Wednesday, December 2, 2009
Wednesday, July 15, 2009
2. social truth
4. universal truth
Religion, no doubt, reflects social truths, and perhaps, in some regards, human truths as well.
Tuesday, July 14, 2009
Monday, July 13, 2009
In context, belief based medicine does a lot more harm than one would guess - but you know that. In a modern, fairly stable society these practices may cause less obvious impacts but -even here- if they hold more sway on every day reality than Bugs Bunny, the Simpsons and flying tea kettles we've got problems.
Imagine then, the consternation of those doctors in the trenches working in parts of the world where anarchy, lawlessness, illiteracy and corruption drip from every pore of society when homeopathy is promulgated as a reality.
Here's hoping the WHO will support their very reasonable and humanitarian plea for support.
"Many people in developing countries urgently need access to evidence-based medical information and to the most effective means of treating these dangerous diseases. The promotion of homeopathy as effective or cheaper makes this difficult task even harder. It puts lives at risk, undermines conventional medicine and spreads misinformation.
We are sure that you will recognise these dangers and ask that you issue a clear international communication condemning the promotion of homeopathy for treating TB, infant diarrhoea, influenza, malaria and HIV. We are sure, too, that you will recognise the urgency of our request, and look forward to your response."
Thursday, June 11, 2009
Thursday, January 29, 2009
The really new thing in the Madsen paper is that although acupuncture still beats no acupuncture, the advantage is too small to be much use to patients. So it may be a theatrical placebo, but the placebo effect isn’t big enough to matter in real life.
If this conclusion is confirmed by others, then acupuncture is dead. You can’t even make the (morally-dubious) argument that it’s a good placebo."
Remember, this particular study relates to the very nebulous, variable and personal concept of pain- a realm fraught with confounding factors. Many studies regarding acupuncture effects deal with these rather subjective areas because that's pretty much what is left as the search for bigger effects has proven fruitless. If it is this hard to tease out any real acupuncture effect here from the a back ground noise of probability, acupuncture -as a legitimate medical modality- has a big, big problem.
really nothing new...as always... just take it with a grain of salt
Dr RW has an interesting post where he responds to Dr Marcia Angells JAMA commentary where she questions the ability to practice evidence based medicine noting that "Physicians can no longer rely on the medical literature for valid and reliable information".
Though, as pointed out by Dr RW, there are prescient challenges and significant problems reagrding industry and non-industry supported research, Dr Angells assertion -reminiscent of the "pharma is all evil" canard- indeed seems far too simplistic.
Unfortunately, her opinion -though important and worth measured consideration- may be taken as fact and used by the ideological or the less scientifically literate to distract from a more balanced approach to considering a litany of real problems. Indeed, the research landscape is far from the useless state Dr Angell seems to claim.
As Dr RW notes:
"What then are practicing doctors to do? Angell’s statement above suggests that in the current environment the practice of evidence based medicine and science based medicine are impossible. Nonsense. EBM is premised on the fact that all research reports have weaknesses and are to be viewed with skepticism. SBM, recognizing that EBM lacks the tools to examine all claims, goes a step further by evaluating reports in light of prior research and scientific plausibility. In short, doctors have the tools to critically appraise the medical literature. It’s hard to believe Dr. Angell wants to abandon EBM altogether."
Hopefully that is not her intent. Dr Angell does seem to favor an "independent body" to serve as overseer and provider of clinical trails...an option fraught with many of the same problems beguiling the present research environment.
In the end, as these issues are -hopefully- objectively and pragmatically addressed, Dr RWs' call to using evidence and science based approaches and tools when evaluating data will continue to serve practitioners and their patients well.
Case studies in debunking fallacious thinking: anti-vaccine apologists and acupuncture "effects"considered
Wednesday, January 28, 2009
Monday, January 26, 2009
Thursday, January 22, 2009
It also brings to the fore a telling problem for Complementary and Alternative supporters. They just don't know when to call off or discontinue a modality when there is little or no supporting evidence of efficacy.
