Since 2012 was rung in a month and a half ago, I've been writing a lot more about placebo medicine than I have in a while. Specifically, I've written a lot more about placebo effects than usual. This proliferation of posts on the topic was sparked by how Harvard University's very own not-a-PhD faculty, credulous promoter of acupuncture and all things "integrative medicine," and generally clever propagandist for woo, Ted Kaptchuk seemed, like Elvis, to be everywhere for a while. The message he was spreading was, although he didn't admit it or put it that way, a response to the growing body of evidence in so-called "complementary and alternative medicine" (CAM) (or, as its proponents like to call it these days, "integrative medicine") demonstrating rather conclusively that most CAM modalities are in fact nothing more than elaborate placebos and that whatever nonspecific effects are observed due to these treatments are, when studied in carefully controlled studies, indistinguishable from placebo effects. While some CAM apologists don't want to face that message, Kaptchuk appears to embrace it whole-heartedly by arguing that placebo effects are powerful. Unfortunately, as they say, he exaggerates. A lot.
On the other hand, I rather like that CAMsters like Kaptchuk are finally just admitting that CAM is nothing more than placebo medicine. It makes it easier for me to remind people that intentionally practicing placebo medicine is unethical (because it requires lying to the patient) and paternalistic, just like 60 years ago when conventional doctors did actually order placebos for patients. In a perfectly Orwellian turn of phrase, advocates of "health freedom" and CAM advocates are in essence advocating a return to that sort of paternalism. As I've pointed out before, CAM cloaks itself in rhetoric suggesting that it "empowering" patients to "take control" of their health. In actuality it denies them the most important tool to do that: A appraisal of the rationale behind a proposed treatment, along with an assessment of its potential benefits and risks based on science, not fantasy. Instead, it substitutes tooth fairy science, pre-scientific vitalism, and utter faith in the practitioner for science and reason. It's not for nothing that recently one CAM apologist argued that placebo effects were "proof" for the existence of God.
It's also not for nothing that I have recently started comparing CAM to The Secret, with its "law of attraction." The Secret, as you might recall, is a New Age belief system popularized by Oprah Winfrey that claims that a person attracts to himself what he really wants. In other words, your thoughts "become things." If you believe the woo-meisters, basically thinking something makes it so. As I've pointed out before, this sort of wishful thinking is infantile but it meshes scarily well with a lot of what various alternative medical systems preach, systems such as German New Medicine, Biologie Totale, and various other forms of quackery emphasizing "mind-body" medicine. This sort of thought, I point out, is not without parallels in mainstream society. For example, prosperity theology has a lot in common with The Secret, except that you don't get good things by thinking about them and wishing really hard for them. Rather, you get good things by thinking about them and praying real hard for them. One could look at God as being the intermediary or tool in prosperity theology who provides good things to those who believe whereas in The Secret it's the universe that somehow magically manifests our thoughts and "attracts" to us what we want. That is, after all, why the New Agers call it the "law of attraction."
A lot of people thought I was exaggerating when I likened the cult of placebo that CAM is developing into to The Secret. I even admit that there were times when I wondered if I had stretched a good analogy a bit too far. Then I saw this post by Sherry Gaba entitled The Law of Attraction and the Placebo Effect. It is, appropriately enough, on Deepak Chopra's group blog IntentBlog. There it is, in black and what, exactly what I've been saying all along, only from the credulous side. I'll show you what I mean. First, she describes the placebo effect in woo terms:
Most people are aware of what is known as the placebo effect. This is a phenomenon that occurs when someone is told that a pill or a medication they are taking is a cure for a health condition even though it is just a simple sugar pill with no medicinal qualities. People that believe they are taking a "cure" actually have mild to extremely positive results from taking the placebo, leading to a partial to complete cure of the condition without any real medical intervention.
This is, of course, a massive misrepresentation of the placebo effect. Placebo responses only "work" for subjective symptoms. They don't "cure" anything. At best, placebo responses are due to a change in perception of subjective symptoms that leads to their bothering the patient less. Even so, they're variable and unreliable, not something that a doctor would want to hang his hat on when he needs to relieve a patient's symptoms. At worst, placebo effects do not exist. Rather, they're due to artifacts in clinical trials, confirmation biases, and observer effects. Either way, nonexistent of the "beer goggles of medicine," placebo effects are unlikely to be of much clinical use but increasingly are the rationale used to justify CAM.
Now here's the kicker:
The placebo effect is, in reality, the medical proof that the Law of Attraction really works. The Law of Attraction simply says that what you focus in on in your life is what you will receive. In the medical case the patients taking the placebo focused in on becoming healthy and overcoming a medical condition, which is exactly what happened. Some people believed so strongly in the effectiveness of the placebo that they were completely cured. Some people were not "cured" but they no longer focused in on the negativity in their life and their ongoing health issues, instead they became happier and more mentally healthy. This in turn led to a better quality of life that significantly improved their environment and enjoyment of the world around them.
This is delusional thinking at its finest. First, again, Shaba has a hugely inflated view of the power of placebo, thinking that it can cure disease when it cannot do anything more than possibly make subjective symptoms seem less troublesome without actually doing anything to affect the pathophysiology of the disease. Yet here it is being sold as "medical proof that the law of attraction really works." In other words, as I put it before, in the fantasy world that is CAM, thinking something makes it so. It really is The Secret. Given some of the magical mystical aspects of CAM, in which modalities like reiki, therapeutic touch, and "energy healing" are represented as channeling healing energy into patients from a "universal source," much of CAM is religious in basis. Maybe the comparison to prosperity theology isn't so off-base after all.
