Friday, November 14, 2008
Taking It to the People.....
I had my first real experience with alternative medicine in residency. Sure I had heard of it before, and was even a little skeptical of the completely outlandish stuff like psychic healing and homeopathy, but I accepted a lot of it at face value. When a commercial for chiropractic came on I didn’t think twice about it. These are licensed doctors of the spine after all. And everyone knows that acupuncture has been proven for things like pain and nausea right? But just as I was discovering the skeptical community thanks to an interview by Penn and Teller of someone named James Randi, I met a little girl one night in the pediatric emergency center who couldn’t breathe.
This little girl, the daughter of a singer who I happened to be a huge fan of, was in something called status asthmaticus, which is when an acute asthma attack isn’t responding well to the standard treatments like albuterol inhalers and intranasal steroids. Her asthma had been flaring up for about a week prior to the acute worsening and the call for an ambulance to bring her in. During this week she had been receiving care by a chiropractor who did not believe that inhalers and steroids were necessary. Now I can’t say that if she had used standard medical treatment at home, her respiratory failure would have been prevented, but I can say with certainty that chiropractic care did nothing to prevent it. Later in the same week I encountered another young girl with difficulty breathing, this time because of an abscess in her throat that had been growing larger and had begun to block her airway. She had been brought to both a chiropractor and an acupuncturist for complaints of fever, cough and sore throat. Any intern, if not most medical students, would have been able to make the diagnosis based on classic findings but it was missed. The ironic thing is that she might have actually benefited somewhat from having a needle shoved into her if it had been shoved into the pocket of infection so that it might drain and decrease in size. The girl with asthma narrowly avoided being placed on a ventilator, the second girl recovered well after emergency surgery, and I became inspired to seek out as much knowledgeable as possible about quackery in all its forms.
These situations are thankfully not that common, but even one child that suffers because of delayed medical care while a parent is seeking out so-called alternative medicine is too many, especially when you consider that in all of these cases there is no chance of a cure. But, like I said, these kind of catastrophic events are not common with kids. Adults are much more likely to make use of alternative therapies and diagnostic modalities when faced with serious medical conditions. And a large number of people of all ages make use of alternative medicine for non-life threatening concerns, especially common signs and symptoms of just getting older like aches and pains, fatigue, decreased memory, etc, etc. So if alternative medicine is so popular, shouldn’t we at least have a decent grasp of what exactly it is?
The truth is that there is no such thing as alternative medicine. There is no such thing as western medicine or eastern medicine either, and claims of the existence of such entities as complementary or integrative medicine are grossly exaggerated regardless of what you may see on Oprah. The simple fact of the matter is that there is only medicine. There is medicine that works, medicine that doesn’t, and medicine that hasn’t yet been evaluated for efficacy. Of course, it goes even deeper than this. There is the question of safety as well as efficacy. Some treatments, thalidomide comes to mind, are very effective for one concern but still not safe for use. Thalidomide treated the nausea associated with early pregnancy very well but was found to cause birth defects.
The foundation of science-based medicine, the scientific method and subsequent development of such tools as the double-blinded placebo-controlled clinical study, although not perfect, are extremely powerful means of rooting out what works, what doesn’t, what is safe, and what isn’t. The bogus category we know as alternative medicine, or any of the other fictional categories I mentioned before, are marketing terms or terms employed with political intent and came about as a means of helping proponents of quackery to circumvent the process that has led to things like vaccines, antibiotics, or any of a vast array of medical treatments that have significantly increased our life spans and added unprecedented quality to our lives.
