Why don't you rant about what I think you should rant about?

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 so smear me as some sort of "pharma shill." It's happened so often ever since my Usenet days that I even sometimes joke about it preemptively sometimes when writing skeptical posts or make smart aleck comments asking where I can sign up to get those big checks from big pharma, given that they'd almost certainly be many orders of magnitude greater than the sum that Seed pays me for my little hobby here. This is (usually) enough to keep me in high speed Internet access, cable TV, and beer (and that's only because I'm usually in the top five ScienceBloggers for traffic), and not much else.

I'm kidding--sort of.

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. In fact, it came from fellow ScienceBlogger Revere and goes something like this:

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.

After discussing several examples of what he considers to be "quacks in suits," Revere concludes:

There are a lot of charlatans about. I'm not sure we should be putting so much energy in sniping at the marginal players and ignore the big fish. But maybe it's just me.

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.

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.

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. I have, for instance, gone after unscrupulous physicians who pushed "screening MRI" or "screening CT scans," tests that are expensive, paid for out of the patients' own pockets, and more likely to result in harm than help, given how they are based on no good evidence. I've also recently had a bit of a run on discussing how tobacco companies have tried to deny the science showing significant health risks due to secondhand smoke. I could point out one of my favorite retorts to alternative medicine mavens who like to portray their favorite woo (particularly nutritional supplements) as the little crusading for "health freedom" being crushed by a combination of big pharma, the FDA, and the AMA, which is that more and more supplement manufacturers are being bought up by big pharma and that it's become a big business that's growing briskly. Indeed, I even coined a term for this, "big suppa." (OK, I admit this wasn't one of my pithier catchphrases. They can't all be good.) Sure, I take on woo far more often than I take on "quacks with business" suits, but that's due more to my inclination more than anything else and also being influenced more and more these days by how woo itself is increasingly becoming big business (more below), aided and abetted by lax laws, the prospect of respectable profits without all those expensive and pesky clinical trials necessary to get FDA approval for new drugs, and the credulity of the masses.

Ironically enough, this accusation of inconsistency with its veiled insinuation of bias reminds me of a discussion that cropped up on this blog just yesterday in response to this post. In it, I expressed approval of a post by Dr. RW adding to my post criticizing the University of Maryland Shock Trauma Center for embracing reiki. This drew a comment:

"They claim to stand for scientific purity, so why do they (with the notable exception of Arnold Relman) remain silent about woo?"

Sorry, but this is the same sort of tu quoque fallacy used by alties, only turned around. The altie equivalent is trying to dismiss concerns about supplement dangers and false claims by saying "Well, why aren't you talking about drug recalls and other problems with Big Pharma?".

It's ethically acceptable to focus one's efforts in either of these areas.

Exactly.

I thought this comment was spot-on, although I did disagree with its applicability to Dr. RW's article:

A lot of the anticorporate folks who quite correctly call out big pharma when it abuses science or starts selling non-evidence-based remedies like supplements don't just ignore woo; they actively embrace it whole-heartedly. AMSA is one example. It touts its "Pharm-Free Day," while at the same time it actively promotes the adoption of non-evidence-based alternative (or, as it puts it, "humanistic") medicine in both medical school curriculae and in the alternative medicine retreats that it sponsors for medical students.

In no way do I think that Revere falls into this category. However, I would be lying if I didn't point out that I think he's using a concern troll-like fallacy ("It's a good project and I'm not against it"--but...and the "but" makes all the difference in the world) and that I resent it, particularly since, when it comes to quackery, we are on the same side.

It's true that my initial interest in quackery and "alternative" medicine started out mainly as a lark, in which the more I read about the various claims the less I could believe what I was reading, followed by a realization of how much harm it can do. However, over time my mission and the mission of this blog have evolved to take on a larger problem. When it comes right down to it, the fact that quackery is increasingly becoming big business is a symptom of this larger problem. Abuses of science by big pharma and other big corporations wouldn't succeed so well if it weren't for the poor understanding of science and credulity that are so rampant among the general public. Moreover, as a member of the academic medical community, it pains me deeply to see just how my profession is aiding and abetting this problem through our permitting with little resistance the infiltration of woo into medical schools and academic medical centers (1, 2, 3, 4, 5, 6, 7) and in the mandatory medical curriculum in at least one medical school.

