Monday, 16 June 2014

David Robert Grimes / Ben Goldacre

(NOTE: the views and arguments presented in this critique are only my opinion. Whilst I believe these opinions provide a vital contribution to the debate emerging in medicine, nothing I say here should be construed as the objective 'truth' - but only an opinion based on evidence and reasoned argument).  

This is a critique of Ben Goldacre's (BG) and David Robert Grimes's (DRG) articles and views expressed during the past few years on topics such as 'alternative' medicine, native and indigenous medicine and wisdom, the placebo effect, and the role of nutrition and other factors to prevent and cure disease. 

In this article, I will argue that both authors have failed to provide a rational and nuanced perspective on this area of healthcare. In part, this could be because they seem to have an intransigent and muddled understanding of some of the key principles in science, logic and medicine. 

Note that both authors have written some excellent articles on other topics. This critique takes a very specific look only at the aforementioned topics, which could be grouped under the umbrella term of ''complementary and lifestyle medicine''. This is an important - arguably the MOST important discussion emerging about modern medicine in developed nations. Why? Because, overwhelmingly, the majority of ill-health, disease, and premature death is related to factors associated with poor diet and poor lifestyle. As such, authors have a huge responsibility to promulgate ideas and information that are accurate and helpful, and - perhaps most importantly - to foster a journalistic and academic environment that encourages people to take responsibility for their own health and well-being

This critique will consider 10 ways in which Ben Goldacre and David Robert Grimes have muddled the topic of complementary and lifestyle medicine. This blog is fairly long, so feel free to read the sections which most interest you. Note, however, that each section informs the others – and so if you want to get the ‘whole picture’, it’s best to read the article in its entirety. 

NOTE: since initially publishing this blog, I have updated it with the addition of 3 further points (a, b, c) which can be found at the end of the article. 


(1) Conflation of True Skepticism with Dogmatic Skepticism – and the misappropriated application of skepticism to science and medicine

Put simply, the difference between these 2 types of skepticism is that a dogmatic skeptic is prejudiced against, or in favour of, certain outcomes. A true skeptic is not.

A true skeptic, as a dictionary states, is ‘one who is undecided as to what is true, one who is looking or inquiring for what is true – an inquirer after facts or reasons’. Thus, a true skeptic (or true scientist) is open minded, eager to consider scientific principles and possible causal mechanisms to generate reasonable hypotheses, and dis-believing of stating something unequivocally to be true in the absence of evidence. Chris French, Professor of Psychology at Goldsmiths University and former Editor-in-Chief of The Skeptic magasine, states that true skepticism is about having reasonable doubt – it is not about knee-jerk dismissal of claims. He also states that true skeptics are ‘moderate’ – they are open minded, have humility when engaging in discussion, and are open to the possibility that they might be wrong.

Dogmatic skeptics, on the other hand, are, as Marcello Truzzi (Professor of Sociology at Eastern Michigan University) says, people whose inquiry starts instead with a pre-conceived notion of what is true. He calls this form of skepticism ‘pathological skepticism’. They are non-believers, which is fundamentally different to being a dis-believer. For dogmatic skeptics, ‘truth’ is equated with ‘evidence’ such that (a) theories without robust evidence are seen as untruths, and can be dismissed as such, and (b) evidence is considered first, rather than the plausibility of scientific principles, logical causal mechanisms, or common sense. They fail to acknowledge that a lack of evidence for something is not evidence against it. Something being dis-proved is fundamentally different to something not having been proved. Also, they often confuse reductive reasoning with objectivity and logic – sometimes, reductive reasoning is not a logical nor objective approach. For example, it is known that sun exposure increases the risk of skin cancer, and so now the medical establishment is warning against sun exposure. However, it is also known that the benefits we receive from sun exposure are protective against many other types of cancer. Furthermore, the risk of skin cancer is dependent on – and works synergistically with – a host of other factors, such as diet. For example, compounds in Green Tea have been shown to protect us from UV damage. There are many other plants that provide a protective role. Clearly, a reductionist model of ''sun exposure = increase skin cancer risk'' is very limited, and side-steps many nuances and ideas that would lead to a more coherent argument. Tragically, diet and lifestyle factors are trivialised and marginalised by dogmatic skeptics and mainstream medicine, time and time and time again. 

Dogmatic skeptics will, of course, deny that they carry a prejudice for certain ideas – in this case, pertaining to complementary and lifestyle medicine. Prejudice is a dirty word. In order to detect prejudice, you just have to examine the tone of their articles, and comments made publicly on sites such as twitter and blog pages. If you do, it will soon become evident that they are very passionate and tirelessly dedicated to debunking aspects of holistic and alternative approaches to medicine that don’t work, and yet so un-enthusiastic and deadpan when accepting results proving the efficacy of treatments outside of the realm of orthodox medicine.

A good example of this is the revelation that nutritional therapies and eating a specific diet can reverse the effects and symptoms of type 2 diabetes. Since type 2 diabetes is a burgeoning epidemic – caused largely by poor lifestyle – and, because DRG and BG write prolifically on matters pertaining to medicine, one would assume that they would advertise such developments in medical understanding with the fervour and dedication they exhibit when debunking spurious health claims. But they don’t. They begrudgingly and reluctantly concede such discoveries. This signals that their skepticism is un-balanced (i.e. pseudo-skeptic) and that their interests are weighted toward ‘debunking’ rather than promulgating inspiring and transformative information. 

Similarly, a study by Oxford University suggests that B-vitamin supplementation could help protect the brain against the 'shrinkage' associated with memory loss in the elderly. B12 seems to be the key vitamin. B12 can be found in specific foods and so does not have to be taken as a supplement. Exciting news - proper nutrition (and perhaps, supplementation) can mitigate the effects of cognitive decline in the elderly. News worth spreading, surely. But - no - dogmatic skeptics don't seem interested in promulgating positive news from research into nutrition. The pharmaceutical companies certainly don't seem interested, for obvious reasons. And lastly, medically trained 'dieticians' don't seem interested either - they just say keep on eating a 'balanced' (read: mediocre) diet. Funny they should say this, considering the fact that the Oxford study quite clearly states that ''none of the people in the study had vitamin B12 deficiency''. 


