White Coat Underground

Science is hard. It often requires us to put aside our beliefs and preconceptions to more accurately understand how the world works. But it is not in any way unimaginative. To paraphrase a wildly brilliant guy, every time a scientist formulates a hypothesis, she must imagine a different world. It can be a very creative process.

We advocates for science are often accused of being unimaginative and uncreative. This is false. We are also accused of being closed-minded. This is false. But it is also true. Scientists are very skeptical. To quote one of our regular readers:

To state the good ideas one embraces is not enough. One must explain what is rejected and why. Science is not a method for accepting what is true. It’s a method for rejecting what is false. So what therapies…do you reject? What standard do you use to reject those ideas?

This is a concept that I’ve never stated quite so clearly. It is one that those involved in cult medicine do not understand. To have a clever idea is one thing, but you must have some logical way of separating the wheat from the chaff, and the sorting cannot be done by whim. We’re talking about people’s lives here, and if you offer up homeopathy, say, and your excuse is “well, we don’t have the data yet, but we will some day,” then you do not deserve the honor of serving your fellow human beings.

And it is an honor—an honor and a privilege, and if your default position is not one of compassionate skepticism, you’re going to hurt someone.

Comments

#1 antipodean
April 16, 2009

Nice post, dude.
#2 Whitecoat Tales
April 16, 2009

And it is an honor—an honor and a privilege, and if your default position is not one of compassionate skepticism, you’re going to hurt someone.

This

My thoughts
#3 Joe Average
April 16, 2009

Nice post. Now for a reality check. Dental Fluorosis and Skeletal Fluorosis are on the rise affecting nearly one in 3 Americans.

Fluoride is a known treatment for Hyperthyroidism, as it depresses thyroid function.

Fluoride drugs cause Fluoride poisoning. Drugs like Cipro, Baycol, Fen-Phen, Fluconazole, Celebrex, etc… These drugs are very commonly prescribed, and seem to all have the same side-effects.

http://en.wikipedia.org/wiki/Fluoride_poisoning

You’re a scientist, why don’t you investigate this one… that these all cause the same side-effects, and may affect as many as 1 in 6 people (depending on dosage/concentration)(depending on a lot of factors)(ie Iodine Deficiency)(fluoride-rich diet).
#4 Ahcuah
April 16, 2009

The way I’ve always thought about the whole process of science was, “What would make you change your mind?” If there is nothing that would do so, then you are not doing science.

And preferably, you commit to this before the data is in, and then if the data really does show you ought to change your mind, you actually change your mind. (We can see this in the autism/vaccine folks: there is nothing that will make them change their minds. For scientists, though, if there were actually well-designed studies that showed a link, then minds would be a-changin’.)
#5 Joe Average
April 16, 2009

The science of Autism is getting better. Looks like heavy metals and/or fungal infection is one cause. A variety of causes… but these doctors seem to be putting together some good science on the topic of Autism.

http://www.metametrix.com/content/LearningCenter/CaseStudies/384.html
http://www.metametrix.com/resources/content/LearningCenter/CaseStudies/GI-Effects-Autistic-Child-Case-Study.pdf

Note: the naturopath pseudo-doctors like Hulda Clark have been saying this for 20 years. Sometimes you can learn alot from these guys, even if their mechanisms are wrong.
#6 Whitecoat Tales
April 16, 2009

Joe-

a) There is no science there.
Thats 2 case studies.
b) Those are some god awful writeups. they are deficient in every possible way.
c) They don’t show causes of autism. They don’t even show fungal infections or heavy metal poisoning in autism.
#7 Blake Stacey
April 17, 2009

“You know when fluoridation first began? … Nineteen hundred and forty-six. Nineteen forty-six, Mandrake. How does that coincide with your post-war Commie conspiracy, huh? It’s incredibly obvious, isn’t it? A foreign substance is introduced into our precious bodily fluids without the knowledge of the individual. Certainly without any choice. That’s the way your hard-core Commie works.”
#8 Dr Benway
April 17, 2009

Joe Average, what synchronicity! The fates must be guiding us both.

I was reviewing some rather odd lab reports from Metametrix just yesterday. I noted a reference to Medical Hypotheses on the printout.

This prompted me to invent the Titmouse Law.
#9 Michael Simpson
April 17, 2009

Joe Average…Wikipedia??? No, please please please, don’t use that misguided anarchy for information on anything controversial. There are one or two medical articles of decent value, but most of the controversial ones, e.g. homeopathy, are rife errors and bias towards fringe ideas, because the goal is consensus and keeping everyone happy instead of great and accurate writing.

