Respectful Insolence

I sometimes think I ought to send a thank you letter to Dr. Mark Hyman.

True, I don’t owe him quite as much as I owe, for example, Mike Adams of NaturalNews.com, anyone on the blogging crew of the anti-vaccine crank propaganda blog Age of Autism, Dr. Jay Gordon, or several other pseudoscientists, quacks, or other assorted cranks who have provided me with blogging material over the last five years. However, whether he’s mangling autism science, postulating dubious “personalized medicine” for Alzheimer’s disease, championing that form of quackery known as “functional medicine,” trying to persuade our legislators to include coverage for alternative medicine in health insurance reform legislation, or, most recently, misrepresenting research, Dr. Hyman is definitely an up-and-comer as far as providing me with grade-A crankery to blog about. For that, I can’t help but be a little bit grateful to him. Truly, he is not only a connoisseur of woo but a constant source of amazingly nonsensensical statements about health.

And he does a lot of it on that wretched hive of scum, villainy, and quackery, The Huffington Post.

Over the weekend, Dr. Hyman was at it again. He dropped a big drippy, stinky turd on science-based medicine, as if to tell SBM what he thought of it, entitled, Is There a Cure for Autoimmune Disease? Truly, the woo doth flow, beginning with an anecdote:

Isabel, a cute 10-year-old girl from Texas who loved riding horses, walked into my office a year and a half ago with one of the most severe cases of autoimmune disease I had ever seen. Her face was swollen, her skin was inflamed, her joints were swollen, her immune system was attacking her entire body–her muscles, her skin, her joints, her blood vessels, her liver, and her white and red blood cells. Isabel couldn’t squeeze her hand or make a fist. The tips of her fingers and toes were always cold from Raynaud’s disease that inflammed her blood vessels. She was tired and miserable and was losing her hair. Isabel was on elephant doses of intravenous steroids every three weeks just to keep her alive, and she was taking prednisone, aspirin, acid blockers, and methotrexate, a chemotherapy drug used to shut down the immune system daily.

I bet you can know what’s coming next, can’t you? And come next it does, but not quite yet. First, Hyman has to go on a bit more about how clueless those “conventional” doctors were, unable to figure out wht was wrong with Isabel or how to treat it. In fact, they were just at the point of adding another powerful immunosuppressant, a TNF-blocking drug, which, Hyman gleefully points out, increases the risk of cancer and the risk of overwhelming sepsis. Unwilling to accept this drug, the parents brought Isabel to…guess who? Of course, they brought her to Dr. Hyman, who did that voodoo woo that he do so well, with the following results:

Two months after I first saw Isabel and discovered and treated the underlying causes of her inflammation–after, as she says she, “stopped eating gluten, dairy, and sugar and took some supplements” she was symptom free. In less than a year, she was completely healthy, her blood tests were normal, and she was off all her medication.

Of course. The savior, the guru, the Messiah saved her.

I’ve noted before how so many of these testimonials are like religious conversion stories. The ill start out lost, suffering, and in pain. They wander from remedy to remedy. Then, suddenly, they find a charismatic figure, someone who can lead them out of the darkness, a Savior, if you will. And suddenly everything is alright again. Disease is banished, health is restored, and the “evil” scientific doctors vanquished, their knowledge revealed to be false. At least, that’s how these testimonials frequently go.

These testimonials also rarely provide enough information to allow an educated reader or physician to hazard a reasonable guess as to whether the interventions used on the patient were actually responsible for the improvement reported. Indeed, I started this blog out by writing about just how such testimonials can seem convincing even if the treatments being promoted do nothing. The same thing is going on here with Dr. Hyman, who says that Isabel stopped eating gluten and dairy and took some supplements and then in less than a year was symptom-free and off medications. Regular readers can probably guess why Hyman’s testimonial is not particularly convincing. It follows one of the cardinal rules of alt-med testimonials in that it is reasonably clear that Isabel continued to take her medications for a considerable period of time after meeting Hyman. After all, he said it took “the better part of a year” for Hyman to get better. At its heart, Hyman’s testimonial is no different than the testimonial about breast cancer that I described so long ago. Basically, in the case of the breast cancer testimonial, it was quite clear that it was the surgery, not the woo, that effected a cure of the woman’s cancer. In this case, it’s not quite as clear, but it’s certainly not at all clear that Hyman’s woo effected this cure, particularly since it took nearly a year. It’s quite possible that conventional therapy finally worked. It’s also possible that Isabel’s autoimmune disease, whatever it is, went into remission, which is not that uncommon for autoimmune diseases, which can wax and wane in intensity. Basically, this testimonial tells us close to nothing about whether Hyman’s woo works.

Not that that stops Hyman from going on a rant about what he calls the “unfortunate demise of the case study in medicine”:

Historically medical discoveries originated from physicians’ keen observation of their patients’ diseases and responses to treatment. Doctors reported their findings to their colleagues or published them as case studies. Today these “case studies” are often dismissed as “anecdotes” and have become increasingly irrelevant. Instead, we now focus on randomized controlled trials as the only standard of “evidence”. Sadly, this dismisses the experience of thousands of patients and physicians as they apply new scientific findings to treat difficult conditions.

Basic scientific discoveries often take decades to be translated into medical practice. Unfortunately, this prevents millions from accessing therapies that could benefit from them now. The determining factor in deciding whether to try a new approach with a patient is the risk/benefit equation. Is the treatment more likely to help than harm? How risky is the treatment? What are the side effects? How dangerous or risky is the current approach to a problem? How debilitating or life threatening is the disease being treated? These questions can guide exploration toward innovative approaches to chronic disease.

