Respectful Insolence

Over my nearly six years of blogging, I’ve become known as a staunch advocate of science- and evidence-based medicine, both in the guise going under my long-used pseudonym “Orac” and under my real name. And so I am, which is why certain varieties of predictable attacks on science-based medicine (SBM) annoy me. Usually, they come down to appeals to other ways of knowing, rants against “arrogance,” or tu quoque arguments trying to claim that SBM is as bad as whatever woo I happen to be criticizing at the time. Actually, strike that. The latter complaint often tries to argue that SBM is actually worse than various non-science-based medical systems because (or so it is alleged) a combination of pharma corruption and an excessively dismissive attitude towards anything that is not science lead (or so it is alleged) to, well, I’m not sure what. Bad care? Bad medicine? Or are we advocates of SBM just plain mean, nasty, and arrogant to have the temerity to criticize the touchy-feelies that advocates of “complementary and alternative medicine” (CAM)? I’m never quite sure.

So it is with the latest broadside against SBM that I’ve become aware of, this time courtesy of Dr. Marya Zilberberg, who apparently doesn’t like what she describes as the Paternalism of Science-Based Medicine (also crossposted to BMJ doc2doc). Yes, it’s like waving the proverbial red cape in front of the charging bull. When I see so many straw men concentrated in such a small area, it’s very hard for me to resist pulling out my handy flamethrower of science and sarcasm and spraying away, much as the Marines did to Japanese pillboxes in the Pacific Theater during World War II. No doubt that makes me a nasty, reductionistic, paternalistic, allopathically vicious robot using the jackboot of science to crush all the crunchy, squishy feelie stuff out of medicine, thus rendering it devoid of any trace of human caring and emotion. Well, not really, but that’s how I’m frequently portrayed. In any case, get a load of how Dr. Zilberberg starts out her broadside against SBM:

The argument goes like this: We who practice science-based medicine are the only ones that are correct in our approach because everything we do comes from a scientifically derived pool of evidence. Anything else is quackery, also referred to as “woo”, which includes all modalities that do not fall in line with this EBM paradigm. They rail equally against healing crystal charlatanism, acupuncture, Reiki, and “anti-vaxers”, lumping them all into the ignorant masses that dare go against what we “know” at their own and societal peril. They maintain that there is not room for anything in healthcare other than the “proven” scientific interventions.

So, if they advocate for science as the prevailing force in medicine, why should I, a firm believer in evidence as the backbone of healthcare, object?

Why, indeed? Of course, this sort of argument is very similar to the “I believe in science, but…,” where the “but” is far more powerful than any belief in science expressed. Dr. Zilberberg says she believes in evidence as the backbone of healthcare and then in this post and another post entitled The reality of science-based medicine, goes to great lengths to show that, when the rubber hits the road, she does not really mean what she says. In essence, the “but” overwhelms everything else, blasting out gaseous emanations much like its real-life anatomic homophone does. Dr. Zilberberg builds an elaborate straw man, only to tear it down with extreme gusto.

First off, those of us who advocate SBM do not argue that we are the only ones who are correct because everything we do comes from a scientifically derived pool of evidence. That is a mischaracterization of what SBM is. Rather, as I’ve discussed many times, there’s a reason we don’t refer to SBM as “science” but rather science-based medicine because so much of medicine can’t ever be made perfectly scientific. However, we do argue that what we do as physicians should be based in science, hence the name science-based medicine. Yet, the bulk of Dr. Zilberberg’s two posts seem to argue that what SBM is is doing nothing in medicine but pure science, much like Sheldon Cooper or Mr. Spock might do. Or so Dr. Zilberberg seems to imagine.

But what do I know? I’m just one of those nasty, reductionistic, “Western” scientists who have the temerity to insist on evidence and science to support the interventions that we physicians use. I know, I know, it’s a difficult and painful concept to grasp, and I’m just so incredibly “arrogant” to assert such things, but there you go. I don’t think that doctors should be offering reiki, for example, because there is no evidence that reiki is anything other than faith healing. The only difference between reiki and faith healing is that reiki uses as its basis Eastern mysticism rather than Christian beliefs. People can decide they want faith healing if they wish, but for a physician to advocate faith healing is a profound betrayal of our profession because we as physicians are supposed to advocate treatments that–oh, you know–actually work and not mystically inspired pseudoscience.

Dr. Ziberberg also goes wrong when she claims that we lump all of these pseudoscientific or anti-scientific treatment modalities into some sort of rant against the “ignorant masses that dare go against what we ‘know.’” For instance, I definitely treat these modalities differently depending on their potential to cause harm to others. The reason I “take no prisoners” when it comes ot the anti-vaccine movement is because the anti-vaccine movement endangers far more than just the children who go unvaccinated because their parents ascribe all sorts of evils to vaccines that are not supported by science. It endangers all children who come into contact with unvaccinated children.

Be that as it may, Dr. Ziberberg’s attitude appears to be encapsulated in this next passage:

First of all, it is my belief that all interventions should be approached with equanimity, if not equipoise. Although I am quite dubious that either healing crystals or Reiki can produce actual results, I do not want to confuse the absence of any evidence to this effect with the evidence of absence of the effect. Although I am not that interested in allocating resources to studying these fields, it would be paternalistic of me to bar their further investigation.

Wow. A straw man that massive, if set on fire in, for example, New York, could be easily seen in Los Angeles. It would take a nuclear reaction to get such a pyre of burning straw men started. No advocates of SBM say that we should “bar further research” into healing crystals, reiki, or whatever. We do, however, point out that prior plausibility would strongly suggest that additional research into healing crystals, reiki, and especially homeopathy would be a waste of money. And, yes, we do suggest that the National Center for Complementary and Alternative Medicine (NCCAM) should not be funding these sorts of studies–indeed, that it shouldn’t exist at all! The reason, of course, is because we reject the term “alternative” medicine. There should be no such thing. There is medicine that works, medicine that has been shown not to work, and medicine where we don’t know. “Alternative” medicine is made up almost completely of the latter two categories. In any case, I would submit to Dr. Ziblerberg that suggesting that the federal government should not be funding studies into pseudoscience is not the same thing as advocating “barring their further investigation.” If someone like, say, Dr. Zilberberg, wants to fund research into woo like reiki, healing crystals, homeopathy, acupuncture, or the healing power of prayer, I say to her: Knock yourself out. Just don’t ask me to pay for this stuff through my tax dollars, and don’t expect me to pay for it through my health insurance policies. Of course, Dr. Zilberberg’s assertion that “all inteventions should be approached with equaniminity, if not equipoise” is utter nonsense, the purest expression of the wrong-headed application of postmodernism to science, where science is “just another narrative” and all “narratives” should be considered equally valid regardless of evidence. Making such a claim is nothing more than being so open-minded that your brains fall out.