Of course, on the surface these ideas seem relatively happy and harmless. After all, there is a grain of truth buried under all the woo. There's little doubt that our emotions, desires, and thoughts shape our lives. Every person who has ever achieved great things achieved them at least in part because he wanted to achieve them really, really bad. However, in most cases, barring freak occurrences, for that thought to "manifest" itself as things, it must first be channeled into hard work, often over a long period of time with much sacrifice. That is what results in success and obtaining what one wants. In a way, it's true that the thought and desire are the first steps, but they are not enough. Part of growing up is to realize that, to achieve your thoughts and desires requires more than just thinking and wanting really hard. The Secret bypasses the hard work and leads to regression straight back to the fantasies of childhood. In many ways, so does a lot of CAM. In fact, Gaba is more right than she knows when she likens the placebo effect to the law of attraction. Well, not quite. She's more right than she knows when she likens the placebo effect as viewed in CAMworld to the law of attraction because that is what it is: The unrelenting belief that wishing makes it so.
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@Orac et al.
I know you can't look at every quackery under the sky, but could I suggest you take a look at one Kenny Meirleir. He claims to asses the Th1/Th2 status of various health conditions (including the all time woo classic Autism) by testing for "metabolites present at high concentration in the urine samples of Th2-shifted individuals".
As far as I know from other forums, that metabolite is hydrogen sulfide (H2S), but I could not find any mention of *what* metabolite he actually tests for in that paper (huh?).
Just some thoughts:
- AFAIK he relied on published "well-known Th1- or Th2-mediated diseases". Are these diseases really "well-known" to be Th1- or Th2-mediated?
- Did he measure the *actual* Th1/Th2 status? I can see he did
- The description of the color change seems bogus: "significant" after 1 min, "substantial" after 2 min and "dramatic" after 3 min? This reads like a text for test that will be pushed on patients.
- The numbers in table 1 look fake. They just look fake
If someone would look at it and tell me if they share these (or other) skeptical thoughts, that would be dandy.
"Placebo responses only "work" for subjective symptoms."
Seriously? Placebos can affect physiological responses too. Hence the need for double blind for so many intervention studies. And the need IMO to figure our how perception, cognition affect eg inflammatory and immune functioning. Physiology and perception are linked; organisms need to be able to respond to the environment with appropriate physiological reactions as well as behaviour, and the body needs to be informed through the senses, mediated by perception, cognition, what is going on. This can happen in a variety of systems. I seem to recall that when we perceive via optics that we have eaten enough, for example, there are changes in substances linked to satiety. A sophisticated system like a human being uses software as well as hardware, and they interact. There are flaky, woo-woo ideas out there, but I feel we should be discriminating and not throw the baby out withu the bath water.
The numbers in table 1 look fake. They just look fake
They are certainly far from a Benford's Law distribution. Numbers whose leading significant digit is 1 are reasonably close to what you should see (10 of 45; Benford's Law predicts 13-14), but 2s are underrepresented (only one in the table, where you should see 9) and 3s are overrepresented (17 instead of 5). I've ignored the ">3.000" results in that table as they appear to be lower bounds rather than actual numbers (it seems sloppy to me that they are reported thus, although there may be a good reason I am not aware of).
I don't know enough about the science to comment on anything else in the paper, and I can't prove that Table 1 is faked, but I can understand why you are suspicious of that table.
Wow. Sooo much wrong with that paper! Some of the biggest problems:
- They claim their test shows Th1/Th2 "balance" but their only evidence for that is the (claimed) correlation of their test results with the (claimed) categorization of diseases as Th1 or Th2.
- They give NO information about where they got their urine samples or how they verified that the subjects had those diseases. That alone is unforgivable and makes this paper a joke. Not even on par with a decent high school science project.
- Even if all their data is correct, that doesn't justify a claim that the test has any value in diagnosing disease or monitoring treatment.
It's also worth noting that this journal isn't even indexed on NLM. If this paper is representative of the stuff it publishes, I can see why.
If we all "attract what you really want", why aren't I rich, handsome and dating Angelina Jolie and Denise Richards?
@4: "why aren't I rich, handsome and dating Angelina Jolie and Denise Richards?"
Can't say on the Rich and Handsome part, but maybe because Angelina Jolie really, really, wants to be with Brad Pitt? Maybe we can make the inference that if you can't get the whole package with The Secret, it won't give you any of it?
But, seriously, I see a lot of parallels with religion in some of this stuff. Didn't get what you wanted? You didn't believe hard enough. Which is roughly the same as saying you didn't pray hard enough. Either way, it shifts the blame from 'this doesn't actually work' to you, for not believing in it enough to make it work.
So it all comes down to "You get what you want...except when you don't". Might as well pray.
A long time ago, Freud wrote about wish fulfillment being characteristic of primary process thought ( the language of dreams, symptoms, fantasy, early childhood) most people grow out of this style altho' there are meds available ( perhaps that's the real reason that Mike Adams hates psychiatric meds- their usage would cut into his customer base and most likely, his own over-inflated self-image as well).
If people buy into vitalism perhaps they think of the Secret or placebo itself as a method of un-blocking the flow of life energy that will posthaste fix up your physical and emotional ills and on a larger scale, your relationships with others and the world. Although there's something charmingly child-like about this notion, leaving out the steps that manoeuvre your position about in reality ( working to achieve what you wish for), many adults function at least partially on this level and *marketting* sees them coming. There's the lottery, investment woo and the alt med fantasy machine.
This is often simultaneously ridiculous and upsetting for me because I work the other side of the fence: I trade upon un-fantasy. A person has a desire to make a change in his or her life and needs support getting from *here* to *there*. Here is where woo and secretists make the switch, where a counsellor might help a person to make change ( first by changing attitudes and understanding what what the situational requirements are, addressing skills) the woo-ist foregoes the real work and smiles and nods approvingly, maybe teaches a few mantras and affirmations.
Of course, you can argue that this is a form of support however you can probably get truer ( and less expensive) support from family, friends and colleagues- they actually might care about what happens to you.
I think there's some confusion here. "The placebo effect" is not synonymous with "responses observed in the placebo arm of a clinical trial." The latter also includes observer biases, differences in what people do due to knowledge of which group they're in, etc.