This is, of course, utter poppycock. The difference between modern medicine, whether you want to call it science-based or evidence-based is the evolution from using anecdotes and case reports as the basis for deciding how to provide care. Before the dawn of scientific medicine, how Hyman advocates practicing medicine was the mainstream. That was how new therapies were evaluated. Individual practitioners would do exactly what Hyman advocates. They’d try new treatments on their patients, record the results, and either communicate them to their colleagues in various venues or, later, write them up as case studies.
Indeed, randomized clinical trials are a relatively new development in the history of medicine. For example, one of the earliest clinical trials was that of John Lind, who showed that scurvy could be treated with citrus fruit, and that wasn’t until 1753. then there were studies such as those done by Ingaz Semmelweis in the mid-1800s that showed that handwashing by physicians and practitioners could greatly decrease the death rate from puerperal fever in the maternity ward. It wasn’t until the early 20th century that the methodology of the modern randomized clinical trial (RCT) took form, and RCTs didn’t come to dominate medicine until the latter half of the 20th century. Even then, it’s only been in the last couple of decades that doctors are truly starting to “get it” and not rely as heavily on anecdotes and the received dogma of the physicians who trained them.

I’ve explained before time and time again how anecdotes (i.e., single patient experiences) can be profoundly misleading. Confirmation bias, confusing correlation with causation, regression to the mean, and various forms of selective memory to which physicians are just as prone as anyone else all conspire to make anecdotal observations of the sort that Hyman advocates profoundly unreliable. Even when the treatment effect is fairly dramatic, anecdotal evidence has a hard time showing it convincingly. To boil it all down, what Hyman wants is to move medicine back from the scientific basis that it took hundreds of years to reach and send the practice of medicine back to the way it was done 200 years ago. The acceptance of anecdotal medicine as the standard of care is the sort of atmosphere that allowed homeopathy not only to be invented but to fluorish and become respectable.

Yes, that’s exactly where Hyman wants to take medicine. To illustrate it, Hyman then goes on to promote his particular brand of woo, namely functional medicine:

Functional medicine is a hidden movement sweeping across the globe, and it is based on a different method of diagnosing and treating disease–one that focuses on causes not symptoms, one that is based on an understanding of the dynamic way our genes interact with environment, one that goes beyond simply treating diseases based on their label. The training I lectured at teaches practitioner to understand the body as a system; to seek the causes of illness; to understand the body’s basic functional systems, where they go awry, and how to restore balance; to understand the interconnections between symptoms and organs rather segregate diseases into specialties.

This approach is a fundamentally different way of solving medical problems, one that allows us to decipher the origins of illness and identify the disturbances in biology that lead to symptoms. Let’s see how this approach worked for Isabel.

To be honest, I’ve read about “functional medicine.” In fact, I have yet to figure out exactly what it is. I do know that it involves a lot of things that have no science to support them, modalities such as “detoxification,” various dubious “gut and digestive health” treatments that are based on the same sorts of “logic” that Andrew Wakefield used to try to link the MMR to autism, and various treatments based on “oxidative stress.” He even spouts germ theory denialism à la Bechamps and says that the germ theory of disease has led us astray in that to him modern medicine “ignores” that our health is determined by the interaction of our genes and our environment. Of course, Hyman has no clue how genes influence our health in concert with the environment any more than the crew at AoA does and has proven it time and time again.

Still, Hyman thinks he understands how genes interact with environment, and he then goes on to tell Isabel’s tale in more detail. His tale is most instructive in that Hyman serially tries out a veritable panoply of woo on Isabel, all the while proclaiming that his woo reigns supreme:

For Isabel, the only response physicians had to her life-threatening illness was to shut down her immune system, leaving her at risk for cancer, infection, osteoporosis, muscle wasting, and psychiatric illness. But there was another way. I simply asked the question WHY. I didn’t focus on WHAT the name of her disease was (mixed connective tissue disease, otherwise known as an autoimmune disease that affects the whole body), but WHY she was inflamed, WHERE this inflammation originated from, and HOW we could locate the causes and restore balance to her overactive immune system that was attacking her own body?

I really, really hate it when woomeisters pull this gambit. They make it seem as though they are the only ones who think about these questions and try to apply the answers to the care of their patients. I guess what I really resent is the sense of utter condescension, the arrogance, the contempt for scientific medicine, none of which they’ve earned the right to through, you know, actually being superior. So what Hyman does is to describe how he tried woo after woo on Isabel based on his pseudoscientific “understanding” of how the body works and how genes interact with the environment. Did it work? Who knows? The story is perfectly consistent with a remission due to the patient’s conventional therapy, a spontaneous remission, with Hyman’s woo actually having done some good, or with a combination of any or all of the above. That’s the problem with anecdotal evidence; there’s no way to tell which possibility is most likely to be the best explanation for Isabel’s apparent recovery. That’s the problem when you rely on anecdotal evidence to dictate your care.

That’s why we need science-based medicine.

For that vast majority of its existence, medicine has relied primarily on anecdotal evidence to determine which treatments work and which do not. That’s how treatments such as homeopathy, bleeding, purging, and treating various diseases with toxic metals persisted so long even though they either do nothing or cause harm. It’s only been in the last 100 years or so that we have seen the rise of randomized clinical trials and truly scientific medicine. As a result, the last 100 years have witnessed the most rapid progress in medicine the world has ever seen. Hyman would like to take us back to the time before that progress while pretending to be more scientific than science-based medicine.