Worse, it is a profound betrayal of medical ethics to view “all interventions should be treated with equaniminity, if not equipoise.” Not all interventions are worthy of being treated that way, and we can make preliminary judgments on such modalities on the basis of basic science alone. Consider homeopathy, for example. I realize that it’s one of my favorite examples, but that’s just because it so starkly illustrates the principles of plausibility and prior probability. For homeopathy to work, many well-established laws and theories of physics, chemistry, and biology, science that has been validated over hundreds of years, would have to be not just wrong, but spectacularly wrong. While it is possible that scientists could be spectacularly wrong about so many areas of well-studied science, it is exceedingly unlikely, making homeopathy exceedingly unlikely to be anything more than water acting as a placebo. There is no reasonable rationale to treat homeopathy with “equanimity, if not equipoise” because most homeopathic remedies, particularly those diluted beyond around 12C, are incredibly unlikely to contain even a single molecule of active ingredient. If CAM advocates want to believe that somehow water remembers the good stuff that’s been in it and forgets, as Tim Minchin so famously put it, all the poo, that’s fine for them, but don’t expect scientists to take such claims seriously without evidence of sufficient quantity and quality to mount a reasonable challenge to the hundreds of years of science that says homeopathy can’t work. The same holds true for reiki, therapeutic touch, and many other highly implausible CAM modalities.

Dr. Zilberberg continues:

So the society can decide what it wants to do with them, and in the meantime every individual can make her/his own choice whether to spend their money on them. Interventions in the broad area of traditional Chinese medicine (TCM), including herbs and acupuncture, elicit less visceral aversion in me, and may be shown down the road to have desired health effects, though their study may not be amenable to our current methodologies. Again, at this time, if an individual wants to try them out, they should be keenly aware of how little we explicitly understand about them, including both their risks and potential benefits.

Ah, yes, where have we seen this argument before? Basically, this is the old claim that science can’t study my woo (“their study may not be amenable to our current methodologies). In other words, its pure special pleading. From my perspective, special pleading, too, is utter nonsense. Our methodologies are more than adequate to study CAM, particularly herbal remedies and traditional Chinese medicine (TCM). The problem, when it comes to apologists for woo, is that science doesn’t show what they want it to show. Science conclusively shows that, for instance, reiki is nothing more than placebo, that acupuncture is no more than placebo, that homeopathy is no more than placebo. That’s why reiki masters, homeopaths, and acupuncturists don’t like it, and that’s why they use special pleading to argue that their woo is actually just ducky, if only scientists would stop being so damned judgmental.

Of course, science is supposed to be judgmental, at least when it comes to distinguishing good science from pseudoscience. Or not, according to Dr. Zilberberg in another post entitled The reality of science-based medicine:

Now, let’s get on to “proof” in science-based medicine. As you well know, while we do have evidence for efficacy and safety of some modalities, many are grandfathered without any science. Even those that are shown to have acceptable efficacy and safety profiles as mandated by the FDA, are arguably (and many do argue) not all that. There is an important concept in clinical science of heterogeneous response to treatment, HTE, which I have addressed extensively on my blog. I did not make it up, it is very real, and it is this phenomenon that makes it difficult to predict how an individual will respond to a particular intervention. This confounds much of what we think is God’s own word on what is supposed to work in allopathic medicine.

Ah, yes. Here’s another dubious argument favored by CAM advocates, the tu quoque combined with the Nirvana fallacy. Basically, it’s “nyah, nyah, SBM has problems,” as if those problems somehow validated CAM modalities and other therapies preferred by woo-meisters. It’s also the Nirvana fallacy (a.k.a. the fallacy of the perfect solution) saying that if something (like SBM) is imperfect it must be total crap. I love binary thinking like that for what it tells about the views of the person using it, who virtually never hold the woo they defend to the same standards. Only SBM is total crap if it isn’t perfect, and that view allows its knee-jerk critics to dismiss it while embracing modalities whose evidence problems beggar the imagination compared to SBM. Dr. Zilberberg also seems to think that SBM doesn’t consider heterogenous responses to treatment as though she’s the only one who considers the fact that not all patients respond to therapies in the same way, to which I respond: “Well, duh!” I also wonder what all those statistical models we apply to clinical trial analysis are for. Oh, wait, I know. They were developed to account for variability in disease progression and response to treatment.

But let’s get back to the original post. I mentioned the other post only to show that apparently these attacks on SBM represent a pattern. Perhaps the most disturbing passage in this whole broadside against SBM is this one:

The vaccine debate is yet another completely different issue altogether. In our privileged society the specter of infectious epidemics is for the most part but a distant memory, yet our concerns for the safety of our children combined with a rampant, albeit not altogether unjustified, distrust of the pharmaceutical industry and the government, have colluded to promote a biased yet durable suite of misinformation about the risk-benefit profile of vaccinations. Some of this prevailing sentiment may be because, in my opinion, we have focused on the wrong outcomes (e.g., the economics rather than morbidity associated with chicken pox), or that we have overstated what we really know and understand, at the risk of sounding too confident and therefore not trustworthy partners in this important area of public health. But these are just my own speculations.

I’m afraid in this case that Dr. Zilberberg’s speculations are a load of fetid dingo’s kidneys. I know, I know, I’m being all mean and “judgmental,” but when it comes to the anti-vaccine movement the pseudoscience is so think and the potential for harm so great that I have a hard time being polite. The anti-vaccine movement is arguably the greatest threat to children; yet Dr. Zilberberg disturbingly poo-poos it and shows evidence that she is in fact sympathetic to antivaccine sentiments, as demonstrated by her swipes at the pharmaceutical industry in the context of criticizing vaccine defenders as being “too confident.” She then drops this on her readers:

My intent is not to belittle what clinical science has and continues to bring to the society.

Yeah, right. Dr. Zilberberg says this after lambasting SBM for being paternalistic and appealing to other ways of knowing to try to make SBM seem hopelessly close-minded when it comes to woo that for which she seems to have a penchant, given that she mentioned them so many times (reiki, healing crystals, etc.). But let’s get to the money quote:

After all, thanks to it, we have a much better understanding of many illnesses now, and we can even take credit for effecting better outcomes for many a sick individual. At the same time we really need to sow humbleness in place of arrogance in all the places where the latter runs rampant. Philosophers of science have understood for decades that there really is no universal truth, and everything we think we know we understand through the prism of our collective human and individual experience. So, instead of wasting time on throwing boulders at our competition, why not take a closer look at the material that our house is made of. Dropping our inveterate paternalism in favor of being truthful about the degree of our uncertainty may make us look more human and fallible, yes. At the same time, it may show our patients and the public at large that we are on the same side. Though this is a risk, it is a necessary one to repair our rapidly crumbling therapeutic relationship. Admitting to not knowing is not only not a weakness, it is the only way to scientific progress.