I read articles like Orgone, and I’m convinced that Wikipedia is just plain garbage.

I apologize in advance for hijacking the thread to Wikipedia. It’s just that I think the place gives us more pseudoscience per megabyte than Jenny McCarthy.
#10 Joe Average
April 17, 2009

“I think the place gives us more pseudoscience per megabyte than Jenny McCarthy”
– Wiki is flawed, but well-sourced and neutral. As for Jenny McCarthy, that’s a nice high profile case… case # 3… her son was treated by a naturopath for heavy metal poisoning plus antifungals. Now she wants to raise $100 million to put this therapy through clinicals.

I agree that Jenny McCarthy is a bad source for medical information; she’s a bit nuts. However, there is nothing wrong with studying how people cured their diseases, looking for common patterns, verifying with scientific data and good medical tests. Testing for fungus and heavy metals in Autism doesn’t seem like such a bad idea.
#11 Joe Average
April 17, 2009

Let’s look at the statins. A nice 0.3% cure rate for heart disease, with 1 in 6 patients having side-effects. For every 1 person helped, 63 people will get side-effects.

Do Cholesterol Drugs Do Any Good?
http://www.businessweek.com/magazine/content/08_04/b4068052092994.htm
http://www.businessweek.com/magazine/content/08_04/b4068052095204.htm
statins – NNT 500+ to prevent death or serious medical conditions

Crestor Study – new study cited by Wikipedia article:
http://www.washingtonpost.com/wp-dyn/content/article/2008/11/09/AR2008110900852.html?hpid=topnews
17,802 – 31 heart attacks in the statin group vs. 68 in the placebo group

Note: that is 31 out of 8900 vs. 68 out of 8900
0.35% vs. 0.76%
**********

http://en.wikipedia.org/wiki/Atorvastatin
“Headache is the most common side effect, occurring in more than 10% of patients.”

http://www.businessweek.com/magazine/content/08_04/b4068057096279.htm
“But many doctors believe they are more common in the real world, afflicting perhaps as many as 15% of patients.”
#12 Dr Benway
April 17, 2009

Testing for fungus and heavy metals in Autism doesn’t seem like such a bad idea.

When patients cannot consent to their own treatment, we need a high degree of confidence that the benefits outweigh the risks, even for experimental therapies.

Nystatin is not benign. Chelation is not benign. The prior plausibility for chronic candidiasis or heavy metal poisoning as a cause of autism is nearly zero.

Chronic candidiasis has never been proven to exist. The heavy metal poisoning of the alt med community is typically a non-falsifiable (and thus non-scientific) hypothesis.
#13 Joe Average
April 17, 2009

Now my point in coming here to post wasn’t to throw stones. It’s not good guys vs. bad guys. Medical Doctors are miracle workers. Naturopaths are wonderful too. They sometimes cure the impossible diseases. My point is to foster a little bit of collaboration.

Any moron like me can nitpick at one group of Doctors or the other. Collaborate and Learn is my message.
#14 Joe Average
April 17, 2009

“Chronic candidiasis has never been proven to exist.”
– What is this nonsense? This is a key difference between a Naturopathic Doctor and a medical doctor. A naturopathic doctor assumes that if your medical doctor can’t cure your illness it may be some type of fungal infection.

Chronic Mucocutaneous Candidiasis: A Case Report.
http://medind.nic.in/jao/t04/i1/jaot04i1p21o.pdf

Candidiasis, Mucosal
http://emedicine.medscape.com/article/1075227-overview

Oral candidiasis
http://dermnetnz.org/fungal/oral-candidiasis.html
“Chronic atrophic candidiasis. This is common in those with dentures.”

http://en.wikipedia.org/wiki/Angular_cheilitis
“Although the disease has an unknown etiology, the sores of angular cheilitis may become infected by the fungus Candida albicans (thrush), or other pathogens.”

That being said, it must be recognized that there are over 100 different strains of Candida (Albicans, Tropicalis, Glabrata, Krusei, etc…), and 100 different pathogenic fungus’s that can infect people.
#15 Michael Simpson
April 17, 2009

Joe Average said:

Wiki is flawed, but well-sourced and neutral.

