Survey Says: I Might Be a Dick

Very occasionally — and I mean that — I forward an interesting skeptical article to my family in the States.  This happened recently when I read Dr. David Gorski’s scathing summary of two recent Dr. Oz episodes at Science Based Medicine last week.  I did think twice before I hit Send — Dr. Gorski can be a bit overwhelming to the uninitiated, and this article was one of his more animated rants — but he was calling out “Americas Doctor” for promoting faith healing on his show and at the time it just seemed like something that needed to be shared.

A Richard, not a Dick

One of my relatives has recently become involved in the CAM community, and reacted to the article…well…negatively.  In retrospect, I should have seen this coming and simply left her off the cc list, and I’m still not quite sure why I didn’t.  I’ve been trying to avoid a confrontation with her for some time now, and up until that point had simply responded to her baiting (or at least, what I’d perceived as her baiting) with deflective humour.  Yet this time I was the one doing the baiting, and when the bullets started flying, I returned fire.

Beyond whatever less than noble personal motives I might have had (I’ll take those up in “group“), what triggered my reply was this: she never addressed what the article had to say.  The response started with an ad hominem attack against Dr. Gorski, followed by the tired trope about physicians managing illness rather than healing, and then an accusation that doctors are deliberately misleading the public about the evidentiary basis of “western medicine”.  Maybe that was a fair response — in all honesty, I probably wasn’t just talking about faith healing when I sent off the link.  But the form of her reply is typical of the type of evasive maneuver I regularly see from the CAM community, and I guess I just went on auto-pilot in my response to it.

Anyway, at the risk of making Thanksgiving even less comfortable this year, I’ve excerpted that response below.  While I stand by the arguments herein and (apparently) think they’re worth making publicly, I’ll add the caution that what follows is also a textbook example of how not to promote skepticism to someone you care about.  Being right doesn’t matter if you say it in a way that no one will listen, and I’m pretty sure I didn’t convince anyone but myself with what you’re about to read.  I’ll let you decide whether you think I steered into Dick territory, but I’m giving it due consideration myself.

[XXX],

I think you can count on one hand the number of these sort of things I’ve sent you in the last couple of years.  Occasionally I read something that I think my family would find interesting and I send it along.  I’m not home during the day, so I didn’t realize quite how credulous Dr. Oz had become…reading this was enlightening to me, and I thought it might be to my family [...] It was really no more than that, and if you don’t want me to send them to you, I’ll gladly stop.

That said, some of the things in your reply I fundamentally disagree with, and I’m going to try to tell you why.  If you don’t care, feel free to stop reading now.

Let’s start with “Western Medicine.”  This is a term I hear a lot, and only from the alt-med community.  It’s intentionally coded language, meant as a pejorative, with roots in postmodern relativism.  Maybe you didn’t realize that, maybe you did, but that’s what it means.  On the most charitable read, it implies that science is just another way to look at the world, no more or less valid than any other way of looking the world, and has no objective basis.  Post-modernists believe that nothing has an objective basis, and that everyone’s subjective experience of reality is equally valid.

More often though, the term ‘Western Medicine’ also implies something more pointed — that science is a tool of imperialism fundamentally opposed to the ‘Eastern Medicine’, which is rooted in an ancient wisdom that has been suppressed by ‘Western’ imperialism.  This shouldn’t be surprising — it’s a common theme that runs through much postmodern deconstruction of official histories / narratives.  And while deconstruction can be a useful tool to force us to double check our deepest assumptions, esp. as they relate to power structures, when applied to medicine it simply sets up a false dichotomy.  ’West’ vs. ‘East’ is a meaningless distinction because geography and history are irrelevant to medicine — the only thing that matters is whether a treatment works.

So the next question becomes, how do we know whether a treatment works?  It seems simple — someone has a complaint, they’re given a treatment, the complaint subsides, therefore it works.  Unfortunately, there’s a big problem with that: we have no idea that the treatment was the cause of the improvement.

Maybe the complaint was self limiting and would have gone away on its own with or without treatment.  Maybe the patient did or took something else unbeknownst to their practitioner that caused the improvement.  Maybe the patient was somatizing and the complaint was illusory in the first place.  Maybe the improvement was based on the placebo effect.  We simply have no idea, and without that, the anecdotes are nothing more than helpful signposts showing where to direct further research.