Comments

  1. #1 David
    October 12, 2010

    “one of the earliest clinical trials was that of John Lind”

    Indeed, to my knowledge, that was the first controlled trial ever. A fascinating tale. Interesting also is the fact that the first true application of science-based medicine concerned vitamins and nutritional supplements.

  2. #2 Terry
    October 12, 2010

    Guys like Dr Hyman are just appealing to emotion. It’s a good thing he told us Isabel was cute. Presumably, if she had been ugly his treatment would not have worked, or he might not have felt so bad about letting those evil doctors treat her.

  3. #3 Dangerous Bacon
    October 12, 2010

    “To be honest, I’ve read about “functional medicine.” In fact, I have yet to figure out exactly what it is. I do know that it involves a lot of things that have no science to support them, modalities such as “detoxification,” various dubious “gut and digestive health” treatments…and various treatments based on “oxidative stress.”

    Sounds like rebranded naturopathy.

    ” He even spouts germ theory denialism…”

    Wonder how many of these denialists suffering from sepsis have had deathbed conversions to Pasteur.

  4. #4 Paul Browne
    October 12, 2010

    Orac “Dr. Hyman is definitely an up-and-comer as far as providing me with grade-A crankery to blog about.”

    Up-and-comer? I suspect he’s already made the grade, after all you yourself included him in your list of the “Four Horsemen of the Woo-pocalypse”.

    http://scienceblogs.com/insolence/2009/03/senator_tom_harkin.php#c1447809

    I guess he hasn’t done anything to change your opinion of him since then.

    I must borrow “wretched hive of scum, villainy, and quackery” from you, an appropriat description for that (virtual) rag!

  5. #5 Mike
    October 12, 2010

    To some extent, many doctors leave themselves open to this kind of woo. I have a gum problem that my dentist sent me to an oral surgeon to check out. They did a biopsy and sent it off, it was inconclusive (“if you do another biopsy and fluoresce it, we can make a better determination”), but it was either this or that autoimmune problem. I asked “What causes this? Where did I get it?” The oral surgeon’s reply was “If you knew that, you’d win the Nobel Prize.” I didn’t need that kind of smart-ass response.

    I’ve been to my MD for 2 years for some issues he can’t nail down. One day I said “Medicine really is more art than science.” He replied “You’re more right than you know.” A lot of medical practice is simply detective work, except it’s not as romantic and exciting as it is on House. My doc has sent me to a rheumatologist, a neurologist, multiple blood workups, and I recently went for a bone scan. No answers yet, but when tort reformers yell that doctors call up too many tests just to cover their asses, I respond “No, they’re trying to figure what’s WRONG with the patient.”

    Suffering from an ongoing and mysterious problem that “science” can’t figure out sure makes that woo look inviting. It’s up to doctors to make sure that the patient understand what’s going on. Has “science-based” medicine killed the bedside manner of doctors? I bet Hyman has a great bedside manner; I bet most of the woomeisters do.

    I enjoy your column, as always.

  6. #6 Science Mom
    October 12, 2010

    You have effectively pointed out the underlying theme of anecdotes trumping trial observations among the anti-intellectuals. Sadly, people are buying into this and I can’t understand the desire to move so backwards.

  7. #7 ERV
    October 12, 2010

    Ive got a friend with an undefined autoimmune disease. Its definitely cyclical– He will be fine/managed by drugs for years, and then BAM! Shit hits the fan for a while, everything is swollen, he cant ‘make a fist’, etc.

    Its got jack shit to do with ‘sugar’.

    Its got to do with the fact he has an undefined autoimmune disease.

  8. #8 Denice Walter
    October 12, 2010

    Exactly! It rivals the tales of religious conversation that comprise Wm. James’ marvelous “The Variety of Religious Experience”. Indeed our usual suspects’ screeds can follow the same pattern: an extremely overweight young woman is “enlightened”- she follows a raw diet and *Voila!*- size four! And she begins to preach herself! (see NaturalNews; last week) or someone suffers from AIDS, cancer, MS, Alzheimer’s, what-have-you, “hears the word” ,”sees the light”, begins to “live right”, and experiences a cure ( see “Miracles Can Happen”,@ Gary Null’s various sites). Each tale involves a “healer”, or at least a “servant of the word” (or of the woo, as the case might be) to reveal the Truth to the sufferer – it usually involves avoiding certain foods as well as the representatives of All Darkness and Evil (that’s us)- on his or her Pathway to Light. Often, it appears that our “humble messengers”- inflated by their own grandiosity- solipcistically blur the line the Eternal Source of Truth and Light and, um, themselves.

  9. #9 Todd W.
    October 12, 2010

    Functional medicine is a hidden movement sweeping across the globe, and it is based on a different method of diagnosing and treating disease–one that focuses on causes not symptoms

    Seriously, Dr. Hyman? Real medical practitioners don’t try to figure out the cause? Wow. That’ll come as shocking news to, well, lots and lots of doctors practicing science-based medicine.

  10. #10 njd
    October 12, 2010

    Todd W.: surely you know that “conventional medicine treats symptoms, but alternative medicine addresses causes”?! No, I didn’t know that either, but it’s an amazingly common meme given what utter nonsense it is.