Quite honestly, after reading this, I got that uncomfortable feeling in the pit of my stomach that signals I’d better stay near the porcelain god. Seriously. Where on earth Dr. Zilberberg gets the idea that those of us who support SBM think that we know everything and would not admit to patients when we don’t know something (at least, any more than any other physician would), I don’t know. In fact, SBM demands far more than what what preceded evidence- and science-based medicine, something I like to call tradition-based or dogma-based medicine. That’s because we have to discuss the actual evidence supporting our decisions for individual patients and our assessment of how likely it is that our intervention will work.

When it comes right down to it, to me Dr. Zilberberg’s attitudes are profoundly anti-science, whether she realizes it or not. (No doubt she does not.) She criticizes virtually everything about SBM and then elevates pseudoscience to the same level as science in a truly postmodern fashion (“Philosophers of science have understood for decades that there is no universial truth, and everything we think we know we understand through the prism of our collective human and individual experience”? That’s as concise a statement of postmodernism applied to science as I’ve seen in a long time.) Worse, like all good postmodernists, Dr. Zilberberg views any attempt to suggest that there might be an objective reality that can be described and defined by science as “paternalistic.” It’s The Man keeping other points of view down, maaaaan! We can’t have that, now, can we?

Unfortunately, Dr. Zilberberg seems to be confusing legitimate authority with excessive paternalism. Whether she’s doing it intentionally or unintentionally, I don’t know, but I do know that she’s doing it. Here’s a hint: Sometimes there is legitimate authority. I know, I know, it’s hard to believe, but legitimate authority exists. That does not necessarily make it “paternalism.” Besides, if you want paternalism, check out alt-med! Sometimes we really do know what the best course of action is. That’s not necessarily “paternalism” or “dogma.” It’s just what the evidence strongly suggests. Moreover, the days of purely paternalistic medicine have long passed. Gone are the visions of doctors from the 1940s in which the doctor told the husband but not the wife that she had incurable cancer or where the doctor told patients to do things just because of his authority. (Female physicians were quite rare back then.) In fact, the decline of paternalism correlates very nicely with the rise of EBM and SBM. True, that correlation does not necessarily equal causation, but it does suggest that Dr. Zilberberg’s cry of “paternalism!” against SBM is exaggerated at the very least.

Her protestations otherwise notwithstanding, Dr. Zilberberg seems to think that SBM is so hopelessly flawed that we might as well all throw up our hands and become reiki masters. In reality, SBM is our best currently existing tool to bring the best care to our patients, and it is important that we know the limitations of this tool. Contrary to what CAM advocates claim, there currently is no better tool. If there were, and it could be demonstrated conclusively to be superior, I’d happily switch to using it, and so would virtually all doctors with whom I associate.

To paraphrase Winston Churchill’s famous speech, many forms of medicine have been tried and will be tried in this world of sin and woe. No one (and certainly not I) pretends that SBM is perfect or all-wise. Indeed, it has been said (most often by me) that SBM is the worst form of medicine except all those other forms that have been tried from time to time. I add to this my own little challenge: Got a better system than SBM? Show me! Prove that it’s better! In the meantime, I share Steve Novella’s view that I really, really wish people who criticize SBM would do so based on real shortcomings rather than on logical fallacies and exaggerations.

Comments

  1. #1 Calli Arcale
    October 25, 2010

    They should be treated with equanimity? Seriously? Personally, I think all modalities (no matter how “sciency” or “mystical” their origin may have been) should be treated the same way — useless until proven otherwise.

    I find it particularly telling that after telling us about how we should treat all modalities with equanimity, she goes on to confess that she has “less visceral aversion” to what she describes as Traditional Chinese Medicine. So she herself is not treating these modalities with equanimity. Just the ones she likes.

    I wonder whether she’s another person who has been burned by the cold, unbiased eye of science when it showed she was wrong about something. Such people tend to like science when it agrees with them, but call it names and dismiss its findings otherwise. In which case, what’s the point of using it at all? Seriously? Why not just leave it at the “caveat emptor” which she extols by saying that society should decide what it wants to use?

    Personally, I’m fine with people using whatever they like: I’m very much in favor of freedom of choice in medicine. I’m not at all okay with people lying about what they’re selling, and it always amazes me that people aware of the limitations of “conventional” medicine are so blind to the same human foibles afflicting “alternative” medicine, and indeed often seem to think alternative medicine is somehow holier despite having even less oversight. It’s a bit like thinking nobody would ever steal from a church or charity — a very common but often tragically misguided belief.

  2. #2 Lawrence
    October 25, 2010

    I, for one (and hopefully many), am very happy that my medical care, medications & treatments that I’ve been exposed to over the years are actually tested and undergo clinical trials (sometimes for decades) before they are presented to the general public.

    For all those that champion (CAM) – where are your studies? Where are the tests? Why do we have to take your word for it that your intentions are “honorable?”

    At least modern medicine does have a series of checks and balances (self-correcting mechanisms – including peer reviews, regulations, and even the court systems), whereas CAM seems to have none of those things…..I just will never understand peoples’ decision to abandon actual evidence in favor of woo/magic!

    Of course, some will go back to the argument that “well, you can’t 100% guarantee results or just because we know something is true today doesn’t mean it will be true tomorrow, etc, etc, etc” – yet that either don’t provide any real alternatives or turn that same kind of interogatory light on their own woo-medicine.

  3. #3 ABradford
    October 25, 2010

    Wishing I had my sketchbook with me. Orac with a “flamethrower of sarcasm” and “jackboots of science” seems like such a great illustration.

  4. #4 Dr Aust
    October 25, 2010

    Her comments on vaccination, and those of a “Dr Synonymous” on her blog, made me quite angry. We just had a letter from our daughter’s school about “don’t send kids to school with spots”, probably because there is a kid in the school under cancer treatment.

    Stuff like that tends to make you see requiring things like varicella vaccination for school/kindergarten in a different light.

    I’ve left a comment on her blog (in moderation). Assuming it gets posted, will be interested to see what she says in response.

  5. #5 Dr Aust
    October 25, 2010

    PS The comment I left is now up on her blog.