The main way that researchers get around this problem is the Randomized Controlled Trial — they test the treatment against a placebo, and if it does better they know it works.  This, it turns out, is harder than it seems, so a number of modifications have been added over time.  Double blinding stops participants and researchers from inadvertently skewing the results. Larger participant pools are used to get around sampling bias.  Statistical analysis is used to provide more objective analysis of the resulting data.

While this solved many of the problems within studies, there were still problems with trying to interpret data across studies.  Given the sheer volume of research done, and the variability of techniques employed, results across studies are often noisy and hard to interpret. The answer to this is the systematic review (e.g. Cochrane Review), a way of evaluating multiple studies at once, normalizing / weighting for different study methodologies, and coming up with a best read of the data as a whole.

Is this process imperfect?  Of course, and this is widely recognized within the research community and discussed openly in the philosophy of science — it’s not some big smoking gun like the alt-med community repeatedly claims.  In fact, scientific knowledge never makes absolute claims — by definition, any good research will include an analysis of study limitations, a discussion of questions left unanswered, and critically, a confidence interval indicating how likely the results are to be right.  Science is a probabilities game by definition, and any doctor who suggests otherwise is being willfully ignorant, because this is 101 stuff taught in medical school.  I’m sure such doctors exist, but despite the vague accusations of the alt-med community, they’re few and far between.  If nothing else, the threat of malpractice litigation encourages doctors to be as forthcoming with this information as possible.

Compare all of this to alt-med modalities.  How do you measure effectiveness?  How do you compare treatments?  What’s the process by which the standard of care improves over time?  The unfortunate answer is that there’s no answer. After all, why would you want to mess with the wisdom of the ancients?  If people have been using it for thousands of years, it must be effective, right?  Never mind that the ancients lived until 40 and we live until 80.

What I see repeatedly in alt-med is a reliance on anecdotes, combined with fantastic abuses of scientific research — cherry picking individual studies with no care for the broader body of work, mistaking what happens in test tube studies / preclinical trials for what happens in the real world, and a refusal to change one’s opinions when the facts change.

Now that’s not to say that any specific alt-med treatment doesn’t work.  Lots of herbal remedies have been shown to have pharmacologically active ingredients.  Aspirin is derived from willow bark, for example.  But in most cases, significant research has been done on these treatments, only to find that the effect disappears when you do proper, well-powered randomized controlled trials.  The data simply isn’t there, yet the practice continues.

The result is that ‘alt-med’ ends up being anything that either hasn’t been proven to work, or that has been proven not to work.  The rest gets incorporated into science-based medicine and is no longer alternative.

So you can hand-wave all you want, call science ‘Western’ as if that were a bad thing, and cast aspersions at science-based researchers for being imperfect.  But none of that makes any alt-med treatment work.  Only chemistry and physics can do that, and if they are, you can test it and find out.

- Erik

13 Responses to “Survey Says: I Might Be a Dick”

  1. Blondin says:

    I can sympathize, Erik. I have a relative who works at a mental health care facility and ‘baits’ me in a similar way. Several times she has mentioned that they schedule extra staff when the moon is full (and furtively glances in my direction). When the time and place is right I will enter into that discussion but I have had to bite my tongue so far.

    I once took the bait when a friend’s wife made the same comment at a campfire get-together – it wasn’t pretty. It’s very difficult to tell someone why you think they are mistaken without sounding like a condescending know-it-all.

    It’s very rare to find a person who is even aware of what the current phase of the moon is (unless it’s actually in view) let alone has an understanding of the mechanics of the phases of the moon and tides. Almost every person I’ve ever met who believes in the ‘full moon effect’ does so purely based on hearsay or ‘accepted wisdom’. Still, they are often prepared to argue and defend their belief because all those police departments, health workers, day-care workers, etc couldn’t possibly be mistaken!

    But don’t get me started…

  2. Dianne Sousa says:

    Erik,

    I too can sympathize, and I don’t think that you strayed into dick territory. Here are some observations about the exchange:

    Your response was long and covered all the relevant points nicely. What’s your sense of your family members ability to understand and assimilate the arguments? If these are new or unfamiliar, it might be the case that the response feels more like a verbal assault, even though its clear that you didn’t intend it to be.

    Was there anything you two could agree on? Any common ground? I’m guessing that your relative feels they are helping people and unless you’re pretty sure otherwise this may be something you want to emphasize going forward.

