Regular readers know that I’ve long been disturbed by the increasing infiltration of non-evidence-based “alternative” medical therapies into academic medical centers (1, 2, 3, 4, 5, 6, 7, 8). I’ve come across another example of how much this has occurred. This time around, it’s come in the form of a “debate” being held at 2 PM on Thursday, October 25 at the University of Connecticut Health Center entitled Homeopathy: Quackery Or A Key To The Future of Medicine? It’s being touted thusly:
On October 25, 2007, the University of Connecticut Health Center will be hosting a historic debate on homeopathy. This event will mark the first time that a major U.S. medical school has examined this subject in this depth. It also marks the first time that the clinical, historical and basic science data has been examined simultaneously. We invite you and your colleagues to watch.
Homeopathy is used by tens of millions of people around the world. On October 25, you are invited to watch a debate between six internationally renowned experts (Iris Bell, M.D., Ph.D., Rustum Roy Ph.D., Andre Saine N.D., Donald Marcus M.D., Steven Novella M.D., and Naduv Davidovitch M.D., Ph.D.) as they examine the basic science as well as the clinical and epidemiological evidence around this 200 year old system of medicine. Is homeopathy pure quackery as some contend or perhaps the future of medicine?
I certainly hope that homeopathy isn’t the future of medicine. Indeed, I find this debate to be yet another symptom of just how deeply woo has infiltrated academic medicine. Not surprisingly, this “debate” is being advertised far and wide by homeopaths.
While I admire salute Steve Novella for no doubt answering the call of the organizers of this event and being willing to step on the same stage, along with Donald Marcus, to go toe-to-toe homeopaths like Iris Bell, Andre Saine, not to mention water über-woomeister Rustum Roy, I hope they’re ready for the sheer number of logical fallacies, cherry-picked studies, and examples of science twisted beyond recognition that are likely to be thrown at them during the two hours that they’re on the stage. As much as I understand the impetus that sometimes makes scientists agree to them, I’ve said before that in general, like Phil Plait, Eugenie Scott, P. Z. Myers, Richard Dawkins, and Lawrence Krauss, I consider such debates between pseudoscientists and scientists to be usually a bad idea, even though I realize that, all reservations taken into account, it’s sometimes very difficult to abstain from them.
As someone who detests seeing pseudoscientific quackery like homeopathy go unanswered and with enough pride to be stung by criticism of “cowardice” over refusals to debate, over time I’ve come to the conclusion that such staged events inherently favor the pseudoscientist so much that it’s rarely worth it to try to overcome this. Indeed, it wasn’t too long ago that an HIV/AIDS denialist going by the name of Casey Cohen tried to entice first Nick Bennett and then, failing with Nick, to tempt me into a “debate” with prominent HIV/AIDS denialist Christine Maggiore, whose child had died of AIDS and who had commissioned fellow denier Dr. Mohammed Al-Bayati to produce a fallacy-filled report to argue otherwise. Early this year, mercury militia cheerleader and disingenuous parrot of antivaccination misinformation David Kirby debated Arthur Allen However, a long time ago, when I first cut my teeth debunking the lies of Holocaust deniers, I learned that cranks view the purpose of such debates very differently than we as scientists and skeptics do. Later, as I branched out into applying skepticism and critical thinking to creationist claims and the claims of alternative medicine, I realized that this was a principle that applies to pretty much all cranks.
The fact is, pseudoscientists, pseudohistorians, and cranks desperately want to debate accepted experts in the field in which they apply their crankery. The reason is simple. While, knowingly (or, more commonly, unknowingly) they crap on science and the scientific method, at the same time they desperately crave its validation. They desperately want to be seen as “one of the boys,” whose ideas are taken seriously by scientists, and such “debates” usually give them exactly what they want. Indeed, debates on college campuses (or, in the case of homeopaths, in academic medical centers) are not viewed as a means of getting at the truth, but rather as a means of P.R. Putting the pseudoscientist on the same stage as a legitimate scientist elevates the pseudoscientist unduly and mistakenly gives the impression to lay people that there is a genuine scientific controversy to be debated when the only controversy being debated is, in fact, ideological. This is because getting a scientist to agree to a debate allows them to portray their pseudoscience as being on equal footing with accepted science, or at least in the same ballpark. Thus, simply being seen on the same stage on an equal footing with a respected scientist, is a victory for the pseudoscientist. Regardless of what actually happens in the debate, it is a virtual certainty that the crank and the supporters of crankery will trumpet it as a “victory” or, at the very minimum, as a “validation” that science is beginning to take them seriously. Not surprisingly, this is exactly what the mercury militia did almost before the light from the last PowerPoint slide of the David Kirby-Arthur Allen debate faded away. Yes, I know Steve Novella is good. I don’t know how good Donald Marcus is in a debate format. I do know that homeopaths will declare victory just as fast as the mercury militia did after the Kirby-Allen debate, namely just as soon as the last photon from the last slide fades away from the screen at the Low Learning Center at the University of Connecticut. And, no matter how much the skeptical side of the forum wipes the floor with the homeopathy supporters, they’ll be right.
