Respectful Insolence

While I’m recovering fro Christmas this weekend and away a good chunk of tomorrow, here’s a question to ponder as 2009 draws to its inevitable close. Val Jones has listed what she views to be the top five threats to science-based medicine that dominated 2009 and look likely to continue to threaten science in medicine during 2010. So, to complement my previous question regarding the worst pseudoscience of the decade, I’d point to Val’s post on the top five threats to science-based medicine of 2009 and ask: What were the worst threats to science-based medicine, not just of 2009, but of the decade that is about to end?

Clearly, Senator Tom Harkin and Congress remain major threats, as all sorts of special interests try to insert provisions trying to legitimize quackery by making reimbursement for such services by the health insurance cooperatives formed under the Obama health care bill that just passed Congress. You can be sure that during the House-Senate conference committee negotiations there will be wheeling and dealing to try to keep the provisions that survived the Senate and perhaps to bring back ones that didn’t. I’d also agree that NCCAM is a major threat.

Val’s list is a good starting point, but I really think that the anti-vaccine movement needs to be inserted in there somewhere, if not near number 1. Whatever NCCAM or Congress does, these tend to be less acute threats to public health than the resurgence of vaccine-preventable disease likely to occur thanks to the efforts of Jenny McCarthy an her ilk. Don’t get me wrong. NCCAM and the infiltration of quackademic medicine into academia represent arguably the worst long-term threat to science in medicine, but, even though the forces behind NCCAM have come far their blurring the line between science and quackery in medicine will still likely not be complete for several more years at least. That’s one reason why I think the anti-vaccine movement needs to be in the top five, but I can’t think of what I’d demote in order to include it.

Comments

  1. #1 Ramel
    December 26, 2009

    Easy, Google is the greatest threat. Without google there’s nothing but a few nutjobs howling at the moon.

  2. #2 Jake Crosby
    December 26, 2009

    The greatest threat to Science-Based Medicine of the decade? Easy, “Science”Blogs!

  3. #3 Chance Gearheart, NREMT-P
    December 26, 2009

    @2 – Oh look. An Age of Autism troll. How quaint. How’s poisoning children with Lupron and contributing to the comeback of previously erradicated lethal childhood diseases in the name of pseudoscientific belief going these days?

    I mean, that pretty much sums up your organization.

  4. #4 Bronwyn
    December 26, 2009

    I appreciate that you let Age of Autism supporters comment here. I think it speaks to your integrity. I have posted conflicting opinions on articles at the AoA site before. Sometimes they get posted, sometimes not. Funnily enough, I’ve NEVER had one posted on an article written by JB Handley.

  5. #5 BaldApe
    December 26, 2009

    FWIW, I’d go with Val’s list, except combine Mainstream Media and “New Media,” (what’s the difference these days anyway?) at #2, and move antivaccine to #1, demoting everything else accordingly.

  6. #6 DLC
    December 26, 2009

    I was watching one of those late night chat shows recently, and some young female celebrity was being interviewed. The host asked her some general question about her health, and she replied that she’s doing fine, but she was having some allergies and a friend referred her to an “allergist” and he gave her some homeopathic medicine and it worked and she is not a “True believer.” The greatest threat to science based medicine : Ignorance. That young woman now joins the legion of fools, because some charlatan sold her an expensive placebo.

  7. #7 Mariah
    December 26, 2009

    I’m with the BaldApe. The MSM + New Media is really blending too much to distinguish where teh stupid emanates.

    But here’s another one I’d add: Scientists are not stepping up to battle teh stupid in public (present company excepted). I attended a CDC meeting on vaccines in my town. The crankitude and conspiracy were off the charts. Of about the 110 general public folks in attendance, I think there were 4 doing battle for science. It was nearly impossible. That meant only 4 of the tables had science sanity. And even those were outnumbered in each case.

    I talked to a CDC rep and said I was sorry about that–that more scientists hadn’t heard about this meeting. I had clearly hit a hot button and he said that had been true for years, that scientists were not supporting public health in helpful ways. He was very frustrated. We’ve ceded the public discussion on the ground to cranks.