Indeed, many in the CAM field defend their particular fixations (be it acupuncture, homeopathy, nutritional supplement...etc.) claiming "more studies are needed"ad infinitum, that you just can't properly test it -when you can if it's real, that it's "complicated" (appeal to complexity) or "you do it too" accusations (Tu Quoque).
Dr Colquhoun nicely sums up some CAM modalities as follows (I'm sure to the shagrin of beleivers) thusly:
"Homeopathy: giving patients medicines that contain no medicine whatsoever.
Herbal medicine: giving patients an unknown dose of a medicine, of unknown effectiveness and unknown safety.
Acupuncture: a rather theatrical placebo, with no real therapeutic benefit in most if not all cases.
Chiropractic: an invention of a 19 th century salesmen, based on nonsensical principles, and shown to be no more effective than other manipulative therapies, but less safe.
Reflexology: plain old foot massage, overlaid with utter nonsense about non-existent connections between your feet and your thyroid gland.
Nutritional therapy: self-styled ‘nutritionists’ making unjustified claims about diet to sell unnecessary supplements."
At any rate, read the article when you can.
Tuesday, January 6, 2009
In science, the person who shows that a generally accepted belief is wrong or incomplete is more likely to be considered a hero than a heretic.
The primary goal of science is to achieve a more complete and more unified understanding of the physical world. Pseudosciences are more likely to be driven by ideological, cultural, or commercial goals. Some examples: astrology (from ancient Babylonian culture,) UFO-ology (popular culture and mistrust of government), Creation Science (attempt to justify a literal interpretation of the Bible), "structure-altered" waters (commercial quackery.) Most scientific fields are the subjects of intense research which result in the continual expansion of knowledge in the discipline. The field has evolved very little since it was first established. The small amount of research and experimentation that is carried out is generally done more to justify the belief than to extend it. The search for new knowledge is the driving force behind the evolution of any scientific field. Nearly every new finding raises new questions that beg exploration. There is little evidence of this in the pseudosciences. Workers in the field commonly seek out counterexamples or findings that appear to be inconsistent with accepted theories. In the pseudosciences, a challenge to accepted dogma is often considered a hostile act if not heresy, and leads to bitter disputes or even schisms. Sciences advance by accommodating themselves to change as new information is obtained. Observations or data that are not consistent with current scientific understanding, once shown to be credible, generate intense interest among scientists and stimulate additional studies. Observations or data that are not consistent with established beliefs tend to be ignored or actively suppressed. Have you noticed how self-styled psychics always seem eager to announce their predictions for the new year, but never like to talk about how many of last years' predictions were correct? Science is a process in which each principle must be tested in the crucible of experience and remains subject to being questioned or rejected at any time. The major tenets and principles of the field are often not falsifiable, and are unlikely ever to be altered or shown to be wrong. Enthusiasts incorrectly take the logical impossibility of disproving a pseudoscientific priniciple as evidence of its validity. Scientific ideas and concepts must stand or fall on their own merits, based on existing knowledge and on evidence. Pseudoscientific concepts tend to be shaped by individual egos and personalities, almost always by individuals who are not in contact with mainstream science. They often invoke authority (a famous name, for example) for support. Have you ever noticed how proponents of pseudoscientific ideas are more likely to list all of the degrees they have? Scientific explanations must be stated in clear, unambigous terms. Pseudoscientific explanations tend to be vague and ambiguous, often invoking scientific terms in dubious contexts. Phrases such as "energy vibrations" or "subtle energy fields" may sound impressive, but they are essentially meaningless.
In science, the person who shows that a generally accepted belief is wrong or incomplete is more likely to be considered a hero than a heretic.
Pediatrics: DC vs. MD Training« Thread Started on Dec 6, 2007, 10:34pm »
Steven Novella at Nuerologica blog has -as usual- an excellent take down of some really juicy pseudoscience and related hubris that can only be described as classic scam artistry.