  6. #6 Seb30
    October 25, 2010

    @ ABradford

    We could start with an illustration like this:
    http://www.coolstuffinc.com/images/Products/Misc%20Art/Steve%20Jackson%20Games/star%20munchkin.jpg

    Flamethrower of sarcasm. Sounds like a winning card.

    Note to self – learn how to embed a link in answers.

  7. #7 Dangerous Bacon
    October 25, 2010

    Doc Zilberberg says: “Although I am quite dubious that either healing crystals or Reiki can produce actual results, I do not want to confuse the absence of any evidence to this effect with the evidence of absence of the effect.”

    Another classic pillar of woo – “Absence of evidence is not evidence of absence.”

    The correct version of this is: “Absence of evidence means you ain’t got nuthin’.”

    Maybe if we keep repeating “paternalistic” over and over again, this will make sense.

    Nah.

  8. #8 Todd W.
    October 25, 2010

    For homeopathy to work, many well-established laws and theories of physics, chemistry, and biology, science that has been validated over hundreds of years, would have to be not just wrong, but spectacularly wrong.

    Interesting timing. I just wrote about a homeopathic product that’s being recalled by FDA because it contained variable amounts of belladonna and there had been reports of serious adverse events consistent with belladonna poisoning. The product? Homeopathic teething tablets.

  9. #9 Travis
    October 25, 2010

    Blech. Equanimity? Obviously she does not want that unless she is asking us to equally ignore all evidence and standards. Of course what she wants is us to loosen our standards for the things she likes. I am curious if she knows she is doing this and this talk is calculated or if she really cannot see past her own biases and believes this is how one treats things with fairness and equality.

  10. #10 Chris
    October 25, 2010

    Ah, I remember Marya now. She never did tell me how I was supposed to predict who my daughter will marry so I could also give him the counsel she told us would prevent HPV exposure.

  11. #11 Denice Walter
    October 25, 2010

    I’ve noticed that the high volume woo-sites which I frequent are currently criticizing SBM for its “lack of science”** ( like they’d be able to tell!): its poor methodology and statistical analyses, its biased experimenters, and ulterior motives, which is intriguing coming from those who cite testimonials, self-reports, “studies” without double-blinding or controls, “studies” with 40 independent variables, “studies” with 14 subjects, Wakefield’s “studies”, telephone surveys or polls while selling products. I’ve heard them cry, “Bad science!” so often you’d think that they’re talking about Dr. Goldacre’s book. A recent screed by Adams ( 10/23/10 ) details how he “cured” his ( formerly called “type 2″, now referred to as “borderline”) diabetes through exercise, diet, supplements, ad nauseum.. Aren’t diet and exercise prime SBM treatments for this condition!

    ** Perhaps this is *finally* evidence for the Collective Unconscious? ( only joking!)

  12. #12 augustine
    October 25, 2010

    [Chris: She never did tell me how I was supposed to predict who my daughter will marry so I could also give him the counsel she told us would prevent HPV exposure.]

    That’s right. I’m sure your daughter is the weakest of the weak and the only thing that will save her from natural selection will be Gardasil. There is absolutely no way her body could be expected clear a papilloma virus. Her constitution is just too weak. I’m sure you agree. Because you believe everyone’s constitution is just too weak to stand the chance of surviving a potentially pathogenic virus. Besides Dr. Julie Gerberding alerted us, while she was chief at CDC that this virus has suddenly become an epidemic.

  13. #13 Jojo
    October 25, 2010

    I really, really want a flamethrower of science and sarcasm. Where can I pick one up?

  14. #14 Michael
    October 25, 2010

    “Another classic pillar of woo – “Absence of evidence is not evidence of absence.”

    The correct version of this is: “Absence of evidence means you ain’t got nuthin’.””
    The “Absence of evidence is not evidence of absence” quote comes from Carl Sagan. And it makes sense for situations where there’s no evidence yet that a proposition is true but there’s a high probability that future discoveries might provide such evidence. For example, there’s no evidence of extraterrestrial life so far, but someone could find evidence tomorrow, for all I know. This is important for scientists to remember- Sautuola was accused of fraud when he discovered the Altamira cave paintings but later similar cave paintings were discovered.
    In the case of reiki, it is extremely unlikely that any new evidence will be discovered that demonstrates its efficacy.

  15. #15 squirrelelite
    October 25, 2010

    @seb30,

    It’s good to see Steve Jackson is still in business, but your link doesn’t seem to work.

    @Chris,

    I remember your verbal jousts with Marya now.

    It seems she has already posted a note on her blog complaining about Dr Novella’s “cherry picking”!

  16. #16 Pablo
    October 25, 2010

    Where on earth Dr. Zilberberg gets the idea that those of us who support SBM think that we know everything and would not admit to patients when we don’t know something

    I contrast this with Suzzanne Sommers’s complaint: Cancer doctors aren’t willing to tell you that they can cure you. The doctors she has in her book have no problem claiming they can cure cancer. It’s a lie, of course, but they claim to be able to do it.

    So I am trying to figure out the real story. Do SBM doctors fail because they think they know everything and won’t admit they don’t know something, or because they are unwilling to lie about being able to cure you of cancer even though they know they can’t?

  17. #17 Namnezia
    October 25, 2010

    I never understand this thing about financial gain as an argument against SBM. Who has more to gain financially? A doctor administering vaccines to a patient, or some one running a clinic administering expensive “chelation therapy” to treat autism? I’m certainly not getting rich from doing my science, while my neighbor the chiropractor is definitely doing quite well.

  18. #18 Orac
    October 25, 2010

    Ah, I remember Marya now. She never did tell me how I was supposed to predict who my daughter will marry so I could also give him the counsel she told us would prevent HPV exposure.

    Oh, yes, I remember her now…

    Assuming that was her on that thread, Marya does appear to have at least some antivax sympathies, if not proclivities (which she might also have, for all I know).

  19. #19 squirrelelite
    October 25, 2010

    It seems to be her.

    I linked to the Healthcare Inc blog from Chris’s link.

    She has a comment up now responding to Dr Novella’s post from today.

  20. #20 Tybo
    October 25, 2010

    “First of all, it is my belief that all interventions should be approached with equanimity, if not equipoise.”

    It really really bothers me when people take the principle of indifference and run away with it.

    Just because I haven’t seen a study that tested the effects of eating broccoli on curing MRSA doesn’t mean I should assign a 50% prior probability to it working. In fact, given all possible combinations of intervention/affliction, the prior probability of anything working without any relevant, tested explanatory model or other prior relevant evidence to back it is pretty low. So why do people insist on this equivalence of interventions so much?

