As many of you probably know, I'm proud to call Dr. Harriet Hall (a.k.a. the SkepDoc) my friend, and, I daresay, so is my wife. We've both hung out with her at the last two TAMs, and we've hit it off pretty well. I also admire her history of standing up for science, reason, and science-based medicine, something she's been doing longer than I have. I can only hope that one day I will reach her level of respect within the skeptical movement. Unfortunately, that will probably never happen until I cease being a Plexiglass box of multicolored blinking lights, but such is the price of pseudonymity. My skeptic envy aside, that's why when a naturopath woo-meister decides to take a swipe at Harriet, I can't let that stand. True, I know that she's perfectly capable of taking care of herself in these exchanges, but I also know she's too classy to get down and dirty in the mud.
Fortunately, as you all know, I have no such qualms. Well, most of the time, at least. So, Oryoki Bowl, prepare for a much deserved dose of not-so-Respectful Insolence for your post The SkepDoc is an Ostrich:
I chose the word Ostrich, because I see your head is buried in the sand and your ass is likely waving in the air.
I suppose this is what passes for cleverness in Oryoki's fragile eggshell mind, but let's see what the meat of her complaint is, that is, if there is any meat:
Unfortunately, reading through your 6 column, 2 page diatribe against naturopathic medicine, your talking points were off target. I am sorry you don't understand what naturopathy is. You said so in your first paragraph, yet still felt entitled to dissect and discredit something you just admitted you didn't understand. You did some random research. You made a lot of gross generalizations and tried a lot of scare tactics. You made up long stories to discredit people using the same rationales you were dismissing.
It's not exactly true that Harriet said that she doesn't understand what naturopathy is. Yes, she did say that, but she qualified it thusly:
When people ask me, "What is naturopathy?" I have never been able to give a good, concise answer. I can confidently explain what acupuncture, chiropractic, and homeopathy are all about, but naturopathy has eluded me. I finally realized that it's not my fault. The whole concept is so ill-conceived and poorly defined that it cannot be grasped with a single definition. It is so nebulous that it allows its practitioners to believe and do almost anything. It is loosely unified by an emphasis on natural treatments that allow the body to heal itself, and an avoidance of drugs and surgery.
The best response that Oryoki can come up with this is to that's a "mighty fine skeptic argument there" and that it "sounds like voodoo," the latter of which is a perfect example of a tu quoque logical fallacy.
It's true, too. I've studied about as much about naturopathy as is possible without actually going to naturopathy school. I've studied under the tutelage of Kimball Atwood, who has studied and written even more than I have over an even longer period of time. In fact, if Oryoki really wants to burst a cerebral aneurysm, I suggest that she read Dr. Atwood's Why Naturopaths should not be licensed, his testimony against licensing naturopaths in Massachussetts, and Naturopathy, Pseudoscience, and Medicine: Myths and Fallacies vs Truth. Let's just put it this way, any "discipline" that accepts that homeopathy is true and a valid therapeutic modality can't be considered scientific by any stretch of the imagination. Indeed, as I've described before, you can't have naturopathy without homeopathy. It's part and parcel of naturopathy.
Of course, to Oryoki, it's not about science. Oh, she does claim she's all about the science, but nowhere in her rant can she actually counter the science Harriet discusses. All she can do is to engage in a bunch of conspiracy-mongering. She paints naturopaths as "persecuted" by the AMA:
For the record, the reason naturopathic medicine is not universally recognized is because of money. The AMA has at its core a mission to wipe homeopathy and naturopathy off the professional field. They spend their lobby dollars fighting our lobby dollars. Our lobby dollars fight for licensing and higher medical standards. We are challenged by MDs, who also challenged the DOs until they co-opted them. We are challenged by chiropractors who were challenged by MDs. We are challenged by people who go to school in unlicensed- and therefore unregulated states- who want the title but not the education. You suggest we are encouraged to sell supplements at our clinics. MDs make money selling supplements as well, also getting lots of free lunches, supplies and fabulous resort dinners from their suppliers. Except the MD world is owned by big pharmacy and big insurance, and we are not. Look at Cancer Treatment Centers of America, they are some of our proudest supporters. We are part of the whole team. Last year, I was hired by a hospice to help develop a program for their patients seeking touch therapy and acupuncture for pain and anxiety. Sadly, since Medicare wouldn't pay for it and our state budget axed, it could not be implemented. I guess alternative care is only good for rich or stupid people.
Well, not exactly. As I've said time and time again, you don't have to be stupid to be taken in by "alternative" practitioners, be they naturopaths, homeopaths, or practitioners of traditional Chinese medicine. What is necessary is a lack of understanding of science and, most importantly, Richard Feynman's old adage, "The first principle is that you must not fool yourself--and you are the easiest person to fool." It has nothing to do with intelligence, either; some highly intelligent people don't realize when they are being fooled, perhaps even Oryoki. In fact, often intelligent people are the easiest to fool, mainly because their intelligence leads them to falsely believe that their knowledge and expertise in one area inoculates them from making fools of themselves in other areas. Sadly, it's not so.
Also, unfortunately, it's not just lay people who forget how easy it is to be fooled; lots of physicians forget too. Naturopathy is built on the very premise of how easy it is to fool both practitioner and patient. It's built up a very science-y sounding bunch of precepts. Schools of naturopathy, like Bastyr University have all the trappings of science, but at their core all the trappings of science lack the one key ingredient of science: Falsifiability and the abandonment of hypotheses not supported by science. If naturopathy did accept science, it would have to reject homeopathy and purge it from its armamentarium of accepted modalities. Indeed, you can see this inability to understand the true core of science in Oryoki's post. At one point, she writes:
Am I working on a belief system? You betcha! I use science, which is empirical. I use traditional labs. I use alternative labs, when traditional labs are insufficient. Are they illegal or alien? No, just not common. I use chinese medicine. It is more useful for many of my chronic allergy patients who don't respond to all the OTC and prescription meds.