No, it isn’t, because it is cluttered with cruft. The pseudoscience crowd edits with a few citations of dubious value. I pointed out Orgone as one, where editors make it appear as if the force actually exists, when science clearly has concluded it doesn’t. There are so many other articles where specious medical claims are made based on weak sources, or where inappropriate conclusions.

Joe Average said:

there is nothing wrong with studying how people cured their diseases, looking for common patterns, verifying with scientific data and good medical tests. Testing for fungus and heavy metals in Autism doesn’t seem like such a bad idea..

This not how science works. You establish a hypothesis, one that was built from years of research, and test it. “Fungus causes autism” is not a hypothesis, because it’s no different than saying “UFO abduction causes autism.” Science is not driven by random theories, but instead, theories are built on years of scientific research. In the case of autism, one must develop a theory based on the basic science of cells, biochemistry, genetics, whatever it is. Simply stating that I observed a fungus here and autism there is not a basis of anything.

Joe Average said:

Naturopaths are wonderful too. They sometimes cure the impossible diseases.

Really? When? They haven’t.
#16 Joe Average
April 17, 2009

“Chronic candidiasis has never been proven to exist.”
– Let’s reword this a little. Certainly there is a medical disease known as Chronic Mucocutaneous Candidiasis. I mean you don’t have to look very hard:

Chronic Mucocutaneous Candidiasis: A Case Report.
http://medind.nic.in/jao/t04/i1/jaot04i1p21o.pdf

(This affects animals as well)
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/200700.htm
“Candidiasis is a mycotic disease of the digestive tract of chickens and turkeys caused by Candida albicans.”

Not to put words in your mouth, but I think what you meant to says is that no clear pathogenesis for candida has been established. People with this problem seem to have a whole host of varying symptoms. There is a lot of ongoing medical research into this pathogen.

On candida, I can talk intelligently on this one, with solid medical studies, if anyone is interested. I can talk about the different Antifungals (ie. Nystatin), clinical effectiveness of treatments. I have a wealth of scientific information on this if people are willing to listen; I also understand that criticism comes with the territory, especially on a controversial topic like Candida.
#17 PalMd
April 17, 2009

Um, no Joe, you’re wrong about this one, too. Candida certainly can cause human disease, just not the ones quacks attribute to it. It can cause common thrush and common vaginitis. It occasionally causes invasive disease such as infective endocarditis. It is NOT the cause of “a whole host of varying symptoms.”

Candida is common enough that almost all of us have a positive immune amnestic response to it—it’s used as a control to check for an intact immune system.

People who blame candida for the shpilkes are very, very wrong.
#18 Denice Walter
April 17, 2009

What I “like” about woo: 1. how so-called theorists get what *they* think is a “clever idea” and then immediately start construction on a Rube Goldberg-type contraption, built of bits and pieces of “found” concepts,assembled *en pastiche*,to arrive at some desired endpoint.Start with some biochemistry, add a pinch of physiology, don’t forget the physics, and hey, while you’re at it,why not some comparative religion:*for balance*?2.How some of these “theories” become baroque, nigh unto *rococo*, in their elaborative structure-a veritable Byzantine imbroglio of interchangeable parts.Think of the creativity!3. How woo follows discernable trends, as does fashion.Right now, I think mitochondria are so very “in”, while candidaisis is well, *passe*, too “’90′s”…. If only we could view woo as art or entertainment or fiction(think of it as science fiction, literally) it could actually be enjoyable.However, there are a few things that spoil it for me:it harms people, enriches charlatans, and encourages disrespect for science and medecine.BTW, I really *don’t* like woo.
#19 Joe Average
April 17, 2009

“Rube Goldberg-type contraption”
– Open to all: here is one proposed scenario, on the pathogenesis of Candida-related symptoms (which I agree are not established).

How do you grow candida in a lab? What does it eat?
B-1, B-3, B-6, Biotin, Proline, etc…

Let’s assume a bloodstream infection, causing these specific water-soluble b-vitamin deficiencies. What would be the symptoms associated with that?
#20 Dr Benway
April 17, 2009

Joe, if you have candida in your blood stream chomping on your B-vitamins, you likely won’t live long enough to care.
#21 PalMD
April 17, 2009

What Dr. B said. If you have invasive candida disease, you’re in big fucking trouble. No amount of detoxification is going to help you.
#22 prolix
April 17, 2009

The normative approach to defining science went out of favor in the 1960′s and was replaced with the historical / sociological approach. Science is what the scientific community does. The quote you cite sounds like an exaggerated version of Popper. Science does much more than falsify hypotheses. It makes predictions, generates new hypotheses, gives explanations, clarifies by developing simplified models, and so on.
#23 Dr Benway
April 17, 2009

Prolix:

The normative approach to defining science went out of favor in the 1960′s and was replaced with the historical / sociological approach.