    Separate note: I’m seeing attacks on nanomedicine and nanotech in general that uses the same playbook as anti-vax and anti-GMO squads. I’m sure that will be one of the battles of the next decade.

  8. #8 Broken Link
    December 26, 2009

    Besides Google (of Google University), Youtube is also a huge concern. This morning I was directed to a terrible/well-made video on 9/11 truthiness. With catchy jingles and bland and semi-plausible messages, this kind of thing can convince the uneducated that there is a vast array of conspiracy out there.

    From this video, I was could have clicked on to “related videos” – concerning nothing less than the Illuminati and anti-vaxers. It’s depressing – a tiny number of people seem to have taken over the popular media to propagate their message, while real science stays quietly confined to the peer-reviewed journal and a few popular press stories.

  9. #9 Jen
    December 27, 2009

    I think that the basic problem is a lack of basic science education and critical thinking skills. It’s difficult for anyone to make an informed decision about medicine or health if they don’t even know (or understand) what a peer-reviewed study is, or to make a decision about the qualities of different studies and headlines if you don’t understand the basics. Everything else flows from that, and as long as education is driven by political, religious, or ‘moral’ agendas that’s not going to change.

  10. #10 Chance Gearheart, NREMT-P
    December 27, 2009

    @#9 – You hit the nail right on the head. The quality of the American educational system in teaching children early that critical thinking, knowledge, and skeptical thought is abhorrant. We have a generation of people out there with the belief that magical thought and anectodal evidence (the N=1 Customer Testimonial) is much better than those evil, godless scientists and their findings. We’re graduating a generation who have a fifth grade science knowledge, at best, in more than just a few cases. We even tolerate it in our primary care populations (such as Nurses, Paramedics/EMTs, and even some Physicians), and encourage the public at an early age to believe in wild, nefarious conspiracy theories that wouldn’t even pass the test of Occam’s Razor, let alone common sense given the general ineptitude and idea that somehow, hundreds of thousands of collective people have been able to keep it a secret.

  11. #11 Denice Walter
    December 27, 2009

    @ Broken Link,Jen,& Chance….:You mention some alarming trends: the decline in relevant education and of responsible traditional journalism paralleling the rise of the new media. Consider if you will, all of these coalescing simultaneously *and* being used to the personal advantage of unscrupulous snake-oil salesmen,shameless theatrical publicity hounds,and get-rich-quick schemers with savior complexes(and believe me,they are *in love* with twitter,you-tube,etc.).I don’t know who to despise more:the arrogant ignoranti(like Adams,Null, Jenny, etc.) or the medically-educated,(i.e. Mercola,Chopra,etc.), who should *know better*.

  12. #12 Dr. Val
    December 27, 2009

    Interesting discussion. I strongly considered putting the anti-vaccine folks in the top 5, but as I thought about it – it seemed to me that the platforms upon which they spin their conspiracy theories and pseudoscience are actually a larger threat than they themselves. Although their beliefs are certainly crazy and deleterious, they are still a fringe group – and the vaccine preventable diseases have not yet come back in as large a way as they could… Plus I just saw a ton of patients in my office, all extremely interested in getting the H1N1 vaccine…

    If I could do it again, I might combine the 2 medias and add lack of science education in schools. But it’s great for us all to be pondering the question. Glad I got the conversation started. :)

  13. #13 Rogue Medic
    December 27, 2009

    I completely agree with Jen and Chance Gearheart.

    If we educate students to be able to recognize faulty logic, then we should not have a problem with the influence of any of the other threats listed in the Top 5. With an education in how to figure things out for one’s self, even Jake Crosby might stop trying to kill children.

    We need to teach students how to figure out problems for themselves, not how to memorize information for tests. When students do not learn to think for themselves, we have failed them.

    Google is not a problem. Google is just a tool that is used by people. Blaming a tool because it is abused by ignorant people is just another form of conspiracy theory. Google, YouTube (owned by Google), the main stream media, et cetera, are just ways for those with faulty educations to spread their ignorance to an audience prepared by our school system.