Except how do you know if traditional Chinese medicine is "more useful" for your chronic allergy patients? Without actual science and clinical trials, you don't. All you have is confirmation bias, placebo effects, and confusing correlation with causation. But you don't believe that Oryoki is deluding herself when she declares herself to be all about the science, read this passage:
If you don't believe in Qi, or the life force, you probably should be teaching anatomy and not going into patient care. If you can't tell the difference, you don't look closely enough at your patients. If you can't tell from the way they walk into your room, from the color of their skin and eyes, the droop of their cheek, the shuffle of their legs, the sound of their voice, and get a really good sense of their vitality, you aren't in the health business. Just sickness management.
Science. You keep using that word. I do not think it means what you think it means.
Let's just put it this way. How a patient looks has nothing to do with qi, that mystical magical life force that woo-meisters claim to be the source of all healing but can seemingly never actually characterize or measure. Observing how patients walk, their color, their voice, their vitality does not require a belief in some woo-ful life force. It's a matter of experience and pattern recognition. There's something known in the biz as "looking sick." Good physicians can observe a patient and immediately make an accurate snap judgment about how sick that patient is. It's not magic. It doesn't depend upon qi. It's just a matter of having seen enough really sick patients to know the difference. We know when to be worried that a patient is about to crash and when not to worry. It's a skill that in general physicians get better at the longer they practice, as long as they have the opportunity to care for really sick patients.
If you really want to know you're dealing with a pseudoscience maven, though, there's one pretty reliable measure, and Oryoki uses it in the comments:
I did not attack the medical community, I particularly refuted the vague generalizations made from narrow minded individuals this person made using her MD to give her credibility where there was none. I do the same with you. Placebo controlled trials are not the only standard of testing. Scientific method does not require placebo. You confused the two. There are a lot of studies on alternative medicine done to the highest standards available, they are findable, you can do the research (but you haven't). They also cost millions to billions of dollars. Because you cannot patent naturally occurring substances, there is no money to pay back doing the research. The FDA does not control things that are not patented. Homeopathy, is, in fact, controlled by the FDA. It's part of the original charter. Many of the studies done are done poorly, which is frustrating for everyone, as we have learned, scientism can make presumptions that are incorrect.
Yep, Orac's law number five (or is it six?) states that a charge of "scientism" leveled against critics of woo is highly correlated with dedication to pure pseudoscience. So is the dubious claim that no one will do studies on natural products that can't be patented, except that uses of natural products can indeed be patented. More importantly, Oryoki is full of, well, BS when she says that the FDA can't regulate things that are not patented. That's simply untrue. The FDA has regulatory control over generic medications, and generic medications don't become generic medications until their patents expire. Similarly, the FDA does have regulatory control over unpatented supplements, thanks to the Dietary Supplements Health and Education Act of 1994. True, the DSHEA irresponsibly gutted much of the FDA's control over supplements, but it still has some.
Oryoki appears to have taken Harriet's criticisms of naturopathy very personally, resulting in an off-base attack on Harriet herself that relies on a heapin' helpin' of nonsense, pseudoscience, and logical fallacies, not to mention the misrepresentation of Harriet's own words as saying that she doesn't understand naturopathy. The fact is that Harriet actually understands naturopathy all too well, as does Kimball Atwood, and as do I.
And Oryoki knows it.
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This entire blog has just been debunked by Linda Perry (former lead singer of the one-hit wonder band 4 Non Blondes):
Oryoki blames some of the criticism of Naturopaths on financial grounds. How exactly does that square with homeopathy and the selling of sugar pills at thousands of times the rate for such crap? What might really be at the root of Oryoki's complaint is that criticism cuts into HER profit. She might have to go out and get a real job. Oh, the horror.
I do hope someone with more direct and substantial knowledge will speak to the placebo-less study point.
I've always wondered, lolwut: is it hard work being that stupid, or does it just kinda come naturally?
I went over to her blog, and it's nothing but an echo chamber. Like AoA, no dissent is allowed.
The issue of what naturopathy "is" evades even naturopaths, which is why most (if not all) of them don't believe in it.
If naturopaths truly believed that "natural" products (vaguely defined) had cures/treatments for all (or most) human ailments, they wouldn't have pushed (be pushing) for licensing legislation that allows them to prescribe a wide range of "artificial" pharmaceuticals.
If you doubt me, look on the website of any state's "Board of Naturopathy" and see what real pharmaceuticals they are permitted to prescribe. In Arizona, for instance, they are allowed to prescribe all medications except for intravenous medications (chelating agents and a few others are excepted) and class I and II controlled substances (morphine is excepted). [Note: not even MD's are allowed to prescribe class I controlled substances except under a few carefully controlled circumstances.]
As a result, naturopaths can (and do) prescribe antibiotics, statins, anti-depressants, etc...all the evil drugs their "profession" claims to reject. It seems - to me, at least - to be a clear failure of their loudly proclaimed faith in "natural" remedies.
So, if naturopaths really believe that "natural" remedies are superior, or even sufficient, why do they universally clamour to be allowed to prescribe those evil pharmaceuticals?
Maybe - just maybe - because they know that the real drugs work and their herbs and flowers don't.
Prometheus
Preferably rich and stupid. That is the most desirable demographic to market to.
When I hear the argument that Big whatever is trying to take them out because of monetary competition, I have to think, then why don't all the doctors become homeopaths or naturopaths or whatever, once it becomes more profitable? And that's what many have done (many of these quacks have MDs). Look at Dr. Oz- started off seemingly ok, now he realizes the cash in woo. Likewise, the pharmaceutical industry and other big business is cashing in on supplements. Nobody has any allegience to the area they are now in if they have no moral qualms about selling out.Funny thing, most of the big websites promoting woo are selling something. All the skeptic blogs countering woo have nothing to gain financially. Orac hasn't offered to sell me prescription drugs lately. His blog doesn't help his practice. Doesn't prove anything, but it counters the point they make about the money motive.