In fact, one could look at it this way: Revere think that I do not go after "quacks with business suits" with sufficient frequency for his taste. To that, I answer: So what? Of course, apparently not being a regular reader of my blog, Revere seems utterly oblivious that over the last year or two I've been starting to go after "quacks in lab coats" because the infiltration of quackery into big academic medical centers is something that truly concerns me. In actuality, in my mind, the vast majority of those whom I facetiously term "quacks with lab coats" in a conscious effort to echo Revere's term are not really quacks. However, in the cause of being "open-minded," we academic physicians are permitting the influx of non-evidence-based modalities as scientifically highly implausible as reiki and even homeopathy into the bastions of academic medicine and the NIH. In doing so, we are endangering the whole enterprise of scientific medicine by granting the patina of scientific respectability to modalities that do not rate it. Much of the motivation behind this is to "give the people what they want," but a lot of it is also because woo pays the bills. These days, big academic medical centers seem to see alternative medicine as both a marketing ploy to make themselves look more "humanistic" and a new revenue stream (most insurance companies won't pay for therapies without solid evidence of efficacy, meaning that it's usually cash on the barrelhead from the patient for woo, without all that nasty hassle of filling out insurance forms and getting preapprovals from tight-fisted claims handlers). Worse, this virus of credulity is infecting medical trainees from the medical student level, as evidenced by the way that the American Medical Student Association actively promotes woo.

Imagine what will happen when these students, taught that woo is equivalent to scientific medicine, finish their training and start advancing into positions of leadership. I fear they'll be more susceptible than my generation to both the blandishments of quacks in hole-in-the-wall offices and quacks in business suits. Fear of the consequences of that credulity manifesting itself in 20 years, when I'll be getting old and susceptible to all the diseases and conditions of age, is one reason for my seemingly increasingly quixotic crusade.

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.

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"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."

Good.

If you don't like the content of a free blog that no body is forcing you to read, don't read it? And, don't complain about the content as if the blog writer is somehow morally or ethically bound to cover only certain topics.

That's not what blogging is about.

Decide for yourself if I'm reading too much into Revere's criticism and leave a comment if you think I am.

I suspect so — I'm not even sure it's a "criticism" directed at you in particular. Note that Revere says, "I'm not sure we should be putting so much energy in sniping at the marginal players" (emphasis mine). It's a general question of priorities which applies to the skeptical community overall.

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.

I'm having a hard time reading Revere's statement as a condemnation; furthermore, I'm not so sure about the "question the motivations" bit. We skeptics have limited resources, two of the most profound being time and energy. I can only write so many words of blog post each day, and explaining the facts and methods of science is not an easy job. If I spent all my time going after physics and math crackpots, demonstrating over and over that one cannot square the circle, but I never addressed the creationist abuse of physics (hi, Sal Cordova!), then I think there's a reasonable argument to be made that I'm misusing my time.

You'd be free to question my motivations if I did that, of course, but the bare question, "Why do you go after the circle-squarers and never the Discovery Institute?" could also be a critique of my poor time-management skills.

I read Revere as suggesting that skeptics in general can have misplaced priorities. In the interests of full disclosure, I should state that I may be biased in Revere's favor since our one meeting in real life was an amicable one (and, to my knowledge, I've never met Orac).

Also, Revere starts off by saying, "ScienceBlogs likes to take on quacks" (emphasis mine). This sounds like a general statement about the SciBling community.

orac: Blake is exactly right. It wasn't directed against you (although you seem sensitive about it) but it was a general comment about the notion of "quakery." Quackery is too often aimed at the marginal players, the nutcases, and not often enough at the Big Players who practice quackery on a regular basis and are infrequently called to account for it by science bloggers. I did NOT criticize you in particular (in fact I made a deserved tip of the hat in your direction). I was making a general comment about the nature of "quack" coverage by scientists.

Of course you can blog about whatever you want, just as I do. If you assume everything is about you, though, it will be a bit hard on the pituitary-adrenal axis.

I agree with Blake on this one, I'm afraid. Nowhere in Revere's post could I find anything that would justify taking this:

There are a lot of charlatans about. I'm not sure we should be putting so much energy in sniping at the marginal players and ignore the big fish. But maybe it's just me.

to mean this:

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).