  21. #21 Dave
    October 25, 2010

    So the society can decide what it wants to do with them, and in the meantime every individual can make her/his own choice whether to spend their money on them.

    That sounds all very nice, but exactly how does “society [] decide?” Not being a single entity, society decides by public discussion, and Boxes of Blinking Lights as well as Breast Cancer Surgeons are as equally entitled to participate in that discussion as are Reiki Masters and CEOs of EviMed Research Group. If the lattter groups dont like it when the discussion isnt going their way, tough titties.

  22. #22 Chris
    October 25, 2010

    Orac:

    Assuming that was her on that thread, Marya does appear to have at least some antivax sympathies, if not proclivities (which she might also have, for all I know)

    Yep, that is her. That blog is linked in her name on that thread.

  23. #23 David N. Brown
    October 25, 2010

    I’ve never heard of a source for the line “absence of evidence is not evidence of absence”, but when I was earning my bachelor’s in paleontology, it was taught as an axiom. I think it’s a very appropriate principle for paleo and other historical sciences, because it is vital to consider what the odds are that, if something did exist, direct and unambiguous would survive. For example, many kinds of animals are unlikely to fossilize due to “taphonomic bias”, so paleontologists are wary of saying they were NOT present at given places and times.

    The best defense against abuse of this principle is simply to say that those who invoke it have an obligation to give logical reasons why evidence that might exist or have existed has not been found.

  24. #24 Pablo
    October 25, 2010

    I’ve never heard of a source for the line “absence of evidence is not evidence of absence”, but when I was earning my bachelor’s in paleontology, it was taught as an axiom. I think it’s a very appropriate principle for paleo and other historical sciences, because it is vital to consider what the odds are that, if something did exist, direct and unambiguous would survive.

    This is the key point. If I were to modify it, it would be to make it, “The absence of evidence THAT SHOULD BE THERE is absolutely evidence of absence.”

    There is no evidence that there is an elephant in my backyard. Does that mean that I cannot say there is not an elephant in my backyard? Of course not. The absence of things like massive piles of elephant dung is most certainly evidence that there is no elephant.

    With stuff like homeopathy, the absence of evidence that it works is not because we haven’t looked or are unable know what we are looking for. It is that the expected evidence has been identified and looked for, and found to be not there. If there is an elephant there, it is one that doesn’t shit. Since elephant’s shit, we are perfectly justified in saying that if something is there, it isn’t an elephant.

    As you explain, THEY are the ones who need to explain why if it is an elephant, there isn’t any elephant dung.

    IOW, they are trying to say, “The absence of elephant dung in my backyard is not evidence there is not an elephant.” Um, yeah, it most certainly is.

  25. #25 René Najera
    October 25, 2010

    @Pablo What if there’s an elephant footprint on the cheesecake in the fridge? Would you argue that there is no elephant in your home?

    I killed that joke in its entirety. Please feel free to ignore me. It’s been a long day.

  26. #26 nybgrus
    October 25, 2010

    @Dr. Aust: (#5)Read the post and jumped in with my own two cents.

  27. #27 Science Mom
    October 25, 2010

    Oh, yes, I remember her now…

    Assuming that was her on that thread, Marya does appear to have at least some antivax sympathies, if not proclivities (which she might also have, for all I know).

    I thought she seemed fairly rational on that RI post. But she sure dropped the ball with this one.

  28. #28 Chris
    October 25, 2010

    She was fairly rational, until she was pressed on the HPV question. At that point she seemed to get a bit moralistic, and dare I say: paternalistic.

  29. #29 Science Mom
    October 25, 2010

    Oh, I should add, that she didn’t come out of the gate on here with the strange HPV comments. Sorry, forgot about that.

  30. #30 Science Mom
    October 25, 2010

    We must have cross-posted Chris, yes, I agree. J

  31. #31 Dianne
    October 25, 2010

    IOW, they are trying to say, “The absence of elephant dung in my backyard is not evidence there is not an elephant.” Um, yeah, it most certainly is.

    It’s evidence of absence but not necessarily proof of absence. There could be an elephant in elephant diapers in your backyard. Or an elephant and an army of elephant cleanup personnel who clean the poop before it hits the ground. Or the fan. However, the burden of proof is still on the person claiming to have seen an elephant in your back yard. They’re the ones who have to explain the absence of poop.

  32. #32 Dianne
    October 25, 2010

    Interventions in the broad area of traditional Chinese medicine (TCM), including herbs and acupuncture, elicit less visceral aversion in me, and may be shown down the road to have desired health effects, though their study may not be amenable to our current methodologies.

    Now this is just silly. We can study TCM, we have studied TCM, in some cases we’ve even adopted bits of TCM. The idea of using arsenic trioxide for APL originally came from study of a TCM which contained arsenic and some other stuff. The arsenic had most of the efficacy, the other stuff had most of the toxicity, so we reductionistic westerners (actually, I think the initial studies were done in China) took the good bits out and began using it in “allopathic” medicine. Works just fine. Accupuncture, on the other hand…has a nice placebo effect in some cases. Also easy enough to study. So, I don’t see what’s “not amenable to current methodologies.”

  33. #33 Mattand
    October 25, 2010

    Is it wrong that I keep reading “Dr. Zilberberg” as “Dr. Zoidberg”? Although, based on the evidence Orac presents, one might be better off seeing Zoidberg for any medical issues.

  34. #34 David N. Brown
    October 25, 2010

    Pablo @24,
    Very good analogy, which actually gets into the field of ichnology. In these terms, the evidence could include the elephant’s effects on other organisms: damaged trees, large, out-of-place seeds, explosions in the dung beetle population, etc.

    It is worthy of note that, with considerations like these, the standard for evidence that something MIGHT exist is very liberal. Yet, “cranks” may well complain at being asked to meet even minimal expectations.

  35. #35 Dangerous Bacon
    October 25, 2010

    In lieu of “absence of evidence is not evidence of absence” it is simpler for many alties to say “You can’t prove it isn’t so!”.

    It’s a similar attempt to get off the hook for lacking evidence of a claim.

  36. #36 Dr Aust
    October 25, 2010

    Re the “level of evidence for different claims” idea, my favourite story relating to this is still the one in the Nature investigative report on Jacques Benveniste’s infamous homeopathy paper.

    I quoted the story in an old post of mine on CAM Journals, but to save you the read I’ll excerpt the relevant bit of the post:

    But….The Alternativists have a counter-argument [against being asked to produce compelling evidence].