Of course, debunking has its place – and Ben Goldacre has done an excellent job of trying to steer the public away from the unsubstantiated belief that vaccines are dangerous and the erroneous belief that ‘Big Pharma’ is scientific and ethical. But let me remind you once again that, in developed nations, poor diet and poor lifestyle is the MAJOR factor in ill-health, disease and premature death. As such, any journalism that does not consider lifestyle medicine in a rational and objective way is, proportionately, more gravely irresponsible. To be fair, Ben Goldacre has made a lot of nuanced and profoundly important points – such as social inequality being a principle driver of ill-health, and the irresponsibility of some alternative healthcare practitioners who dissuade their patients from being vaccinated. These are good points. But they can also be seen as red herring arguments – a case of using socio-economic arguments when it suits his case and using reductionist arguments the rest of the time. Here, I am only discussing the specific arguments pertaining to the application (and rational) of using aspects of lifestyle and complementary medicine. 

David Robert Grimes has often suggested that he would be interested in understanding the psychological attributes of ‘conspiracy theorists’ and deniers of climate change (i.e. the other type of pseudo-skeptic). I agree – this would be fascinating research. But, equally, I think it would be fascinating if the psychological profile which pre-disposes someone to dogmatic skepticism was better understood. I am not a psychologist, but I could imagine that the assumed intellectual prowess felt by using reductive reasoning might make people feel that they truly have an objective grip on reality. Notions of the materialistic divisibility of the universe (and everything in it) might be reassuring at a psychological or intellectual level, regardless of the fact that some fundamental ‘fixed’ truths - especially in physics - rely on unproven assumptions and major philosophical loopholes.

It would not be an exaggeration to say that any scientific research that challenges the materialistic paradigm is considered heresy - because it simply must be wrong. But dogmatism isn’t science, it’s fundamentalism. If you think politics and censorship doesn’t occur in scientific circles, think again. An interesting case study is John Edward Mach, late Professor of Psychiatry at Harvard University.  You will find his story on Wikipedia. The relevant point is not what his research was, but the reaction of the scientific establishment to his research. Luckily, all relevant aspects of alternative and lifestyle medicine discussed here can be explained according to the rational world of classical physics.

Dogmatic skeptics have often been heard to say things like ‘’I know it’s wrong, I just need to work out why’’. Obviously, this is logically in-congruent and dogmatic. Scientists knew the earth was flat until it was discovered to be round, and scientists knew (and still know) things operate according to the laws of classical mechanistic physics until quantum physics came about. The controversy surrounding ‘the hard problem’ in science (i.e. consciousness) is a perfect metaphor for this state of affairs. This is a very exciting topic – and has drawn brilliant and respected scientists to opposing points of view. This debate, and its outcome, has profound and far-reaching consequences, not only in science, but also for society and for academic discourse in every other discipline. Non-locality of consciousness is a fervently debated topic that has attracted some of the best thinkers in philosophy and quantum physics. In turn, evidence for non-locality would prise open the debate for taboo subjects such as parapsychology. But dogmatic skeptics know parapsychology is hocus-pocus. Even if indisputable evidence was presented showing aspects of parapsychology to be true, dogmatic skeptics would say there is error in the data, or that it is fraudulent. You see, it simply cannot be right. Even if it were shown to be true, it must be false. Parapsychology would negate the very foundations of a mechanistic world view, and therefore, it will never be allowed to be true by mainstream science. This attitude is akin in principle to religious fundamentalism.

What do I think? Personally, I would say - of course consciousness is generated by the brain! This seems the most parsimonious and logical conclusion. However, speak to many scientists far cleverer and more knowledgeable about this topic than myself, and they will tell you that locality of consciousness is nothing more than an assumption in science. Whatever the case may be, this article is not about the metaphysics of consciousness, and anyway it’s largely irrelevant to all aspects of alternative or complementary medicine discussed in this article. For example, the placebo effect and mind-body medicine can be explained perfectly using the Darwinian principles of biology. I only raise the example of non-locality to show how dogma is prevalent in scientific institutions.


For dogmatic skeptics, perhaps it is easier to seem clever and rational through becoming a professional debunker rather than by engaging in original research.

Aaron Moritz, in his blog entitled ‘Do extraordinary claims require extraordinary evidence?’ says: ‘’Max Planck, the father of quantum mechanics, is often famously quoted as saying that science progresses one funeral at a time. This outlook, while certainly cynical, rings true to something I think we can all recognize about ourselves: people don’t like to be wrong. Especially when they perceive that being wrong could threaten their identity’’.


(2) Undervaluing and misunderstanding the role of placebo effects in medicine

Let’s begin by asking a simple question: Is it possible that a homeopathic remedy (which is, it can be agreed, 100% placebo) could work better for a specific ailment than a drug that has been proved through clinical trial to work better than placebo? The answer is YES.

Herein lies the paradox and wonder of what is commonly referred to as ‘the’ placebo effect. The truth is, when people refer to ''the'' placebo effect, they should really be saying ''a'' placebo effect - because they are many types of placebo effect which fall on a spectrum from 'very weak' to 'very strong'. This is a nuance which must be made clear, and which Ben Goldacre and David Robert Grimes have failed to elucidate well. DRG has called homeopathy 'useless' and, although Ben Goldacre provides a more nuanced position, he seems driven to use knowledge about placebos to negate research, rather than support its use as a functional component of medicine.

This ties in with a valid criticism of RCTs - or randomised controlled trials. Here, a drug or treatment is tested against a placebo. But, in the case of pharmaceutical drugs, the efficacy of the drug is put in the relatively unchallenged position of being tested against one of the weakest forms of placebo - a dummy pill of the same size and colour as the pill containing the active ingredient. Now, I am assuming (and it is an optimistic assumption) that the goal of conventional medicine is to heal or treat people in the most effective way with the least possible side effects. What if the drug was tested against the whole spectrum of possible placebo effects - from the weakest (dummy pill) to the strongest (perhaps something like acupuncture). Would the drug still out-perform all of them? For a large swathe of medical conditions (particularly psycho-somatic and stress related conditions) the answer would probably be a resounding NO. Indeed, it is for this reason why homeopathy could work better than a drug that has been approved by clinical trial. The efficacy of relatively strong placebos - like homeopathy or acupuncture - are undervalued because they are pitted against relatively strong placebos, i.e. themselves!!! We are faced with a ridiculous situation where the effectiveness of a treatment is measured by how it compares relative to placebo, rather than simply how effective it is in helping a patientThis is why there is an urgent need for out-come based trials instead of RCTs, and this will be discussed later.

