evidence based support or support with a great deal of contradictory evidence. Modern “scientific” clinical practice isn’t close to being mostly evidence based. The trouble with your “biological plausibility” criterion is that it opens the door for the kind of scientific seeming claims of drug companies, large corporations, and yes, purveyors of out and out nonsense. Your claim of a privileged status for the non evidence based practices we engage in as doctors that have plausible “scientific” explanations is weak. At best.

    If you think that gives aid and comfort to the enemy, well, I can’t help that.

  18. #18 M. Randolph Kruger
    October 17, 2007

    Hey Orac, I understand your very passionate feelings about this. I an assure you that whatever the case Revere didnt mean to denigrate your postings. He does this kind of stuff to promote free thought and agreement to disagree. he and I butt heads all the time, but I still respect his thoughts on the matters at hand. I dont apologize for anyone, nor do I ever take personal swipes at them unless they draw the first “personal” blood. I do try to understand their position(s) and then see if it fits with me as we all really live in the moment of time that something is said or done.

    I read your stuff too and as a centrist Republican I can find a lot in what you both say because rightists are sometimes too far rightist and lefties have to come from around the block nowadays just to get into sight of the center. Take it easy old man. I agree with most of what you say about what I consider to be holistic medicine. You have a different term, so does Revere. I would consider this to be a conversation about dark matter in between two physicists. Fastest way to start a fight as there is…

  19. #19 Stinky7s
    October 17, 2007

    “left than the average (we are reality-based and rational, after all)”

    You forgot to put a smiley face. You don’t really believe this, do you?

  20. #20 Nat
    October 17, 2007

    I guess I just don’t separate the possibly dodgy behaviour of drugs companies (or big pharma if you will) from anybody else’s possibly or definately dodgy behaviour (including vitamin pill companies, surgeons, physicians, guys selling boxes that go beep and somehow cure cancer, chiropractors, reiki practioners, nutriceutical manufacturers etc etc etc).

    They all deserve the same level of scrutiny. The only reason big pharma operates differently from all of the other company types making ‘health products’ is because we’ve (properly?) legislated their behaviour.

    Maybe because I’m trained to think both like ORAC and Revere (experimental design, clinical trials, EBM, clinical and population-based epidemiology) I just don’t see the touchpoint of the conflict here. We all agree that there are issues and more importantly we are professionally invested in fixing problems.

    Revere’s original post was complimentary, I thought, and one can hardly claim he’s playing some sort of pharma shill gambit. Orac can blog about whatever he wants and does a good job of doing it. Revere can concentrate on the greyer issues closer to mainstream if they would like. All is good, people. Get back to writing about shonky behaviour and reasoning by whomever can damage the public health. Please, it’s like watching a pointless political party schism.

  21. #21 bar
    October 17, 2007

    IMHO, Blake’s Seven was probably one of the best Terry Nation series ever, and TN was probably one of the best ever.

    With the computer age blowing copyrights to bitz, the next development will (I hope) be in medicine. Every medical practitioner will get a database listing, showing success rate (discounted for difficulty) in the various chapters of medicine. The premium factor in patient selection of a physician would then (probably) be the discounted success rate, followed by cost/fee.

    That innovation (hopefully) will come concurrently with online patient medical records, accessible only by a patient’s encryption key in the hands of the physician.

    So it won’t matter a damn what training we give physicians. Junior physicians would be “apprenticed” and rated on their trainer’s success. (To be completely clear on the implications, no more need for government licensing.)

    Big pharma has currently got copyright and other legislative assistances and protections. Short of dismantling patent & copyright laws, I do not see how we can successfully challenge big pharma. (Although removing the scriptwriting licenses of Physicians would help.)

  22. #22 Nat
    October 17, 2007

    “scriptwriting licenses of Physicians”

    I guess that explains ER, House, Grey Anatomy et al

  23. #23 anon
    October 18, 2007

    this is getting too complicated and too lengthy
    too quickly. Can someone summarize:

    who/what does revere think is a quack/quackery
    where Orac disagrees ?

  24. #24 bar
    October 18, 2007

    Nat,

    It is a conceit of professionals that only rigorously trained professionals can be entrusted with complex, life critical tasks.

    As the second engineer in a medium sized fabrication company I worked with a chief engineer who had designed, quoted and successfully bid for parts of a petrochemical plant. He had quoted against international corporations several multiples our size.