Human fashion trends are as irrelevant to the fundamentals of the scientific method as they are to fundamentals of arithmetic.

Science is what the scientific community does.

Not always. Sometimes they eat lunch or tell jokes. And sometimes non-scientists use the scientific method to solve problems.

The quote you cite sounds like an exaggerated version of Popper.

“Sounds like” is associative. Associative categories tend to be unreliable and useless for science. BTW, I did not signify that I was quoting anyone. I wonder why you assumed so.

Science does much more than falsify hypotheses. It makes predictions…

Specific predictions arising from hypotheses are opportunities for falsification.

… generates new hypotheses

Yes, all humans generate new hypotheses. However, we are under no obligation to take any new hypothesis seriously until it has survived some attempt to prove it false.

… gives explanations

“Explanation” in science can be a synonym for “hypothesis” or “set of related hypotheses” or “proven fact,” in the case of well-tested, well-corroborated hypotheses.

…clarifies by developing simplified models…

“Models” is a synonym for “hypotheses” (see above).

… and so on.

“And so on” is not informative.

Nothing you have said breaks the outline of methodological naturalism I provided.

Your puzzling argument seems to take this form: “Bakers do so much more than merely bake things. They also make cupcakes, loaves of bread; they whip up batter for cakes, create new recipes for cookies, and so on.”

Kinda goes without saying, no?
#24 Joe Average
April 17, 2009

“Joe, if you have candida in your blood stream chomping on your B-vitamins, you likely won’t live long enough to care.”
– It’s a little tricky, but you’re right. The body has some natural defenses against yeast. ie. Lactoferrin, Histatin, natural antifungals in food, etc… If the yeast is growing faster than your body can kill it, you are in big trouble (ie. invasive candidiasis). Even with antifungals and good medical care.

There are usually predisposing conditions though, like a cancer or aids. I’m sure having staph(a common cause of food poisoning) plus a candida problem isn’t very helpful(opinion).

But there is some other factor that turns this normally benign infection deadly:

Virulence factor that induces fatal Candida infection identified
http://www.innovations-report.com/html/reports/life_sciences/report-114764.html

There is a brain fog/add/depression symptom that is anecdotally reported by many candida sufferers. Theoretically, a B-1 deficiency could explain the brain fog. There are many anecdotally reported symptoms that seem to match with B-vitamin deficiencies.
Note: this brainfog is an unproven symptom; as are all candida-related symptoms. However, anecdotally, some people cure their candida problem and their spurratic brain fog goes away.

Symptoms of Vitamin B deficiencies:
http://en.wikipedia.org/wiki/Vitamin_B
http://en.wikipedia.org/wiki/Dementia

Another uncommon symptom of fungal infections is fungal arthritis:
http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1005712&pageindex=1

Fungal Arthritis:
http://www.nlm.nih.gov/medlineplus/ency/article/000444.htm

If a fungus is hitting your joints, then it must have hit your blood at some point (bad cold… something)(the cold goes away, and the problem is localized)(opinion).
******
Note: I have a lot of opinions in here combined with some science papers. There are alot of things to comment on. My next 2 posts will be on the problem with anti-fungal drugs, followed by the miracles of anti-fungal drugs.
#25 rb
April 17, 2009

something that woo propagators wouldn’t appreciate…this quote from Huxley:

The great tragedy of science – the slaying of a beautiful hypothesis by an ugly fact.
Thomas Huxley

of course he doesn’t really mean that this is a tragedy, it is the beauty of science, that you can (must) often give up your lovely beautiful hypothesis when the data comes in.
#26 Dr Benway
April 17, 2009

Prolix,

I’m apparently talking to you in the wrong thread. I’d made a point about falsification somewhere else which got quoted here. I got distracted and assumed I was there. However I am here, where my post is not.

Sorry for the confusion.
#27 prolix
April 17, 2009

if you offer up homeopathy, say, and your excuse is “well, we don’t have the data yet, but we will some day,” then you do not deserve the honor of serving your fellow human beings.