Within the confines of an all-inclusive category such as alternative medicine are hundreds, if not thousands, of different, often contradictory therapies. Many chiropractors makes claims that the root of poor health is the obstruction of an innate healing force, which travels from the heavens through the spine. Believers in traditional Chinese medicine accept the existence of a mystical healing energy that flows, not through the spine, but along a number of energy pathways throughout the body known as meridians. Homeopaths propose that water remembers the healing essence of substances no longer present in their pills and drops, and naturopaths, who also accept homeopathy, prescribe herbs and supplements with measurable quantities of ingredients in them. Reflexologists look at the bottom of your feet to diagnose and treat medical maladies while iridologists believe that the pathway to discovering what was, is, or will be ailing you is in the flecks of pigment in your iris. All of these systems, and considerably more, fall under the all-inclusive term alternative medicine.
Sunday, November 9, 2008
Breaking Down the WHO Pro-Alternative Medicine Agenda.....
The WHO is no stranger to making unfounded conclusions regarding so-called alternative medicine, an essentially meaningless marketing term that is highly politicized and unfairly allows a large number of modalities utterly lacking in legitimate scientific support to ride the coattails of a few high-profile but equally unfounded therapies. In a May 2003 for instance, the WHO claimed that,
"Acupuncture has been proven effective in relieving postoperative pain, nausea during pregnancy, nausea and vomiting resulting from chemotherapy, and dental pain with extremely low side effects. It can also alleviate anxiety, panic disorders and insomnia."This is true only if the lack of plausibility and the totality of the medical literature on acupuncture is ignored, and only cherry-picked poorly conceived, or small and unconvincing, studies are used to support such claims. The information on traditional medicine provided by the WHO is full of equally unfounded and misleading statements.
A Reuters report on the aforementioned conference reveals just how uncritically the WHO is approaching the subject of traditional medicine. According to the article, the conference, which was attended by representatives from 70+ countries, was an opportunity for brainstorming on how to achieve a wider distribution of traditional medical systems, and how to better combine them with conventional medicine so that both systems benefit. This is, of course, pure and total hogwash. Alternative medical modalities add nothing to conventional medicine.
One WHO official is quoted as saying that"Integration of traditional medicine into national health systems will not only bring benefits to patients, but will also ensure safety and proper use." This sounds reasonable but never pans out. Putting the weight of the WHO behind treatments that are not based on good science, and which often call for the bending of fundamental laws of reality, benefits nobody but those who sell such treatments. And one need look no further than the efforts of the NCCAM to realize that calls for increased research in order to determing what is safe and what works is an expensive waste of time. Proponents of alternative medicine don't care about research unless it supports their belief system.
The author writes that WHO director-general Margaret Chan called traditional medicine "a valuable source of leads for therapeutic advances and the discovery of new classes of drugs." It's true that modern medicine owes much to substances derived from the natural world, but this is a classic bait and switch. The fact that some ingested plants have measurable effects on human physiology that can be harnassed for our benefit in no way supports the silly pre-scientific notions behind most of these traditional systems of healing. There are already rational scientists looking into natural medicines and we don't need the wholesale acceptance of a seemingly unbounded entity such as alternative medicine to encourage more to enter the field.
The article further reveals that,
"Traditional medicine is used throughout China and in other developing countries, even with access to Western-style health care growing. Leech therapy is used in parts of India to treat pain and skin diseases, and hospitals in China often offer both Western treatment and traditional cures like acupuncture or herbal antidotes."This is merely the WHO applying the illogical argument that popularity serves as valid proof of efficacy. It doesn't or else we would still be bleeding folks to relieve their excess blood or purging impurities from our patient's bodies with oral mercurous chloride. But pandering to the masses is the name of the game these days, as evidenced by the growing number of alternative medicine departments in academic medical centers across the United States.
The WHO isn't all bad, not by a long shot. They provide a valuable service and add much to international efforts to end suffering and save lives. But they leave a lot to be desired when it comes to rationally evaluating the place of alternative medicine in global healthcare. The position they are taking runs the risk of adding suffering to the world but emphasizing therapies that have failed to meet the standards of science-based medicine in a number of areas by placing far too much importance on popularity and anecdotal evidence.
Saturday, October 18, 2008
Halloween MMVIII: The Return of Fluff Journalism.....