    If you are looking for a treatment modality that concentrates only on symptoms without having the slightest interest in causes, homeopathy would be hard to beat.

  11. #11 stripey_cat
    October 12, 2010

    How plausible is it that her autoimmune problems were exacerbated by dietary allergens? I ask because, during the hayfever season, I sometimes get random acheyness and skin problems as well as respiratory symptoms. I also know someone with skin allergies worsened by some types of white wine! Luckily, over-the-counter antihistamines sort it out for me, and my friend simply sticks to red wine, but could the child’s symptoms be a more severe version of the same sort of problem? I’m surprised that no conventional doctor did allergy tests or suggested dietary restriction of common allergens, if that sort of thing is widespread.

  12. #12 RJ
    October 12, 2010

    What is it with this guy? Everything comes back to food and supplements. All of the world’s health problems are cured with food and supplements. If only it were that easy.

  13. #13 augustine
    October 12, 2010

    [Todd W. :Seriously, Dr. Hyman? Real medical practitioners don't try to figure out the cause? Wow. That'll come as shocking news to, well, lots and lots of doctors practicing science-based medicine.]

    Um, uh. Surgical breast cancer oncologists try to figure out the cause of breast cancer? I don’t think so! Is high cholesterol the cause of heart disease? Is high blood sugar the cause of diabetes? Is low serotonin the cause of depression?

    Why do I have heart disease? It doesn’t matter take this pill have this surgery

    Why do I have diabetes? You should “try” exercise and diet(whatever that means). But you have to take this pill.

    Why am I depressed? Take this pill to see if this works.

    “Why” is actually a good question to ask your science based medicine doctor? It’s one word that’ll cause them to look at you puzzled. Because science based medicine doesn’t have the answer to those questions.

    Really, Todd? C’mon.

  14. #14 Gregory Goldmacher
    October 12, 2010

    My favorite phrase:
    “that voodoo woo that he do”

  15. #15 DonZilla
    October 12, 2010

    Mike @ #5:

    “Has science based medicine killed the bedside manner of doctors?”

    NO. Insurance companies have.

  16. #16 Clam
    October 12, 2010

    #5 Have you seriously considered vitamin C? Not woo! I had a similar prob some thirty years ago. My (very old and very scientific) doctor said “Haven’t seen this since WW II. You’ve got scurvy!” Although I was eating a balanced diet, a combination of moderate drinking and heavy smoking had left me short of Vitamin C, which is used by the body in elimination of various bits and bobs left by my immoderate habits (as I understand it). It took an old doctor who had seen the symptoms before to spot the link.

  17. #17 Mephistopheles O'Brien
    October 12, 2010

    @stripey_cat – from my view, it’s reasonable that food allergies could have been part of her problem. The questions are – how did Dr. Hyman determine that was so, what allergies in particular were causing the problems, and did the evidence bear him out that this was the issue? Based on what we see from this article, there’s no reason to believe he actually had a basis to know any of this.

  18. #18 Lawrence
    October 12, 2010

    Wow augie – that’s a stinking pile even for you. That should come as a huge surprise to the thousands of medical professionals that are currently involved in finding the root causes (genetic, viral, baterial, etc) of modern diseases.

    So, I guess every time it is announced that a “cause” of a particular disease or ailment is discovered (particularly if it can be linked to a defective gene) it isn’t really the cause, huh?

  19. #19 augustine
    October 12, 2010

    [Lawerence: That should come as a huge surprise to the thousands of medical professionals that are currently involved in finding the root causes (genetic, viral, baterial, etc) of modern diseases.]

    Wow. Genetics, bacteria,and viruses are the root cause of modern disease?

    Is this what SBMers have to offer? Interesting. This gives a little more insight into the belief systems of an SBMer. So are you sure about this?

  20. #20 shasta
    October 12, 2010

    Hyman’s “Articles” on Huffpo are really just a big woo-vertisement, and nothing more.

  21. #21 Dangerous Bacon
    October 12, 2010

    “Wow. Genetics, bacteria,and viruses are the root cause of modern disease?

    Is this what SBMers have to offer? Interesting. This gives a little more insight into the belief systems of an SBMer. So are you sure about this?”

    Nah, it’s gotta be the vaccines as the source of all disease. Especially ’cause they’re given with Large Invasive Sharp Pointy Needles.

    How’s you belonephobia today, augie?

  22. #22 Pen
    October 12, 2010

    Suffering from an ongoing and mysterious problem that “science” can’t figure out sure makes that woo look inviting. It’s up to doctors to make sure that the patient understand what’s going on.

    I’m really sorry about your health problems, and I bet the doctors are too, but if nobody, no scientist, no doctor, knows the answer (yet), what is it you want to hear? Something someone made up in a confident tone?

  23. #23 augustine
    October 12, 2010

    [Dangerous Bacon: How's you belonephobia today, augie?]

    Sorry, I didn’t have one today. I don’t eat baloney. But I know it when I see it.

    No offense Bacon, but I don’t eat pork.

  24. #24 Calli Arcale
    October 12, 2010

    Yes, people do want to hear something in a confident tone, though not something made-up, or least, not something that they think was made-up. That goes for all of us, really. Mike didn’t say he want someone to lie to him, nor even that he sympathizes with the woosters. He sympathizes with the marks.

    Honestly, I can too. When you’re sick and you don’t know why, it’s scary. The longer it goes on, the more you just want someone to make it go away or at least give you an answer you can hold onto. It takes a certain amount of effort to not be taken advantage of in that situation.