Who decides how much data is enough and what counts as valid data? People have a curiously fluid idea on the matter, depending on if the data supports their own viewpoint. In any case, homeopaths have come to a conclusion on the subject and if they must endure the criticism of the allopaths who have concluded differently, well, they have done so since the days when allopaths were dosing their patients with mercury.
#28 prolix
April 17, 2009

Human fashion trends are as irrelevant to the fundamentals of the scientific method as they are to fundamentals of arithmetic.

I look forward to you laying out the fundamentals of the scientific method when a generation of philosophers have failed (see the history of logical positivism). That is, if your fundamentals are anything more than the usual platitudes.
#29 Whitecoat Tales
April 17, 2009

allopaths were dosing their patients with mercury.

The difference being, allopaths stopped dosing with mercury, homeopaths still dose sugar water.
#30 Joe Average
April 17, 2009

“This not how science works. You establish a hypothesis, one that was built from years of research, and test it.”
– I will bite on this one, knowing that I shouldn’t. Learning is pattern recognition. Science is establishing a methodology to test these patterns objectively. “Years of Research” is a measurement of time, and has nothing to do with science (even if science is slow, sometimes). I mean you can spend years trying to prove a false hypothesis, that sugar cures cancer. And then you can switch directions since this didn’t work. That being said, I recognize that even if you have proven a hypothesis true to yourself, convincing others often takes years(non-medical-specific)(any discipline).
#31 Michael Simpson
April 18, 2009

Joe, I find it difficult, if not impossible, to engage in discussion when it appears that you just write a bunch of words that more or less follow good sentence construction, but makes no sense. Science is actually a philosophy of studying the natural world, that has several steps. Since you are so enamored of Wikipedia, I suggest you read their marginal article there.

What pattern recognition might have to do with this is beyond me, but honestly, it’s 0117 in the morning, and my brain might need a homeopathic potion, as long as that potion is a Starbucks coffee.
#32 Whitecoat Tales
April 18, 2009

I think Joe just failed the Turing test.
#33 PalMD
April 18, 2009

I think Joe just failed the Turing test.

/spit take
#34 Jennifer B. Phillips
April 18, 2009

The fact that Joe keeps talking about ‘proving’ hypotheses tells me all I need to know about his understanding of science. While the Turing test results have yet to be confirmed, ‘garbage in, garbage out’ applies either way.
#35 Dr Benway
April 18, 2009

Do naturopaths develop comprehensive differential diagnoses at any point?

What’s the differential for anxiety attacks, for example?
#36 Michael Simpson
April 18, 2009

Dr. Benway, well you and I know they can’t do a differential diagnosis, because they haven’t been trained to do so. And to be a good diagnostician takes years of practice.

Joe Average is trying to a make a point on something, I just don’t know what it is.
#37 Abel Pharmboy
April 20, 2009

And while allopaths no longer use mercury, science-based medicine was used to seize upon the traditional use of arsenic compounds in two traditional Chinese remedies. A thorough investigation of these remedies in controlled clinical trials in China in the early 1990s led physicians in China, Japan, Canada, then the US to introduce arsenic trioxide (Trisenox) for the treatment of some leukemias and it is now being investigated for multiple myeloma.

The difference today is not only that allopathic medicine has the open-mindedness to discard therapies no longer useful or obsolete, but that we are also willing to consider traditional medicines with science- and evidence-based utility.
#38 The Blind Watchmaker
April 21, 2009

Let’s get back on track. This post is really about the philosophy of science.

Much misunderstanding comes from the incorrect assumption that science is about proving things. This is not what happens. It actually is about disproving things (or “rejecting” ideas that are shown to be false).

If I have a hypothesis, what I actually test is the opposite of my hypothesis, ie “the Null Hypothesis”.

Let’s say I think that Native Americans descended from the Middle East and therefore are closely, genetically related to Middle Easterners (sorry to those Mormons out there). I cannot actually prove this. I can however form the null hypothesis. This would be that Native Americans are NOT from the Mid East and are not closely related genetically.

I can then do genetic studies. In this case, the studies would be more in line with the Null hypothesis. I would therefore Accept the Null hypothesis and consequently reject my original idea. If genetic testing actually showed a close relation, I would Reject the Null hypothesis, and my idea would live on to undergo more testing.

This whole process does not allow us to really prove ideas, but merely to either reject them or accept them until better ideas come along. The more Null hypothesis can be rejected, the stronger the idea becomes as a model of the “truth”.

I’m not sure who said it, but I think the saying goes something like…”Proof without certainty is science. Certainty without proof is dogma.”