In it, Conger reveals that "Some people might be hesitant to admit that they believe in ghosts. But if you've ever heard a chilling bump in the night when you're home alone, ghosts might not be such a leap of faith." Apparantly Conger subscribes to the notion that there are no unbelievers when things get spooky. A similiar sentiment, assumed to be an unassailable fact of life by a substantial percentage of Americans, that there are no atheists in foxholes, is equally patently false. Far from being the exception to the rule (ever heard of Joe Nickell?), I don't break a sweat when confronted with eerie noises or unexplained visual phenomena.
Conger, while researching the subject of ghosts and hauntings, doesn't seem to have broken a sweat either, likely having simply clicked on the first few links provided by Google. These are almost always void of any skeptical input. But Conger isn't alone in taking such a credulous approach to reporting on ghouls and goblins. Not thinking critically and asking important questions, like are their legitimate contrary opinions on what I'm writing about (or in this case is their near total agreement by the scientific community that what I'm writing about is hokum), is the hallmark of pseudojournalism. Conger actually does list his sources, which consist of just a few unskeptical compendiums of popular haunted dwellings, at the end of the piece.
Conger cites the Association for the Scientific Study of Anomalous Phenomena (ASSAP) in the piece, failing to mention that this organization merely uses "science" as a thin facade while it employs a wide range of unproven investigational methods. They make a concerted effort to seperate themselves from other paranormal investigators by pointing out how flawed their research is and how challenging it is to do a proper scientific investigation of ghosts and other entities which according to true skeptics are lacking in both plausibility and legitimate evidence to support their existence. But their approach is far from unique with its blatant use of pseudoscience.
On their website, they point out that the many instruments used in the ghost hunting trade are not always reliable yet they still rely on them to snooker folks who may not know that the all the digital readings of room temperature and electromagnetic fields, and electronic voice phenomena, are examples of the misuse of scientific equipment and paredolia. Members of ASSAP fall into the same trap of circular logic that every ghost hunter eventually does. They use instruments to aid in differentiating true hauntings from frauds, hallucinations and misperceptions, while citing true hauntings as the means of establishing what meaningful anomalous instrument readings are. The entire endeavor is a house of cards built on a shaky foundation of anecdotes and buttressed by meaningless bells and whistles.
Conger addresses readers who may be concerned that their own home has been invaded by spirits and spectres and reveals a list of things to pay attention to provided by the science-based ASSAP. Accordig to these experts, you are at risk of being haunted if you "see apparitions, hear weird sounds, smell odd odors, feel "cold spots" within a room, notice objects that have been moved or observe your pet acting agitated." Having a toddler and a newborn in my house, I can personally attest to having experienced several of these warning signs recently but Conger and ASSAP can keep their digital video cameras and infrared thermometers to themselves. I'll stick to reality and base any concerns on properly performed studies. It's a heck of a lot more interesting, and considerably less likely to waste my time and energy.
Thursday, September 25, 2008
Magical Australian Fertility Water.....
There are two problems regarding celebrity opinion. One is that the media presents such opinion as newsworthy, inflating its legitimacy and confusing it with something akin to expert testimony. The other is that the American public generally expresses interest in what these celebrities have to say about topics that are often far outside the scope of what they can claim expertise in. And even when we know it's bullshit, we still eat up steaming piles of celebrity blather with gusto on a daily basis. Take, for instance, yesterday's revelation in an Associated Press story that Nicole Kidman believes in the existence of magical Australian waterfalls that promote fertility.
Kidman welcomed her first child with singer Keith Urban into the world on July 7, 2008. Roughly nine months prior to this occasion she was on location in the Australian Outback filming the soon to be released epic movie Australia. Kidman believes that there has to be more to her pregnancy than the obvious fact that it is intimately related to her having had sex with her husband during ovulation. She is 41 and the pregnancy was unexpected, six other women who swam in the magic waterfalls near Kununurra, a small town in northwestern Australia, during production got pregnant, and of the seven babies only one was a boy. According to the lovely and talented, if not skeptically minded Kidman, "There is something up there in the Kununurra water because we all went swimming in the waterfalls, so we can call it the fertility waters now."
