Well, I won't back down
No, I won't back down
You can stand me up at the gates of hell
But I won't back downGonna stand my ground
Won't be turned around
And I'll keep this world from draggin' me down
Gonna stand my ground
And I won't back downFrom I Won't Back Down by Tom Petty, 1989
On Friday, I wrote a rather long post about the whole issue of "framing" science and the issue of anti-vaccine activism. In essence, I tweaked Matt Nisbett and Chris Mooney to give those of us in the trenches fighting the antiscientific belief that drives antivaccinationism some tools, some "frames," to use to combat the dangerous nonsense that has driven vaccination rates lower and provoked the resurgence of measles in the U.K. and the U.S. Over the weekend, though, I got to thinking about this issue (again, always a dangerous thing), and I realized that antivaccine activism is but a symptom of a broader problem in medicine, mainly the increasing tendency for modern medicine to embrace pseudoscience and for society to accept it.
Writing that post led me to harken back to a couple of posts that I did a few weeks ago that called, tongue-in-cheek, Resistance Is Futile, Part 1 and Part 2. It turns out that I took some criticism for those posts, especially the first one. It has indeed been insinuated in some quarters that they were indications of despair, that I had given up. Add to that the further pessimistic post that in essence asked for help from people who are science communicators who have made their name proposing better means of communicating complext science to society, and it was not entirely unreasonable that some perceived my attitude to be one of defeatism or of surrender.
Nothing could be further from the truth.
After all, if it is true that "resistance is futile" and we have already lost, why bother blogging vitually every day about science- and evidence-based medicine? My traffic, although only around 1/10 of Pharyngula's (on a good day for me and a bad day for P.Z.), is still--shockingly to me--among the highest in the medical blogosphere; I have to believe that I'm having an effect somewhere. The problem, of course, is that I'm putting my at most a few thousand readers a day against the millions and even billions influenced by "complementary and alternative" medicine (CAM). Even if you add up every skeptical medical blogger, from me to Steve Novella, to Doctor RW, too Denialism.com, Quackometer, Aetiology, and everyone else, compared to society and the mass media it's all still just a drop in the bucket, pissing in the wind, or whatever other metaphor you want for any action that is so overwhelmed by opposing forces as to seem utterly futile.
Sadly, of course, there are many reasons to be pessimistic. There's no way of getting around it. By any measure you care to name, scientific medicine is presently losing the war against quackery at every level. Advocates of scientific medicine are outnumbered, outfunded, and outmaneuvered, while the vast majority of medicine and--this is what really galls me--even academic medical faculty remains apathetic. Woo is infiltrating the most prestigious academic medical centers without almost no resistance from those of us who believe that medicine based on a firm background of science represents the best patient care and the best hope for the develpment of new treatments.
Consider:
- As both Wally Sampson and Kimball Atwood have pointed out on the blog Science-Based Medicine, advocates of unscientific medicine have cleverly coopted the very language of science and medicine, turning it against those who would resist the infiltration of pseudoscience, while lamenting how accepting we as the medical profession have become towards pseudoscience. What once was "quackery" is now merely "unconventional," and extreme lack of scientific plausibility for a treatment modality seems no longer to be a barrier to clinical trials.
- The federal government has hobbled the FDA and in essence given free rein to supplement manufacturers to make almost any dubious health claim they wish, as long as the claim is sufficiently vague, through the passage of the DSHEA of 1994. Meanwhile legislators such as Dan Burton and Ron Paul lobby aggressively for "health freedom" laws that would in essence inoculate quackery from prosecution and allow quacks to operate without any pesky interference from the FDA or FTC.
- Due to high profile cases where state child welfare agencies have attempted to strip parents of custody of children with cancer to prevent them from choosing quackery over scientific medicine for their child, ill-advised laws, such as "Abraham's Law" in Virginia, have been passed that in effect strip protections against quackery from teens and older children unfortunate enough to have parents who believe in unscientific medicine.
- As I and others have pointed out, quackery has infiltrated academic medicine to such an extent that not only are many of our major academic medical centers dedicating divisions, centers, or departments to what Dr. R. W. Donnell has termed "quackademic medicine," but at least one has required it as part of the mandatory medical school curriculum from day one, bringing a whole new meaning to the term "integrative" medicine, as it integrates scientific medicine with pseudoscientific quackery.