Orac has made this pointbefore: naturopathy has no consistent practice. See my exchange with a naturopath in the comments there. His response to my list of statements common to multiple naturopaths' marks is a classic No True Scotsman argument.
Wow. I read her post, and it's pretty cranky.
Oryoki:
Translation: Naturopathy is entirely supported by unblinded experiments with no control groups. That's seriously shaky ground.
I see your "You can't patent natural products" and raise you a paclitaxel.
And given Naturopaths frequently claim to cure cancer, AIDS, hepatitis etc., without surgery, without nasty side-effects, and with 100% success rates, if it worked, there'd be money to study it. It does not work. Still, NCCAM has money to "study" it. So that excuse is wearing pretty damn thin.
So MDs don't disclose what the medicine is, why they chose it or how it works because they're snobby meanies who hold simple honest folks in contempt.
You, on the other hand, withhold that information, even though you know your herbs might not actually work, because they really wouldn't understand, then shout "Hooray informed consent! Hooray health freedom!"
Yup. It's official. You make less than zero sense.
The failings of the US insurance system and Big Pharma's criminal shenannigans don't make your criminal shenannigans any better.
I can tell you what Naturopaths are - they're the Leprechaun Mafia. We know they're leprechauns because if you actually examine their magic nostrums, they turn back into overhyped non-therapeutic plants, bogus rituals, and plain old water. We know they're a mafia because they're a tight-knight collection of professional organizations whose only prupose is to commit fraud, circumvent the law, and worm their way into positions of influence, the better to do numbers one and two. Leprechauns. Mafia.
I'm looking over her site for a way for her to prove her claims using her "science" and I'm coming up with nothing. Perhaps she's published it under a real name?
There have been a surprising (to me anyway) number of studies on various modalities of alternative medicine, the majority of which found that it works no better than placebo. Prof Edzard Ernst does a good job trawling through such studies - his book 'Trick or Treatment' written with Simon Singh is well worth reading for anyone in any doubt. I follow them both on Twitter @EdzardErnst and @SLSingh.
A lot of research into alternative medicine is funded by the US government - NCCAM's annual budget was $122 million in 2009, as was the budget for the NIH's Office of Cancer Complementary and Alternative Medicine. That's nearly a quarter of a billion dollars a year in the US alone.
I would be very surprised if any single study of alternative medicine cost "billions of dollars".
If magic worked, as naturopaths and homeopaths seem to think, it would be used in many more endeavors than just medicine. That's what the woo huggers keep missing. We make use of tools that work, and magic just does not work.
You just can't make this stuff up!
Funny thing, my doctor does explain to me why she chooses acetaminophen over ibuprofen (or vice versa) and if she thinks I don't understand her reasoning, she takes the time to explain it to me.
As for choosing "...lavender over clary sage...", can any naturopath actually give a reason other than "my experience" or "the anecdotes of my teachers"? I don't think so. I've checked the medical and biological literature (and even that part of the naturopathic literature that is indexed) and I've failed to find an explanation that didn't boil down to "in my vast experience".
But wait, there's more!
Why is it important to believe in "Qi" or "life force" if - as she goes on to explain - they are nothing more than "magical" names for what real doctors call affect and energy? I suppose that "belief" is necessary in order to delude yourself (and your patients) into believing that needles or magical hand waving (TFT) can change affect and energy by "redirecting" or "unblocking" the magical (and non-existent) "Qi" or "life force".
It may work - as a type of placebo - but only at the expense of deceiving the patient (and the practitioner).
I stand by my previous statement: if naturopaths truly believed their line of bull***, they wouldn't be wanting to prescribe real medications. Res ipsa loquitur.
Prometheus
@JayK
It's science by anecdote. Just about every second paragraph is a scary anecdote about how she or someone she loves was almost killed in a hospital setting. Weakness of one is supposed to prove strength of the other, somehow.
True, but these physicians are few and far between.
When I was very sick, I saw many doctors. Many doctors thought I didn't look sick while observing me from 15 feet across the room.
However, I had a wonderful endocrinologist. He immediately recognized how ill I was and cancelled a slot or two in his schedule in attempt to evaluate me head to toe, do neurological exams, eye exams, blood pressure for POTS and orthostatic intolerance, resting heart rate, and standing heart rate. He noticed that when I stood up my heart would fly above 150 bpm. He used every one of his Welch Allyn instruments, percussion on all my organs, and so on. He was no idiot. He has published a couple dozen medical journals and works at a major university hospital.
Was he the one that diagnosed me? No, but I know he was trying his hardest to figure things out. I mean, what other doctor calls you at 9 PM to ask additional questions?
And my cardiologist? Well, he did an EKG and said perhaps I needed Paxil and a beta blocker. But to his defense, he did later recognize that I was indeed ill, but still, the only touch was a handshake.
When you become a patient of many doctors, you realize just how important touch is. Believe me, touch is much more comforting than the "I hope I gave you some peace of mind" phrase. In fact, that phrase really doesn't work. Unless you like making patients frustrated, don't use it.
And all that being said, if you have been there yourself, you recognize the validity of many of her arguments. You don't have to agree with all her points, but some of her paragraphs are spot on.
And perhaps this is why I am seen as a rebel or an outcast. It doesn't bother me. My illness shifted my perspective. This is when I started thinking for myself and started seeing what I feel is the truth.
"And I have a LABCOAT!"
The Analyst@15: That YOUR experience.
Yes, I am also a patient, with several chronic complaints. So I'm good friends with my doctor. But I'd much rather he gave me clear explanations for everything and be open to my opinions and suggestions (which he does and is) than get all touchy-feely with me. That's what my husband is for.
@Scott Cunningham
Right. So that conversation I had with my MD about the relative risks and benefits of long-term use of aspirin, acetominophen, ibuprofen, ketoprofen and naproxyn never happened. Or the similar ones about other medications.