Any citation for the proposition that the act of taking a sugar pill itself produces such physiological responses? For an example of evidence that it does not, I offer this article Orac previously discussed:
There have been a few studies that seem to show that placebos can have an effect on objective measures of inflammation, such as CRP. For example, mock ultrasound in this study: http://rheumatology.oxfordjournals.org/content/25/1/77.abstract
Can placebo effects impact mental/emotional disorders that otherwise respond to traditional therapies? Some disorders such as bipolar disorder seem to respond to i.e. cognitive/behavioral therapy, so might such disorders also respond to a "well presented" placebo? That seems like it would nicely explain some seemingly positive outcomes for certain issues.
Are these diseases really "well-known" to be Th1- or Th2-mediated?
As always, It's More Complicated Than That. There are definitely certain autoimmune diseases that have a characterstic Th1 or Th2 profile, there are some where the mouse models are absolutely Th1 or Th2 driven, there are some where interventions that are shown to affect the generation or function of Th1s or Th2s (or their downstream mediators) have efficacy. Many conditions that are given one umbrella diagnosis get more and more diverse the closer you look. And there are some where it's pulled out of his ass a bit (e.g. autism; I looked at the data in the '98 Gupta paper and am unconvinced, even with it as a tiny pilot study).
Roelant's paper also doesn't even mention Th17s, which are potent inflammatory cells involved in a number of autoimmune diseases.
Oh, god, I just got past the Introduction. This paper is terrible. No link of how cells at the site of disease or in the blood can possibly affect the redox state of urine, no look at any confounding factors that influence the urine, and of course, no mention that there was any blinding of the tester to the disease status, and I assume there wasn't. I also like the very scientific M&M of "A few drops of urine." My fish tank Ph kit is more precise. And just to pile on, he doesn't say what spectrophotometer he used to make his readings; some of the older Bio-Rads can take half a minute or more for a 96-well read and when you're dealing with 1-minute windows, the order in which you line up your samples can make a diffierence. Combine that with the lack of blinding...
(Also, FWIW, Th1/Th2 isn't a zero-sum game. You can dampen an overactive immune response overall; you don't need to bang up the Th2s to match the Th1s, e.g.)
Yes, it's called the "Word of Faith" movement that Joyce Meyer, Creflo Dollar (seriously, that's his name), Joel Osteen, etcetera. They say that all you need to be prosperous is to speak it. Something about being like God and speaking ("And God said 'let there be light!'") and blah, blah, blah. They've taken a lot of money from people, promising to intercede for them with the Almighty and nothing has happened. Of course.
"The Secret" and all that have a ton of parallels in the "prosperity gospel" movement in the Christian Church. I don't know if that's the case in other religions.
While I have a comment in moderation about the Wish ( primary process thinking)-
Every person is caught in the pull between reality and fantasy- I've heard the call of the Muse myself**- however, growing up involves developing the ability to tell the two realms apart and keep them separate. Although both art and science may call upon imagination, abstraction and hypothetical thought, each imposes different sorts of limits and rules: science even includes mathemathics and blinded controls to rein in and tame our wandering speculation. Woo advocates fall prey to that allure and think it ground-breaking discovery.
** a morose-looking, dark-haired fellow, usually murmuring softly in Gaelic- uh-oh, that sounds like my ex.
One of the things that this really clarifies is how the common CAM claim that regular medicine fights only symptoms while CAM fights the causes is projection. It's the opposite.
I always like to point at homeopathy for that one. An entire major discipline of CAM which HAS no concept of cause and is exclusively symptomatic.
I am not sure there is any evidence you have to believe in a Placebo for it to be effective.
Then state of mind has very real physiological affects. Stress and anxiety will often increase the level of distress created by a symptom. Feeling that one has something to try (placebo) gives the illusion that one is doing something and is therefore more in control, which may alleviate stress and reduce distress.
Medicine is quackery. I healed myself simply by changing my thoughts. 30 years of medication did not do that. I said daily "I deny disease and now live with ease comfort and joy." I am healthier than i have ever been. i consider sueing every dr. I ever saw for prescribing medication which did nothing but treat symptoms and fatten Drs pockets.
Jeff = Poe?
And why do these guys have so much trouble with basic English grammar?
When one views reality as malleable to fit one's baseless beliefs, what chance is there for the ever changing rules of the English language?
Maybe you should try changing your thoughts to make yourself smarter and less deluded.
If we all "attract what you really want", why aren't I rich, handsome and dating Angelina Jolie and Denise Richards?
You don't know what your unconscious mind really wants, of course.
Which unconscious mind? Freud's would be a seething mass of sex and violence where opposites rule while Jung's would spew forth archetypal representations of the collective?
Neither of those options sounds in the least bit attractive.
Monsters from the Id!!
Sounds like a certain 1960's skeptic machine needs a software upgrade.
Pain is a subjective symptom.
A hug, or someone shouting at you have both subjective and measurable physiological effects - on blood pressure, neurotransmitters and cortisol for example. I don't think we should classify these as forms of medicine. I don't think we should class anything as a medicine if its effects are entirely mediated through the central nervous system.
To say that a treatment such as acupuncture does not do nothing does not make it medicine.
I will not belabor the point - or hang around to argue with your minions - but I'd like to point out that, as the years go by, your view of all this is continuing to get dangerously close to mine. There's hardly anything in this post I haven't written before, and now you're up to inserting "the c-word" without a second thought:
"A lot of people thought I was exaggerating when I likened the cult of placebo that CAM is developing into to The Secret. I even admit that there were times when I wondered if I had stretched a good analogy a bit too far."
Which is exactly what you've accused me of, but I still stand by it - we are dealing with cultism in a myriad of forms.
I'm (naturally) happy you're getting it, finally, except for the fact you don't give me any credit for setting you on the right road.
Despite our disagreements over style, I still write posts lauding you - and will continue to do so - but hope, one day, you'll talk to me directly (without hostility) about where you're heading. It's nice you're taking these baby-steps my way, but, man, I want to see you run!