- Meanwhile, Dr. Andrew Weil has succeeded in "integrating" pseudoscience into the eight family practice residencies, with more virtually guaranteed to follow, and Dr. David Katz at Yale has constructed the foundation for an academic empire of woo based on a more "fluid" concept of evidence.
- The Bravewell Collaborative has many millions of dollars to spend promoting unscientific medicine to any medical school or academic medical center willing to receive its largesse.
- NCCAM has a budget of over $120 million a year and has spent over $1 billion so far researching, but also promoting CAM. Worse, it is funding trials that are not only scientifically dubious but arguably downright unethical; for example, the TACT trial of chelation therapy for atherosclerotic coronary artery disease, the trial of the "Gonzalez regimen" for pancreatic cancer, and the proposed trial of chelation therapy for autism. Adding an approximately equal money to the pot of CAM funding is the National Cancer Institute, which funds over $120 million a year worth of CAM research related to cancer.
- Legislatures are passing laws that not only recognize unscientific "healing" traditions as legitimate professions but some states have even mandated that health insurance plans pay for such "treatments."
- Anti-vaccine activists are sowing fear and distrust over vaccines, even going so far as to march on Washington. As a result, in the U.K. measles, once thought conquered, has become endemic again, and in the U.S. measles outbreaks are increasingly common.
- Our government is making deals with China to study "traditional Chinese medicine," possibly as a quid pro quo for the Chinese granting the FDA inspection stations in Chinese cities, possibly as an attempt to control adulteration of Chinese herbal medicines.
Yes, folks, it's bad out there in medicine right now. Real bad. Horribly, bad. So bad that even the usually ever-optimistic Steve Novella recently agreed when Quackwatch webmaster Stephen Barrett characterized the era we live in as the "golden age of quackery and antiscience." There's nothing to be gained for us by pretending otherwise other than perhaps the happy self-delusion of ignorance, and we have to face facts: The situation isn't going to get better any time soon, no matter what we do. In fact, it very well may continue to get worse for the foreseeable future. That's not being "pessimistic." It's being realistic. The forces arrayed against scientific medicine are strong, well-funded, and utterly ruthless about forwarding their agenda, the "integration" of antiscience with science. Maybe resistance is futile. Maybe science is irrelevant. Maybe scientific medicine will be forced to adapt to serve CAM.
To which I reply: Hell, no!
I can speak for no one but myself, while breath remains in me and I can still do something, I will not give up, even though I do not anticipate anything resembling victory in the few decades I'm likely to have left on this earth. The stakes are too high, and future generations will not judge us kindly if we surrender to antiscience with a whimper. In this age of seeming science, where the human genome has been sequenced, where we understand more than at any time in history about how the body works and where things break down, resulting in disease, it is a bitter irony that it is at this very same time that at the same time academic medicine is retreating to therapies based on pre-scientific concepts of how nature and the human body work. Thanks to unprecedented scientific advances in our understanding of disease, we stand at the threshold of what could be a golden age of medicine and surgery. It is prfoundly disturbing to me that we risk undermining all of that.
Regular readers of this blog know that I'm a World War II buff. Indeed, I have been one ever since I was around 12 or so. As a teenager, I used to devour books on World War II history. When I was a teenager I had a simplistic understanding of the war, but as I got older I realized that the situation was always more complex than the simple narrative that we are taught in school. I also now realize that using World War II analogies is fraught with danger in that it's hard not to fall prey to Godwin's Law or sounding as though I had fallen victim to the Hitler Zombie. However, I point out that World War Ii remains a good analogy for not giving up even when things seem utterly beyond redemption.