That one's like the "MDs won't talk to you about diet and exercise -- they always go straight to the drugs" canard. Or the ones about profiting. She, and other woo purveyors, build a strawman of the medical world that they then wage their "noble fight" against.
The essay from which the Feynman quote is extracted is an absolute classic, and a wonderful read. For anyone reading this who isn't familiar with it, it's at
http://www.lhup.edu/~DSIMANEK/cargocul.htm
It's an afterward to his classic informal memoir, "Surely You're Joking, Mr. Feynman!".
Re.: "if you don't believe in qi, or the life force..."
I think it's a much more fascinating Universe we live in being that all the amazing things that cause 'life' to do its thing DO NOT require a qi / life force geist -- that immeasurable invisible but all potent place-filler for real knowledge [naturopathy usually codes it "healing power of nature"].
"Me"'s blog is opinion, of course, but since the opinion is deficient in BASIC facts about biology and such, her opinion is a place-filler for a useful opinion.
6th grade level, IMHO.
-r.c.
Thank goodness she covered Hamer ground: "Most illness and disease are not accidents." And it's your own damned fault if dowsing suggests the wrong homeopathic remedy.
My doctor rarely bothers to talk to me about diet and exercise -- she knows my diet is fairly good (but did give me some handouts to take home when I asked), and knows I exercise regularly. She also knows that the stuff that's wrong with me isn't caused by my being an out-of-shape slob who subsists on Cheetos, so we're quite free to cut to the chase (or the drugs, as it were).
I'm on quite a few prescriptions. I'm much happier this way.
I skimmed a few more of her articles and got a headache from all the hippie bollocks. Jebus. She gives feminists a really bad name.
The Analyst -- there are both good and bad doctors, and it is quite possible to get a skewed perspective because of getting a run of either type. A family friend was recently taken off the high doses of totally unnecessary thyroid hormone that a bad doctor had put her on. My mom, meanwhile, had a bona fide thyroid problem, but her GP never spotted it. It was her optometrist who spotted it. Mileage varies.
As written, that comes off as a bit circular; how about "abandonment of hypotheses not supported by evidence"?
Oryoki's inference of "life force" from what really amounts to a bunch of correlated observations reminds me of the way Charles Spearman and his followers, on observing that results of most mental-ability tests are positively correlated, concluded that the tests must all be imperfect measures of a Real Thing, a "general intelligence" that Spearman described in near-vitalistic terms (including calling it a "force"). Thurstone and others demonstrated that there were completely mathematically equivalent ways of explaining the correlation structure that did not require the creation of a new entity. The history of the whole thing is covered in Gould's Mismeasure of Man.
Such classic woo-based arguments from Oryoki, our Quaker-Buddhist cat-loving naturopathy promoter.
Particularly notable is the your-science-can't-measure-my-woo-but-science-supports-me-except-for-the-scientism-part.
I wish it was just the quackery advocates who advise us to disregard science in favor of anecdote and intuition, but there was a sad example of this attitude coming from one of Orac's academic medicine colleagues in last Friday's Wall St. Journal. In a letter to the editor, Scot Silverstein of Drexel University (whose area of expertise is identified online as IT) disparaged the idea of clinical guidelines based on the best scientific evidence, citing:
"rampant commercialization of medicine, research universities with lax conflict of interest policies, faculty as de facto employees of industry through grants, academics paid to be "key opinion leaders" to stealth-market drugs and devices, control of clinical research given to commercial sponsors, conflicts of interest allowing manipulation and suppression of clinical research, academics taking credit for articles written by commercially paid industry "ghost writers,", whistleblowing discouraged, leadership of academic medical centers by business people, and medical school leaders becoming stewards (as members of boards of directors) of for-profit health-care corporations.
As for me, until the medical literature can be freed of these contaminants, I'd rather trust a well-trained personal physician's good judgment in my own medical care."
So Dr. Silverstein thinks that the defects he cites (many of which have been revealed by and hotly debated within the scientific community) are ample justification for tossing out the entirety of research in favor of the sort of "clinical intuition" that's repeatedly been found false over the years, not to mention the conflicts of interest affecting individual physicians that never see the light of day because their opinions are not subject to peer review.
Dr. Silverstein, we've got a swell pediatrician for you to send your kids to, if they don't mind traveling across country.
Has anyone else taken a look at her fiction? Not the stuff about naturopathy... no, seriously, she writes armageddon and romantic fiction:
"Denise leaned over and kissed her shoulder top, "You are soooooo yummy." Her fingers slid behind Anna's back, undoing the clasp on her bra. It slipped forward and the water pulled it away from her. Her large round breasts were floating at the surface, and her nipples were just visible. Anna turned to Denise, and instead of pulling back leaned in and kissed her. She had never done this before, but the tequila and the evening and the Javier Bardem had done their job"
I generally enjoy things that are so bad their good, but woof, this is too much.
Has anyone else taken a look at her fiction? Not the stuff about naturopathy... no, seriously, she writes armageddon and romantic fiction:
"Denise leaned over and kissed her shoulder top, "You are soooooo yummy." Her fingers slid behind Anna's back, undoing the clasp on her bra. It slipped forward and the water pulled it away from her. Her large round breasts were floating at the surface, and her nipples were just visible. Anna turned to Denise, and instead of pulling back leaned in and kissed her. She had never done this before, but the tequila and the evening and the Javier Bardem had done their job"
I generally enjoy things that are so bad their good, but woof, this is too much.
@Artk
Dude, sarcasm. It doesn't come across well in writing.
It was Oryoki who characterised MDs this way, while painting herself the perfect saint who always "informs" her patients of the risks and benefits of magic nonsense. Which is nonsense because it doesn't really work.
@Dangerous Bacon, isaacschumann
Yes, once again my assumptions about the flaky hippy-woo connection are vindicated. It bugs me, because I'm a lefty in the leftiest part of a left-leaning town. Woo seems to draw in everyone around me like a magnet. One minute you're talking about something sensible, and the next thing you know, out comes "I cured epilepsy with a magnet bra!"