    “That’s NOT FAIR”, they say. “You don’t make the mainstream scientists do all this extra work eliminating every possible source of bias. Why should we do it, when they don’t have to?”

    This sounds good, but the main answer is actually an obvious one. The wilder and less plausible the statement, or the supposed experimental result, the better quality the evidence for it has to be.

    And this finally, is where James Randi comes in. Randi was one of the people Nature sent to investigate Benveniste’s lab.

    At the end of Nature’s report on the affair, the Nature trio describe trying to explain to Benveniste and his team, both why the data were seriously flawed, and also why the data needed to be watertight (which they clearly weren’t) if their “effect of no molecules” were to be believed.

    ““If I told you that I keep a goat in the backyard of my house” Randi said “…and if you happened to have a man nearby, you might ask him to look over my garden fence, when he’d say “That man keeps a goat”. But what would you do if I said “I keep a unicorn in my backyard?””

    In essence, would you accept the same level of proof for the second statement as for the first? Of course you wouldn’t. You would want photographs, experts’ reports, forensic horn analysis, x-rays and DNA genetic testing before you would accept that the animal was what it was said to be. And quite right too.

  37. #37 purenoiz
    October 25, 2010

    ” So, instead of wasting time on throwing boulders at our competition,”

    This is the heart of the matter. There is a limited amount of resources available, it is all about money, at least in their eyes. Do heart surgeons compete with oncologists and optometrists?
    This isn’t about the best outcome for the patient, this is about the best outcome for the practitioner. Supply side economics in the field of health care. It doesn’t help when their are stories floating around about the loss of general practitioners since there no more money in that. So of course the argument is that it is about competing resources, not what works, not whats is best for the patient.

    can I pull my hair out now…

  38. #38 anthrosciguy
    October 25, 2010

    I’m all for “additional research into healing crystals, reiki, and especially homeopathy” as long as it’s funded by the fairly massive “alt-med” industry. So why don’t they do it?

  39. #39 Jarred C
    October 25, 2010

    “So why don’t they do it?”

    The most common response I’ve heard (and the one I hate the most) is: Why should we spend money studying something which we already know works?

  40. #40 She-Liger
    October 25, 2010

    The struggle of the skeptics against the quacks is a struggle of the fools against other fools. The skeptics are sort of new “communists” – talentless, indifferent and cruel. And their activity will be as unsuccessful as a socialism in the only country.

  41. #41 Chris
    October 25, 2010

    She-Liger, what planet are you on? Pleas elaborate using something other than a string of baseless insults. How exactly is trying to prevent harm to other people by exposing fallacies, especially medical quackery, “cruel”? Give us some examples of the skeptics being cruel and indifferent.

    And what is the “only country”?

  42. #42 She-Liger
    October 25, 2010

    “The only country” was Soviet Russia, which then turned into USSR . Socialism failed and USSR died. Or do you disagree with such statement? ;) Or don’t you know about this fact at all? ;)
    The skeptics actually resemble soviet communists-”partocrats”. Believe me, I know. I lived in USSR.

    As for cruelty of skeptics… Maybe not cruelty. I’ve expressed too harshly. Rather – extreme indifference and non-professionalism. Plus – amorality and inclination to gossips. I made several attempts to ask the skeptics-doctors for medical help for a sick friend. In all cases I got either indifference or non-professionalism. Well… Maybe they dislike me. But the friend hasn’t gotten the help from them at all! Note, it was rather their friend, not mine even. He is their compatriot and the sceptic like them. Are they the doctors after this? And are they moral? By the way, in their indifference they are even worse than communists. Latter could be cruel with the enemies, but indifference was being condemned by their community.

    The activity of skeptics are quite useless. Clever people need no their blogs. And the quacks are irreparable. And as for the fools and nerds, they need good education, but not stupid scepticism. Education will make them clever, but not screaming skeptics with their stupid blogs.

    In brief, my several-years relations with skeptics ended by complete disappointment and even aversion to them.

  43. #43 Chris
    October 25, 2010

    USSR had other issues. Socialism is alive and well in other countries like France, the UK, Sweden, Denmark and elsewhere. So I do not see how that is a valid comparison to those criticize with evidence the activities of quacks.

    Communism is an economic system, nothing else. It is neither moral, nor immoral. It was actually the system put in place in the Panama Canal Zone when it was run by the US Army Corps of Engineers. Not only did the Pan-Can Company own every house, every store and every school (which were placed in the Dept. of Defense School system), they controlled who could or could not live there. You can look up the stories on what it was like at the CZ Brats website. Life there was much like privileged colonial life of the British Empire. (yes, I lived there)

    You have have countered with an anecdote. There is no way to validate the anecdote.

    You seem to forget we are each individuals, not a homogeneous group that all think alike. So your comments are to be taken as your frustration with some people you know, nothing else. Plus they have nothing to do with the article above.

    Do you have an issue with how medicine should be evaluated? Do you believe that there should be prior plausibility in seeing if something works?

  44. #44 CanadianChick
    October 25, 2010

    I get SOOOO tired of people claiming that the USSR was communist. It was not, if one is following the Marx/Engles definition, instead of some contrived “socialism=communism” definition.

    The USSR by definition could NOT be communist as it was never capitalist. Communism follows capitalism, not feudalism, which is the state that the USSR was in.

    All of which is totally OT.

    I also get frustrated at the “western medicine is all about money” bullshit. Really? My GP gets paid a lot less than a naturopath. My pharmaceutical company had to pay millions to research my lifestyle-saving drugs – how much has Sisu spent researching their supplements? I could go on, but why? I’m preaching to the choir here.

    And yes, I also think “Zoidberg”. *lol*

    I’ve never found any of my doctors (and there is quite a roster) to be paternalistic – at least not since I was about 10. Even as a teenager, my GP would explain what the meds or treatment was, why it would help, etc, if I wanted to know. I have had doctors say “there’s nothing new we can try for your condition, but research is continuing” and sure enough, research has continued and I’ve directly benefited from it.

    I’d believe the CAM purveyors were after something other than money if they’d actually work to standardize and regulate themselves and their products and try to prevent disastrous consequences like belladonna-rich teething products or steroid containing “natural” psoriasis preps.

  45. #45 Mephistopheles O'Brien
    October 25, 2010

    @She-Liger,

    I’m unfamiliar with why “the only country” and “the USSR” should be synonymous. I’ve certainly heard about the USSR. And I’ve certainly heard that it had a little experiment with communism which went badly. but the term “the only country” is a new one for me. Can you explain?