Medicine should seek to utilise and maximise the placebo effect as much as possible. Hippocrates - the Father of modern medicine - knew this when he spoke of ‘intrinsic factors’ crucial to healing and prevention of disease. Anyone who dismisses the placebo effect or says things like ''it's just the placebo effect'' clearly has an incomplete vision of medicine and of the founding ethos of modern medicine itself.

Unfortunately, the placebo effect is as much a victim of semantics as it is of misunderstanding. It has come to be seen as a 'nuisance' or even a negative thing in scientific discourse. Replace the term 'placebo effect' with a descriptive definition of what it is, and academic discussions about it begin to seem like an ironical satire straight out of Monty Python. Indeed, we can parody this with a dialogue. Here, 'the placebo effect' has been replaced with an accurate descriptive definition of what it is - ''an intrinsic set of Darwinian healing mechanisms evolved over 3.5 billion years to produce the most powerful natural pharmacopoeia in the known universe''. 

Jack: ''hello mate, you won't believe what happened. I had this really bad stomach ache and I took this magic potion and now I feel a lot better''.

Dogmatic Skeptic: ''haha dude, you've been duped! You got better for no other reason than the fact that the magic potion triggered your intrinsic set of Darwinian healing mechanisms evolved over 3.5 billion years to produce the most powerful natural pharmacopoeia in the known universe''.

Jack: ''ah no, you cannot be serious! You mean to say the only reason I got better is because the magic potion I took triggered my intrinsic set of Darwinian healing mechanisms evolved over 3.5 billion years to produce the most powerful natural pharmacopoeia in the known universe? Shit, I've been duped! It's not a magic potion at all! Give me something that truly works!''

Of course, the placebo effect must be used wisely and ethically in medicine, and any reasonable and sensible person would consider this. What’s truly shocking is how common it is for pharmaceutical drugs to be prescribed unwisely and unethically by conventional doctors. For example, Prozac is dished out like candy even though doctors must be or should be aware of the evidence that Prozac works no better than placebo for a lot of users and carries the proven risk of serious side effects.


(3) Obsession with RCTs as the foundation of Evidence Based Medicine (EBM)

One major criticism of RCTs is that they are designed specifically to test whether a drug or intervention works better than a placebo control.

This criticism might sound counter-intuitive, but analyse it for a while and you will discover its validity. Because there are many placebo strengths – from very weak to very strong – the overall healing effect of a drug or treatment is likely to be over-valued when it is tested against a weak placebo (e.g. bland dummy pill) and under-valued when it is tested against a stronger placebo (e.g. acupuncture).

As mentioned, this presents the erroneous situation in medicine where we can value a treatment with a relatively weak healing effect just because it works better than a placebo and dismiss a treatment with a stronger healing effect just because it works no better than a strong placebo effect. If we simply consider actual efficacy / healing effect, this situation often positively biases results from pharmaceutical trials and negatively biases results from trials looking at complementary or holistic approaches to healthcare (where many approaches can be used synergistically, making the RCT model redundant anyway).

A much better and fairer approach is to use out-come based trials. Here, you consider all the possible approaches to a health condition or disease - both conventional and alternative – and apply it to randomised groups of patients. For example, we could divide patients with, say, gastric ulcers into 10 different treatment groups – conventional drugs / acupuncture / herbal remedies / nutritional therapies etc., and then simply observe changes in prognosis over time. Here, we are not primarily interested in the relative influence of placebo effect in healing – we are simply interested in the magnitude and efficacy of the healing response itself. (Note: as a function of cost effectiveness). 

Another valid criticism of RCTs – and ‘Evidence Based Medicine’ in general – is that its fervent proponents such as Ben Goldacre and David Robert Grimes seem to inculcate an academic atmosphere which undermines the need for the precautionary principle, and, for basic common sense. This was illustrated by a brilliant satirical piece in the British Medical Journal nicknamed ‘The Parachute Article’ which questions the use of parachutes when jumping out a plane on the grounds that there has been no systematic review of randomised controlled trials to validate their use. Revealingly, Ben Goldacre dismissed the article as a ‘passive-aggressive epidemiology paper’, apparently avoiding or misunderstanding its profound relevance to wider medical and social discourse. As I shall discuss later, skeptics seem to have a very poor understanding of – and attribute little social relevance to – the precautionary principle. 


(4) Mis-representing ‘alternative’ / complementary medicine

David Robert Grimes is particularly fond of the slogan ''Alternative medicines fall into 2 categories – treatments that have not been proved to work, and treatments that have been proved not to work. Treatments that have been proved to work are simply called medicine''.

The problem with this slogan is not only that it’s disingenuous – it’s also both incredibly misleading and simply wrong.

Why? Because there are many treatments firmly associated with the ‘alternative medicine’ camp that have been proven to be medically efficacious through clinical trial BUT are not – and probably will never be – called ‘medicine’. These include (to name but a few) – mind body techniques such as yoga and meditation, various nutritional therapies, aspects of Chinese and indigenous medicine, and various strong placebo treatments. ‘Alternative’ just means alternative to orthodox – it doesn't mean it doesn't work. For cancer, ‘alternative’ just means alternative to chemotherapy, radiotherapy and surgery. Don’t think there are any alternatives? Think again. Watch this TED talk by William Li where he discusses the ‘medical revolution’ of using nutrition to starve cancer – a process called angiogenesis: http://www.youtube.com/watch?v=B9bDZ5-zPtY. Is the medical establishment going to start calling food 'medicine'? I don’t think so. Why not, if it is medicinal? The answer to this question speaks volumes.

It is partly because skeptics don’t sympathise with the philosophy of alternative medicine, and partly because they misunderstand the ethos of medicine itself, that they promulgate this fundamental error. Put simply, ‘medicine’ is any treatment that heals or makes better. Indeed, this was certainly the ethos promoted by Hippocrates, the Father of modern medicine, who said, among many other similar things – ‘let food be thy medicine and medicine thy food’


(5) Inaccurate definition of ‘Medicine’ and ‘Doctor’

Unfortunately, and to the detriment of our society, the word ‘medicine’ has become synonymous with ‘giving drugs’ - but this is radically different from the original meaning of the word.