You're a better writer than I, with a lot more influence for now, so the potential of you having a real impact - when fully vetted on what you're dealing with - is unfathomable.
You're a doctor, and as one of the many targets of these cultists (as I am) I have always been concerned about what they're doing to your profession - just as I've been concerned, should I ever need medical care, I'm not faced with a group of them instead of someone like you. We need each other - we're on the same side - and, in my opinion, together we can nip this particular problem in the bud. But first, we have to agree A) what the problem is - which, as this post proves, is happening - and B) how to realistically address it.
I hope we can.
You ought to do a post on these guys - they deserve it.
I think the concept you're looking for -- the one that ties together alternative medicine, woo, The Secret, religion, and God -- is that of the "supernatural."
Although there are a lot of definitions of that term out there, I think the best ones concentrate not on distinguishing between inside and outside of 'nature' (or what can or can't be known through science), but on distinguishing between the basic characteristics of natural and supernatural: how does it view the Mental?
Is every mental thing entirely caused by fundamentally nonmental things, and entirely dependent on nonmental things for its existence? That's naturalism. It's both the conclusion and working theory of science.
Or are at least some mental things irreducible to nonmental things? Are thoughts a kind of force? Are values a type of field? Is consciousness a primary element of the cosmos and intentionality an active power? Do emotions themselves have impact and is 'agency' something that exists and acts apart from physical matter? Does God exist?
That's supernaturalism. That's what the supernatural is -- non-material, irreducible mental Being, beings, or forces which exist apart from and/or âaboveâ the material realm, do not obey common physical laws, and which affect the natural world through the direct power of intentions or values. The category includes: disembodied souls, ghosts, ESP, psychokenesis, magical correspondences, vitalism, karma, prana, God, cosmic consciousness, mind as "energy force," a universal tendency towards the harmonic balance of Good and Evil, progressive evolution towards Higher States, Nature as creative benevolence, mind/body substance dualism, holistic nonmaterialistic monism -- and virtually every form of 'energy' medicine.
The definition excludes pretty much everything we've discovered through science -- all the stuff that's noncontroversial. Supernaturalists agree with naturalism ... and then add on. And they bring in explanations that don't cohere with what else we know.
"Religion" is any system which describes how one ought to work with or relate to the supernatural. Yes, religions involves faith and rituals and communities -- but without the supernatural element, it's not a religion.
I think some forms of alternative medicine (and the groups which promote them) come close to being religions. But most of them do -- sooner or later -- end up involving the supernatural. There's an emphasis put on the primary concept of Pure Mentality.
It's useful to compare placebo hype to the "Law of Attraction" nonsense. However, since placebo interventions have been shown to affect behavioral responses (see, for example, balanced placebo design research on alcohol effects), it's not true that placebo only has subjective or symptomatic effects. But I think your point is really that placebo has not been shown to reverse pathological changes and that's an important point to continue to make.
William M. London,
That's nitpicking, surely. A subjective or symptomatic effect can lead to a behavioral response. Someone waving a gun in my face will lead to subjective effects, measurable physiological changes and a behavioral response, I guarantee it. Are the effects of a placebo qualitatively different?
The important question is whether lying to patients can do anything useful that a sympathetic chat or a walk in the sunshine, for example, can't do. I haven't seen any convincing evidence that it can.
I was thinking more along the lines of samskara chitta. Should've put 'wants' in scare quotes, I suppose.
I like to think that medical woo is attractive to those who haven't an inkling about the workings of physiology, biology et al and supernaturalistic woo is tolerated by those without any understanding of psychology: I especially mean phenomena that reflect memory, learning, personality. People have *soul mates* rather than similar attitudes; your basic outlook is formed via astrological allignments or past lives; rather than looking at people's abilities at understanding others, precognition or thought transfer is invoked; ghosts reign rather than events triggered by memory, attachment or loss.
Hilariously, a older guy who believes in this nonsense explained my own interests in Asian art, food etc by my past lives! Because I've evil, I concocted a short story about the Raj where I, a young wife, dis-enchanted with my rigidly proper husband- a Major- fell in love with a young Indian student. This tale was elaborated with images of bright turquoise saris wafting in the breeze, temples carved with undulating voluptuous *devas*, servants preparing spices and observing the monsoons as I smelled sandalwood incense burning... He believed that I had had a glimpse into a past life! I told him it was fabricated of parts of movies and images of art. He didn't believe me.
Re. past lives, I find it very interesting that there are so many "dukes" and so few "dustmen." Everyone was previously a prince or a princess, but nobody ever seems to have been a tradesman or a common worker.
Some years ago I had a friend who was a New Ager and who had the irksome habit of cracking his knuckles, the sound of which I find highly annoying. Politely asking him to stop didn't have much of an effect, so one day I said, "Please don't do that. In a past life I was a common thief who was hanged by the neck until dead, and *that sound* was the last thing I heard." Guess what? He stopped! Yes, and I can only imagine what must have gone through his head upon hearing that a friend had been a *common thief* in a past life, there being so few people who admit to such lowly origins.
One can do "interesting" psychotherapy without recourse to woo. I've heard that there are New Age therapists who use hypnosis to enable their clients to "access their past lives." Clearly what's going on here is that their patients are imagining stories that feel personally meaningful and relevant to their wellbeing. If it works (in the sense of providing insight and improvement), great, but one can remove the nonsense and keep the useful parts.
One could as easily tell patients this: "We're going to use hypnosis to give your imagination access to a wide range of your life experiences, including art, music, and fiction that you've found moving. From this, you'll begin to develop stories and narratives that provide insight, a sense of meaning, and goals."
Though, there is something to be said for psychologists making use of their patients' own belief systems, so long as those belief systems are not harmful. If a patient believes in a deity or a demon-haunted world, "fine, whatever," the psychologist's task isn't to deprogram them of every last shred of their own nonsense, but to help them learn new ways of thinking and acting that are healthier for them.