    His quote was 30% higher than that of the nearest competitor. The petrochemical people chose his quote because he displayed a greater understanding of the problems to be overcome.

    I eventually discovered the chief engineer had no engineering qualifications whatsoever.

    I would generally select a person with a verified success record over one with verified academic qualifications.

  25. #25 Alan Kellogg
    October 18, 2007

    anon, Orac and Revere are arguing over who gets to sleep in the wet spot.

  26. #26 Pup
    October 18, 2007

    As someone just a few months from graduating from Orac’s own alma mater med school, his misconceptions of what our curricula actually contain and emphasize are remarkable, based on his previous posts slamming particular medical schools. Our EBM training is substantially more powerful than our CAM training, though a superficial look at our curriculum would not give that sense. Why he continues to perseverate about the culture of medical education without actually talking to the medical students who will soon be his residents and colleagues is anyone’s guess.

    But that’s a single criticism of a guy who maintains an absolute top-notch blog, with especially wonderful coverage of autism nutjobs.

  27. #27 Orac
    October 19, 2007

    Our EBM training is substantially more powerful than our CAM training, though a superficial look at our curriculum would not give that sense.

    I would certainly hope so! In fact, I assumed so; assuming otherwise would have caused me extreme distress. My distress was that such woo was finding its way into the curriculum at all in the manner described, clearly with a strong push from the administration to support it.

  28. #28 Orac
    October 19, 2007

    Finally, on the subject of EBM and what we teach. We teach students many things with no evidence based support or worse: evidence they don’t work. I won’t go after surgery too much for that, although surgical practice is a bastion of that kind of thing. But so are many other specialties. Many, probably most, of our clinical practices have no evidence based support or support with a great deal of contradictory evidence. Modern “scientific” clinical practice isn’t close to being mostly evidence based.

    I think that’s a gross exaggeration.

    Actually, I’ve written many times on what is and is not evidence-based in various practices. Perhaps my perspective is colored by my involvement in oncology, which is one specialty that is arguably very evidence-based. My point with regard to CAM is that we should be doing everything possible to increase the teaching of evidence-based medicine, not decrease it. In fact, even if your exaggeration were totally accurate, it would be an even more compelling argument for not teaching CAM credulously because doing so would make a bad situation vis-a-vis the low level of truly evidence-based therapy in modern medicine worse. You may think that things are so bad that it won’t matter. I ask: If things really are that bad, why make them worse by adding woo that is implausible at best and impossible at worst to the medical school curriculum? After all, it’s a zero sum game. To make room for woo, something has to go, and that’s likely to be teaching of some evidence-based topic or other.

  29. #29 suzyf921
    October 19, 2007

    I haven’t had the chance to read all the posts in detail but it seems to me that the reason for med students to know something about CAM is that their patients will be using it!! In a small survey I carried out in the north of England among the elderly, use of various CAM practices was almost universal, yet they were reluctant to admit it to their GPs (who had asked for the survey) who therefore were never told about any of it. So — a well informed physician ought to know something about it, perhaps not to PRACTICE it but to recognize its potential and most importantly, that its use could interfere with his or her own recommendations for care.

  30. #31 Pup
    October 19, 2007

    Orac, to warm your heart, I remember very fondly a small group in which a handful of us tore apart the methods section of a “meta-analysis” (you’d use quotes too, if you saw this thing) showing that glucosamine did something or other for osteoarthritis, much to the devastation of our poorly-trained facilitator.

    I mean, come on. We almost made a chiropractor cry once!

    For the most part, we learn CAM the same way kids at Hogwarts learn Defense Against the Dark Arts.

  31. #32 SmellyTerror
    October 20, 2007

    ScienceBlogs likes to take on quacks. Orac, over at Respectful Insolence, does it every Friday and does it well. It’s a good project and I’m not against it. But there are a lot of quacks around that aren’t called quacks. They have corporate suits and research departments. And advertising and marketing departments. Big companies. Like Nestle.

    Well I’m pretty dopey. I thought that was a compliment. Sure, a gratuitous compliment thrown into the introduction for an only slightly related topic, and probably part of some ongoing intellectual circle-jerk that those lefty pinko femmo greeny bigheads are always getting involved in. But an insult? Never would have guessed.

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