Think of the world in May 1942, six months after Pearl Harbor. Put yourself in the Allies' place. Europe was in the hands of the enemy, who was rapidly advancing east into Russia, having only been stopped within sight of the minarets of the Kremlin, only to advance on new fronts to the south in the spring. In the Pacific, Japanese forces had driven U.S forces out of Guam, the Philippines, Wake Island, and virtually the entire Pacific west of Hawaii other than Midway Island and Australia. By any measure, the Allies were in deep, deep trouble. I imagine myself alive at that time, beset by a constant barrage of bad news, of loss after loss and retreat after retreat. How could anyone alive at that time believe that the Allies would eventually not just prevail but utterly destroy their enemies less than four years hence? Or picture yourself in London in the fall of 1940, with wave after wave of bombers hitting your fair city and other cities in Britain, pushing the RAF to the brink of destruction fending them off. How could any Londoner alive in late 1940 ever envision total victory less than five years hence?
Of course, the battle we are in is not World War II and CAM advocates are certainly not Nazis (with the possible exception of Ernst Zündel and Dr. Lorraine Day; every movement has its bad apples, I guess), but in terms of whether medicine continues to strengthen its fragile commitment to a scientific basis for its treatments or retreats to the age of Samuel Hahnemann it is every bit as apocalyptic. In terms of the strategic situation, we advocates of science-based medicine are the Allies in 1942, except that we cannot count on a brief battle during four days in June near Midway Island to turn the tide of the war. There will be no sudden reversals. Our task is more akin to the "island hopping" that the U.S. Marines undertook in the Pacific, in which Marines starting with Guadalcanal had to take one little island after another away from the Japanese, than it is to D-Day.
And, yet, despite how badly we are outgunned, outnumbered, and out-spent, there is reason for hope. It is at the moment but a glimmer, but if we can convince enough physicians that there is a serious problem we may have a chance. Particularly heartening to me is that in the last year we have seen something I cannot recall ever seeing before: three major books on alternative medicine that do not represent feel-good, credulous acceptance of the tenets of unscientific medicine. They are not books whose authors you are likely ever to see on The Oprah Winfrey Show any time soon. No, rather they are hard-nosed, skeptical, and they take no prisoners in describing why the vast majority of so-called CAM is nothing more than a demonstration of the power of the placebo effect and all-too-human cognitive shortcomings that all humans, doctors and patients alike, have. I'm referring, of course, to R. Barker Bausell's Snake Oil Science: The Truth about Complementary and Alternative Medicine; Simon Singh's and Edzard Ernst's Trick or Treatment: Alternative Medicine on Trial; and Rose Shapiro's Suckers: How Alternative Medicine Makes Fools of Us All. Moreover, as the popularity of CAM grows and as it infiltrates "conventional" medicine more and more, inevitably its profile will become high enough that even the apathetic physicians may become alarmed as stories of patients who come to harm through quackery come to light. There will be a backlash; indeed, the backlash may have already started. For example, just last month, the FDA, roused out of its torpor for reasons known only to its leaders but nonetheless fortuitously, started an aggressive campaign to stop the selling of fraudulent cancer "cures." Meanwhile, there is a growing and vibrant movement in the medical and scientific blogosphere to counter the pseudoscience that makes up so much of "alternative medicine." Indeed, that may be our last, best hope for ultimately prevailing. All is not lost, but it could be if we allow ourselves to fall into complacency again.
Of course, what the Allies had in World War II were leaders who would not give up, who would not surrender, no matter how hopeless the situation seemed. There was Winston Churchill saying in the darkest depths of the war after the fall of France and the retreat at Dunkirk:
We shall go on to the end, we shall fight in France, we shall fight on the seas and oceans, we shall fight with growing confidence and growing strength in the air, we shall defend our Island, whatever the cost may be, we shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender, and even if, which I do not for a moment believe, this Island or a large part of it were subjugated and starving, then our Empire beyond the seas, armed and guarded by the British Fleet, would carry on the struggle, until, in God's good time, the New World, with all its power and might, steps forth to the rescue and the liberation of the Old.
Where is science-based medicine's Winston Churchill? (No, it isn't me. I can write, but at best I'm a passable public speaker, and no one ever accused me of being particularly inspirational.)