I'm just a humble skeptic, with no claims of expertise in the epidemiology of fertility, but I am sure that Kidman is not the first somewhat older woman to unexpectedly become pregnant. A quick online search revealed that women at Kidman's age have a 44% chance of becoming pregnant and going on to celebrate a live birth within one year of trying, and 64% will do so within four years. Those numbers aren't great, especially if you are one of the greater than 50% that may be increasingly frustrated with a lack of success, but they aren't bad. Of course, Kidman isn't an epidemiologist or a fertility specialist either. She is a human. An incredibly sexy human. But her preternatural attractiveness doesn't protect her from committing the same errors in thinking that plague us regular folk.
In this case, Kidman has fallen prey to one of the most common logical fallacies around, and one which lies at the heart of a variety of mistaken beliefs ranging from psychic powers to claims of effectiveness by proponents of unproven medical treatments. Post hoc reasoning, more formally known as the post hoc ergo propter hoc (after this therefore because of this) fallacy, occurs when a temporal relationship is confused for a causal one. Just because B follows A doesn't mean that A caused B. It could only be a coincidence, or there may be many factors at play with A only serving a minor role in causing B.
Typically unique experiences benefit from this logical fallacy the most, such as a novel treatment for an illness or a memorable dream of something bad happening. Many herbal supplements and homeopathic remedies achieve word-of-mouth success because they are advertised with claims of treating self-limited maladies like viral illnesses. As I tell my students, you can take [insert OTC supplement] to cure your cold and feel better in a week, or do nothing and feel better in seven days. What personal claims of effectiveness of a treatment, or of getting pregnant after taking a swim, amount to are uncontrolled anecdotes. We don't know what would have happened had Kidman not gone for a swim. It's very likely she would still be celebrating the birth of her daughter, only instead of the magic Australian water she would be praising something else entirely for its fertility boosting effects. Perhaps a new food she ate or a mud bath.
But as it stands right now, it is only a matter of nanoseconds before someone is selling magical Australian fertility water by the bottle, or arranging for fertility boosting baths under the waterfalls. People with too much money, and not enough critical thinking skills, will fly there at great expense to improve the health of their uterus. Somebody is going to get rich off of this, and a lot of desperate women are going to throw good money down the drain.
Tuesday, September 23, 2008
Weekly Science and Skepticism Pop Quiz #2.....
What mysterious entities are unlikely to be revealed within the LHC?
A. The ever-elusive chiropractic subluxation, or more specifically the complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system and general health. Despite not actually being proven to exist yet, it is theorized by some experts that the subluxation may account for most of the money in the chiropractor's bank account.
B. Water memory. Theorized by homeopathic scientists, who seem to employ reasoning skills diluted beyond measurement, homeopathic remedies are said to be able to benefit from the healing powers of a substance no longer contained within them. A liberal pilfering of scientific terms, like quantum and vibration, has become standard practice for those defending water memory.
C. Human energy. This undetectable phenomenon is claimed to be at the bottom of pretty much all medical maladies, and just needs the gentle touch, or non-touch in most instances, of a qualified human energy manipulator to straighten out. Western science, with its pesky and cumbersome methodological naturalism just hasn't been able to isolate this wonderous whatever yet, but perhaps soon the time will come for healing touch and reiki practitioners to put use their ability to do work celebrating.
D. Bigfoot. Cryptozoologists have looked everywhere else.
E. All of the above
Answer: E
Wednesday, September 10, 2008
Weekly Science and Skepticism Pop Quiz #1.....
Which of the following survival strategies have also been put into use by members of the animal kingdom?
A. The ability of antivaccinationists to quickly move goalposts in response to contradictory evidence, thus protecting their irrational belief system.
