Skepfeeds-The Best Skeptical blogs of the day

Why good medicine requires materialism

Posted in Denialism by Skepdude on October 30, 2008


I don’t like to repost, but Steve Novella has some great pieces up right now, and this is directly related. –PalMD

s I’ve clearly demonstrated in earlier posts, I’m no philosopher. But I am a doctor, and, I believe, a good one at that, and I find some of this talk about “non-materialist” perspectives in science to be frankly disturbing, and not a little dangerous.

To catch you up on things, consider reading one of Steve Novella’s best posts ever over at Neurologica. While you are there, you can also follow his debate with neurosurgeon Michael Egnor, the latest guru of mind-body dualism.

To sum up (remember, IANAP), most of us science-y types hold to a materialist view of reality, that is, reality is all there is. This reality is susceptible to the investigations of science. Non-materialists and mind-body dualists hold that there is also a “non-material” reality. What exactly this might be, and how one might observe or measure it is never specified. Instead, they usually use a god-of-the-gaps argument, whereby any gaps in scientific understanding are automatically ascribed to the supernatural. The proof of the supernatural is stated is a lack of disproof of the supernatural.

Personally, I have no problem with people believing in God, Satan, fairies, or the Flying Spaghetti Monster (may we all be touched by His Noodley Appendages). What I have a problem with is people applying these beliefs to science and medicine.

Non-scientific medical practices, such as homeopathy, faith-healing, and reiki state various claims of efficacy and of mechanism of action. They can never prove these, but ask us to take their word, and the word of their clients. Once again, if someone takes communion and feels closer to their God, it’s none of my business. But if someone is claiming to affect the health of an individual by invoking supernatural powers, this is immoral and harmful

The point is simple: if reiki manipulates unseen, unmeasurable forces by unseen and unmeasurable means, creating solely subjective individual results, then reiki (and practices like it) is completely irrelevant to health. What matters in medicine is results, and results that cannot be observed and measured do not, for all practical purposes, exist.

We can measure the effect of beta blockers on a population of heart attack survivors. We can compare the number of subsequent heart attacks in those who do and do not receive the drug. We can come up with a scientifically valid explanation for the results, and we can replicate them.

None of the cult medicine practices that are so popular can do this. Their effects are either unmeasurable by definition (show me a qi), or when we try to measure the results of their application, results in aggregate are no better than by chance alone.

In all this discussion about naturopathy over the last week or so, what has been left out is that it doesn’t matter if naturopaths consider what they do to be “medicine-plus”—the plus is irrelevant because it cannot be measured or observed reliably. Unless and until it can, forget the “plus”. It’s only a dream.



Hypnosis and hot flashes: When will they ever learn?

Posted in Respectful Insolence by Skepdude on October 8, 2008

For women undergoing menopause, hot flashes are a real problem. In my specialty, as I’ve pointed out before, women undergoing treatment for breast cancer are often forced into premature menopause by the treatments to which we subject them. It can be chemotherapy, although far more often it’s the estrogen-blocking drugs that we use to treat breast cancers that have the estrogen receptor. Estrogen stimulates such tumors to grow, and blocking estrogen is a very effective treatment for them, be it with tamoxifen or the newer aromatase inhibors like Arimidex. The utterly predictable consequence, unfortunately, is an artificially-induced menopause.

I’ve written at least twice before about this topic in the context of various poorly designed studies of acupuncture for breast cancer-induced hot flashes. There’s a reason for this. Despite studies demonstrating that hormone replacement therapy doesn’t decrease cardiovascular disease in postmenopausal women and increased the risk of breast cancer, for severe menopausal symptoms in women without breast cancer, estrogen remains the gold standard, and it’s reasonably safe to use for short periods of time. Consequently, for menopause having nothing to do with breast cancer, estrogen can be used, at least for the short term, if nonhormonal therapies don’t work. Not so in the case of women rendered menopausal by breast cancer therapy. Indeed, it defeats the purpose of antiestrogen drugs to replace the estrogen they are blocking. Not only that, but even after breast cancer therapy when a woman undergos menopause naturally, estrogen replacement increases their risk of a recurrence. Consequently, if nonhormonal methods supported by science don’t work, then there’s nothing else, and, unfortunately, most science-based nonhormonal therapies such as antidepressants do not work very well and have significant side effects.