    Additionally, I don’t understand your issues with skeptics and their blogs. Apparently you’ve had some bad experiences. You seem to think that any attempt by skeptics to try to drill down to the truth is doomed to failure – much as communism was in the USSR. But then – what is the alternative?

  46. #46 Marya
    October 26, 2010

    Dear Orac,

    I have posted my response to you and Dr. Novella here: http://evimedgroup.blogspot.com/2010/10/furthering-discussion.html

    As I cannot leave a comment on Dr. Novella’s blog, please, could you let him know as well?

    I really appreciate both of you pushing me to continue developing my understanding of these important issues.

    Respectfully,
    Marya

  47. #47 Matthew Cline
    October 26, 2010

    @Mephistopheles O’Brien:

    You seem to think that any attempt by skeptics to try to drill down to the truth is doomed to failure – much as communism was in the USSR.

    I think that She-Liger isn’t saying that, but is rather saying that skeptics are similar in personality to USSR politicos.

  48. #48 She-Liger
    October 26, 2010

    Ah! I forgot that you are experts in socialistic theory ;) As usual I haven’t taken it into consideration that most your people read marxists (or rather – economists and journalists, reasoning about marxism) and have your (their) own ideas about socialism…
    Yes, really, there were some attempts to build a sort of “bourgeois socialism” in France, the UK, Sweden, Denmark, etc. But look at UK to see the finale of this “socialism”. The current world crisis is a crash of “bourgeois socialism” in fact. Your “socialism” is dying.
    As for “proletarian socialism” (it was sort of socialism, which was in USSR. And it was classical Marx’s socialism), it died earlier.

    Why? Because socialism is not only an economics, as you try to state. Socialism is economics+ideology. And just an ideology had to be main component of it. But nobody took it into account. And just an ideology was weakness of any socialism.

    But the efforts of the skeptics to play a role of new ideologists are farcical. In field of ideology, human behaviour, moral, friendship, etc the sceptics are much worse than even simple illiterate people. It seems the skeptics forgot that they are the humans at all… :( Unfortunately I am forced to say it after my experience of relations with them.
    I am disappointed.

  49. #49 Antaeus Feldspar
    October 26, 2010

    But the efforts of the skeptics to play a role of new ideologists are farcical. In field of ideology, human behaviour, moral, friendship, etc the sceptics are much worse than even simple illiterate people. It seems the skeptics forgot that they are the humans at all… :( Unfortunately I am forced to say it after my experience of relations with them.

    This would be so much more believable (and if it is correct, helpful) if the critic was able to provide some sort of example of what she would do better than the skeptics.

    There is no group on earth against whom vague “I am disappointed in them / therefore obviously they did something wrong” attacks. Such attacks lack the credibility of giving specific examples and pointing out what would have been a superior course of action. For instance, “I am disappointed in vaccine/autism believers for their double standards. For years they have yelled about how you can’t trust Paul Offit because he developed a vaccine and has received financial reward for that work and that supposedly constitutes a conflict of interest that prevents him from saying anything else on the subject of vaccines. Yet when it was revealed that when Andrew Wakefield was getting up at a press conference and announcing that everyone should stay away from the MMR vaccine and seek single vaccines instead, he was attempting to patent his own single vaccine, none of his followers held him to account for that real conflict of interest. I am disappointed in the vaccine/autism crowd that they will hold their heroes to looser standards than their perceived enemies; they should be consistent.”

    It goes without saying that if you can’t provide such specifics for the people you’re actually criticizing and have to try to pass judgment by analogy, i.e. “Skeptics are bad; because socialists are bad and supposedly skeptics are like socialists” — clearly your case is weak, indeed.

  50. #50 Mephistopheles O'Brien
    October 26, 2010

    @Matthew Cline

    I think that She-Liger isn’t saying that, but is rather saying that skeptics are similar in personality to USSR politicos.

    Well, She-Liger certainly said that. She-Liger also said, “The activity of skeptics are quite useless,” which I suppose could also be a reference to USSR politicos or could be a separate thought.

  51. #51 Composer99
    October 26, 2010

    She-Liger’s commentary is really rather vague (to the point of being nonsensical), and has pretty much nothing to do with this post’s topic.

    We’d be better off ignoring it, on the whole.

  52. #52 Orac
    October 26, 2010

    She-Liger has a definite ax to grind. I could reveal it, but then I don’t out my commenters unless they become threatening enough that I feel a call to the police is in order. I also only rarely ban them (maybe three in the last six years).

  53. #53 Calli Arcale
    October 26, 2010

    Marya @ 46:

    As I cannot leave a comment on Dr. Novella’s blog, please, could you let him know as well?

    FYI, you should be able to register on Neurologica and post. It’s not actually a very intrusive process; you just need a username and an e-mail account, and then you’ll have to reply to an autogenerated e-mail to show you’re a real person and not a spambot.

  54. #54 Todd W.
    October 26, 2010

    @Calli Arcale

    Unless, of course, she has registered before and done something so incredibly egregious that even Steve would ban her. I don’t see that as having happened, though. He’s pretty lenient when it comes to comments.

  55. #55 colmcq
    October 26, 2010

    “(to the point of being nonsensical)”

    how about total frootloopery.

  56. #56 Chris
    October 26, 2010

    colmcq:

    how about total frootloopery.

    With a hint of tea-baggery.

  57. #57 opit
    October 26, 2010

    Well, no. It is the ‘evidence based science’ that’s the problem. That has, in its way been hugely useful. And interventionist medicine is fine … for intervening. There is a problem of focus when the gut – a basic organ – and nutrition are ignored in our world proliferating with ‘processed’ foods and ‘preservatives.’
    It should be an obvious fact of life that raw food and natural methods are superior in delivering essentials to deny diseases and conditions breeding in malnutrition their prepared bodies of neglect.
    That should be the oxymoron ‘common sense’ at work. The truth of it is evident in raw foods being superior for animals – simply as much as they will sicken and die if you feed them a steady diet of treats instead of chow.

  58. #58 Chris
    October 26, 2010

    Silly spam spotted at 10:16 am!

  59. #59 Todd W.
    October 26, 2010

    @Calli

    Hmm. Perhaps she is referring to Dr. Novella’s most recent post on NeuroLogica, which has comments closed.

  60. #60 Chris
    October 26, 2010

    No, Todd, Marya posted last night before Dr. Novella’s most recent article was posted. By the way, you can now comment on it.

  61. #61 Scott
    October 26, 2010

    There is a problem of focus when the gut – a basic organ – and nutrition are ignored in our world proliferating with ‘processed’ foods and ‘preservatives.’