Monday, January 5, 2009
Here is a humorous comparative list translating some “politically correct” phrases into what is really meant when they are uttered. Postmodernism is an interesting philosophical exercise with respect to human social interactions, but it does have one major drawback if extended beyond the realm of the mind – reality.
A brief guide to deconstructing academically fashionable phrases for the uninitiated (partial exerpt)
David A. Levy
All points of view are equally valid
…….I am willing to abandon all logic and evidence just to maintain the illusion that I am being open-minded and fair.
There is no objective reality
…….except for what I’m saying right now.
In our culture, empiricism is over-privileged
…….I don’t have any facts to back up my argument.
I’m not saying better,I’m saying different
…..I’m saying better.
Let us start a dialogue
….Let me start a monologue.
This warrants more conversation
…I can’t believe that you have the temerity not to agree with me.
Don’t you think that sounds kind of racist?
….good luck disagreeing with me now.
One can prove anything with statistics
…I should have paid more attention in stats class.
The interreferential nature of our phenomenological field can be neither deconstructed nor decontextualized from our ontological meta-narrative
…Don’t I sound really intellectual and hip?
Science is merely one more opinion
…My Uncle Bill told me so.
Ref: Skeptical Inquirer Vol32, No. 6 Nov/Dec 2008
Sunday, January 4, 2009
For the last 6 weeks, Sam the dog had been seen and treated with acupuncture for an undetermined lameness by a local “natural” veterinarian who specializes in Chinese Medicine and Acupuncture therapy. Sam was being seen by a conventional vet and wasn’t responding typically to palliative treatment. That is, he would get better and then get worse intermittently.
After declining, for the moment, further diagnostics this veterinarian grudgingly ceded to the clients wishes to pursue alternative treatments making clear –to her credit- the difference between science and non-science based modalities. This is an unfortunate, yet fairly common scenario among a percentage of many a veterinarians client roster. The ever present, albeit usually tiny, clad of holistically oriented people who innocently –and sometimes tragically- muffle and slow the course of getting to the bottom of a case like Sam.
On the other hand, this is fairly familiar territory and many veterinarians will attempt to establish some kind of continued interaction with these folks in the interest of their patients. In fact, to some alternative veterinarians’ credit there are those who insist on some type of interaction with science based practice and require that a “conventional” diagnosis be given.
That most of these cases are either chronically or terminally ill patients undergoing a constellation of naturally occurring waxing & waning cycles of disease seems to be overlooked –especially when they are experiencing a usually quite temporary upswing. Anything good is ultimately and erroneously attributed to whatever strange concoction or instrument is used.
Because Sam wasn’t responding “as expected” it was determined -quite correctly by the attending alternative vet- that a clearer diagnosis was needed. The regular conventional veterinarian was called on to now pursue a diagnosis after the clients’ discussion with their alternative vet. Yes, the irony is duly noted.
However, by claiming that the acupuncture treatment wasn’t working and actually making the problem worse he used the wrong reasons. Whether an animal is getting better or worse, without a profound knowledge base of the natural history of disease and a good dollop of solid science based studies and data supporting the therapy being used, you really can’t claim anything –good or bad.
It turns out Sam the dog was dying from a severely malignant form of spinal bone cancer. He was basically terminal from day one and is now under focused conventional and humane end of life care…and Chinese herbs for cancer. Any improvement quite possibly will be attributed to the herbs.
The main point of this tale is that when something bad happens in the realm of alternative medicine, the problem is often attributed to an equivocal diagnosis, or that the alternative treatment was started too late, or that some diseases are made worse by one alternative modality…all mostly claims made without any solid evidence (including -on balance- acupuncture studies).
…and here’s one of the big problems. There is always something else to try or mix with the science…often without really knowing what’s going on. This brings all involved dangerously close to the edge of a dark abyss.
Without the proper tools -the light of reason- we're destined to stumble through interminable blind alleys and false hopes...armed with little more than hat tricks to bide the time.