The word ‘medicine’ comes from an ancient Indo-Iranian root that translates to ''thoughtful action to establish order''.  This same linguistic root also gives us the words ‘meditate’ and ‘measure’.

Furthermore, the word ‘Doctor’ originally comes from the Greek for ‘teacher’.

Clearly, something has been lost in translation. Firstly, modern orthodox healthcare medicine is wildly out of touch with the founding ethos of modern medicine itself – so much so, that if Hippocrates were alive today he might well consider orthodox medicine to be the alternative version. More alarmingly perhaps, the idea of a dialectical and educational relationship between doctor and patient has been supplanted by the concept of the doctor as an authoritarian agency who just tells the patient what to do.

The rise of type 2 diabetes in affluent nations is perfectly symbolic of this point. No amount of pharmaceutical drugs or medical intervention could parallel the efficacy of simply getting patients to eat an excellent diet and adjust their lifestyle habits. This is what works best. If Doctors practiced medicine according to the founding ethos of Hippocrates and modern medicine itself, then disease epidemics related to poor lifestyle could be tackled in a more mature, scientific and intelligent way. 


(6) Precautionary Principle – what Precautionary Principle?

The need to enforce the precautionary principle is directly related to the scientific plausibility or likelihood of a specific claim, a point Ben Goldacre and David Robert Grimes seem to miss completely. The precautionary principle is used precisely because there is insufficient evidence!

For example, if someone makes a claim that light bulbs cause cancer, we can be sure that the plausibility of this statement is incredibly low. In this case, the precautionary principle is not applicable – indeed, it would be ridiculous. Now, consider the claim that synthetic Agro-Chemicals (e.g. pesticides) are bad for you. The veracity of this statement is of a much higher plausibility – in fact, it is almost certain to be true. As Dr. Andrew Weil says, we know pesticides can’t be good for us, the only question is how bad they are. We know that pesticides have catastrophic effects on other species. For example, the consensus view in science is that Colony Collapse Disorder in bees is largely due to contamination from pesticides. Also, we do know that pesticides are bad for humans – they can have negative effects all systems of the body. However, there might not be any broad-scale epidemiological evidence at present for the long-term health impact of relatively low concentrations of Agro-Chemicals (i.e. found in foods). 

A recent study discussed in this article in The Guardian suggests that the evidence in support of organic food is growing stronger: http://www.theguardian.com/environment/2014/jul/11/organic-food-more-antioxidants-study. This study will, no doubt, be berated by some members of the skeptic community. It should be noted, however, that it is perfectly consistent with scientific principles that organic food should contain a different nutrient profile to non-organic food. Why? Because nutrients and phyto-chemicals in plants are produced in response to environmental conditions. Since plants grown organically need to be more resistant to pests and fungi, and because they need are generally grown on more nutrient rich soil, we would fully expect organic plants to exhibit different bio-chemical profiles.  


Tragically, skeptics have got away with (and keep getting away with) an irresponsible neglect of the precautionary principle. 

This neglect might stem in part from a type of denialism or ‘black or white’ thinking. Whether or not this is the case, what is clear is that they get the need for evidence totally back-to-front regarding the precautionary principle. They would say, ''where’s the evidence that pesticides are detrimental to human health''. The correct question is ''where’s the evidence that pesticides are not detrimental to human health''. You only have to look back in history to see that many negative health impacts could have been avoided by simply asking the correct question. DDT is one example, among thousands.

It should be a legal requirement that, where the scientific plausibility for a specific claim is high, evidence must be produced to negate the claim, rather than support it.

Not only do Ben Goldacre and David Robert Grimes ridicule organic food, they also rail against many highly plausible and sensible scientific claims which, as of yet, have little evidence to support them.

For example, Ben Goldacre is unconvinced by the idea that excessive computer use at a young age could have negative effects on childhood psychological development. You can research his ongoing debate about this with Susan Greenfield and Aric Sigman on the web. David Robert Grimes, on the other hand, is unconvinced by the idea that the total death count from Chernobyl and Fukushima exceeds 43. In both cases, these authors seem to insist on proof from direct causation even though they are happy to use correlation data in support of other assertions. Perhaps David Robert Grimes would like to debate nuclear power with Professor Michio kaku – who is very out-spoken about its negative side, particularly about Fukushima. But some skeptics seem to avoid intelligent debate at all costs – something which will be addressed later. 

Both authors resist the idea that novel EMFs (Electro-Magnetic Frequencies) from devices such as internet routers and Wi-Fi could have negative health effects, even though there is some evidence that childhood leukaemia rates are positively correlated with proximity to high voltage power lines. They resist the idea simply because the evidence for the claim is weak (or so they say) rather than because they have examined the scientific principles surrounding the claim and concluded that the scientific plausibility is low. 

I will not comment further on these claims here – I only mention them to highlight some other case studies on the precautionary principle.  

By demanding that public health policies should be structured solely around evidence, in these cases skeptics are inadvertently consenting to mass social and medical Guinea Pig experiments. 


(7) Attacking the Out-liers

Ben Goldacre and David Robert Grimes are both in the habit of concentrating their attacks on the outliers – people or therapies which quite obviously fall into the category of quackery. Fair enough, you might say – quacks should be exposed, it only to protect those members of society who are not aware of the dubious claim of a product. Fair enough. I agree. But there is a danger that the outlier becomes the perfect Straw Man, which polarises and antagonises the debate between different approaches to medicine, and jeopardises any rational debate on the topic of ‘integrated medicine’. Furthermore, both these authors rarely suggest any alternatives nor direct the reader toward more nuanced and reasonable research.