    Finally, you said that your response was prompted by the fact that your relative didn’t address anything in the article. You might have omitted sentences pointing this out from what you shared above. I’m wondering if the discussion would have been more productive if you had asked for one or two specific points in Dr. Gorski’s article that the relative disagreed with. In other words, keep the discussion tightly focused and return the burden of explanation back onto the relative.

    Try to think of ways of eliciting the person’s own reasons for skepticism. What parts of CAM do they think lack credibility? How do they decide what works and what doesn’t? What would they need to see to convince them that their particular belief is wrong?

  3. Parrot says:

    It’s really tough confronting friends and family members, I had a similar experience which I’ve written about. The confrontation made me feel lousy for a couple of days afterwards, it’s really different having these kinds of arguments with somebody you know and care about.

    But I don’t think that just being confrontational is an example of dickishness. As I’ve said before, to me being a dick is something more fundamentally fallacious. I see it as more of a betrayal of common expectations of courtesy and respectable discourse.

    I think it’s a misuse of the term “dick” to dilute it’s meaning into just being aggressive or confrontational.

  4. Funkydebunker says:

    The whole “don’t be a dick” thing has been helpful to me in some ways. Once I realized that I was basically picking a fight with any and all folks “wooish” I stopped (sort of). I believe that long lasting change is the end result of incremental steps in our cultural dialogue. There are people who take on the big issues, tirelessly exposing the frauds and exploitation of ignorance. My challenging the deeply held beliefs of my friends or relatives only serves to create distance between us. I just don’t “go there” now. However, those same people have no problem with trying to convince me of their pet conspiracy theory or accupunture or whatever. It makes for a frustrating double standard, but I put up with it because I love them. My consolation is that I no longer feel alone in my view because I can meet with fellow skeptics, or rant and rave in a blog if I need to. Hopefully I have not alienated those close to me to the point where they won’t listen if I warn them about any truely dangerous alt med they are considering. I have had to choose between being right or being happy.

  5. Blondin says:

    A double standard is exactly what it is and, quite frankly, I think we’re being intellectually dishonest when we give in to the DBAD philosophy. As you say, Funkydebunker, people usually have no reservations about telling us about their pet conspiracies or whacky beliefs but for some reason it’s rude of us to point out that they are wrong? We are not allowed to be offended when someone tells us we are brain-dead sheep for believing in the scientific method but we are strident and abusive when we point out the flaws in their pet alt-med claims?

    I really believe this whole DBAD thing has come about because the people who can’t make an honest, logical argument (or subconsciously realize they are wrong) resort to whining about their opponent’s tone. They make enough noise about rude treatment or bad manners that some people in the skeptic community begin to believe the “you’re not helping” bullshit and we have these DBAD controversies.

    I’ve seen some rude behaviour on both sides of many arguments (and certainly been guilty of it myself) but I don’t hear anybody in the skeptic community deriding the woo purveyors for their manners – only for being consistently, persistently, willfully ignorant (as some of them are). If anything I see more effort to be reasonable, fair and honest from skeptics than I do from climate change deniers or evangelical religious fundies or alt-med proponents.

    In my opinion the DBAD ‘movement’ is the result of a successful tactic by close-minded, dishonest woo purveyors to keep the playing field tilted in their favour. Obviously we should pick our battles and our battlefields but I’m sick & tired of being expected to keep my mouth shut and keep smiling when some aquaintance or dickhead brother-in-law is spouting shite.

    I suspect we’ve all been the one who was spouting shite at one time or another by repeating some urban myth or other interesting bit of trivia we picked up somewhere (I know I have). Eventually you either discover for yourself that it was bullshit or someone finally tells you. My reaction to such a situation is to be grateful to who ever put me straight (or sowed the seeds of doubt so I would investigate further). Only people who are not concerned with truth get upset/offended when their beliefs are questioned.

  6. Paul says:

    Nicely said. Unfortunately, your relative is not going to understand a word of it.

  7. Tony says:

    My vote is that you were not a dick. Your points were lucid and respectful, possibly a little patronizing if one wanted to be hypercritical.

    I have many friends and a partner
    who believe in unscientific or downright supernatural nonsense. I’m very clear I don’t buy into it at all and think they’re wasting their time and money – but because they’re friends we agree to differ. Our bond as friends who value and care about each other is greater than our need to have our beliefs upheld at all costs by those around us.

    I also work in the health field in a community setting in which complementary treatments are offered. I make no secret of the fact that I don’t believe they have any scientific validity but that clients feel better because of the placebo effect or simply having someone attend to them kindly. Again, there is no conflict between me and my team members who do support CAM.

