Arrowman

Miscellaneous Musings

The homeopathy discussion, and recent experience, has got me thinking about the more general issue of how one approaches the subject of critiquing "alternative medicine" (ie, quackery) to a "lay audience". (Or indeed, critiquing any other weird belief from a Skeptical perspective). So I've written down some experiences and thoughts; I'd like to share them here and I'd be interested in any "war stories" or thoughts that people might have.

First off - by "lay audience", I mean a person who is not formally educated in the field in question (in this case, biosciences/medicine, or science in general) - and also, who does not conduct "critical thinking" or skepticism as a core part of their life. I don't mean they're "gullible" or "stupid", I just mean they are every day people who don't spend a lot of time thinking about these issues in critical terms. They've never read Sagan, they don't know who James Randi is, they believe in "keeping an open mind", they think a skeptic is a cynic, etc.

- Also, they don't necessarily hold a strong belief in the "phenomenon" in question, they just "have an open mind".

They are, in short, the most important audience for skeptics because they are the majority! And we [skeptics] need to learn to deal with them!

In particular, we need to recognise that they do not have the same passion for, or understanding of, skeptical thinking as we do; indeed, they see a skeptic as a bit of a grumpy killjoy who'd kill off Santa Clause given half a chance.

OK - so here's my recent experience. A friend of mine divulged that she had been to a Naturopath and had had a "live cell analysis". This set off my skeptic radar. I suggested that perhaps this was quackery.

She defended Naturopathy. I pointed out that Naturopathy at its core has some validity - after all, some plants are known to contain chemicals/drugs that are efficacious in certain conditions etc - but the problem is
(a) Naturopaths don't have anywhere near the regulatory control, requirement for professional qualification etc that governs "conventional medicine" - essentially, anyone can hang out their shingle as a Naturopath and they won't be breaking the law.
(and yet our private health insurers will pay benefits for naturopathic treatment )
(b) Naturopaths tend to embellish the legitimate core of their "profession" with weird quackery such as live cell analysis.

I looked up "live cell analysis" in my little "skeptic's guide to alternative therapies" and sure enough, it's quackery. I lent her the book. A few weeks later I saw her again and her reaction was - "Thanks, interesting - but that book was very negative, wasn't it? I mean, all it did was criticise and never said anything positive - it didn't seem to be very open to possibilities".

(PS she paid $200 for this quackery, so she's invested in it. I'm not expecting her to readily accept that she's been conned.)

But she did act like she wouldn't have another "live cell analysis" and I suggested that next time she goes to her Naturopath she might like to, just for fun, ask a few challenging questions about the procedure. I doubt that that will happen.

It wasn't the time or place for in depth debate, so I just casually remarked with a smile that when you're studying weird claims and quackery for which there is no supporting evidence, it's pretty hard to be anything other than "negative".

We haven't discussed the subject any further or in any depth - it wasn't the time or place - but her reaction just reminded me of the challenge one faces with the "lay audience":

- Skepticism = cynicism
- Skepticism = negative thought
- Skepticism = closed mind / not open to "the possibilities"
- Applies much looser standards of proof to "alternative" medicine than to "conventional" medicine - would probably be horrified at the thought of being treated by a "doctor" without a medical degree, but thinks nothing of going to a Naturopath and blithely assumes they know what they're doing - and that all they do is valid, because some of it is.

Still, I'm enjoying the challenge of spreading skeptical thought without being seen as some sort of weird grumpy old sod.

acampbell

For a start, I think we need to be cautious about accepting the label "alternative medicine" (now often renamed "Complementary and alternative medicine" (CAM). This comprises literally hundreds of treatments, many eccentric to the point of lunacy and some positively dangerous (e.g. colonic irrigation). But others are on the border of science and indeed may be in the process of crossing over into orthodoxy.

The mainstream treatments are homeopathy, acupuncture, osteopathy/chiropractic, herbalism, and perhaps hypnotherapy. With the exception of herbalism, all these are practised by numbers of orthodox doctors and all have at least some research evidence to back up their claims.

Herbalism does of course include medicines that are undoubtedly physiologically effective, and indeed potentially dangerous; the effects have to be taken into account when patients are given anaesthetics, for instance. Until comparatively recently, almost all the medicines available to doctors were herbal, and even today some still are derived from plants.

Acupuncture is increasingly coming into use in pain clinics and elsewhere. But one needs to distinguish between traditional acupuncture, which makes use of diagnostic methods and theories that are more or less impossible to reconcile with a scientific physiology, and modern (medical) acupuncture, which uses "ordinary" ideas of physiology and pathology and largely ignores the traditional apparatus of "points" and "meridians" (both mistranslations of the Chinese terms, by the way).

Hypnotism, likewise, has moved at least part of the way from fringe to orthodoxy.

Osteopaths and chiropractics seem to be moving away from the dubious theories that were put forth by the respective founders of their disciplines. In my experience, many of them are surprisingly open-minded and self-critical. We need to keep in mind that their treatments overlap to a considerable extent with those used by modern physiotherapists (who are, of course, regarded as mainstream); many physio treatments lack an adequate evidence base.