By no means to I profess to speak for Revere, but I believe he made an extremely valid point. While we have our bases covered exploding the myths of laser reiki and the like (extremely amusing, definitely valid, but nevertheless focused on the outermost margins of woo), perhaps more potentially destructive, but arguably less exposed, is the woo we face on a daily basis from consumer products.

Does that mean that you absolutely must drop what you're doing and cover that instead? Of course not, and nowhere does Revere suggest that you relinquish creative control of your blog for his sake.

There is a rather large divide between serving up some food for thought and concern trolling.

I find it scarry really.
Apparently Orac reaches a large enough audience, or the people that comment about his blog are merely the few that pay attention to his blog.

I suppose the fact that "Orac" is brought up at all is a compliment in and of itself. Whom else is exposing this phenomena called Woo on such a scale?

If your running, your not running fast enough
if your sitting, your not sitting quite right
if you drink at all, it is likely too much.

I believe this is where fame has a price.

By Uncle Dave (not verified) on 17 Oct 2007 #permalink

Of course you can blog about whatever you want, just as I do. If you assume everything is about you, though, it will be a bit hard on the pituitary-adrenal axis.

When you use me as the main example of what you're talking about (skeptics at ScienceBlogs overemphasizing quackery and underemphasizing "quacks in suits") and when you've complained about me a bit before in the context of debunking quackery, you'll excuse me for concluding that it is at least partially about me. When I'm mentioned that way, why am I incorrect to assume that I'm being held up as an example of the very thing you're unhappy about (skeptics spending more time on woo and not enough time--in your opinion, at least--on corporate-promoted woo)? You didn't mention any other examples of such "inconsistent" skeptics. Given that I'm the one on ScienceBlogs who is far and away the best known for discussing quackery skeptically on a regular basis (it seems to have become my main niche here), I don't think I'm being unreasonable at all. (Sensitive, possibly, unreasonable, no.)

Otherwise, why did you mention me at all, much less in the very beginning as a means of setting up (or--dare I say it?--framing) your argument?

I can see why you would read it that way, but I think it could also be reasonably parsed as 'we have Orac doing stellar work on topic A, but where's his counterpart in the sceptical community doing such work on topic B?'

Incoming ramble warning!

Anyone have any suggestions as to which corporate or government quacks in suits the following should be addressed?

Recently media have reported a method of testing sewer discharge for illicit substance use within a community. The results were quite enlightening. (Sorry it was in the papers so I am not sure what study to cite due to faulty memory or lax motivation to pursue citation.)

Could it be posited that by the same methods that the illicit substances show up in the sewage, that so also are the unprocessed remains of various therapeutics, i.e. antibiotics, antivirals, and other agents? (We already knew about this, I'm sure, but perhaps passed it off as of negligible environmental impact.)

Additionally it could be suggested that at least part of the blame for over or under use of those agents, that is many times blamed on the prescibers and users, not to mention direct disposal, is due to normal inefficiencies in metabolism/elimination of the agents made and approved for use by the quacks in suits.

Furthermore, the impact of subject agents when released into the wild (with every flush!) might tend to have a toughening effect via natural selection processes on the proliferation of drug resistant strains of various undesirable species.

Unfounded concern, or plausible explanation for the recent rise in some things like the growing reports of CA-MRSA?

Yours Truly, an underinformed analyst.

Rewording for appropriateness and content are invited if someone knows how better to state the issue and make it roll back up the hill.

There is no ScienceBlog more relentlessly politicizing than Effect Measure. A hallmark of those who politicize everything is the redefinition of emotionally loaded terms. Like "quack." Or "terrorist."

http://scienceblogs.com/effectmeasure/2007/08/medicaid_medicare_and_rea…

"...humdreds of millions of Americans being held up for their money and put at risk of life and limb by pharmaceutical and insurance companies and their paid representatives in Congress, you wonder who the real terrorists are."

From a Seinfeld outtake:

Jerry: Did you tell the HMFIC@scienceblogs about this?

Elaine: Well, I tried, but he thought it was some sort of blogger cat fight.

Kramer: Blogger cat fight?

Elaine: Ok, why? Why do guys do this? What is so appealing to men about a blogger cat fight?