Come to think of it, I'd even settle for science-based medicine's Bluto Blutarski (from one of the greatest comedies of all time, Animal House) asking, "Was it over when the Germans bombed Pearl Harbor?" and confidently rallying the troops by bellowing, "Nothing is over until we decide it is":
That scene from Animal House always cracks me up. In this context, I can't help but think that a Deathmobile for science-based medicine would be an über-cool thing to have, perhaps with the head from a statue of Samuel Hahnemann bolted to its hood instead than the head of Faber. The humor aside, the scene above also has a very cogent message for us: No matter how bad things are, never give up. There is always something that can be done, although in our current predicament as advocates of scientific medicine what should be done probably doesn't involve armor-plating a car, painting it black with skulls on it, and crashing it into the grandstand at a parade. Too bad.
I realize that I've not only painted a very dire picture but probably also gone completely off the deep end with the World War II analogies. No doubt some of the woo-friendly commenters here (and perhaps even some of those on "our" side) will react to this post with the conclusion that Orac has completely lost his friggin' mind--or at least lost all sense of proportion and restraint. But desperate times call for desperate rhetoric. I want you to realize that, as bad as things are now, there is still some reason to hope, but nurturing that hope from a sputtering spark to a roaring flame will require fuel, and that fuel is passion coupled with an understanding not only of what we're up against but the will to act against it. Either that, or I'm bipolar, with my original post being written when I was in a depressive phase and this post being written while I am in a manic phase. You be the judge.
Fortunately, I also don't think that resistance to the infiltration will require that a "really futile and stupid gesture be done on somebody's part," as Animal House tells us in the scene above. Taking the long view, I realize that it may, however, require the proverbial fight with conventional weapons that will take years. It will, mainly, require that advocates of science-based medicine who have until now been keeping their head down become involved and vocal. Too, it will require years, if not decades, of resistance, diplomacy, and, yes, public relations, as much as we hate that term. It will require fighting smart, because that's the only way to win against forces that are so much stronger than us, and it may require us to get our hands dirty in politics. It may require strategic retreats, and it will definitely require that we as advocates of science-based medicine be willing and sufficiently open-minded to embrace any aspect of CAM that is actually scientifically validated, thereby making its strength our strength. Dedication to science and patient care demands no less, because, as I have said many times before, there is no such thing as "alternative medicine," just medicine. Most importantly, however, it will require that we rethink what we are doing, because clearly what we are doing is not working. A major change in strategy is clearly required.
Whatever this battle requires, though, I ask myself and anyone else who is as dismayed as I at the infiltration of woo in medicine: Are we "just the guys to do it?"
Well, are we?
And, if we are "just the guys (and gals) to do it," then what, specifically, are we going to do? We're getting our posteriors handed to us in a sling right now. Something has to change. I don't yet know just what yet (stay tuned), but, as Pete Townsend once so eloquently put it, "The music must change."
If it doesn't, we will lose, and it could be many decades before scientific medicine recovers.
Meanwhile in the UK, homoeopaths are complaining that Edzard Ernst's activities have caused prescriptions for homeopathic preparations by doctors to fall by almost 50% over the last two years:
"GPs shun homeopathy as prescriptions halve"
http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4120112
A good point, Mojo. That shows that the fight can be won, at least in incrememnts.
In any case, a cause that invokes Animal House (and Bluto's speech in particular) as a rallying cry usually gains my support. But since you already had it, my esteem simply grows.
Agh. Previewed twice and I still left in "incrememnts". I suck at morning typing.
"prescriptions for homeopathic preparations by doctors to fall by almost 50% over the last two years"
Wouldn't that just mean the prescriptions are that much stronger? :D
I agree with the premise that medicine should be based on sound science. However, I do think there is room for an open mind at the intersection of possibility and proven scientific fact. I too deplore the exploitation of the masses by the marketing of products with unproven benefits. Neither the CAM industry nor the pharmaceutical industry have clean hands here.
Replacing one dogma with another is rarely useful. Without genuine inquiry into the possibilities at the edge of 'regular' science, there would be no progress in medicine or science.
From my horribly uninformed and naive perspective (as just a patient), I feel that today medicine relies too much on procedures and medications, sometimes failing to recognize there is a human being just sitting there in the exam room. My doctor is better than many; he actually listens when I talk. I've been to many others who seemed too busy or too preoccupied. They just whipped out the scrip pad and started scribbling away. That's the part that's depressing me.