Sweet Cthulhu, why?!
Re: a perfect example of a tu quoque logical fallacy.
I regret to have to say this.
Pointing out logical fallacies to those who don't believe in logic to begin with was recognized as fruitless several millenia ago.
Cf. the biblical saying:
"Do not give what is holy to dogs, and do not throw your pearls before swine, or they will trample them under their feet, and turn and tear you to pieces."
Matthew 7:6
#26 dangerous bacon
Thanks for the laughs - and for sending readers here to my Wall Street Journal letter to the editor via the link to Healthcare Renewal.
That said, not only do you 'misunderestimate' my credentials, you commit another logical fallacy, that of the Strawman argument:
A straw man is a component of an argument and is an informal fallacy based on misrepresentation of an opponent's position.
Unfortunately, you will not understand what I am referring to, as in my post #31.
You instantiate the ancient biblical passage I wrote there well.
Thanks for your offer of a pediatrician, too, but no thanks. I know several excellent ones, former classmates.
I read Dr. Silverstein's letter in the WSJ and was disturbed by the apparent false dilemma he posed:
It appears, from Dr. Silverstein's letter, that we must completely reject all medical literature because a portion (a small portion) of it is "contaminated" by "conflict of interest", ghost-writing and outright fraud. In his view, this small percentage of "bad" literature completely invalidates (or renders untrustworthy) all the rest.
Now, I understand that it is impossible to know for certain which parts of the medical literature are "contaminated" - witness the problem of discovering fraudulent research by Scott Reuben and Andrew Wakefield. On the other hand, both researchers were "found out" largely because their findings couldn't be replicated by others (despite loud protests to the contrary by Dr. Wakefield).
Since Dr. Silverstein seems unaware of the simple steps people can take to safeguard themselves from fraudulent (or even simply incorrect) research results, let me set down a few guidelines that I have found helpful.
[1] Don't buy into any findings that haven't been replicated by independent research groups.
Too often, exciting new results are simply the result of error, random chance or poor experimental design. Remember that there is an inherent (and natural) bias against publishing "negative" results, so the one study that finds a correlation between pickled beet and leukaemia will get published, while the hundreds that don't find a correlation won't...until after the "Beets Cause Leukaemia" study is published.
Therein is the beauty of the current system of scientific (and medical) literature. As soon as someone publishes a radical new result, there will be people trying to replicate it. And, if there has been research that failed to replicate those findings, it is now readily publishable. Good information drives out bad, which is why we (and Dr. Silverstein) know about the failures in medical research.
[2] If all of the studies supporting a hypothesis come from a small group of researchers (or, worse yet, a single research group), be very suspicious.
This is sort of a corrolary to [1]. Read the author lists and the affiliations carefully; if they are all working together, they may all be making the same mistake.
[3] "Conflict of interest" isn't black and white.
Someone receiving funding from a company or interest group is less likely to "skew" their results than someone working for a company or interest group. The person getting funding has to go out and get more funding in the future, often from other sources. A reputation for bad research (or worse, research fraud) will make it hard or impossible to get more funding.
I get funding from the NSF - does that mean that my results are "skewed" toward the NSF's priorities? No. I also have received funding from the AHA, but I didn't "skew" my results there, either. Getting a reputation as a researcher who "fudges" results is a sure-fire way of not getting any more funding.
When it comes to "conflict of interest", the worst ones are the philosophical conflicts. Researchers who desperately want a particular result often find exactly what they want, even if the data don't support it. I'm much more concerned about a researcher who is pursuing a "cause" than I am about one pursuing money.
[4] Wait for the big studies before hopping on the band-wagon.
A study of ten people showing a correlation between coffee and "muffin top" is interesting, but shouldn't change your lifestyle. A study of ten thousand people showing that correlation should make you stop and think. Given the genetic and life-style variability in humans, a small-group study is only useful to get funding for a larger study.
[5] Mice (and rats) aren't people. Cell cultures aren't even mice.
Rodent (or even primate) studies revealing shocking new information need to be correlated with human data before they are accepted. Too often, we've found that something that causes - for instance - cancer in mice isn't a factor in humans (and vice versa, although that doesn't get as much press). Cell culture studies are even weaker.
The reason we do rodent (or primate) studies is that they are [a] cheaper than human studies and [b] some things can't ethically be studied in humans (see: Nuremburg).
Cell culture is even cheaper and you don't have to follow the rules for ethical animal studies because cell culture isn't an animal. It also isn't a substitute for an intact organism. Again, cell culture studies are a good way to gather justification for an animal study or even a human study.
As for trusting the judgment of a "well-trained personal physician", well, Dr. Mehmet Oz, Dr. Andrew Weil, etc. are all "well-trained" and their judgment shows some serious defects. I submit that you have to be just as skeptical about the judgment of a physician as you do about the validity of the medical literature.
Prometheus
Allow me to share a gem she dropped in my blog's comment thread earlier today:
"I will draw the line though at presuming that critical thinking can only be applied with scientific method or peer reviewed research. Otherwise, none of us would be here as our ancestors would have all died during childhood or childbirth from their bad choices."
and then...
"I, too, fell in love with anthopology in undergrad, and it still informs my ability to assess my patients where they are- not just where I think they should be- including their critical need for spiritual and religious identity."
I'm not sure anthropology means what she thinks it means.
Prometheus at #33 wastes considerable digital ink on a doubly defective argument.
He/she commits two logical errors in one, in stating "It appears that we must completely reject all medical literature because a portion (a small portion) of it is "contaminated" by "conflict of interest", ghost-writing and outright fraud."
Point: "Completely reject all medical literature" - as in previous posts e.g., #32, that is a strawman argument.
Point: "Because a portion (a small portion) of it is contaminated" - without good evidence for the actual size of that portion, this statement is conjecture. It makes an assumption that could have dangerous consequences for patients.