Supernatural: "existing outside of nature." Thus, "not amenable to scientific method."
To my mind, for something to not be amenable to scientific method, it needs to be completely unfalsifiable or have inherent and insurmountable confounds. Most of the examples that are typically given, fail that definition. One that remains is the question of the deity, which as normally conceived, is a being who is omniscient and omnipotent. Such a being would be able to confound any experiment to test its existence, therefore no such experiment can be valid, therefore the question of a deity is outside the scope of science. Strictly speaking this gets us agnosticism, though for those who set their thresholds such that "all propositions not supported as true are necessarily false," it leads to atheism.
Though, certain theories in physics, such as the Many Worlds theory (Everett et. al.) and some elements of string theory, are effectively unfalsifiable by any empirical experiment. Conventionally this doesn't make them "supernatural," only perhaps "metaphysical." Hmm...
Woo Watch dep't.: I was at Whole Foods the other day, buying groceries. There at the checkout line I noticed a display for Oscillococcinum (sp?), a "homeopathic medicine." I read the verbiage on the display and burst out laughing. The gal at the checkout asked what's so funny, and in order to not hold up the line, all I said was "oh, nothing, it would take too long to explain..."
There is a significant difference between "The Secret" and suchlike wishful thinking, and "the Prosperity Gospel."
The Secret is true. At least true in the sense that attention affects perception, and if you establish an explicit goal of whatever kind, you'll be more likely to perceive (or be consciously aware of perceiving) things that are relevant to your goal.
The underlying principle was first revealed to me by none other than an elementary school teacher, in a lesson about vocabulary: once you learn a new word, you're more likely to notice the word popping up often in your reading. A lightbulb went on in my head that generalized to: when you pay more attention to something, you're more likely to notice it.
How anyone could impute guru-like wisdom to someone for something so obvious, is beyond me. Perhaps if it's festooned with nonsense it looks more important...?
Prosperity Gospel on the other hand, is downright pernicious. Basically it comes down to the idea that God favors faith with economic reward. The converse is that those who are economically deprived are lacking in faith and being punished by God. And the corollary is that humans should not "coddle" those who God seeks to punish.
What's pernicious about this, is that it provides an excuse for believers to have utter disregard and contempt for the poor, and rationalize their attitude by claiming it to be a reflection of divine principle.
And this in turn translates to support for public policies that also treat the poor with callousness and cruelty. To my mind that's worse that teaching creationism in biology classes: creationism merely makes people stupid, but the application of the Prosperity Gospel in public policy makes people hungry and homeless.
Anyone who's interested can go to http://www.talk2action.org , which is an expert-level site for discussion of religious extremism. Many of the regulars there are conventionally religious, but all are opposed to religious extremism influencing public policy. When you study this stuff in any detail, you'll also begin to notice the prevalence of religious right buzzwords in certain political campaigns.
No wonder the world is more religious than ever. The skeptical community has little to offer common people other than diatribes about how "terribly stupid" and "ignorant of science" the poor dears must be if they deign to disagree with them (the only!) great skeptics.
Until more articulate skeptics emerge who have an understanding of the human psyche and it's need to endlessly project order onto the seemingly disordered--humanity will continue to be bamboozled. Yes, duped, lied to, and misled by the shamans, the priests, the charlatans and idiots who sell religion, superstition, lies, and woo-woo medicine. Ugh.
Even for a die-hard skeptic like me it would be much more fun to live with a Christian priest and a New Age fortune teller for a year than deal with most of you self-obsessed control freaks for five minutes.
p.s. Are you the same people who get on forums and blather about your IQs, adding twenty points to your score, then dismissing IQ tests as "silly"? I thought so.
Really? More than ever?
So, you decided to come to the defense of people you scornfully labeled as "common", and went on a broadly insulting diatribe which accused the skeptics of engaging in insulting diatribes. No wonder the world is more skeptical than ever.
No wonder why the skeptical community is more skeptical than ever. Our little community is concerned that seemingly intelligent people are terribly stupid and ignorant of science.
I for one, and other "regulars", appreciate our more articulate skeptics. We all try to understand the human psyche that wastes its time and energies on the shamans, priests and charlatans. It's nice to have fellow travelers to partake of the skeptical inquiry.
"Even for a die-hard skeptic like me it would be much more fun to live with a Christian priest and a New Age fortune teller for a year than deal with most of you self-obsessed control freaks for five minutes."
I doubt that you are a die-hard skeptic and if you want think it would be fun to live with a Christian priest and a New Age fortune teller...be my guest. How would one be able to tell the difference between a Christian priest and a fortune teller?
p.s. Are you the same person who is a hit and run poster who posts on Respectful Insolence...and makes assumptions that any of the "regulars" here blather about our IQs, adding twenty points to our score?
p.p.s. The last poster here who bragged about his Mensa membership got a good dose of derision from the skeptics. Do you usually ask a question...then reply to your own question? I thought so.
"No wonder the world is more religious than ever. "
So before I worry about any of the rest of your rant, perhaps you might want to provide non-assertive justification for this claim. Since your entire complaint with the behavior of skeptics hinges on your belief that the world is more religious than ever, I would presume you have an iron-clad basis for believing that, and aren't just basing it on something like "your perception.". I mean, a RE sketic like you would never base their opinions on something so subjective, right?
BTW, Lucia, if you didn't catch my drift in the post above, I'll summarize:
"I'm calling your bluff, punk. Put up or shut up"
I think Lucia cemented passive aggressive post AND concern troll of the week with that post. I don't think she'd be much of a joy to live with either.
Lucia, the fact that you demand anything other than derision for a concept as plainly idiotic as THE SECRET shows you aren't much of a skeptic at all.