For example, there is a video of Ben Goldacre on YouTube where he discusses the quackery surrounding ‘detox’ products. He gives a demonstration of such a product – a phony foot-bath detox device that claims to be able to extract toxins from a person’s body. Goldacre uses a toy doll for the experiment – and when a brownish sludge develops in the foot bath, it becomes obvious that it’s a quack product. Fair enough. However, Goldacre’s discussion surrounding the topic of detox reveals pitfalls in his argument. Firstly, he speaks at length about how healthy lifestyle over the long-term is more important than quick fixes and how the correlation between social inequality and ill-health is a far more important topic. These are both true, and excellent points – but it doesn’t deal with the specific question at hand, which is whether there are products or therapies which improve the process of detoxification in the body. Secondly, he doesn’t say that there are actually products and therapies that have been clinically proven to help the process of detox. Milk Thistle, for example, is well known to protect the liver and therefore enhance its detoxification efficacy. Also, Sauna has been shown to be an effective therapeutic tool for stimulating the body’s natural detox mechanisms. Furthermore, there is a growing body of research to suggest that various phytochemical and mineral supplements might be effective chelation agents for the removal of heavy metals and pollutants from the body.

‘Detox’ is actually not a trivial matter – since we know that the accumulation of pollutants in the body (such as various forms of plastic, heavy metals and other pollutants) can have serious effects on the endocrine and neurological systems. For example, certain pollutants can cause estrogenic effects, and estrogenic imbalances have been linked to specific cancers. Many pollutants are novel compounds that have been introduced into the environment, and which are category 1 carcinogens. 

More alarmingly, when Ben Goldacre goes on to talk about how long-term health can be improved generally, he says ''it’s quite difficult to have a meaningful impact on your long-term health risk outcome''. It seems irresponsible that Ben Goldacre should appeal to the ‘genetic roulette’ aspect of health rather than reflect on broad-scale epidemiological studies which show conclusively that your lifestyle (e.g. diet, exercise and psychological well-being) significantly and substantially impact your long-term health risk outcome.

In a similar vein, David Robert Grimes seems to relish debunking the outliers – and this is especially evident in his articles on cancer. For example, he berates organisations that make dubious claims for alternative cancer therapies, but always fails to provide a nuanced, balanced or helpful perspective on the current debate in cancer research. There are some very reasonable organisations that take a more integrated approach to cancer care, using the best of both conventional and alternative therapies. Here, ‘alternative’ simply means alternative to chemotherapy, radiotherapy and surgery. Two such organisations are the Arizona Centre for Integrated Medicine, and the Hippocrates Health Institute. If you are unaware that there even is a debate on cancer, you might want to watch this TED video by William Li where he discusses the ‘medical revolution’ of using nutrition to starve cancer – a process called angiogenesis: http://www.youtube.com/watch?v=B9bDZ5-zPtY.


(8) Attacking Nutritionists – Supporting Dieticians

The way Ben Goldacre and David Robert Grimes attack nutritionists is deeply symbolic of the central premise which inspired me to write this article.

To understand this point clearly, it must be remembered that the majority of ill-health, disease and premature death in developed nations is, overwhelmingly, due to poor diet and poor lifestyle. When dogmatic skeptics mercilessly and tirelessly attack nutritionists for ‘not being medically trained’ or ‘not providing peer-reviewed evidence to back up their advice’ they are missing the point entirely by not seeing the bigger picture, and they’re also making fundamental errors in logic and objective reasoning.

Why? Because the most important things to remedy a situation where people are getting sicker through poor lifestyle are not more academic papers or academic qualifications – the most important things are inspirationpassion and encouragement.

Through epidemiological and cross-cultural studies, science has already come to the robust understanding that health in developed countries is very strongly correlated to healthy lifestyle – and this includes physical and psycho-social / psycho-emotional factors.  In this sense, reductionist science (including many aspects of Evidence Based Medicine such as RCTs) really has very little to offer. Health and lifestyle medicine are co-dependent in a deeply social way.

When I say ‘social’ I do not mean this in the same way Ben Goldacre uses the term when highlighting that social inequality is strongly correlated to health risk outcome. This is a great point, but it is also a great red herring when used out of context. I mean ‘social’ in the sense that medicine itself is intrinsically a social as much as a scientific discipline. The founding ethos of modern medicine is echoed in the linguistic root of the terms ‘medicine’ and ‘doctor’ which uphold the idea that medicine is as much an art as a science – requiring an educational and dialectical relationship between doctor and patient to consider ’thoughtful action to establish order’.

Accordingly, you are more likely to develop and maintain a healthy lifestyle if you are inspired to become interested in your health and this, in turn, is more likely to happen if a healthcare practitioner or community of like-minded people have inculcated a sense of passion and sovereignty for one’s own health and well-being. It is interesting to consider that you are more likely to improve your long-term health risk outcome by seeing a psychologist than by visiting a conventional doctor.

Tragically, some skeptics believe that ‘dietitians’ should be more trusted and respected than ‘nutritionists’ for the only reason that dieticians are likely to have an academic qualification. This is profoundly arrogant and prejudiced, and - most importantly - misses the point, yet again. For everyone’s sake, leave your intellectual snobbery at the door. 

This situation is analogous to saying you rate one yoga instructor higher than another just because they've got a PhD in sports science. Who gives a shit? It’s totally irrelevant, for all the aforementioned reasons.

Have you ever heard a dietitian talk about things such as growing your own food, eating sprouted seeds or harvesting wild food, the benefits of fermented foods, juicing green leafy vegetables, collecting spring water, raw food or saunas? No, I thought not. Dietitians don’t inspire people to educate themselves and become self-empowered over their own health and well-being. All they seem to do is promote a ‘balanced diet’.

When a dietitian uses the term ‘balanced diet’ it is rather meaningless. They’re not promoting a balanced diet at all – they’re promoting a mediocre diet. Eating a mixture of good and bad food doesn't equate to balance. There’s no such thing as a balanced diet – your diet is either excellent, or good, or not so good, or average, or poor etc. To borrow a term from politics and economics, dietitians are interested in keeping the population just above the ‘poverty line’ of health – that is, keeping them un-sick rather than positively flourishing. I've heard dietitians say things like ‘frosted cornflakes for breakfast can be part of a healthy, balanced diet’. No, it can’t. It can be part of a mediocre diet, for sure. There is no place for artificial sugary ‘dead’ food such as cornflakes in the diet. A recent report by the UN World Health Organization has stated unequivocally that sugar intake must be drastically reduced if the world is to stand any chance at all of mitigating the burgeoning lifestyle-disease epidemic. The slogan ‘5 a day’ is nonsensical. Considering what our chimpanzee cousins eat every day, the slogan ‘100 a day’ would be far more appropriate.