Kramer: Yeye blogger cat fight!

Jerry: Because men think if bloggers are grabbing and clawing at each other there's a chance they might somehow kiss.

By Bazooka Joe (not verified) on 17 Oct 2007 #permalink

Good one Jerry!!

By Uncle Dave (not verified) on 17 Oct 2007 #permalink

I think a distinction could be drawn between the kind of quackery Orac targets and the kind of quackery Revere thinks is underaddressed.

The latter seem to be all about advertising, making a commercial product seem more sciencey than it is. Not that this is commendable, but I don't see it as a large danger to the public's health.

The woo that Orac debunks is the kind of stuff that tries to persuade people to abandon mainstream medicine, shun vaccines, fire their doctors and go to a Mexican cancer clinic. The kind that tells them to spend their child's college fund on a hyperbaric oxygen chamber. The kind that has them convinced the world is run by a shadowy conspiracy.

I think it's worth going after the pernicious woo first.

"However, in the cause of being "open-minded," we academic physicians are permitting the influx of non-evidence-based modalities as scientifically highly implausible as reiki and even homeopathy into the bastions of academic medicine and the NIH."

I'm reminded of the old phrase:

Don't be so open-minded that your brain falls out.

I read both blogs daily and let me tell you this is like watching your favorite lab partners fight about what solvent to use.

I don't think Revere meant to say that you personally need to spend more time chewing out the pharmaceuticals. As I read it he thinks that the greater community of scientists should hold large corporations to the same standard of veracity as you hold the energy field cleaners and crystal peddlers. Ideally thats what the FDA should be doing, but I don't know anyone holding their breath waiting for the FDA to do its job.

One common variation on the "misdirected concern" theme goes like this: "Why are you so interested in alternative medicine quackery when medical mistakes/malfeasance kills MILLIONS?"

As a physician, I spend a portion of every day (sometimes a hefty portion) working on quality assurance - trying to minimize error and produce the highest quality medicine possible. It's a bit much for this to consume my spare time as well. Quackery, beyond its implications for patient care and public understanding of scientific methodology, is an entertaining diversion.

And it can be fascinating, especially if you have some knowledge of its history and how its themes repeat. One Conan Doyle story has Sherlock Holmes advising Lestrade to take time out to research the history of crime, as new outrages always have their basis in historical skulduggery. And so it is for health quackery.

Besides, as Orac noted, those who exploit public gullibility and misunderstanding of science are getting bigger and better organized all the time. Mark Ridinger
recently coined the term "the Nutraceutical-Industrial Complex":

http://www.nature.com/clpt/journal/v82/n4/full/6100354a.html;jsessionid…

Naturally, his stinging comments have led to griping about how he should be paying attention to other concerns - with one rebuke, not surprisingly, coming from the Nutraceutical-Industrial Complex itself:

http://www.alliance-natural-health.org/_docs/ANHwebsiteDoc_283.pdf

The latter document is a treasure trove of ad hominem and tu quoque fallacies, for those wishing to explore.

Enjoy.

By Dangerous Bacon (not verified) on 17 Oct 2007 #permalink

Revere:It wasn't directed against you (although you seem sensitive about it) but it was a general comment about the notion of "quakery." [...] I did NOT criticize you in particular (in fact I made a deserved tip of the hat in your direction).

Orac: When you use me as the main example of what you're talking about (skeptics at ScienceBlogs overemphasizing quackery and underemphasizing "quacks in suits") and when you've complained about me a bit before in the context of debunking quackery, you'll excuse me for concluding that it is at least partially about me.

I think you're both right ;)

By John Morales (not verified) on 17 Oct 2007 #permalink

Beth said:

*I don't think Revere meant to say that you personally need to spend more time chewing out the pharmaceuticals. As I read it he thinks that the greater community of scientists should hold large corporations to the same standard of veracity as you hold the energy field cleaners and crystal peddlers. Ideally thats what the FDA should be doing, but I don't know anyone holding their breath waiting for the FDA to do its job.*

"If only it were true" I think I hear Orac lamenting! But it's the woosters who get the free pass on evidentiary standards by the guvment, academic medicine and, all too often, the popular media as Orac and I have pointed out on our blogs all too many times.