    What am I doing wrong?

  8. Tim K says:

    Objecting that it’s a double standard misses the point. The point of not arguing like this is that it generally doesn’t work, not that it’s rude. Just like you would never be convinced by a lengthy email about how you’re a dupe for believing in Western medicine or 9-11 or some other consensus, why would you expect someone to respond positively to you taking that approach? The fact that you are sure you’re right is irrelevant, since the other person is too.

    Ask yourself everytime you want to rant or lecture: how would I respond to the same from a woo-believer? If you would roll your eyes and get defensive or annoyed, then STOP. Changing minds is done a little at a time, not in a fell swoop with your irresistible logic. Diatribes are for blogs and books, not personal conversations with someone you’ll see at Thanksgiving.

    • Erik Davis says:

      Tim – I think you hit the point I was trying to make in writing this. I don’t honestly think I was being a dick in the sense of obstreperous or rude, but I also don’t think it was likely to achieve my aim, which was to change a mind. I put this up really as an object lesson (or for me, a subject lesson)…and also because I think this sort of introspection is healthy as long as it doesn’t become self-indulgent.

  9. Chrios11 says:

    Your response was inspiring and in no way disrespectful. My entire family believes in alt-med, and only turns to science bases med after alt-treatments fail to work. The sad fact is, like with every other WOO, they only remember the hits and fail to remember the many misses. And when I try to explain that the hits are likely the self limiting and normal progression of the disease or possibly even (dare I say the P word) placebo, they call me a stooge of big pharma.

    Did I mention that I am a “Western” trained doctor.

  10. Ethan Clow says:

    It’s a pretty big misrepresentation to suggest that no one would be convinced by an argument or method that Eric used with his relative. I once believed in many a number pseudosciences and conspiracy theories and was finally turned off it because someone plainly and bluntly explained why I was wrong.

    When you’re trying to change someone’s mind, you must employ some critical thinking and determine that the best method is for that person and that particular situation.

    • Funkydebunker says:

      One thing that I would like to add to this discussion is that consideration should be given to the fact that logic and reason must be cultivated. I am sure that readers here are by now aware of the sort of tricks that our brains play upon us. In addition, I think that we should also account for human nature when trying to educate others. Unfortunately, logic is not the only force which can guide our beliefs. We are emotionally driven beings. In your case Ethan you were turned off pseudosciences etc. by persuasive logic, evidence and clear thinking. I wonder however if you would have found blunt explanation to be convincing if you had been emotionally invested in your belief system. I may have alluded to this in previous posts, but let me rephrase it here. I think that the problem with trying to convince an individual of their unreasonable convictions (apart from the fact that they are ..er.. unreasonable) is that they simply are not listening.

      I am not absolutely sure about the reasons for this, but it seems to me that some people are unwilling to accept an argument or a fact from someone close to them, but will be convinced by a neutral third party. It may be that the emotional content of the relationship causes a person to view a discussion of their erroneous views as a personal insult. After all, it is difficult to be dispassionate about things you care deeply about. If the person trying to convince you is close to you, it may be too hard to separate the messanger from the message. There was also a time in my life where I was firmly in the “woo” camp. In my case, it was the study of history and theology that turned me into an atheist. It was the deeper study of things metaphysical that finally convinced me that it was all a house of cards. It was only later in life that I found confirmation of my conclusions in the skeptical community. Yet before I came to these conclusions on my own I would have taken any skeptical dialogue as an affront, and yes- I simply would not have listened.

  11. John says:

    I am with you 100%.

    I am sick with an, as yet undiagnosed, stomach malady. Potentially life threatening. The internet is a morass of testimonials, anecdotes and unintelligible (to the layman) technical studies. And yet I spend hours looking for a clue to what ails me because I am scared.

    The alt.medicine world brings hope to people like me but I fear it is mostly a false hope.

    I go for a scope soon. The docs will tell me what is wrong (I hope) and I will have to decide whether they are credible.

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  • Erik Davis

    Erik is a technology professional based in Toronto, focused on the intersection of the internet and the traditional media and telecommunications sectors. A reluctant blogger, he was inspired by the great work Skeptic North has done to combat misinformation and shoddy science reporting in the Canadian media, and in the public at large. Erik has a particular interest in critical reasoning, and in understanding why there’s so little of it in the public discourse. You can follow Erik's occasional 140 character musings @erikjdavis