It is an especially strange statement to make after making the assertion that "I understand that it is impossible to know for certain which parts of the medical literature are "contaminated."
Then, a simple statement lacking merit: "Since Dr. Silverstein seems unaware of the simple steps people can take to safeguard themselves from fraudulent (or even simply incorrect) research results, let me set down a few guidelines that I have found helpful."
As to the rest of the post, I leave it up to others to decide if the "contamination detection guidelines" as specified are reasonable or not. And if you'd bet you life on them.
I present this link for all:
Taxonomy of the Logical Fallacies
http://www.fallacyfiles.org/taxonomy.html
Finally, a good rule of thumb in biomedicine:
"Critical thinking, always, or your patient's dead." - Victor P. Satinsky, MD, Hahnemann Medical College, 1972.
Forgot one:
Re #33
"As for trusting the judgment of a "well-trained personal physician", well, Dr. Mehmet Oz, Dr. Andrew Weil, etc. are all "well-trained" and their judgment shows some serious defects. I submit that you have to be just as skeptical about the judgment of a physician as you do about the validity of the medical literature."
This is yet nother logical fallacy: Hasty Generalization, http://www.nizkor.org/features/fallacies/hasty-generalization.html
This fallacy is committed when a person draws a conclusion about a population based on a sample that is not large enough. It has the following form:
1. Sample S, which is too small, is taken from population P.
2. Conclusion C is drawn about Population P based on S.
One notes that Scot is not above using a logical fallacy of his own. Specifically, he has pulled out one of the hoariest logical fallacies of them all, a.k.a. the ad hominem fallacy, pharma shill gambit subtype, tacked on as an addendum to his original post:
Lame, lame, lame, lame.
I do not appreciate the insinuation that one of my longstanding and reliably solid commenters is a pharma shill. And, no that's not a straw man argument, and, yes, that's exactly what Scot did, as much as he will try to deny it.
Seriously, that's really, really pathetic. Embarrassingly so.
Dr. Silverstein, you complain about Prometheus and Dangerous Bacon developing a straw man fallacy from the last sentence of your letter. Funny thing, I interpreted that sentence exactly the same way.
Maybe the problem is not so much in the reading, as in the writing. Think about it.
Dear Mr. McNeedy,
As a professor who has written megabytes on health IT difficulties, including conflicted literature, and other issues for almost 15 years now, as well as who writes on a blog (http://hcrenewal.blogspot.com) where others write specifically on COI's and problems with the medical literature, you, Prometheus and Dangerous Bacon disappoint me. You all proffer opinions, and dole out ad hominem (another logical fallacy) without apparently doing any research.
Think about that.
Do I have to actually spell out that a "well trained physician" is someone who knows how to deal with patients and the medical literature, with its flaws, both?
A medical professional who applies critical thinking and judgment, as opposed to the POV in the WSJ I was responding to about a person who prefers his physician to recommend only treatments proven in the "synthesized medical literature?"
Perhaps my prior WSJ letter to the editor states the case for human judgment in medicine even better:
WSJ
Letters to the Editor
FEBRUARY 25, 2011
http://online.wsj.com/article/SB100014240527487045467045761507832850608…
Regarding Ray Kurzweil's "When Computers Beat Humans on Jeopardy" (op-ed, Feb. 17): Librarians often receive requests for information as cryptic as "Jeopardy!" clues, from people who are sometimes not even sure what they're seeking. Watson is, in essence, a librarian that retrieves facts.
Regarding natural language processing and fact-retrieval systems like IBM's Watson, medicine is about cognition. It's about human judgment born of experience in dealing with ambiguity, not just of language but also, and this is critical, of observations, findings, lab data, image interpretation, etc. It is about human intuition, assemblage and the integration of a huge amount of disparate information in ways not well understood even by its practitioners. The end result is not just the recall of a piece of information, obscure as the information might be.
I consider predictions of Watson spearheading cybernetic miracles in medicine to imply just as grandiose a valuation to the technology as the statements I heard two decades ago about the health information technology of the day, or even today, "revolutionizing medicine." That has not happened.
A cybernetic librarian is no physician. As for me, for now I'll stick to people in my own medical care. Let Mr. Kurzweil see the machine for his ailments.
I shall now retire from this thread. I think I've said all I can to make my points clear.
Logical fallacy: Appeal to authority.
Really, you disappoint me. You come in here, accuse two of my oldest and most reliable commenters of various logical fallacies while throwing about your apparent favorite logical fallacy yourself, namely the ad hominem.
Then, like Brave Sir Robin, you bravely, bravely run away.
#37 Orac
You have committed a logical fallacy yourself: Burden of proof.
Burden of Proof is a fallacy in which the burden of proof is placed on the wrong side. Another version occurs when a lack of evidence for side A is taken to be evidence for side B in cases in which the burden of proof actually rests on side B. A common name for this is an Appeal to Ignorance. This sort of reasoning typically has the following form:
1. Claim X is presented by side A and the burden of proof actually rests on side B.
2. Side B claims that X is false because there is no proof for X.
Since the commenter I was writing about remains anonymous, I think the burden of proof rests on you and them to prove they have no COI's affecting their views on the medical literature.
You yourself have also deflected the discussion from the main topic - binary thinking and strawman arguments about my views as being "totally opposed to the medical literature."
Learn some nuance, man!
Re: #40
Appeal to authority?
Orac, on the topics I write about, I am an authority.
I don't think referencing my own writing is an appeal to authority. It's an appeal for others to actually read before they opine.
Interestingly, I am quite well aligned to the overall views of your blog. That is, "on the miscellaneous ramblings of a surgeon/scientist on medicine, quackery, science, pseudoscience, history, and pseudohistory." I am quite the anti-quack; my specialty is debunking the healthcare IT quacks and pseudoscientists.
A simple read of my views such as here: http://hcrenewal.blogspot.com/2008/12/21st-century-plague-syndrome-of.h… would have been beneficial. But I was not asked to clarify my WSJ post. Instead, I was attacked in post # 26, despite being non-anonymous.