I have gone to a chiropractor, and felt some relief from pain, for a while, but I did not pursue that route in place of seeing a "regular" doctor. Science can (and does) make a measurable positive impact on our health, it's just not the only thing to be considered.
Something is missing in patient care, today. I would propose that is the major motivating factor behind so much "feel good" alternative approaches--a perceived lack in the traditional practices.
FWIW. What do I know?
these cam nuts are very convincing personalities- ever meet an alcoholic who convincingly argues that he has not been drinking? that's what they remind me of...
we ran across one during our multi-year search for chronic back pain relief. this chiropractor very convincingly argued that my husband should be eating 5-6 eggs per day to reduce his serum cholesterol. fortunately, he came home and asked me about it and then he never went back. but imagine the people who are taking shotgun cardiovascular health tips from a chiropractor (oh oh, and let's not forget all those "natural medicine" certifications she has, she must be qualified) and the harm that may do.
Google rankings. It may seem a little manipulative but if some of the science and medical blogs linked to each other more, particularly on important public health issues such as vaccination, then I wonder if the posts would be easier to find for parents who are searching for information.
I can't find your post (ironic) but didn't you write something about how the first page or more of returns for some search terms to do with vaccination are full of anti-vax sentiments? I'm sure it has been done somewhere but you have to know what search terms parents are using when they look for information and make sure that those appear in a post that you want to promote.
Similarly for other issues. For instance, sceptics know that homeopathy involves dilution to the point where it has no meaning and breaks known laws but how much of the public think that it is herbalism?
Of course, I write this days after Ben Goldacre revealed the dispiriting news that a broadsheet paper in the UK has let go both its science editor and correspondent in a period of 2 months.
One could go even farther with the WWII analogies, since Germany during the third Reich had largely embraced all the current pseudoscientific forms of "medicine" that were floating around at the time. I always thought that a contributing factor that allowed much of the world to unquestioningly allow a maniac such as Hitler to take so much power was the prevalence and embrace of pseudoscience in every realm of life, including medicine, that was happening at that time. People had essentially lost their ability to reason and think critically. When whole swaths of society give up reason for squishy logic and magical thinking, it sets the stage for dangerous people to come into power.
I most appreciatively applaud your persistence in fighting the 'woo' intrusion into mainstream science. You are quite correct, this conflict is not a short term, yell disparaging remarks at them and go home type of battle. It will be a long term, and possibly continuous, engagement. You write well, you are committed, and you are young, all of which are qualities that foreshadow the success that you will undoubtedly attain in your career.
I also read with interest your Sunday posting (Overcoming Difficulties Reporting Science). It was, as is today's issuance, a most thought provoking post. One of the post's introductory comments, concerning the lamentations of recent commenters, struck a nerve with me.
That comment was, "with reporters using an all too common fallacy of presenting "both sides" of a debate or controversy (such as "intelligent design") as though they carried equal or near equal weight, even if one is science and one is pseudoscience".
It played over and over in my mind last evening, only achieving closure this morning while reading the BBC News online. An article by Richard Black, a BBC environmental correspondent, entitled: "Climate documentary 'broke rules'" quite correctly summed up my thoughts on this issue.
"The Great Global Warming Swindle, a controversial Channel 4 film, broke Ofcom rules, the media regulator says.
In a long-awaited judgement, Ofcom says Channel 4 did not fulfil obligations to be impartial and to reflect a range of views on controversial issues."
...
"The Broadcasting Code requires Channel 4 to show "due impartiality" on "matters of major political and industrial controversy and major matters relating to current public policy".
My rhetorical question is this: In rightfully confronting 'woo', do we do ourselves a disservice when we place blame on the ethical standard of the messenger rather than on our own inadequacies in communicating what we believe to be the 'right' answers to the ills of our world?
Let's just hope that our equivalent of the Stauffenberg coup succeeds. I was shocked when I learned how much bloodshed could have been averted had they been successful.
Orac, I am with you. With a background in engineering and a blog with fractional readership - I am constantly challenging folks to "ask for the evidence". Far from being a killjoy, I simply want what can be proven and for our rersources to be placed in support of the possible rather than the improbable.