  25. #25 Sastra
    October 12, 2010

    Science Mom #6 wrote:

    You have effectively pointed out the underlying theme of anecdotes trumping trial observations among the anti-intellectuals. Sadly, people are buying into this and I can’t understand the desire to move so backwards.

    I’m reminded here of a quote from Wendy Kaminer’s Sleeping with Extra-Terrestrials:

    “I can’t stress strongly enough how much this reliance on personal testimony and this mandate that we take personal testimony at face value contributes to the irrationalism that abounds today. It comes right out of popular therapies, and popular therapies took it straight from the religious tradition of testifying and the conflation of feelings about god’s immanence with facts about his existence.”

    The common wisdom of the day has it that one of the hardest tasks we have is to “believe in ourselves.” We need to trust ourselves, follow our instincts, listen to our intuition, think with our guts, come to our own conclusions, make up our own minds, and never give up faith that we know what’s best for us and our family — even when all the experts are telling us we’re wrong. This is really, really hard work, and takes a lot of self-discipline and character.

    Which is usually crap: it takes a lot more self-control and humility to doubt yourself and your conclusions enough to put it them up to an objective test. But ‘popular wisdom’ often turns it the other way around. These anecdotes don’t just sound like religious conversions: they also sound like therapy sessions.

  26. #26 Mephistopheles O'Brien
    October 12, 2010

    @Augustine,
    I’m missing your point. Lawrence’s use of “etc.” indicates he didn’t provide an exhaustive list. Which of the items he listed (genetics, viruses, bacteria) do you believe is not a root cause of disease?

  27. #27 The Gregarious Misanthrope
    October 12, 2010

    @Mephistopheles O’Brien
    “I’m missing your point”

    The point is, there is no point. No point to anything it says. It’s a steaming pile of bad math, bad analogies, unsupported assertions, and phobias (phobias of needles, cross-dressers, and who knows what else). Whoever owns the wifi that seeps into its basement lair needs to do us all a favor and tighten up his encryption.

  28. #28 Matthew Cline
    October 12, 2010

    I think augustine’s point is that if scientists were really attempting to find the root causes, they’d have found better treatments than pills and surgery.

  29. #29 Composer99
    October 12, 2010

    So when someone points out to the ugh troll that cancers are caused by cells gone haywire, and those are, in fact, the root causes of cancers… what is his reply?

  30. #30 Todd W.
    October 12, 2010

    So when someone points out to the ugh troll that cancers are caused by cells gone haywire, and those are, in fact, the root causes of cancers… what is his reply?

    “Oh yeah?”

  31. #31 augustine
    October 12, 2010

    [Composer: So when someone points out to the ugh troll that cancers are caused by cells gone haywire, and those are, in fact, the root causes of cancers... what is his reply?]

    SBMedical doctER: “I have found the cause of flat tires. It is a breach in cohesion of the substance of the tire. It is a leak.”

    Saying there is a leak behind every flat tire is not an enlightening statement. Neither is saying that cancer is “cells gone haywire”.

    Cells are life. Life has gone haywire. What is life? You’ll first need to know this before you find out what the condition of cancer is. Biology has not yet answered the question.

  32. #32 skeptiverse
    October 12, 2010

    @Matthew Cline
    Your comparison is faulty, finding the root of a problem and finding a treatment for that problem are two very different excercises. further your assertion that pills and surgery are the excercises of a profession that is not looking for the root cause, why is it that most of these pills and surgeries WORK.

  33. #33 Antipatharia
    October 13, 2010

    @augustine
    Life is the ability to take in energy from the outside in order to keep your internal entropy from increasing.

    I’ve never understood why people think that’s a hard question.

  34. #34 Chris
    October 13, 2010

    I love wanking, esp. Thinking about Orac.

  35. #35 RobertL
    October 13, 2010

    But isn’t there actually quite a significant difference between an “anecdote” and a “case study”?

    I’ve always thought of an anecdote as a layperson’s story, and a case study as something that’s scientifically documented. And they could even be the “same” story about the same event – but told from two different points of view.

    Sure, a single case study isn’t the same as a randomised clinical trial, but they can be very useful if they cover new or interesting events.

    I remember during psych classes being told of the story of that guy* who had the crowbar exploded through his skull – and the things that they learnt from him.

    The anecdotal version would be along the lines of, “some guy got a crowbar blown through his head. He lived OK afterwards, but it completely changed his character.”

    The case study version would be more scientific, be written up somewhere, and outline the various tests and findings.

    Or is that just my unique spin on the matter?

    * sorry – can’t be bothered looking up the details.

  36. #36 Matthew Cline
    October 13, 2010

    @skeptiverse:

    I was trying to summarize augustine’s point (or at least my impression of augustine’s point); I don’t agree with it.

    @augustine:

    Cells are life. Life has gone haywire. What is life? You’ll first need to know this before you find out what the condition of cancer is. Biology has not yet answered the question.

    So, there are non-biologists who have figured out what life is, and thus have figured out “the condition of cancer”? Care to give us a pointer in their direction?

    Also, by “condition of cancer”, do you mean “conditions that give rise to cancer”, or “what an established instance of cancer is”?

  37. #37 Chris
    October 13, 2010

    Matthew you sound like wanker too!

  38. #38 Chris
    October 13, 2010

    Excuse me? Is Little Augie playing with imitating people he does not like?