I like *your* past life! About the psychotherapeutic angles, I do believe that using writing and art to provide insight was briefly popular amongst a few reality-based therapists for a while ( UK & US)- when people still had money ( 1970s-1980s). Notice that my own *creation* ain't no duchess- but an Orientalist/ Sensualist c. 1930's ( she had great outfits -btw-) altho' it deliberately doesn't provide insight into *my* psyche because my family background involves the breaking of traditions more than the upholding of them. One of those *interesting* families.
Actually, I *am* fun- I constantly get invited to soirees, salons, benefits, gallery openings, tennis matches, dining parties and Irish pubs ( and I'm not even Irish).
More seriously: what are sceptics for, anyway? We express our dis-satisfaction at what seems to be an alarming drift towards unrealistic ideas about medicine and general science that will make other peoples lives *worse* and simultaneously enrich irresponsible poseurs who offer *pretend* science. So why us? Why speak out to lurkers?
I survey alt med "new media" ( websites, internet radio) that have many followers: the audiences seem hungry for information that will affect important areas in their lives- especially health. I then observe un-scrupulous manipulators- who don't have a decent basic background in life and social sciences- HOLD ON-
Skeptic evangelism. Out to save society and each individual by "fixing" them. If they only knew science then they'd be happy and the world would be a better place.
We're heading toward utopia through technology if those pesky musl.. er, luddites will just be gone.
Not much different than religion. Just a different god.
- OK- you might witness a nearly un-educated yokel carry on about how the medical Establishment is *all* wrong and offer up protocols and dietary regimes as "cures". Another idiot will rant about how people can *improve* their cognition while preaching a political doctrine that works against general education. Another, an actual *doctor*, gives bad medical advice. People eat this garbage up and laud its perpetrators.
A significant portion of the general public- through no fault of their own- can't 'see through' the ruses and braggadocio to spy the hard sell techniques. They believe that they are hearing *real* science and criticism that will *benefit* them . They believe the wretched conspiracy-mongering that provides the scaffolding that supports alt med.
Who I am? Someone who has a good education and would like to share. In an era of cost-cutting and busy schedules, most adults can't afford to "go back to school"- I believe that sceptics can provide an *alternative* to altmed, pseudo-psych, New Age meanderings and woo-ful economics.And we're on the web- scene of the aforementioned crimes.
Seriously, who came up with the ridiculous idea that skeptics can't have fun or enjoy life?
Oh, wait, that's right: It was fabricated for propaganda purposes. It's easy to demonize us as "the other," and ignore our humanity by taking biased samples and assuming that if a person is angry about one issue, they're always angry about everything at all times.
On the opposite side, if you actually bother to read what skeptics write instead of what non-skeptics say about us, you'll see that we recognize that people are people. People make mistakes, especially in desperate times. The problem is when someone uses excuses and defense mechanisms to avoid learning from their mistakes and the mistakes of others. We recognize that we're fallible like everyone else, therefore we try to uphold certain standards designed to counteract our human flaws. We try not to lower those standards for ourselves, so why should we lower them for others?
Of course CAM treatments can have physiological effects - it's not all just boring pills, you know. I was once given 1 session of some sort of exotic aromatherapy-massage as a gift - the sort of thing that is marketed as both a nice relaxing spa treatment and at the same time, a cure for various health problems. It was quite... interesting. I was told to undress down to my underwear and lie face down on a padded table. Then the therapist (a pretty, athletic young woman; barefoot in shorts and a sleeveless top) got up on the table with me and proceded to give me a very vigorous massage not just with her hands, but also her arms and feet/legs. I feel pretty confident that treatment had a physiological effect - or several. Still doesn't make it a cure for cancer. But perhaps it might cure a headache ;)
Lucia, Lucia, she whose name means light. Won't you please enlighten us with more of your dreary stereotypes of the cold, socially awkward, self-absorbed, humorless, insecure skeptic? You left out the part about us ranting away in our parent's basements. These messy, subterranean lairs, where we sit, with our geasy, unkempt hair, all unfit and pasty, surrounded by old homebuilt PCs and a cadre of sullen, indifferent cats. This, of course, is the only world we know since we have no "real" friends. Our ancient, long-suffering parents bring us hot pockets and Red Bulls from time to time, and we only get off the internet to watch The Big Bang Theory. Don't forget to mention that our main form of exercise is stepping over empty energy drink cans, fast food containers and piles of porn on our way to the bathroom. Did I leave anything out o illuminated one? We're all Libertarians? Mysogynists? Male? Have tape on our glasses? Pocket liners?
--Humbled (by your blazing insight) Skeptic
What this thread is trying to get at is the distinction between discussions *within* a given community, and discussions between that community *and the public at-large.*
This blog is "within" the skeptic community. As far as I can tell it doesn't have any intention to communicate directly to the general public about these issues: only to equip people here to do so in other forums where we may hang out. When we post in those places we modify our language to deal with the local social realities.
For example in a Daily Kos (progressive Democrats) posting on one health issue or another, I saw someone comment that they were taking homeopathic remedies for something (arthritis pain?) and found them beneficial. OK, now I can choose to a) go on a rant about how homeopathy is silly nonsense for nincompoops, or I can b) leave the situation alone. I chose (b), because it's not my job to tell someone that their placebos are no good, and thereby deprive them of the benefits of a placebo effect that's working for them. However I did post comments favorable to pharmacology, with the deliberate intent of attracting more "undecideds" to go that route.
Each of us has to judge, in our interactions with the general public, what stands to take and where, and how to go about it. Each of us also has variations in our own beliefs about whatever-it-is, and variations in our rank-ordering of the importance of promoting those beliefs in various forums.
For example it may surprise some of you to find out that I believe that the findings of Jahn & Dunne, Targ & Puthoff, and Krippner & Ullman (among others) are valid and that "psi" phenomena are physically real and will eventually be found to have mechanisms that are within the paradigms of the physical and biological sciences. However I'm not going to argue that case here because it would stir up a needless stinkypoo and get exactly nowhere. It's more productive to cooperate on the items on which I agree with the local culture here, and leave the other stuff to other forums.