Here is a fascinating exposition of winning images from Nikons annual small world phot0micrography competition. Check it out!
Artists rendering of an alien cyborg? Actually a chicken embryo photographed at 6X. ( by Tomas Pais de Azevedo of Lisbon, Portugal, using stereomicroscopy.)
A Borg mother ship? Really, a 14x image of rare mineral called arsenuranospathite. (It was submitted by Stephan Wolfsried of Germany.)
Rows of towels hanging in the midst of some Florence neighborhood? No, this beauty is a 100x magnification of scales on the wing of Urania riphaeus, the sunset moth. (The fiber-optic illumination was submitted by Charles Krebs from Issaquah, Wash.)
Saturday, January 3, 2009
Adam Savage of “Myth Busters” fame demonstrates, in this talk, some of the qualities that define the essence of human inquiry and discovery so crucial to authentic enlightenment. Could this be called a healthy obsession? Yep…and the type of focus and energy needed to look under the mask of mystery to reveal untold riches of knowledge.
Tim Minchin asks at the end of his beautifully brutal deconstruction of credulity in his poem “Storm”,
“ Isn't this enough? Just, this world? Just this Beautiful, Complex, Wonderfully Unfathomable, Natural, World? How does it so fail to hold our attention that we have to diminish it with the invention of cheap man-made myths and monsters?”
Indeed. One wonders if the opiate of the masses –credulous belief- will ever be put back on the shelf of human character quirks’. Perhaps still vital to a degree, but best taken off the pedestal it’s on.
(hat tip Bad Astronomy)
Friday, January 2, 2009
"Skepticism has become a legitimate form of inquiry that Deepak parenthetically acknowledges (in a left-handed sort of way) as occasionally laudable, another refrain we often hear in the form of “I’m a skeptic too, but…,” where skepticism is fine as long as it is someone else’s codswallop under the microscope."
It is important to note that Chopra, over the years, has developed whole made up world views from stunningly naive, flimsy and often outright wrong assumptions about the actual nature of phenomena around him.
Mind you he has said some pretty interesting things regarding human wisdom and how we can all get along but this guy is just as fallible and screwed up as any of us. He really needs to get off that high horse and admit it though.
If Chopra wants to promulgate a belief system, that's fine. What he can't -or at least shouldn't be aloud to do- is force this system on everybody else. This is exactly what he would like to do imposing "magic" based medicine onto science based medicine.
He should just get real, put on a priest robe, stick to teaching ancient Hindu wisdom and call it good.
...or how to insert foot in mouth
Orac has a nice response to Chopras most recent "rebutal" against reason which just so happens to be related to yesterdays post about Steve Salernos very fine take down of the "Integrative" medicine movement. For good measure, Chopra calls on the "authority" of alternative medicine experts Andrew Weil and Rustum Roy to shore up his vain effort to claim scientific legitimacy -failing miserably.
As Orac notes "... Basically, the argument being made by the Woo-meisters Three boils down to an attack on evidence-based medicine based on exaggeration and cherry picking, topped off with a huge dollop of conspiracy-mongering and playing the victim. There is not a single positive, science-based argument that Chopra's woo or Andrew Weil's "integration" of the dubious with the evidence-based produces better health outcomes than the evidence-based medicine they attack..."
Yep...you can dress it up with the finest of imaginary cloth...but it still comes down to one simple fact...the emporers' still butt naked!
The bigger problem though, as Salerno points out so eloquently, is that in spite of the fact that most of the alternative movement is more illusion than real...more belief based than fact based...more bullshit and sofist rhetoric than a real reflection of reality...it is poised to adversely influence and contaminate an already severely strained health system.
The Chinese did something like this decades ago. They dressed up -made up- a scam health system to "appease" the populace who were devoid of access to science based medicine. It was called Traditional Chinese Medicine.