  39. #39 Coryat
    October 13, 2010

    Augustine sez:

    “Cells are life. Life has gone haywire. What is life? You’ll first need to know this before you find out what the condition of cancer is.”

    I can’t figure it out. You sound like you’re on a strong dissociative. Ketamine maybe? Really, what did that screed even mean? What could you possibly expect as a sufficient explanation for what ‘life’ is? We know you won’t accept a scientific account.

    “Wow. Genetics, bacteria,and viruses are the root cause of modern disease?

    Is this what SBMers have to offer? Interesting. This gives a little more insight into the belief systems of an SBMer. So are you sure about this?”

    I’d like some more insight into your beliefs. What are the root causes of modern disease then? An imbalance of the humours? Some kind of gypsy curse?

  40. #40 Mephistopheles O'Brien
    October 13, 2010

    @Augustine,

    I’m still curious about why you believe that genetics, bacteria, and viruses are not root causes of disease.

    Also, in regard to 31, why is it not useful to know that a cause of a flat tire is a leak (as opposed to, say, and air thief, prankster, or malign influence of the heavenly orbs)? At that point you can test to see if the tire has a hole; if it has a leaky valve; or if it is poorly constructed and air simply flows through it. Based on those tests, you can take appropriate action to remedy it.

  41. #41 W. Kevin Vicklund
    October 13, 2010

    Chris, let’s make it formal.

    Orac, it appears that someone is deliberately using an established username to smear that user and other users. The offending comments:

    [34] I love wanking, esp. Thinking about Orac.

    Posted by: Chris | October 13, 2010 1:33 AM

    [37] Matthew you sound like wanker too!

    Posted by: Chris | October 13, 2010 1:51 AM

  42. #42 John C. Welch
    October 13, 2010

    SBMedical doctER: “I have found the cause of flat tires. It is a breach in cohesion of the substance of the tire. It is a leak.”

    In addition to everything else, you fail at problem identification. Don’t ever go into IT, I have enough idiots to deal with already.

    The leak is not the cause of the flat tire. The leak is the primary method enabling the removal of air from the tire, creating the flat.

    The *cause* of the flat tire is one level below, namely, what caused the leak.

    Saying there is a leak behind every flat tire is not an enlightening statement.

    Well, that’s because it’s wrong. a tire that was never inflated is flat, but has no leak.

    But then, no scientist studying flats would say something that stupid, because they’d know it’d be wrong. It’s only oversimplifying prats like you, who think that spaghetti-testing is a valid form of diagnosis who say that.

  43. #43 Todd W.
    October 13, 2010

    augie is engaging in reductio ad absurdam. No matter what you toss out as a root cause, it’ll shift the goalposts to “Ah, but what caused that, Mr. Smartypants!” It is really pretty juvenile.

  44. #44 Chris
    October 13, 2010

    If anything, W. Kevin Vickland, that person is showing what a sad little existence he lives. I was not even really participating in this thread.

  45. #45 Scientizzle
    October 13, 2010

    @ RobertL: That Guy is Phineas Gage, a facinating case and profoundly important in shaping the young field of neuroscience.

    I love the idea that until “Biology has…answered the question…What is life?” we’ll never really know whether Mycobacterium tuberculosis infection can cause tuberculosis, mutations in CFTR can lead to cyctic fibrosis, untreated HIV infection almost invariably leads to AIDS, or whether the numbers of trinucleotide repeats within an individual’s Huntingtin genes can alter protein aggregation patters and lead to a dose-response in the onset and severity of Huntington’s disease.

    …It’s the sort of pseudophilosophical babble, with a thin veneer of profundity, that one expects from stoned college freshmen. What if this universe is, like, just an atom in a speck of dirt in, like, a whole other universe?

  46. #46 W. Kevin Vicklund
    October 13, 2010

    Folks, let’s keep personal choices out of the comments section.

  47. #47 Chris
    October 13, 2010

    I wasn’t commenting here cuz I was “busy” (wink, wink).

  48. #48 augustine
    October 13, 2010

    [John C. Welch: The leak is not the cause of the flat tire.]

    Genius! You shouldn’t have wasted your talent in IT. You should be a skeptic based medical doctor.

  49. #49 augustine
    October 13, 2010

    [scientizzle: we'll never really know whether Mycobacterium tuberculosis infection can cause tuberculosis, mutations in CFTR can lead to cyctic fibrosis, untreated HIV infection almost invariably leads to AIDS, or whether the numbers of trinucleotide repeats within an individual's Huntingtin genes can alter protein aggregation patters and lead to a dose-response in the onset and severity of Huntington's disease.]

    Who said that?

    fishizzle mynizzle scientizzle

  50. #50 Scientizzle
    October 13, 2010

    Who said that?

    Oh, I know you didn’t actually say any of that. You never provide any clear and cogent commentary; you’re not willing to be pinned down to any falsifiable claims nor do you ever present a supportable, testable alternative explanatory model for any current explanation favored by your SBM bogeyman.

    Your contributions consist wholly of risible commentary, such as “Wow. Genetics, bacteria,and viruses are the root cause of modern disease? Is this what SBMers have to offer?” that simultaneously discounts two obvious realities: the pivotal role that genetics and pathogens play in nearly every disease and the voluminous research on environmental and behavioral contributions to numerous maladies and the complex interactions these have with the aforementioned genetics and pathogens.