So about the skeptic stereotypes. The less-than-skillful use of language is relevant here. For example how often do you hear people use the phrase "the cold hard facts"...? That's not objective language, it's emotionally loaded, in a manner that's aversive to most readers. How'bout "the warm fuzzy facts" instead, eh? I guarantee that if you start using the phrase "the warm and fuzzy facts," you'll make progress with people who associate "cold and hard" with various other forms of unpleasantness.
Take a look at Carl Sagan, whose use of language, and significantly, nonverbal communication such as tone of voice, were brilliant. He was a master at evoking the sense of awe and wonder in reference to astronomy and space exploration: emotions that are more commonly associated with religion. In doing so he undoubtedly offered a path into the scientific paradigm for many who might otherwise not have gone there.
Here's a core truth about humans: they don't seek validation of their *ideas,* they seek validation of their *emotions.* The way to shift someone's ideas about anything is not to attack their emotions, but to validate the emotions and associate them with a different set of ideas. You can try this in everyday life: do the proverbial experiment and see what happens.
g724: Not to stir up a stinkypoo about your endorsement of telepathy, but just to point out the wonderfully warm, cuddly and fuzzy fact (or is the correct word hypothesis?) that if telepathy were real we wouldn't be arguing about it or running endless lab tests to see if it exists. It would be such an evolutionary useful sense to have that we'd all be using it, same as we already use our eyes and ears.
Communicating with the general public is no walk in the park: I worked for/ with a few non-profits and had to sometimes speak or write. Cold, hard vs warm, fuzzy?: the *raison d'etre* was getting information out to those who had very poor ideas about issues that affected them profoundly. You've heard the phrase "urban legends": mis-information can often reach frightening levels of mythologising.
I survey woo-meisters because I have seen up close how bad information can harm people( e.g. STDs, SMI): woo involves the deliberate structuring of myth from outside a community- which might already have a few tales growing on its own- with the goal of diverting people from SBM towards products( including media) that directly financially reward the perpetrator. SBM is not merely a philosophy but a means by which people can learn to avoid *harm*- i.e. the consequences of entirely preventable serious STDs or un-treated SMI.
RI is an exceedingly genteel arena than that which I have formerly encountered. Also sceptic-to-sceptic talk -with an occasional intrusive dose of bally fol-de-rol from an outsider- allows us to look at others' paths and trade war stories. Diverse skills and proclivities lead to different approaches.
Re. Sophia8 at 49: The brief summary of findings is that psi has a small effect size that is statistically persistent. Hypothetically, any perceptual or cognitive ability that has that profile, could confer a slight selection advantage and persist over the course of evolution. But I'm not going to go down the digression trail here on that subject; the point was to illustrate that individuals within the science-based or reality-based community often differ in their "accept" and "reject" thresholds for various phenomena and hypotheses.
Reality-based / science-based, is not a monolith with automatic orthodoxy that can be taken for granted. Each of us weighs evidence and comes to conclusions, and they may not always agree with everyone else. IMHO that's a good thing because it prevents stagnation of ideas and occasionally results in an expansion of knowledge.
Re. Denise Walter at 50: Yes, and when the issue is public health, nonsense sprints like a hare and the facts crawl like a tortoise: anti-vaccine quackery being the most egregious example at the moment (pox parties and mailing of infectious material included). The key to this is, people tend to accept ideas that are presented in a manner that validates their emotions and creates a sense of belonging to a defined social group.
Very often, the reason that BS is propagated isn't for the financial benefit of the woo-meisters, but for the *emotional* benefit or reinforcement of "true believers." This dynamic functions similarly to religious proselytizing: the reason someone wants you to join their extremist church, or not-vaccinate your kid, or take some magic potion rather than medicine, isn't that they're seeking to make money off you, but that they're seeking emotional and social reinforcement.
To be quite clear about this: I'm active in a number of public forums and it frustrates the hell out of me to have to pander to emotionalism, irrationalism, and the myriad forms of socially-reinforced BS that are circulating out there. It would be a great thing if people eagerly sought out the facts and the supported hypotheses, and willingly (eagerly, dammit!:-) changed their beliefs and emotional reinforcers accordingly. It's most probable that the relevant characteristics of humans are in part innate and in part socialized, and what we have to work with are the latter: the items that can be affected by education and media.
I'd be interested in hearing more about the approaches you found actually worked in persuading people to deal with STDs and SMIs, and about the communities in which those approaches worked.
I agree that effective communication requires understanding the context and the desired outcome and not just blasting away with both barrels (unless that's what you think will work).
As for PSU, I thought they were onto something for a while too but taking a course in meta analysis disabused me of that notion. PSI is only statistically significant when you employ meta analyses over decades. Even if the effects weren't basically artifacts of the creative use of meta analyses, the results they've reported are incredibly weak and would be less than useless in any real world application. Besides, any mechanism for it to work is utterly improbable even though I wish it were real.
Talking about "The Secret" I think if it works at all, it works only on placebo and nothing else. But let's not take hope from these people. They need illusions to feel good. This is what I observe among my "Secret-Is-Awesome" friends.
"a response to the growing body of evidence in so-called "complementary and alternative medicine" (CAM) "
Funny how you're always talking about evidence, Orac, when you come from a medical specialty (surgery) that requires zero to little evidence.
Talk about the the pot smoking itself silly and shooting its own credibility in the foot. Lol.
...and it's also funny that all your supporters are smoking the same batch because there's not an objectively critical one among them that get this.
Citation for this bizarre idea of yours?
Didn't realize did ya, Foolgold. Thanks for proving my point.
All those thousands of controlled studies looking at different surgical techniques for everything from transplant surgery to cosmetic surgery I think I can see on PubMed must be mere hallucinations.
There goes another irony meter. Why don't you check you have your facts right before making yourself look like a complete idiot like that? Lol indeed.
No country has set up a systematic program for evaluating new surgeries = lack of regulation = lack of science-based evidence.