I've been a lurking layperson until now, but now I must say that your blog has provided me with information and references that I have successfully used to help woo-infested friends, family, and even strangers to think critically about whatever woo has sucked them in, along with their money and their health. Your hard work gives me the ammunition I need to fire away at the woo. Thank you. Never give up!
While I'm no expert scientist, doctor, or researcher, I would gladly drive any Deathmobile you might choose to build. Can we run over Andrew Weil first?
Why do I smell a defamation suit in the making? As I recall, under UK law "truth" is not a defense against a complaint of defamation.
Sheryl said:
Isn't that intersection where research happens?
What would your reaction be if your physician said: "We think it's possible that this treatment works, but we haven't proven it yet." If it were you, or your child, or even your cat whose health was in question, how open would your mind be to the possiblities of that unproven medicine?
Would you say, sure, why not, one has to have an open mind about these possibilities?
Just to bring matters down to specifics, consider this case:
Your (aging) dog has fairly severe arthritis in her hips. The vet says that you could try glucosamine, which anecdotally seems to help about half of the dogs whose owners try it. Meanwhile, reading SBM, you know that glucosamine is at best unproven in clinical research.
What do you do?
I truthfully didn't know how bad things were until I started my blog in April. That's when I began systematically surfing the blogosphere and was fully exposed to the "the golden age of quackery and anti-science." Now I'm depressed most of the time. The only solution I see is to keep on blogging and to present the science-based evidence time after time after time. Your "call to arms" is right on.
I have to agree. It doesn't look like a rosy picture from where I sit. Quackery has infiltrated the mainstream like a bunch of cancer cells in someone's bloodstream. But in this case, what's needed isn't chemotherapy, but educational therapy. Most adherence to quackery or woo is due to ignorance. If you can cure the ignorance the quackery-cancer will go into remission. (okay, crummy analogy but my mind's been on cancer today)
Oh, and for those who remind us to keep an open mind about
unusual therapies: Sometimes, a new treatment makes it's way into the mainstream because someone researched the matter and managed to prove it works. However, the overwhelming majority of quack treatments have been shown time and time again to not work. Some of them, like homeopathy cannot possibly work, and have been around for a hundred years anyway. Sorry, but there's keeping an open mind to new and untried treatments and then there's having a mind so open that your brain falls out.
keep up the good fight, Orac!
I do what I can in my little world - I think that's how to beat it - that's how it starts, after all.
Of ourse, it would help if critical thinking was a component of education these days...
I would suggest giving every medical student and every nursing student a copy of a book like Snake Oil Science or Trick or Treatment. We need to persuade someone like Warren Buffet or Bill Gates that this is good idea.
Perhaps a less threatening (to woos) book promoting critical think such as "How we Know What isn't So" might be better received.
Google rankings. It may seem a little manipulative but if some of the science and medical blogs linked to each other more, particularly on important public health issues such as vaccination, then I wonder if the posts would be easier to find for parents who are searching for information.
I can't find your post (ironic) but didn't you write something about how the first page or more of returns for some search terms to do with vaccination are full of anti-vax sentiments? I'm sure it has been done somewhere but you have to know what search terms parents are using when they look for information and make sure that those appear in a post that you want to promote.
EXACTLY!
I've been saying this for months now: One of the best things we can do would cost us very little time and no money, and that's to put up a list of genuine resources on autism and vaccines specifically designed to debunk the bull -- and then link to that list early and often.
EXACTLY!
I've been saying this for months now: One of the best things we can do would cost us very little time and no money, and that's to put up a list of genuine resources on autism and vaccines specifically designed to debunk the bull -- and then link to that list early and often.
wow, this was actually a pretty inspiring post!
also, kudos for mentioning Snake Oil Science. I just finished it, twas a good read
Ah, that's the Orac I come here for.
I would suggest that there's a thread here, starting with Chomsky in the '50's, wending it's way through Cognitive "Science" and on to Post-Modernism, all of which lends support to general woo.
As Skinner said: "Those who so triumphantly announce the death of behaviorism are announcing their own escape from the canons of scientific method."
Doubt that will be popular, but there you go.