    When you take that kind of posting history, and combine it with the pure sophistry of “Biology [must answer] the question….What is life?…[to] find out what the condition of cancer is,” it’s easy to extrapolate your nonsense beyond cancer. Is it fair? Maybe not; feel free to clarify the “why questions” of TB, CF, HIV/AIDS and Huntington’s, though. I’m sure you have an opinion on whether SBM can ever adequately address these conditions.

    You’re like a creationist. You can’t formulate (or at least, can’t articulate) a supportable, rational model of reality that coincides with your belief system…so you attack rationality to reduce your cognitive dissonance. It’d be cute if you weren’t so repetitively inane and joyless.

  51. #51 Fuzzzone
    October 13, 2010

    “What if this universe is, like, just an atom in a speck of dirt in, like, a whole other universe?”

    Whoa… you just, like, blew my mind…

  52. #52 Scienfizzle
    October 13, 2010

    not very hard to do that is it, fuzzzone.

  53. #53 augustine
    October 13, 2010

    [snoopaloop: you're not willing to be pinned down to any falsifiable claims nor do you ever present a supportable, testable alternative explanatory model for any current explanation favored by your SBM bogeyman.]

    Your claims should be able to stand on their own merits. But yet you feel like you need to attack in order to defend. It’s the science based skeptical atheist way.

    You don’t believe in the possibility of a god do you? And you have based your worldview around that. Including the role of science and it’s boundaries. Because to you life and existence stops at the boundaries of science.

  54. #54 mikerattlesnake
    October 13, 2010

    @augustine

    If you gave us any good reason to believe in your nonsense we’d take it seriously, but as per usual you are all stocked up on flailing snark (nad your usual anti-atheist nonsense) and completely out of evidence. Put up or shut up.

  55. #55 Chris
    October 13, 2010

    Mikerattlesnake, once in a great while Sid Troll says something interesting, but there is absolutely no reason to engage Little Augie.

  56. #56 Coryat
    October 13, 2010

    One again then Augustine. You said:

    “Wow. Genetics, bacteria,and viruses are the root cause of modern disease?

    Is this what SBMers have to offer? Interesting. This gives a little more insight into the belief systems of an SBMer. So are you sure about this?””

    Now as you have been asked to do, put up or shut up. What do you have to offer instead as the root cause of modern disease?

  57. #57 Sauceress
    October 13, 2010

    So yet again the anti-vaxxers revert to impersonation and sock-puppetry? Absolutely hilarious :)
    Says a great deal about the lack of supporting evidence for their *arguments* doesn’t it!

    However I think it would be wise to inform themselves of the detrimental effects of coating their keyboard in so much froth and spittle.

  58. #58 augustine
    October 13, 2010

    [corycat: Now as you have been asked to do, put up or shut up. What do you have to offer instead as the root cause of modern disease?]

    It doesn’t matter what I have to offer. You really don’t care what I have to offer. You just now know that “your” root causes of disease don’t stand up to scrutiny.

  59. #59 Lawrence
    October 13, 2010

    So that’s augie’s way of saying he doesn’t have an answer….his/her entire existence here is one-way, without offering a single shred of an original idea or theory on the other side of things. Which leads me to believe that all this person wants is to be contrarian, for the sake of it.

    So, another one in the kill-file….I wonder, if no one is listening, will it still make a sound?

  60. #60 Mephistopheles O'Brien
    October 13, 2010

    Gosh, Augustine, I’m sorry you believe that genetics, bacteria, and viruses don’t stand up to scrutiny as root causes of disease. Why do you believe that? And why do you say “You just now know that ‘your’ root causes of disease don’t stand up to scrutiny.”? Did you post something that I missed? Did someone else post something that clearly pointed out why genetics, bacteria, and viruses are not root causes of disease? Honestly, I’m eager to know.

  61. #61 augustine
    October 14, 2010

    {memphis obrien: Why do you believe that? And why do you say “You just now know that ‘your’ root causes of disease don’t stand up to scrutiny.”? Did you post something that I missed? Did someone else post something that clearly pointed out why genetics, bacteria, and viruses are not root causes of disease? Honestly, I’m eager to know.}

    I guess we’ll just sit back and watch your leader, Oracle, and pharmaceutical scientists, like, Offit, conquer disease with there grants. It’s only a matter of time now, right? Because we know the cause now, right?

    So what is the cause of heart disease again? please tell me. I can’t wait until you get ripped a new one. Help him, Chris, oh please, I’m sure you know. Any day, now, statins will conquer it all.

    And cancer please tell me it’s all genetics. Oh wait, I’m sorry it’s viruses, that’s why we have Gardasil, to completely wipe out cervical cancer!

    Please state your name and your children’s names so we can laugh at you and your family in the future for your claims today! Please Identify yourself as a “skeptic” and a scientific atheist brand of ‘evidence based ” medicine also.

  62. #62 augustine
    October 14, 2010

    [Larry: So, another one in the kill-file….I wonder, if no one is listening, will it still make a sound?}

    somehow, I don’t think you can do it. But, we’ll see. The SBMer in you can’t resist the urge to talk to the “lurker” that you think exists. Maybe I’ll persuade them and you won’t. Oh, no! You can’t stand it. Kill file, be gone.

    Here states larry. he will not engage Augustine again. We shall see, Larry. We shall, see. I doubt it. If Chris can’t do it. Neither can you. And s/he’s the queen of cap ends.

  63. #63 Coryat
    October 14, 2010

    “It doesn’t matter what I have to offer. You really don’t care what I have to offer.”