The other reason that debates with pseudoscientists are usually not a good idea is that the debate format (two participants) or the forum format (multiple participants) provides a huge advantage to the pseudoscientist. The reason is simple. While true scientific debates between scientists can sometimes be illuminating, pseudoscientists aren’t bound by evidence or an accurate representation of the state of science. This means that they can emphasize rhetoric and debating tactics over substance. As Lenny Flank put it so accurately when discussing debates between creationists and evolution supporters:
…the usual format for such debates, a forty-five minute presentation by each side, followed by a half-hour rebuttal, will shackle the debater’s hands. The subject of biological evolution is so huge and so complex that people spend their whole professional lives investigating just tiny portions of it. It is simply impossible to give an adequate overview of such a complex subject in the space of a forty-five minute presentation, particularly when one understands the often abysmal level of science education among the audience. The creationists, on the other hand, are helped greatly by these time limits. Since they have no scientific model of their own to present, they will spend all of their time in what is known affectionately as the “Gish Gallop”, in which they skip around from topic to topic spewing out an unceasing blizzard of baloney and unsupported assertions about evolutionary theory, leaving the poor evolutionist to attempt to catch up and correct them all. It is an impossible task. As Scott points out, “The evolutionist debater is never going to be able to counter all of the misinformation that a creationist can put out in a lengthy debate format.” (Scott, “Debates and the Globetrotters“, undated) Whenever the scientist presents a valid piece of scientific data, the creationist need simply answer with, “That’s not true.” It is then incumbent upon the scientist to spend twenty minutes explaining why it is true. Meanwhile, the scientist’s basic message will not be getting out; the creationist’s will.
The same is true of debating homeopaths. That is not to say that it’s impossible to counter these attacks, but it is exceedingly difficult. Homeopaths will quote “studies,” most (but not all) published in woo-friendly journals, such ones claiming to show that homeopathy is useful against infectious diarrhea in children or that it helps critically ill patients come off of the ventilator faster and survive longer. It’s impossible to be familiar with them all, and it takes a long time to explain why each one is flawed, and each time one is debunked another will appear. As Eugenie Scott puts it, “The creationist has made a simple declarative sentence, and you have to deal with not an easily-grasped factual error, but a logical error and a methodological error, which will take you far longer to explain.” With Rustum Roy up there doing his hand-waving about the “memory of water,” the defenders of evidence-based medicine had better be well-prepared to explain why the science that he uses to support his claims that water has memory through which homeopathy can “work” does not in fact support homeopathy at all.
One aspect that would give me hope that this debate/forum won’t turn out like so many debates with pseudoscientists before, with the skeptical side winning on science and logic but appearing to lose otherwise, would be if a true devotee of evidence-based medicine were in charge of setting the format and the topics. Debates with pseudoscientists allow skeptics the best chance when they are designed to focus like laser beams on key claims of the pseudoscientists, thus putting them on the defense. In the case of creationism, examples would include common creationist canards that evolution violates the Second Law of Thermodynamics or that the gaps in the fossil record somehow disprove evolution. In the case of homeopathy, good examples might include the Law of Similars, which is the very basis of homeopathy and is based more on sympathetic magic than science, or the claim that water can retain memory of something that it has come in contact with. Rustum Roy will make this difficult, given that he can throw around more “quantum-y” pseudoscientific B.S. about water than anyone other than Lionel Milgrom, but this claim can be deconstructed, if done in a forceful and focused fashion that doesn’t let the homeopaths obfuscate with irrelevant observations.
In the end, I can’t really blame Steve Novella, Donald Marcus, or other skeptics for agreeing to engage in such debates. Steve, at least, has certainly done way more to advance skepticism and scientific medicine than I have, and Donald Marcus has spoken out against pseudoscience at NCCAM. As someone who shares their passion for science and its application to medicine to develop the most effective evidence-based medicine, I can fully understand the dilemma that an invitation to participate in this forum probably presented. I don’t know how I would have reacted. (Given the level of traffic that my blog gets and my notoriety in the medical blogosphere, it’s arguable that one of the advantages of anonymity is that I don’t get invitations to such forums. Not that it’s hard to find out who I really am–heck, fellow academic physicians could just e-mail and ask me, and I’d probably tell them–but it’s an extra step and no one knows me by my real name anyway.) After all, such offers put skeptics in a quandary, and pseudoscientists know it. If the skeptic refuses, one of two things will happen: either the organizers will be forced to find a skeptic who may not be as skilled or the skeptical side may go unrepresented. In the setting of an academic medical center, the hateful thought of letting woo like homeopathy to go unchallenged in what should be a bastion of evidence-based medicine, might be enough even to sucker me into saying yes.
The bottom line is that the question of whether it is ever a good idea or does any good to debate pseudoscientists in a public forum such as the debate at the University of Connecticut leaves me conflicted. I’ve struggled with the question over the years, and at times have come to different conclusions about the wisdom of being roped into such events. For now, although others may disagree with me, as a rule of thumb, I conclude that being a skeptic taking part in such debates probably does more harm than good to the skeptical cause in most cases.