Orac nails it with this ominous warning:
"...Chopra's article demonstrates beyond a shadow of a doubt is that advocates of unscientific medicine and quackery apologists are a potent political force, and their new strategy has become clear. With the impending inauguration of Barack Obama as the President of the United States, they see a huge opportunity in his plans to overhaul the government health care system to insert into legislation provisions that will pay for unproven and pseudoscientific CAM/IM modalities. They will sell these provisions as "reform" and as "health maintenance," when they represent neither."
It is my hope his voice and the many others calling for reason be heard.
It appears Dr. Chopra has earned an additional well deserved laser guided intellectual thumping from Skeptico:
"Chopra’s piece is just one logical fallacy after another. This is Chopra's article, summarized:
Appeal to authority
Science was wrong before
Appeal to other ways of knowing
Add claims of “concerted research and clinical practice” that his woo works, without one shred of evidence that his woo works, and you have Chopra’s entire article. (He should employ me as his editor.)"
Thursday, January 1, 2009
...either way, the stink still comes through
"The Touch That Doesn't Heal" is a very insightful article regarding the rather sad tale of the insiduous and undeserved penetration of unproven...and disproven (within the realm of reason) "alternative' or "integrative" therapies into more mainstream medicine.
Steve Salerno nicely articulates the problem of incorporating therapuetic modalities built on smoke and mirror "logic" into the real world of disease, limited funds and the false assumptions of efficacy proffered by CAM (Complementary and Alternative Medicine) to a credulous population (many doctors included).
"...A survey of 32,000 Americans by the National Center for Health Statistics, released earlier this month, suggests that 38% of adults use some form of "complementary and alternative medicine," or CAM -- now aggressively promoted for everything from Attention Deficit Disorder to the Zoster virus. The survey polled consumers on 10 provider-based therapies -- for example, acupuncture -- and 26 home remedies, such as herbal supplements.
On the other hand, it should be noted that all is not lost. The reality of CAMs inroads may not be as entrenched as appears as suggested by Mark Crislips excellent post at the Science Based Medicine Blog . Still, there is a critical disconnect -a collective cognitve dissonence- opening a "back door" and for non-science based practices to garner a legitamacy that doesn't exist. You can use all the perfume you'd like...but bullshit is bullshit and that ol' smell eventually comes through!
Salerno continues "...This should be a laughing matter, but it isn't -- not with the Obama administration about to confront the snarling colossus of healtallowing h-care reform. Today's ubiquitous celebration of "empowerment," combined with disenchantment over the cost, bureaucracy and possible side effects of conventional care, has spurred an exodus from medical orthodoxy. As a result, what was once a ragtag assortment of New Age nostrums has metastasized into a multibillion-dollar industry championed by dozens of lobbyists and their congressional sympathizers..."
"Indeed, one of the great ironies of modern health care is that many of the august medical centers that once went to great lengths to vilify nontraditional methods as quackery now have brought those regimens in-house. "We're all channeling East Indian healers along with doing gall-bladder removal," says Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics. Mr. Caplan harbors no illusions about what's behind the trend: "It's not as noble as, 'I want to be respectful to Chinese healing arts.' It's more, 'People are spending a fortune on this stuff! We could do this plus our regular stuff and bill 'em for all of it!'..."
"...Meanwhile, CAM has secured its own beachhead within the National Institutes of Health in the form of the National Center for Complementary and Alternative Medicine (NCCAM). "Special commercial interests and irrational, wishful thinking created NCCAM," writes Wallace Sampson, a medical doctor and director of the National Council Against Health Fraud, on the Web site Quackwatch.com. And Sen. Tom Harkin (D., Iowa), who credited bee pollen with quelling his allergies, was single-handedly responsible for the $2 million earmark that provided seed money for NCCAM, chartered in 1992 as the Office of Alternative Medicine. Despite the $1 billion spent in the interim, the center has failed to affirm a single therapy that can withstand the rigors of science..."
This article is well worth reading. One take away is that the battle for reason goes on...and on. Here's to a great year of critical thinking!