    Well, yes and no Augustine. Yes, I certainly do care what you have to offer. It’s been said that the sleep of reason breeds monsters, and I’d love to see what denizens of the dark are crawling around in your head. No, it doesn’t matter what you have to offer.

  64. #64 Matthew Cline
    October 14, 2010

    @augustine:

    You don’t believe in the possibility of a god do you? And you have based your worldview around that. Including the role of science and it’s boundaries.

    What relevance does that have to medicine, especially vaccines (since that’s a common topic around here)? For example, as far as I can remember, both Edward Jenner and Louis Pasteur were theists, but I don’t think that had any influence on their work with vaccines, nor would their having been atheists have made any difference.

  65. #65 Mephistopheles O'Brien
    October 14, 2010

    @Augustine,
    As I understand it, “heart disease” is an entire range of diseases that includes congenital defects, problems caused by atherosclerosis, atrophy caused by inactivity, and damage caused by various germ-related diseases like scarlet fever.

    Your turn: what’s the root cause of anthrax?

  66. #66 Sauceress
    October 14, 2010

    #60 Mephistopheles O’Brien

    Why do you believe that?

    Considering…
    #53 Augie

    You don’t believe in the possibility of a god do you? And you have based your worldview around that. Including the role of science and it’s boundaries.Because to you life and existence stops at the boundaries of science.

    and…
    #61

    ..scientific atheist brand of ‘evidence based ” medicine also.

    The root causes of disease are no doubt Satan and/or evil spirits and/or bad/imbalanced humors.

  67. #67 John C. Welch
    October 14, 2010

    Genius! You shouldn’t have wasted your talent in IT. You should be a skeptic based medical doctor.

    I don’t like people. Well, not enough to heal them. A consistent low-level misanthropy makes IT a far better choice for me. But thank you for reminding me *why* I dislike people.

    So many augustines, so few ice floes.

  68. #68 Ender
    October 14, 2010

    Augustine, you and I have had an almost successful conversation in the past, where we discussed whether this was a secret atheist website.

    I said that it was a science website, and asked if you had anything against science. You said you didn’t.

    I felt we had some rapport, so I’m going to try again.

    I suspect that (and correct me if I’m wrong) you see your role here as one of pointing out the large gaps in people’s logic. Highlighting inconsistencies etc. I also suspect that you know that if you post what you believe, people would disagree with you, and insult you. So quite reasonably you don’t.

    However, that doesn’t have to be it. If you try emphasising the bits of science and medicine that you agree with, before pointing out the further claims that you disagree with, then people will know where you are coming from, and at least know that you don’t reject all medical science.

    Also, why not put some context in your criticisms: “Wow. Genetics, bacteria,and viruses are the root cause of modern disease? Is this what SBMers have to offer?” – what does this mean?
    I assume you agree that the interactions of your genetic code’s influence on your body, your body and bacteria and viruses are the root of a whole lot of disease.
    So what’s your disagreement? You might be saying a) there are more causes your list is incomplete b) spiritual factors have to be taken into account c) all disease is nutritional deficiency d) God did it e) etc etc etc. – but you don’t give a reason. All you say is “that is wrong”. How can anyone learn anything from that?

  69. #69 augustine
    October 14, 2010

    [Matthew Cline: What relevance does that have to medicine, especially vaccines ]

    I guess when one has a reductionist view of the world then this would be hard to comprehend. If one believes everything can be broken down, separated, and put into neat little boxes that are completely independent of their context, it would be puzzling to think something like “beliefs” about the nature of the universe would have any effect at all of such things that don’t involve thinking about such beliefs.

  70. #70 Coryat
    October 15, 2010

    Classic Augustine. Still ducking, still dodging, still weaving, still unwilling to answer a straight question.

  71. #71 Mephistopheles O'Brien
    October 15, 2010

    @66 Sauceress,
    You could be right – I don’t want to be accused of fighting straw man with straw man, which is why I asked.

  72. #72 Mephistopheles O'Brien
    October 15, 2010

    @69 – Augustine, you remind me of Dirk Gently. As everything connects to everything else and to all past events, the root cause of a particular case of a particular disease can be attributed to a germ, farming practices in Peru, the conquest of Egypt by Rome, and the orbit of the asteroid Ceres. When you think holistically, everything you do once you are assigned a problem is related to solving that problem – regardless of how apparently unrelated it is.

  73. #73 Todd W.
    October 15, 2010

    @MO

    I wonder if augie has a sofa stuck in his stair well.

  74. #74 Matthew Cline
    October 15, 2010

    @augustine:

    I guess when one has a reductionist view of the world then this would be hard to comprehend. If one believes everything can be broken down, separated, and put into neat little boxes that are completely independent of their context, it would be puzzling to think something like “beliefs” about the nature of the universe would have any effect at all of such things that don’t involve thinking about such beliefs.

    I… So, you have theistic based critiques of many modern medical practices, but we’d be unable to comprehend them, so you aren’t even going to bother? Or maybe it’s something that can’t even be put into words?

    Were Edward Jenner and Louis Pasteur thinking reductionistically when they were working on vaccines? If so, how was their thinking reductionistic?

  75. #75 novalox
    October 16, 2010

    Wow, another ad hominem attack from augustine… can’t say I’m surprised.

  76. #76 Nevil
    October 19, 2010

    Yes I agree with Kevin…please keep personal choices out of the comments.

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