B. The technique, used by proponents of implausible and unproven diagnostic and therapeutic modalities, of confusing the general public with marketing terms like "alternative" and "holistic" while distracting academic medical institutions with claims of popularity as they slip quietly through the back door to sneak away with ill-gained legitimacy.
C. The capability of Intelligent Design proponents to use state legislatures to pass "academic freedom" laws in order to more easily indoctrinate young minds and help to ensure their continued existence.
D.All of the above
Answer: D
Monday, August 18, 2008
Military to Study Mind Reading.....
Yes, the military is studying mind reading but not in the way you might think. They aren't looking into ESP, remote viewing, or psychokinesis, though they have done that before to the tune of almost thirty million taxpayer dollars, I'm embarrased to admit, with Project Stargate and a 2005 study on psychic teleportation. But it is every bit as much a project based on pseudoscience.
According to a August 15th CNN article, the United States military has granted four million dollars to researchers from the University of California-Irvine, Carnegie Mellon University, and the University of Maryland so that they can attempt to learn how to translate EEG signals into actual words. If successful, the ability to do so would be incalculably valuabe to patients suffering from severe forms of paralysis, especially the dreaded locked-in syndrome, among many other conditions which hamper or prevent communication. But if I wasn't reading about it with my own eyes, I would swear that this was a joke, or something thought up by a participant in a fifth grade school science fair.
In the study, researchers place electrodes on the scalps of volunteers and analyze the electrical activity that results when certain words are thought of. In the process, they hope to be able to match specific patterns to each individual word. It sounds simple enough, and even plausible if you aren't aware of the nature and limitations of EEG readings, but it is in effect not all that different than trying to learn how to speak baby by analyzing their cries.
The problem in this is that EEG output, which primarily comes only from the most superficial layers of the cortex, is nowhere near sensitive enough to allow differentiation of specific patterns associated with single words. It isn't even known if there would be a pattern specific to individual words. Perhaps such a crude means of measuring cortical activity would only provide patterns specific to types of words, like nouns or verbs, or to groupings such as animals or plants. So naturally this would become even more complex and difficult to interpret when attempting to read thoughts made up of longer word groupings, sentences, or mental images.
EEGs are are helpful in giving a general picture of the electrical activity occuring in large groups of neurons, such as when attempting to diagnose a seizure or as an adjunct to a brain death exam, but they are often full of artifacts caused by muscle contractions, eye movements and the electircal activity of the heart. Even if patterns of thought were recognizable in a test subject as reproducibly unique EEG waveforms, there would likely be a great deal of difference between subjects, rendering the technology very cumbersome if not useless. We all have different thought processes and associations with words based on individual experiences. EEG patterns of the word beach might vary greatly depending on if one thinks of the world positively or negatively. This is far too complex to work out as simply as the researchers hope.
Another concern is that there is a long track record of such endeavors not being properly, as in skeptically, approached. This could easily turn into another "Emperor's New Clothes" phenomenon where people falsely claim to be trained in interpreting EEG signals. I can easily imagine this replacing Facilitated Communication (FC) as the in vogue means for parents of children with autism to reveal their hidden intelligence. Then the phony accusations of sexual abuse will inevitably arise. It's not a slipperly slope fallacy because it has happened exactly that way before with FC. What's worse is that FC was easily shown to be only in the mind of the facilitator while EEG mind reading would be much more difficult to disprove to a parent that has already become a believer.
Four millions dollars is a lot of money, and a lot of good could come from the proper investment of it. The military needs a better means of evaluating which projects deserve funding and which should be rejected.
Monday, July 14, 2008
Anecdotes are like.....
-Homer
We are continuously bombarded with facts. They are, in fact, inescapable additions to our daily routine, lurking around every corner and entering our awareness in a variety of forms via myriad routes of delivery. We discover them in books and newspapers, have them shoved down our throats on infomercials or on local news reports, or simply pick them up from conversations with other primates.