Arguably, diet is one of the least important factors in maintaining good health. Psychological factors such as low stress, loving relationships, genuine social networks and enjoyable / nurturing work environments are key to health, both at a personal and societal level. Good health is about realising what’s most important – and thus, about realising the limitations of focusing on diet if one doesn't address other aspects of lifestyle. Since nutritionists take a holistic approach to health, they are perhaps more likely to advocate beneficial relaxation therapies such as yoga and meditation.


(9) Un-professionalism and intellectual dishonesty

Now, I don’t mind at all if someone like Ben Goldacre is scathing and aggressive about ‘Big Pharma’. Am I advocating a double standard here? No. Some of the antics of the pharmaceutical industry are truly appalling, unethical and corrupt. Many alternative health care practitioners and nutritionists might be wrong about certain things, but they are generally well-meaning. Vitriol has to be apportioned proportionately. Revealingly, David Robert Grimes seems very reluctant to slam ‘Big Pharma’, but relishes scathing and vitriolic attacks on seemingly all aspects of alternative medicine. This shows an unbalanced (i.e. biased) application of skeptical reasoning. 

In one of his articles, BG says ''stick with me, science is fun when you’re making people look stupid''. In the same vein, DRG believes people who believe in conspiracy theories have a ‘lower cognitive complexity in thinking patterns’ than people who are, well, like him. What he fails to mention is that his idea of a conspiracy theory (such as anti-fluoridation) often has very little to do with conspiracy, and simply much more to do with opposing points of view. 

Husting et al. in their article ‘Dangerous Machinery: ‘Conspiracy Theorist’ as a Trans-personal Strategy of Exclusion’ say;

In a culture of fear, we should expect the rise of new mechanisms of social control to deflect distrust, anxiety, and threat. Relying on the analysis of popular and academic texts, we examine one such mechanism, the label conspiracy theory, and explore how it works in public discourse to “go meta” by sidestepping the examination of evidence. Our findings suggest that authors use the conspiracy theorist label as (1) a routinized strategy of exclusion; (2) a reframing mechanism that deflects questions or concerns about power, corruption, and motive; and (3) an attack upon the personhood and competence of the questioner. This label becomes dangerous machinery at the transpersonal levels of media and academic discourse, symbolically stripping the claimant of the status of reasonable interlocutor—often to avoid the need to account for one's own action or speech. We argue that this and similar mechanisms simultaneously control the flow of information and symbolically demobilize certain voices and issues in public discourse


Dogmatic skeptics love picking the low-hanging fruit and have developed sophisticated methods to thwart intelligent criticism. They avoid intelligent debate at all costs. If they want a serious debate, there are plenty of people I could point them in the direction of. Rupert Sheldrake, Andrew Weil, Chris French, Roger Penrose, Michio kaku. There are hundreds of people they could engage with, but they prefer to pick the low hanging fruit. 



(10) Nature of Evidence


Both Ben Goldacre and David Robert Grimes put a premium on peer-reviewed evidence from RCTs - Randomised Controlled Trials. All other types and sources of evidence are seen as inferior.

Firstly, peer-reviewed evidence is not infallible, as highlighted by this report in the Journal of the Royal Society of Medicine entitled: ‘Peer review – a flawed process at the heart of science and journals’ (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420798/). Furthermore, non-peer reviewed evidence is not automatically wrong. The process of peer-review can be illustrated using this analogy: Imagine someone told you they put 10 pounds into a charity box. Now, in one scenario there were observers to lay testament to the claim, and in another scenario there were no observers. Peer review is analogous to the first scenario – i.e. there are people to check and validate the claim, and critically observe it. Non-peer review is analogous to the second scenario – i.e. there is nothing to validate the veracity of the claim.

However, a scientific experiment that has not been peer reviewed is not necessarily flawed. In fact, there’s no evidence that it is. We simply cannot be certain that it is accurate, experimentally and statistically. Even for peer reviewed evidence there is no guarantee that it is accurate, because we cannot be certain of the neutrality of the observers (i.e. peer reviewers). There might be strong conflicts of interest.

Therefore, when Ben Goldacre and David Robert Grimes exalt peer review, they are not being objective nor are they exercising due skepticism about the process of peer review itself.

Secondly, there are many different types of evidence – not just that arising from RCTs.

Consider the case of Green Tea. Recently, RCTs have shown the efficacy of Green Tea to help with a wide variety of health issues, including skin cancer. However, Green Tea has been revered for thousands of years for its health protective properties. Was this long-held belief simply unsubstantiated speculation? Well, no. Foods and herbs that have been used for thousands of years are subject to a process that can be called cultural natural selection – a process whereby the physical and psychological experiences of people over thousands of years are registered in the collective psyche, and passed on down the generations, perhaps in the form of folklore and the indigenous wisdom traditions still present today.

The case studies that could be named where the efficacy of indigenous plant medicines have been verified by the modern clinical RCT trial are very numerous. Another wonderful example is Chaga Mushroon (Inonotus obliquus), revered by Siberian Shamans for thousands of years for its health promoting properties – and recently confirmed by modern science. Of course, it is good to know ‘conclusively’ if specific plant remedies have a beneficial effect beyond placebo – and so RCTs are welcome. But the point is – we shouldn’t automatically dismiss something just because it hasn't been subject to an RCT, especially if it has been used for millennia by ancient cultures.

So, one needs to remember that lack of clinical evidence for something is NOT evidence against it. Unless something has been tested by clinical trial, it cannot simply be dismissed. We should also bear in mind that research funding is heavily weighted in favour of substances that can be patented, and so only an infinitely small fraction of natural compounds have been tested by medical trial. Indeed, it is in the interest of pharmaceutical companies to de-value the role that natural (i.e. non-patentable) compounds could play in disease prevention, cure and management. Finally, dogmatic skeptics fail to acknowledge when experimental evidence for specific claims is difficult to obtain. This is the case, for example, for (1) EMFs (2) computer use and child psychological development. There are inherent difficulties with testing these claims. Here, even though something is scientifically plausible and ‘makes sense’, the complexity of investigating the claim might rule out a ‘proof’ with low statistical error. Yet again, the lack of evidence for something is NOT evidence against it – and, where scientific plausibility is high, the precautionary principle must be adopted.