That, sir, is a disappointment.
S.
You may have written all kinds of stuff over many years. You may have the vocabulary of logical fallacies down pat. You do, however, have a problem with basic rules of grammar. Maybe that explains your lack of clarity.
Re: #43
Mr. McNeely,
your point is puerile and irrelevant.
One notes that you don't address your use of the pharma shill gambit, which is a form of ad hominem and poisoning the well. Apparently logical fallacies are good for you but not so good for anyone else, eh?
As for your being aligned with the values of this blog, I would argue that you have a way to go to reach that point given that you have used the pharma shill gambit based on no evidence. That gambit is one that I frequently mock ruthlessly--and with good reason.
As for Dangerous Bacon "attacking" you, really? Seriously? God, man, thicken your skin! That was really mild.
Guilty until proven otherwise?
A nice way to say "if you disagree with me, shut up".
As I've been reminded by many friends and foes alike, the usage of big words to convey simple points says more about you than you realize. I quick psychoanalysis of your postings indicates a person with an ego that far outweighs his contributions and most likely suffers from significant performance anxieties. You project those personal failures onto others, most likely those you work with, and so you are ostracized. You're probably a job hopper, someone with a long CV and you've convinced yourself that it is a positive attribute.
Your ignorance and inability to compromise are indeed factors that make you unlikable even in most social settings, but you never let that stop you from butting into situations far beyond your personal experience or expertise.
Your posting in the WSJ indicates that you seek confirmation from others. I'd likely contribute this to a poor relationship with your father, and you're probably a middle child with few years between you and your younger sibling(s).
Bullshit. Burden of proof. You keep using that term. I do not think it means what you think it means.
You made the insinuation that the person in question is a pharma shill first. The burden of proof is on you.
Also, what Heliantus said.
Seriously, the pharma shill gambit is a favorite gambit of quacks. Why are you using it so unapologetically?
Scott Cunningham @29
Sorry Scott, I was agreeing with you. I got the sarcasm. I probably should have said "Exactly" instead of "Right." Ah well.
Followed by almost immediately by a further plethora of comments. That has to be the most egregious failure to stick the flounce that have ever seen.
The fact that you think that demonstrates that, while you can copy and paste from Nizkor, you don't actually understand what you're copying.
If Prometheus, the poster you slandered, had made an argument from the authority of his neutrality, it might have looked something like this:
"I, Prometheus, believe X-Y-Z.
"I, Prometheus, am unencumbered by any conflicts of interest.
"Therefore, because I am a party without any conflicts of interest, you should believe even more than you ordinarily would that X-Y-Z is the truth."
If he had made an argument such as that, where his neutrality served as one of the premises of the argument, then the burden of proof would be upon him to prove his premise.
But as anyone can tell by simply reading what was written, it was not Prometheus but you who tried to build an argument on the issue of Prometheus' entirely hypothesized-by-you conflicts of interest. Your argument amounted to:
"Prometheus thinks my arguments are poorly reasoned.
"But Prometheus is almost certainly a corporate sockpuppet; I can just tell by the 'feel' of his writing. (And even though I'm slandering him by alleging such a serious charge without any sort of evidence, let alone proof, I'll claim it's actually charitable of me to impugn his honesty, because the alternative is that he really doesn't agree with me - and who can imagine anything worse than being as stupid as you'd have to be to not agree with me?)
"Therefore, because Prometheus is a corporate sockpuppet, you should treat anything he claims with suspicion and disbelief."
When you are the one making an extraordinary claim as a premise of an argument (and yes, "X must be criticizing my arguments because a big corporation is paying him to do so" is a pretty extraordinary claim) you are the one who has the burden of proof. It is not the responsibility of Orac or Prometheus or anyone else to disprove whatever slanderous smear you can hurl, just because you can hurl it.
And that's only scratching the surface of your mistakes in just this one matter. Really, Mr. Silverstein, it's positively embarrassing to read you smugly prattling on, copy-pasting descriptions of logical fallacies while demonstrating no understanding of actual logic. Have you never heard of ad hominem circumstantial? Did it ring not even the tiniest bell in your consciousness (or perhaps conscience) that you were demanding proof of a negative? Honestly, you should really get yourself an introductory logic textbook and devote some time to going through it thoroughly. It's worth the effort for its own sake, and as a side benefit you'll look less foolish.
@MIMD (Scot Sliverstein)
With respect to your WSJ letter about Ray Kurzweil's op-ed, congratulations: You just successfully argued with an idiot. Kurzweil loves to make these grandiose predictions, the vast majority of which are total BS. In the 1950s he would have been predicting that we'd have flying cars by the year 2000.
The people who worked on Watson have a far better handle on what it and its descendants are or will be capable of. There will be a role in medicine -- not replacing a physician's judgment, but supplementing it. It's becoming more difficult every day to keep up with changes in medicine, and searching the literature is a skill that most family practitioners lack, and don't have the time to develop. Being able to find information based on a vague question or confusing symptoms would be a boon to almost any doctor. Revolutionary? Probably not.
*sniff* Another drive-by. Were we supposed to be so stunned by your brilliance that we just accepted everything you said? I notice that your promised retirement lasted one whole comment.
Sorry, bub, it doesn't work that way. "Authority" is something granted to you by others, based on the quality of what you write or say or do. While the blog post you linked to was interesting, I didn't find it compelling. Possibly the diversions into ham radio and sunspots had something to do with that.
On what you write, you're not an authority. You're just another random blowhard until you establish your bona fides. (Some friendly advice: Coming onto a blog and insulting long-time commentors is not a great way to establish those bona fides. People don't usually respond well to "You're idiots and I'm smarter than you.")
I would be very surprised if any single study of alternative medicine cost "billions of dollars".
I've always thought these vastly inflated claims stem from their "Cargo-cult science" attitude.