It depends on the situation at hand, but the most common practice is to equate fact with reality, or more importantly with truth. For example, an evolutionary biologist may claim that the focus of their scientific endeavor is a fact, meaning it is accepted as something that exists or has happened as verified by an established means of scientific evaluation, naturally having something along the lines of molecular genetics or paleontology in mind. Of course, an astrologer might use the term in a similar fashion when he declares as fact that the position of celestial bodies enfluence whether or not you might get a raise or meet a mysterious, and handsome no doubt, stranger. Both believe themselves to be correctly using the term because what is an established means of evaluation, be it the scientific method or divination, is in the eye of beholder.
The following perceived facts have something in common:
1. "With my last bad cold, I tried Zicam and felt better immediately. Zicam works!"
2. "Every time I see a newborn who spits up, I switch them to soy formula and they improve. Lactose intolerance is a common cause of reflux in infants!"
3. I had a terrible feeling that something bad happened to my sister last night only to receive a phone call notifying me of her death. I am psychic!"
4. I eat at fine restaurants frequently and can always tell the difference between cheap and expensive wine. I have a highly trained palate!"
5. Every time there is a full moon, our unit fills up with mothers whose water has broken. The gravitational pull of the moon effects amniotic fluid like it does the sea!"
The common thread between these statements of fact is that they are anecdotes, the bane of any tried and true skeptic. Even for juggernauts of critical thought, like Harriet Hall and Steven Novella, standing up to an Oprah of anecdotes is often a losing battle because, instead of a reasonable evaluation of the available evidence, they rely on overestimation, overgeneralization, unfalsifiability, post hoc reasoning and, all too often, a hefty dose of emotion. Though the logical errors inherent in these examples may quickly become evident with even a superficial critical analyses, nevertheless they are more than adequate to convince thousands of believers.
Anecdotes are kryptonite to the skeptic, who relies on rational interpretations of the events that befall us. There is no variable in the equation for emotion. And while it may seem impressive that an individual's cold symptoms improved so dramatically after using Zicam, that observation in no way equates to proof of a causal relationship. It may only represent regression towards the mean, a common source of confusion for humans, who share a tendency to seek aid when symptoms are at their worst. This is especially evident in chronic conditions that are known to wax and wane in severity and is the very reason why use of a control group in studies seeking to discover the effectiveness of a treatment is so vital.
The powerful nature of anecdotal evidence, and the difficulty overcoming it, makes sense if one keeps in mind that the scientific method is a relatively new phenomenon, and scientific medicine merely a recent eye blink in the two hundred thousand years since modern humans diverged from one of the many twigs on the evolutionary bush. In the distant past, considerably farther back than the six to ten thousand years that make up human existence according to biblical literalists, there was a time when relying on the advice from another to not eat the red berries, for instance, was the only means of learning important and potentially life-prolonging information about our environment.
Another reason that anecdotal information fosters such a cognitive sticky wicket for skeptics is the innate human bias towards temporal relationships when defining cause and effect. Once again, this trate would have resulted in significant benefit thousands of years ago, when our earliest ancestors were more at the mercy of environmental pressures than the current state of affairs, but is now more of a hinderance outside of early childhood. This logical error, known as the post hoc ergo propter hoc fallacy, post hoc reasoning, or correlation not causation, is evident in most testimonials regarding unproven and implausible therapies.
The above example involving psychic powers being evident in the ability to know when a friend or relative is in harm's way is a classic example of yet another source of miscalculation in many anecdotes. The remembering of hits and forgetting of misses leaves the best of us vulnerable to erroneous beliefs whether in the realm of John Edwards style cold reading or deciding if a particular home remedy works. Yet another illustration of how fallible human memory can be.
This brief discussion merely scratches the surface but it is a good start. With this blog I hope to go into more detail on a number of topics vital to critical thinking, with a focus on pseudoscience and irrational approaches to healthcare. I also hope to have some fun and encourage reasonable discussion and debate.