A uniform standard (and i'll take the liberty of speaking for Orac here, too) would be just fine with us.

Orac why do ignore the deaths of Jesse Gelsinger and Ben Kolb? Hah?

I nominate that you call this the Jan Drew Gambit.

By Chris Noble (not verified) on 17 Oct 2007 #permalink

I feel kind of like Marv Thornberry in the earliest Lite Beer commercials (tastes great, less filling) when Marv says, "I feel strongly both ways."

I also say this with Orac being a fabulous influence on me getting started blogging, a friend, and colleague, and my tremendous respect for revere as a scientist and ambassador for public and environmental health: I can see why Orac would take reveres post personally and why revere might feel that the intro reference of his post to Orac was only a segue to the more important issue of the need for us to all be criticizing "Big Woo."

Like all ScienceBloggers who run regular Friday features, Oracs Friday Dose of Woo is meant to be an expose of the most outrageous examples of woo that you think are made up but are actually real. My guess is that he never intended it as a public service to maximize exposure to the woo that impacts the most number of people. I think that where Orac takes offense is that revere did not acknowledge that the Plexiglas-Boxed One also promotes critiques of more widespread woo, particularly the uncritical incorporation of CAM coursework into medical curricula.

On the other hand, reveres intent in his post may have seemed personal to Orac - Ive sat on the sidelines for this to see what readers think since I know both of these gentlemen of medicine and science and may be biased one way or another. I havent yet read reveres response at Effect Measure but my guess is that there is a difference in perception by both parties due to the tone that we are often incapable of conveying with precision in electronic communications. Ill read more and comment more later, if anyone care. (Actually, it now seems that revere intended a positive nod but I could see how it would be taken either way).

btw Orac, if you still have money left to buy beer after the Seed proceeds pay for your cable and internet, you are either drinking very cheap beer or not enough of the good stuff!

well, as someone who takes hits for *both* being in the pocket of pesticide companies, AND being an anti-pesticide hippie tree-hugger, I can empathize with Orac here.

Also, Orac, I have a question about several papers involving honey in the International J. Clinical Practice--drop me a line, if you have time?

Orac and I have each had our say (and then some), here and over at Effect Measure. As far as I am concerned this little set to is over and I agree with Orac it wasn't a fight but just a little mutual tweaking. Boys have funny ways of amusing themselves. I offer an olive branch. In keeping with the evidence based theme, it is either a real one or a placebo.

Orac, of course Revere was talking about you. He has an adrenarch crush on you, and that has an affect on behavior. He's at that stage of hormonal development when people become aggressively friendly and a bit chaotic in their behavior. It's nothing to worry about, really. By third grade he'll be settled down.

I didn't know about this "scibling" community.
How it evolved in history, how there is competition
and motivation inside it and how/whether/how much
these blogs would even be able to exist outside
this community.
Seems to me that "blogs" are just "in" currently
and other forms of internet-discussion like usenet
(which however is a technically more advanced discussion
platform over blogs) is "out". So I guess there just has
to be some interference with the blogs to justify the
community. Just about behaviour/wording, no dissent
in principle, or about any concrete subject, right ?

Way up top, Orac said:

This is (usually) enough to keep me in high speed Internet access, cable TV, and beer (and that's only because I'm usually in the top five ScienceBloggers for traffic), and not much else.

Hey! Is this a sly way of telling us that ScienceBloggers just quarrel with each other to boost their hit counts and win more money?

Don't try to hide. I know those SB back-channels exist: I got many hits from them when I wrote the story treatment for ScienceBlogs: The Movie. I bet this all started with a chat between Orac and Revere.

"Hey, everybody's getting tired of the 'framing' thing, and even Al Gore's Nobel isn't gonna be a breadwinner forever. What can we do to stir up a teapot tempest and get our traffic counts back up?"

"Well, what if I write something in my usual style, with some phrase which people won't think twice about. . . ."

"And then I can take exception to it —"

"— and I'll respond —"

"— and everybody will wonder why in blazes we're arguing with each other!"

"Perfect! Should we call PZ and Matt?"

Blake, you've overlooked something obvious - both revere and Orac posts anonymously, and about health issues, yet no one have seen them in the same room.

The only logical conclusions it that revere is Orac