A favourite slogan of David Robert Grimes is Carl Sagan’s dictum ‘extraordinary claims require extraordinary evidence’. Unfortunately, Dr. Grimes has fundamentally misunderstood it. For example, he scoffs at the idea that compounds from cannabis could cure cancer, even though compounds from two plants – the Rosy Periwinkle and the Pacific Yew – are used as chemotherapy agents in mainstream medicine. There’s nothing extraordinary at all about compounds from Cannabis, or any other plant, having chemotherapeutic properties. It all boils down to the nature of the biochemical interaction of a compound with a cancer cell – some will work, others won’t. What would be extraordinary is if there aren't thousands of plants out there with chemotherapeutic properties. Science has a lot of research still to do. 

Similarly, David Robert Grimes thinks the idea that magnetic wave therapy could destroy tumours to be inconceivable. But this idea is based on exactly the same principle as radiotherapy treatment. The only difference is magnitude – magnetic waves and radiotherapy waves both belong to the electromagnetic spectrum. Yes, magnetic waves might be far too weak to have a biological effect, but the principle is the same. That’s why the idea – although far-fetched – is so un-extraordinary. Tell me that you can make squirrels shoot out of your ass by doing transcendental yoga, and I would call that an extraordinary claim.

Ironically, in appealing to the consensus view in science, dogmatic skeptics often accept ideas with no evidence. And when ideas are suggested which they don’t like, they require infinite amounts of evidence for it to be proved. Aaron Moritz says:


‘’Unfortunately, the phrase about extraordinary evidence is thrown around as if it were a shield that could protect one from having to consider any information that might upset their current worldview. Evidence standards become artificially high for claims these people don’t like, and artificially low for the claims they do like. Even if it isn't the intent, the function of such a rule becomes the maintenance of the status quo. Those who are looked up to and who’s opinions are thought highly of tend to be the ones whose influence determines what is and isn't extraordinary.  Scientific consensus devolves into an ideological popularity contest’’. 
                          

(a) Asking the right question - to me, the most important thing is to ask the right question. In schools and academic institutions we are praised according to the quality of the answers we provide to a given question, but we are rarely taught that the most important thing is to pose the best question. The quality of a question is the limiting factor on the relevance an article or opinion will have for improving the welfare of people and the environment. To use an analogy - the quality of one's answer to a specific question might be an 'A+', but if the quality of the question is only a 'D+', then the overall relevance of the answer can never be above a 'D+'.

For example, DRG has written articles about the debate on water fluoridation. But - however much brilliant science and statistical analyses you could use to prove that fluoridated water is not harmful (at low levels) and/or that fluoridated water offers protection against tooth decay - the quality of the question of whether water should be fluoridated is only about a 'D+'. Why? Because the protective role of good diet, good lifestyle and good dental hygiene is orders of magnitude more important for the prevention of tooth decay than drinking fluoridated water. 

If you don't believe this, think about this hypothetical experiment: In this experiment there are 3 treatments: (a) for 2 years, eat an excellent diet and keep an excellent dental hygiene regime (and drink un-fluoridated water) (b) for 2 years, drink fluoridated water, but eat a terrible diet and don't brush your teeth (c) for 2 years, follow the first (a) regime, but drink fluoridated water.

If you were to do this, regime 'a' would undoubtedly lead to much better dental health than regime 'b'. Arguably, regime 'c' would result in the best dental health, but the added benefit of fluoridated water would be negligible - orders of magnitude less effective than eating good food and maintaining a perfect dental health regime. Indeed, it could be argued that the negligible benefit provided by drinking fluoridated water might be counteracted anyway by a complacency toward dental health inculcated by journalists who promulgate the 'benefits' of drinking fluoridated water for the prevention of tooth decay. 

I am not automatically against the enforced 'medicalisation' of the general public - but at least we could do it with more beneficial nutrients, such as vitamin D or folic acid (a type of B-vitamin). 

Another example of a poor question is illustrated by the debate about 'statins' at the moment. Even the most impressive statistical models and scientific studies cannot disguise the fact that the scientists debating this idea are asking a very poor question. Surely, a life of regular exercise, good food and a good lifestyle is far more protective against heart attacks and strokes than taking a pill. The question should not be - what pill can we develop . It should be -  what are the root causes for the epidemic in heart disease and strokes? Let's get to the root cause of the problems in society, instead of skirting around the periphery by constantly only seeking to treat the symptoms. It seems that when respected journalists like Ben Goldacre discuss topics like statins, their very participation (regardless of whether they agree of disagree) gives credence to a discussion which distracts everyone from more urgent, and more profound, questions. 

A final example is Ben Goldacre's book Bad Science. I applaud and respect Ben Goldacre for writing this book, but I feel that, still, a relatively poor question is being asked. The book criticises the antics of the pharmaceutical industry, which is a good thing. But Ben Goldacre is not against pharmaceutical drugs per se. In my opinion, a far deeper question is to confront the medicalisation of society head on, and ask why the prescription of drugs has sky-rocketed. I have no doubt that the vast majority of prescription drugs in developed countries are for ailments that are directly related to poor diet, poor lifestyle and/or poor emotional well-being. 

We are all used to politicians and government asking poor questions. It's just a shame that some journalists are asking equally poor questions. It appears that, in newspapers, only a certain stratum of wisdom is encouraged; - and only certain shades of nuance are allowed, to give people the illusion they're being invited to think critically about a situation. 

(b) Double Standards - I feel that, sometimes, Ben Goldacre and David Robert Grimes are inconsistent in the way they approach arguments. For example, when berating detox products, Ben Goldacre suggests we consider health in a more 'holistic' sense - i.e it's more important to lead a healthy lifestyle over the long term than buy in to quick fixes like detox products. Yes, I agree. But when Goldacre criticises the organic food movement for extolling the health benefits of organic food, he accuses them of 'gamesmanship' when they insist on seeing the 'broad-scale', 'holistic' benefits of organic food, i.e. for the environment and for wildlife. 

For organic food, you simply can't separate the arguments. What is bad for the environment is bad for us - it really is as simple as that. 'Holistic' means the 'whole' picture; - therefore, it means reality. 

It seems that, depending on what Ben Goldacre and David Robert Grimes want to argue, they either choose reductionist argument or more nuanced positions. But if a journalist is able to select the questions which they choose to answer, I don't see how we can be sure that they are giving a meaningful and undistorted view of the whole picture. 