Proper pharma companies spend a vast amount of money getting one product to market, that cost incorporates the failed and nearly made it to market.
Most of the established alt-med remedies could probably be started at phase II "Controlled clinical studies conducted to evaluate the effectiveness of the drug for a particular indication or indications in patients with the disease or condition under study and to determine the common short-term side effects and risks." (From http://clinicaltrials.gov)
Wow, Dr. Silverstein, very impressive. You're a massive fucking moron, yet you manage to write so much.
Dr. Silverstein berates me for asserting without citation that only a small part of the medical literature is "contaminated". I suppose I must plead mea culpa. I note, however, that Dr. Silverstein has also claimed - indirectly - that the medical literature is massively contaminated by "conflict of interest", fraud and corruption without - to my knowledge - citing his sources. I await enlightenment.
As for my own conflicts of interest, I must admit that I have a philosophical conflict of interest in that I believe that "conflict of interest" is an over-worked excuse used to ignore studies that one doesn't agree with. I also believe (without rigorous support) that the medical and scientific literature is largely free of deliberate manipulation of data. Those are my conflicts of interest, apart from having an NSF grant and having received AHA and NIH grants in the past.
Oh, and I snagged a free pen from the Merck representative at a conference two years ago. I guess than makes me a "Pharma Shill", too.
Dr. Silverstein also accuses me of committing the "Hasty Generalisation" fallacy when I point out that Drs. Oz and Weil - both "well-trained" physicians - are not good sources of medical advice. That would have been the case if I had said that since Drs. Oz and Weil are woo-friendly that every physician is woo-friendly, which I not only didn't say but is also not true. (That's one "Straw Man" fallacy on your book, Dr. Silverstein)
My point, as several people (except Dr. Silverstein) noted, is that it is well known (and documented) that some physicians give outdated, unsupported or outright false medical advice. As a result, we should be just as skeptical of physician advice as we are of the medical literature. In fact, I would argue that since advice from a "well-trained" physician is not subject to peer review and is not public (and therefore not subject to rebuttal by letters to the editor and other studies), it is even less reliable than the medical literature.
Dr. Silverstein expresses his profound disappointment in me (and others) by saying:
Perhaps it also doesn't need to be spelled out that a "well trained physician" may have learned all of these things, may be capable of doing them, and yet may not practice them. Surely, Dr. Oz and Dr. Weil, graduates of prestigious medical schools, know how to read and evaluate the medical literature and can tell a supported hypothesis from moonbeams and fairy dust, but they still promote medical "therapies" that are utter nonsense (i.e. unsupported by or contradicted by the available data).
So, without supposing that we are able to see inside a doctors' heads and know whether they are using the skills they have learned, how is a person to know whether their "well trained physician" (based on credentials) is actually "dealing" with the medical literature and its flaws?
As a result, it is simply prudent to regard the pronouncements of a physician (well-trained or no) as suspect if they conflict with the medical literature. In fact, it is probably a good general rule to be skeptical about anything a physician says. That doesn't mean that you don't believe them or follow their advice, just that you need to consider the possibility that what they say isn't supported by data.
I realise that Dr. Silverstein has announced that he will no longer return to this den of skepticism because of his profound disappointment (that we didn't just blindly accept his "expert opinion", perhaps?), but I hope that other people with more open minds will read this and give it heed.
Prometheus
Of course, it could be claimed that obviously Drs. Oz and Weil must not be "well trained" after all, but that would simply be a No True Scotsman fallacy.
Beamup,
Logic and logical fallacies must not be a part of Dr. Silverstein's "expertise", since he has failed to correctly state several of them, not the least of which was when he accused me of "hasty generalisation" when what I had actually done was show that his generalisation of "well trained physicians" was faulty (the "if there is a single black sheep, all sheep cannot be white" proof).
There is a sort of circular reasoning in Dr. Silverstein's assertion that a "well trained physician" is better than all the world's medical literature. As I tried to express above, the trick is knowing which of the "well trained physicians" are actually practising what they learned in school/residency.
His rejoinder was to assert that only an idiot wouldn't know that when he said "well trained physician" he meant someone who didn't ignore their training and follow the woo-wagon (like Drs. Oz and Weil). To paraphrase Dr. Silverstein:
Of course, without knowing the medical literature and how to interpret it and understand its potential flaws and limitations, patients have no way of knowing whether their particular "well trained physician" is using evidence-based medicine or just making it up as they go along. So how, exactly, is the average patient to make this determination? Dr. Silverstein gives us no clue.
Maybe it's like art - he knows it when he sees it.
Prometheus
There are a lot of studies on alternative medicine done to the highest standards available, they are findable, you can do the research (but you haven't). They also cost millions to billions of dollars. Because you cannot patent naturally occurring substances, there is no money to pay back doing
Blatant Spammer:
If you make a claim, you are expected to produce the evidence. Did you forget that?
If you wish to be taken seriously then post the journal, title, date and authors of the papers that support your claims.
The anti-cancer drug Taxol, derived from the bark of the Pacific yew tree, was patented. (The company which bought the patent later lost it due to patent abuse, but that's a different matter)
"Because you cannot patent naturally occurring substances, there is no money to pay back doing"
Blatant Scammer forgets morphine, digitalis and quinine...to name just a few more drugs from "naturally occurring substances."
Aspirin too. And many, many other drugs that originally came from plants and had the theraputic ingredient isolated, refined and dosage controlled to improve efficacy and decrease side effects.
And to say that Orac or any of us hasn't looked for these studies on alternative medicine done to the highest standards available, they are findable, you can do the research (but you haven't). They also cost millions to billions of dollars. is really funny. I needed the laugh today so thanks, Natural Acupuncture Berkeley, for the laugh.
MI Dawn
As a result, naturopaths can (and do) prescribe antibiotics, statins, anti-depressants, etc...all the evil drugs their "profession" claims to reject. It seems - to me, at least - to be a clear failure of their loudly proclaimed faith in "natural" remedies.