    Wikipedia used to be similarly criticized, but the frauds are finding that they have to provide evidence to support the edits they post. This is leading to imitations of Wikipedia, but without standards other than approved by whoever has the authority to approve/modify/remove the edits.

    We also need to work to not be fooled by superficial solutions to complex problems. If we can reason for ourselves, we should not have this problem.

  14. #14 clamboy
    December 27, 2009

    The state of public education seems to top some people’s list, but what is behind that? I would lump together the purposeful defunding of schools through so-called “tax revolts,” the allotment of school funds based on property tax revenue, NCLB, etc. Maybe “the disdain towards, and inequity in, education” is one way to sum up this problem.
    However, I had a very good experience substituting in a public JHS recently. The 7th grade science class was learning, yes, the scientific method, and in detail! I remarked upon this to the teacher, who said she was thrilled to be teaching that curriculum, as students would use that process throughout their lives.

  15. #15 Grant
    December 28, 2009

    If you’re going to look “behind” the standards of public education in the USA, you might take a look at the lack of standards for teaching at high school (compared to other nations) and the lack of solid curricula. I still cannot get over the lack of standards for teaching in the USA. (In high schools, that is: while my knowledge of the standards for high schools is only just enough to have some confidence in commenting on them, I’m not familiar with the situation in primary schools at all, but I’m guessing it’s no better-?)

  16. #16 BB
    December 28, 2009

    How about the rise of animal rights threatening the safety of every new treatment? When medical schools and trauma centers are under attack for using lab animals, how will new cures be found and developed?

  17. #17 Orac
    December 28, 2009

    Holy crap! You’re right! Animal rights extremism is a very serious threat to science-based medicine, and it has shown a remarkable rise, particularly in the U.K., over the last decade.

  18. #18 geridoc
    December 30, 2009

    I’m a little surprised at the objections to NCCAM. It is clearly the case that many alternative therapies are touted with very scant evidence, and the faith in a lot of these therapies is seriously misplaced. But NCCAM does not exist to promote these therapies. It’s purpose is to subject these therapies to rigorous evaluation. I think it is kind of problematic to criticize all these therapies for lack of evidence, but then not support funding of NIH programs that actually test these therapies.

    A case in point is the just released study of Ginko, an agent that was touted to prevent cognitive decline. (http://jama.ama-assn.org/cgi/reprint/302/24/2663). This study is quite convincing that Ginko is not effective. But it seems good that this study was funded. Ginko use was very common, and many credible alzheimer disease experts felt there were plausible mechanisms for why it would work. In situations like this, it is important to fund rigorous studies that provide the answer, and “let the chips fall where they may.”

  19. #19 James Sweet
    December 30, 2009

    Easy, Google is the greatest threat. Without google there’s nothing but a few nutjobs howling at the moon.

    I have to disagree whole-heartedly. The mainstream media made me think there might be something to this whole vaccine-autism link. It was Google that brought me the truth.

    I was going to make the same comment about “New Media” coming in at #5 on Val’s list. New media is both the greatest threat and the greatest asset. A science-based approach will never get good airing on mainstream news outlets (because it’s too boring for most people) and many of us — myself included — are just not going to go to the freaking library to study every single possible topic that might affect their lives.

    Why am I able to shoot down anti-vax activists who try to convince me? Google. And that’s the truth.

    @geridoc: There are a couple of schools of thought on that one. I’m not sure where I lie exactly. If we look at the issue in a vacuum, of course a study based on virtually no pilot information and with no plausible mechanism should not be funded in preference to more promising research. But the truth of this statement doesn’t change the reality of how ginko (for example) is being marketed, and what the mass consumer perception is. So it may be that, in a bit of realpolitik, you are right that such studies need to be funded. It’s a really tough call.

  20. #20 Pablo
    December 31, 2009

    geridoc – in one respect, you are of course correct. It’s great that sCAM treatments are being subjected to testing. However, the problem is, what is the response when they fail? Have the constant failures of the NCCAM trials actually caused any supporter to reconsider their position? No, I suspect what it does is make them insist on more funding and trials to find something that DOES work.

    Instead of saying, “Jeez, maybe there’s nothing to these claims” they just move to the next one.

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