That’s where the temptation to turn to woo comes in.


Scientific bias and the void-of-course moon

Posted in Pharyngula by Skepdude on October 6, 2008

Stuart Buck persists in claiming that scientists have a bias against the supernatural, and that we dismiss it out of hand. This isn’t true; the problem is that supernatural explanations are poorly framed and typically unaddressable, so we tend to avoid them as unproductive. What one would actually find, if one took the trouble to discuss the ideas with a scientist, is that they are perfectly willing to consider peculiar possibilities if they are clearly stated. We’ll even briefly consider something as insane and worthless as astrology, which is even less credible as a field of study than Intelligent Design.

Here’s an example from years ago on Usenet, in the newsgroup sci.skeptic. An astrologer, Thomas Seers, was insisting that his weird little pseudoscience was a suitable topic for a science course. One of the skeptics, Robert Grumbine, politely asks him for specifics:

Robert Grumbine: Let us say that I teach astronomy.  Let us suppose I’ve decided to spend an hour on astrology.  What would my presentation be?  Keep in mind that this is a science class, so part of my job would be to discuss what experiments have been done that demonstrate that it works, as well as to describe how it works (in the sense of how the students could make the predictions themselves).

Thomas Seers: Hello Robert,
You appear to be asking a serious question, so I will give you an experiment to try.  This will also give you an insight to what Alchemists did years ago.
On 10/20/99 from 2 AM to 8 AM EDT, mix a bowl of jello and you will find it won’t jel. My basic students have this as a homework assigmnet to learn of a void-of-course Moon period. Silly thing, huh. It can be repeated over and over again. Don’t spill it now :-).


Hubris, Thy Name Is Jenny McCarthy

Posted in Neurologica by Skepdude on October 2, 2008

There are many words I could attach to the dangerous freakshow that is Jenny McCarthy – self-made advocate for the pseudoscientific notion that there is a link between vaccines and autism: deluded, self-righteous, irrational, the Mayor of Wooville, etc. But I am always interested in the process that gets people to their profound confusion. I believe at the core of Jenny McCarthy’s tragic crusade is an utter lack of humility.

Her lack of humility also seems consistent with someone who has never risen to a level of competence, let alone mastery, in any intellectual discipline. Those who have understand on some level the value of excellence and expertise, and the gulf that separates superficial public knowledge (or what has been called in the internet age, the University of Google knowledge) from a functional depth of understanding.

This brings to mind yet another word that could apply to McCarthy – sophomoric. She has garnered just enough knowledge to think she knows what she is talking about, but not enough to appreciate the depths of her own ignorance.


University announces review of woo

Posted in improbable science by Skepdude on September 4, 2008

After the announcement that the University of Central Lancashire (Uclan) was suspending its homeopathy “BSc” course, it seems that their vice chancellor has listened to the pressure, both internal and external, to stop bringing his university into disrepute.

An internal review of all their courses in alternative medicine was announced shortly after the course  closure.   Congratulations to Malcolm McVicar for grasping the nettle at last.  Let’s hope other universities follow his example soon.

I have acquired, indirectly, a copy of the announcement of the welcome news.


Doctor Who?

Posted in improbable science by Skepdude on July 25, 2008

Who should use the title ‘doctor’? The title is widely abused as shown by Gilbey1 in this issue of the NZMJ in an article entitled Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. Meanwhile, Evans and colleagues 2, also in this issue, discuss usage and attitudes to alternative treatments.

Gilbey finds that the abuse of the title doctor is widespread and that chiropractors are the main culprits. An amazing 82% of 146 chiropractics used the title Doctor, andL most of them used the title to imply falsely that they were registered medical practitioners.

Read the full entry here at the Improbable Science website.