To summarize: I think it is too facile to simply equate CAM with quackery. We have to particularize and talk about individual treatments rather than alternative medicine in general; it is too diverse. If one wants to be an honest skeptic one has to do a great deal of homework. For example, just to get to grips with the placebo effect entails a large amount of reading.

We also need to understand that there are two different tendencies within CAM: some practitioners want to build bridges with orthodox medicine, while others wish to distance themselves completely from science (and this includes some doctors). This distinction in attitude is, to my mind, absolutely fundamental. You can reason with the first group but the second lot are hopeless.

There is a lot of stuff about CAM, acupuncture, and similar things on my web page:
<a href="http://www.acampbell.org.uk/" target="_blank">http://www.acampbell.org.uk/</a>

See particularly the "mainly for skeptics" section.

The Other Michael

That strikes me as a good argument to use when trying to get someone to be more cautious in trying the alternate forms of "medicine".

But I forsee a possibility of the x-opathic practioner replying "oh, but the medical establishment is afraid of our treatment usurping their monopoly, so they won't give us credentials".

cheers,
Michael

Undercurrent

It seems that the world is full of "politeness writ large" in these kinds of things. The precepts:

• The poorer someone is, the better person they are.
• The poorer someone is, the wiser they are, and the more likely it is that their beliefs are true.
• The older a belief is, the more likely it is to be true.
• "The Establishment" only exists to give power to its adherents. Any labs or resarch faclities are only there for show.
• "The Establishment" only ever opposes things that are true and threaten its power.
• Even though "The Establishment" is composed of people, it's perfectly all right to slander "The Esablishment" so long as no specific people are named.

IMO, the best attack on these kind of beliefs is an attack upon the last point. Many people are willing to slander entire fields as vast conspriacies to keep their preferred beliefs down, but are unwilling to slander any specific person.

E.g. a consipriacy-minded friend of mine decided that the car found after the WTC attacks in the airport parking lot full of evidence of islamic terrorism was planted by the CIA to justify retaliation because it was "too obvious." But when I pointed out to her that that would involve at least one person with full knowlege that he was planting evidence doing such an act, she immediately backed off. People like to accuse "The CIA" or "The Medical Establishment" or "Evolutionists" of evil things, but they hate to accuse actual people of evil things.

m.

Arrowman

"We need to distinguish between ancient wisdom, and ancient stupidity."

- I don't recall who said that, but I think it's a very appropriate phrase. People express great wonderment at "the wisdom of the ancients" (like, how did those Egyptians manage to build the pyramids? - er, by stacking stones one on top of the other based on some primary school maths, addmittedly advanced for the time) and extrapolate that to assume that every weird and primitive belief must have some validity. Anyway..

acampbell - I agree. Chiropractic is I think a very good example - there is the purely physical nature of manipulation, and then there is the belief in "subluxation" (?) and other "life force" type stuff which has no scientific basis.

The problem is that people can recognise the valid stuff (manipulating bones makes you feel good and often in fact helps to heal a problem) and take the practitioner's word that there's "something else going on here".

Conversely, the skeptic must imho tread carefully lest they "throw the baby out with the bathwater", even if it means compromising some of their own opinions.

So I'm prepared to acknowledge the undoubted validity of some aspects of naturopathy (btw that's not "compromising", I accept it) while pointing out the weirder stuff. Even if I had serious doubts about the validity of a given practice, I might be prepared to suppress those doubts in discussion, for the sake of making a broader point.

Example - I recently wrote a letter to my health fund and the Australian Health Minister, asking why private health funds provide benefits for practices such as homeopathy and iridology (and by implication, taxpayer funding as well). (I never got a reply ). I was careful to leave naturopathy off the list because I did not want my point to be confused or diluted by the undoubted validity of some naturopathic practices.

It depends on - one of my favourite phrases in reference to debate and argument - "do you want to make a point, or make a difference?". In other words, do you want to make yourself feel better (or superior!) for having expressed your opinion, or do you want to actually persaude the other person?

Secular Pinoy

acampbell, I'll wait til chiro, osteo, homeo, naturo, etc., crosses over to scientific orthodoxy. Until then, the burden of proof is on the quacks. 200 years and the alternative medicine crowd has precious little positive results in rigorous settings to show for (statistical chimeras, IMO). Evidence based medication have favorable results in a decade.

I think we can provisionally consider, since they've been here for centuries, that they are, on the whole, wrong. They may have some use, a few tidbits here and there, but that's all.

It's funny that they're now called complementary medicine. Do they plan to take a piggy back ride from legitimate evidence-based medicine, to be administered along with it, and when there is a favorable result, claim that the CM was responsible?

I'm sorry, but there is no alternative medicine, complementary medicine, or integrative midicine. There's either medicine that can be proven to work, and there's snake oil. After 200 years with little success, I have a fair opinion of these unorthodox methods.

(It's midnight here, and I've been staring at the screen for several hours now, so I may not be totally agreeable. Sorry if I sound a bit abrasive.)