Read again: the FDA regulates drugs, devices, and many tests, but it does not control how doctors use them and has NO CONTROL OVER SURGERIES.
Lack of strong oversight means doctors often have limited information about procedures and products used for years. One surgeon complained, "Device makers could sell us a piece of curtain and call it surgical mesh and we wouldn't know the difference." http://discovermagazine.com/2010/nov/11-the-problem-with-medicine-don.t…
Ya talk as if you're one who know, but ya don't. That's called feld talk.
Publishing a study means little if there's no regulatory body to evaluate the efficacy of the treatment.
I don't understand why you guys like to prove my point over and over...ad nauseum...
Thanks for the "high" school arguments. Good bye.
Do you really think that follows logically? There is no lack of science-based evidence in surgery and there are dozens of professional regulatory bodies that provide standards of practice for surgeons based on that evidence. If a surgeon does not adhere to those standards he or she can be sued, or just like any other doctor.
I have been involved in research into the relative effectiveness of different surgical techniques myself, so please don't tell me science-based evidence for surgery doesn't exist.
If you are complaining that doctors in general and surgeons in particular do not practice science based medicine as much as they should, and that this should be better regulated, I agree with you. Perhaps you haven't noticed that Orac has been advocating just this for years.
There's no regulatory body for basic physics, chemistry, or biology. Does that mean that none of that research is science-based either?
Not by me or anyone else in the English-speaking world. The usual term is bullshit.
Of which your comment is an excellent example.
I see the Orac sycophants are still arguing against fact.
"A panel of experts convened in 2007 by the prestigious Institute of Medicine estimated that âwell below halfâ of the procedures doctors perform and the decisions they make about surgeries...have been adequately investigated and shown to be effective. The rest are based on a combination of guesswork, theory, and tradition, with a strong dose of marketing by drug and device companies."
Enjoy your inability (ineptitude) to be objective of the facts, you woo-loving crank hypocrites.
"There's no regulatory body for basic physics, chemistry, or biology. Does that mean that none of that research is science-based either?"
You obviously don't understand the role of the FDA, as it applies to surgery.
Great argument...pure opinion, zero facts or citations.
"this should be better regulated"
...you mean regulated at all.
"Orac has been advocating just this for years."
Please. Open your eyes of bias, if at all possible. What is the ratio of rants for greater-advocacy-for-surgery-regulation articles vs rants against CAM? At a very conservative estimate, probably 1:100+.
When someone is objective, there's equitable focus given to all aspects.
Great to see that critical thinking is still endangered and growing here.
Sock puppets alert...this blog reeks of smelly socks.
CarOWhatever - I'm not arguing the state of surgery today or its regulation. You made a statement that, in essence, there is no useful science without a (government) regulating body. I dispute this.
So the goalposts move and "zero to little evidence" has now increased to "well below half" of surgical decisions have been shown to be effective. Where do these "facts" come from? Discover Magazine it seems. Do you have a citation for the IoM report written by a panel of experts? The only publication by the IoM I can find that fits the description is the Evidence-Based Medicine and the Changing Nature of Healthcare: Meeting Summary (IOM Roundtable on Evidence-Based Medicine) which says nothing at all about clinical decisions being based on guesswork or tradition. It does state the IoM's goal is that:
Which sounds like a good idea to me.
Try providing some facts from a peer reviewed journal and perhaps we could have an objective discussion about them.
The Discovery Magazine article you link to and refer to was written by Jeanne Lenzer & Shannon Brownlee who have written articles attacking science-based medicine before, one of which was discussed here some time ago - use the search box top left. Of this article Orac concluded "In the 25 years I've been a subscriber, I've never seen such a credulous, irresponsible piece of "journalism" appear in The Atlantic." They do seem to be adept at cherry-picking evidence and distorting it to fit their preconceptions. For example they complain that there is little RCT evidence for using warfarin for clotting disorders, yet they link to a Cochrane review that discusses the reasons for the lack of such evidence, and agrees that it would be unethical to do such clinical trials. Cochrane says:
It concludes that:
This is hardly evidence that warfarin is an ineffective or dangerous treatment, is it? That's just one example of several similar misleading statements.
As I understand it, the FDA has no regulatory role over surgery. That doesn't mean that surgery is unregulated. Try setting up an operating theater in your basement and you will rapidly discover this.
Loving the hilarious nickname, you are obviously halfway to being quite a wit. There is board certification, and the professional bodies I mentioned that also have a regulatory role, and any hospital that has operating theaters will have protocols for introducing new surgical techniques based on published evidence. It is nonsense to suggest surgery is unregulated.
Orac can write about what he likes. It's his blog and he writes about things that capture his interest. I don't remember him arguing against improved regulation for surgery and other medical specialties. He has certainly written about improving regulation and use of SBM in several areas of medicine.
No there isn't, this is a blog, not a textbook of medical practice. Where has Orac argued against better regulation of surgery, or suggested that there is no problem? That would be unobjective. Your objections are just an elaborate tu quoque fallacy.
You haven't displayed any at all yourself. Have you looked at PubMed to see how many papers are published on surgery every year, providing an evidence base for practice? Do you understand the regulatory role of board certification or of professional bodies like American Board of Surgery (ABS), the American College of Surgeons (ACS), the American Surgical Association (ASA), the Association of Program Directors in Surgery (APDS), the Association for Surgical Education (ASE), and the Residency Review Committee for Surgery of the Accreditation Council on Graduate Medical Education(RRC-S)? Me neither, but their existence and a brief perusal of their briefs demonstrates that your claims that surgery lacks an evidence base and is unregulated is nonsense.
I wonder where carO and his/her sockpuppets came up with the notion that:
Really? On what basis can you justify this? What is "all aspects" anyway?
One can objectively examine any issue at any level, as long as one is putting aside one's own biases (which you appear to fail to do) at the outset and critically review the evidence.
I think you are confusing what "objective" means and replacing it with some false notion of balance or fairness.