    This is, quite simply, a deliberate lie. Proper nutrition is a major concern of mainstream medicine, both evidence-based and science-based.

    It should be an obvious fact of life that raw food and natural methods are superior in delivering essentials to deny diseases and conditions breeding in malnutrition their prepared bodies of neglect.

    Ah yes, “it should be obvious.” Always a signature of someone who knows full well that it ISN’T obvious, and indeed probably isn’t true at all, but is unwilling to admit it.

    That should be the oxymoron ‘common sense’ at work. The truth of it is evident in raw foods being superior for animals – simply as much as they will sicken and die if you feed them a steady diet of treats instead of chow.

    Citation needed that raw foods are superior.

  62. #62 Calli Arcale
    October 26, 2010

    opit @ 57:

    That should be the oxymoron ‘common sense’ at work. The truth of it is evident in raw foods being superior for animals – simply as much as they will sicken and die if you feed them a steady diet of treats instead of chow.

    So, you’re comparing a junk food diet to a balanced diet, and claiming this says something about raw versus cooked food? Actually, dogs and cats do fine on cooked food, and have a lower rate of diarrhea. (It is, in fact, a myth that dogs and cats are invulnerable to salmonella, E. coli, and other common causes of human food poisoning. They just tend to complain less than humans, and sadly, the majority of owners don’t take their illnesses as seriously, which skews the statistics and public perception.)

    Eat a diet of nothing but raw tomatoes and tell me how you do. It’s not whether it’s cooked or not; it’s the overall diet that matters. Vegans are often healthier not because they eschew meat but because they’re usually paying more attention to planning their meals. The veganism is a red herring.

  63. #63 Prometheus
    October 26, 2010

    Oh, my! So much nonsense; so little time…

    “First of all, it is my belief that all interventions should be approached with equanimity, if not equipoise. …I do not want to confuse the absence of any evidence to this effect with the evidence of absence of the effect. Although I am not that interested in allocating resources to studying these fields, it would be paternalistic of me to bar their further investigation.
    ” [emphasis added]

    Let’s start with the “all interventions” nonsense. I am assuming – without any data to support said assumption – that Dr. Zilberberg isn’t extending “all interventions” to include those that have already been shown to not work, which would eliminate chiropractic (except for musculo-skeletal lower back pain), homeopathy (for anything but thirst), “energy field manipulation” and a whole rogues’ gallery of others.

    The “absence of evidence is not evidence of absence” concept only goes so far; it also isn’t evidence of existence; as someone once said, “The invisible and the non-existent look very much alike.” It is all well and good to “keep an open mind”, but I don’t see any point in looking for effects that are extremely unlikely or that would violate one or more well-tested laws of physics.

    “Energy-field manipulation”, crystal healing, homeopathy, and Deepak Chopra’s entire published works would violate one or more well-tested (and supported) laws of physics if they were true, so I think that “absence of evidence” – in these cases, at least – is functionally equivalent to “evidence of absence”.

    Finally, the straw man – the hypothetical “paternalistic” bar to research in these “phenomena”. There is nothing barring those that believe in crystal healing etc. from researching their beliefs. In fact, it would probably do them a world of good. However, I’d like them to keep their hands out of my pockets when looking for research funding.

    While it would be “paternalistic” (or “maternalistic”?) of me to forbid them to do research, I think it only prudent of me to insist that none of my money (including tax revenues) be spent on research that is unlikely to yield useful results. There isn’t such a surplus of research funding that we can afford to waste it on hypotheses that are either extremely unlikely or are in violation of well-established physical law.

    If the practitioners want to spend their own money researching homeopathy or crystal healing or chelation for autism, I have no objection. In fact, it would be a good sign that these practitioners actually believe in what they are doing, rather than just being in it for the money. And I’d be willing to reconsider using public funds for research if they did a legitimate study showing a real, statistically significant effect. Until then, however, all they have is an “absence of evidence”.

    Prometheus

  64. #64 JEff Read
    October 26, 2010

    The latter complaint often tries to argue that SBM is actually worse than various non-science-based medical systems because (or so it is alleged) a combination of pharma corruption and an excessively dismissive attitude towards anything that is not science lead (or so it is alleged) to, well, I’m not sure what. Bad care? Bad medicine? Or are we advocates of SBM just plain mean, nasty, and arrogant to have the temerity to criticize the touchy-feelies that advocates of “complementary and alternative medicine” (CAM)? I’m never quite sure.

    Worse. Science-based medical practitioners are viewed as butchers akin to Dr. Josef Mengele. So dogmatic are they that only their “Western” scientific methods work, so determined are they to overlook “thousands of years of research and practice” that they will happily condemn people to death by the thousands or millions in the name of their dogma.

  65. #65 WilliamLawrenceUtrdige
    October 27, 2010

    It should be an obvious fact of life that raw food and natural methods are superior in delivering essentials to deny diseases and conditions breeding in malnutrition their prepared bodies of neglect.

    Raw food may deliver essentials but it also delivers pathogens. Also, what’s a “natural method”? Cooking with heat? Monkeys who use thermal baths to boil potatoes? Fermentation? Adding salt to food to preserve it? Dehydration? This statement assumes that raw food and natural methods are better, it doesn’t prove it, certainly not by appealing to what is “obvious”. It’s “obvious” the sun revolves around the Earth, it just happens to be wrong. Both revolve around a mutually determined stable point.

    The truth of it is evident in raw foods being superior for animals

    Really? We are humans, yet cooked food appears to be healthier and lead to more evolutionary success. Hard-core raw foodists tend to be underweight and women tend to stop menstruating.

    http://en.wikipedia.org/wiki/Catching_Fire:_How_Cooking_Made_Us_Human

    Not to mention humans can develop anemia due to B12 deficiency that is due to a failure to produce intrinsic factor. And cows are fed raw corn, which is natural, but causes massive problems in their guts. “Natural” does not equal “better”, all it implies is unguided development over vast spans of time with no destination or goal in site beyond survival. You can’t generalize, everything rests on specifics.

  66. #66 Marya
    October 27, 2010

    Really, Orac, did you take my words to mean that I am crying into my pillow? Not at all, I do have pretty thick skin. I simply wanted to take the discussion in the direction of a real debate, rather than personal attacks. Really, you may not believe it, but tone actually matters.

    I eagerly await your answers to my questions.

  67. #67 nybgrus
    November 8, 2010

    @3: My girlfriend apparently decided to sketch exactly that. Here is her doodle. It sure made my day!

    http://1337percent.tumblr.com/post/1508292102/let-me-introduce-my-boyfriend-dr-drey-purveyor

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