In DRG's case, this inconsistency is illustrated when he says that the total death count from both Chernobyl and Fukushima is 43 - and yet he says that ''1.3 million people a year die as a result of pollution from coal-burning plants''. This is actually a misquote from the WHO report, which actually says ''Urban outdoor air pollution is estimated to cause 1.3 million deaths worldwide per year''. These statements sound similar, but they are actually different. 

Here, DRG only considers deaths from absolute direct causation for nuclear accidents, but is happy to use a misquote from a WHO report to urge that 1.3 million people die every year as a result of coal-burning plants. He doesn't concede that the nuclear fallout from Chernobyl and Fukushina are a likely major contributory factor in far more deaths (e.g. from cancer) than 43. 

(c) Homeostasis - Lastly, some skeptics seem to have a confused understanding and uncritical acceptance of the process of homeostasis - or 'balance maintenance' - within the body. For example, Ben Goldacre is critical of detox products not only because a lot of them don't work, but also because he seems to promulgate the idea that 'the body will work it out'. 

True, the body is an incredible organism, with powerful and wonderful mechanisms for self-regulation. But, like an elastic band that eventually looses it's resilience when over-stretched, the body has it's limits. This is seen in type-2 diabetes, which is (usually) caused by the body eventually succumbing to the long-term onslaught the insulin system is subjected to by the regular intake of bad food. 


Also, just because the body is amazing at homeostasis does't mean that yanking the body out of balance doesn't have negative effects. For example, if you get drunk, the body will recover, but this recovery will require resources (such as energy and nutrients) that could have detrimental effects on the rest of the body, especially over the long term. 

                                        ---------------------------------------------
Let's end on a philosophical note: You can spend your whole life studying honey - you can even get a PhD and become a professor in honey - without ever having tasted it. Don't waste your life in your head. Taste the honey! 

24 comments:

  1. Hi YK,

    thanks for taking the time to put down your thoughts and making them available for comment. I read through the intro and first section. I think generally, I agree with you in the emphasis on lifestyle in people's well being, including in relation to alcohol, tobacco, sugar and so on and that proportion should be applied to the main risks people face during their lives. I have read Bad Pharma and Bad Science by Dr Goldacre and I respect and admire his achievements, although I do not think he is beyond criticism.

    My comment is that it is not always easy to separate when someone is being

    - dismissive,
    - rude,
    - or blunt.

    What I am trying to get at is that the dismissive behavior is the rejection of evidence or a point of view despite having the means to understand the issue. Reasons for this might include political, religious beliefs, and other nameless forces lurking in the social / cultural fabric.
    Rude behavior may look similar, but someone may apparently reject or, deliberately act to cause some level of offense in an argument irrespective of whether they agree with the opponent.
    Bluntness is common with people who are professional (e.g. doctor, lawer, engineer etc...), who don't have or the energy to explain how they know, or why they know what they know.And can come accross as being dismissive, but whose actual views are not clear without the time and effort to unpack them.

    I think it is necessary to make a second comment that supports the first. That is that writing on broad-brush issues in a brief format, such as is the case in blogs and newspaper articles, is intrinsically ambiguous. This is because people in different areas of life use language and concepts differently. In practise the context helps to narrow this ambiguity, and this usually comes in the form of links to reports and papers. For my part, reading many of these sources is typically more than I can commit to (be bothered with), so I have to recognise that I am applying my own mental framework to the articles / blogs I am reading assuming that that corresponds reasonably well to the author's.

    Personally I think both BG and DRG are rude on occasions, maybe to the point of harming debates. That is my value judgement. If the aim is to foster constructive debates, rudeness can certainly be corrosive. On the other hand, zero rudeness is probably not practical and eliminate any sense of humour.I'm not convinced BG is dismissive in the way I mean above. As for DRG I'm not sure, I'm not that familiar with his writing.

    Lastly will just like to say the above is my (fallible) perception of these debates.
    cheers,
    big ears

    ReplyDelete
  2. Dear summertown5,

    Thanks for your intelligent comment. I agree with what you say. I also admire Ben Goldacre - he has written some excellent stuff. But let me first just bring this back to the critical context in which I write the article - that is, that the VAST majority of ill-health in developed countries (probably ~85%) is related to poor diet and poor lifestyle. As such, when journalists such as BG and DRG promulgate facts and ideas pertaining to ''lifestyle medicine'' they have the (heavily weighted) responsibility of making sure that the information is accurate and, perhaps most importantly, inspiring.

    Before I comment on your point, let me just emphasise that my article has very little to do with the style of BG's and DRG's articles and very much to do with the NATURE and QUALITY of their arguments. This might not have become apparent because you only read the first section. I encourage you to read all 10 sections in order to get the 'whole picture' of my critique.

    Regarding your ideas about style - i.e. ''dismissive'', ''rude'' and ''blunt'' - yes, I agree with you here. Honestly, I don't care about people being dismissive, rude or blunt in journalistic / academic contexts - as long as the information promulgated is (a) accurate and (b) doesn't stifle rational debate.

    I feel that it is a responsibility of journalists promulgating information on health to be succinct and UN-ambiguous. If they can't do this, I don't think they shouldn't be given the job in the first place.

    On a related point - the social consequences of being dismissive or blunt are directly related to whether a topic is ''black and white'' or has a big ''middle ground''. In this sense, the style of being dismissive or blunt may be appropriate in some situations and inappropriate in others. Regarding 'complementary and lifestyle medicine', I argue that the journalistic style of BG and DRG is not only inappropriate - it is also inaccurate, misleading and lacks relevant nuance.

    ReplyDelete
  3. Can you rewrite the entire article but with bullet points this time?

    ReplyDelete
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    1. Hello, thanks for your comment. Would you be able to provide a bit more feedback on the article? - i.e. you think bullet points would make the points more succinct? Thanks.

      Delete
  4. Hello, thanks for your comment. Would you be able to provide a bit more feedback on the article? - i.e. you think bullet points would make the points more succinct? Thanks.

    ReplyDelete
  5. Interesting article but regardless of what is best for health overall, its important for science to keep solid tabs on what the pure chemical/biological effect and what the effect which is psychological is. Yes ideally we would have doctors who are more like witch doctors who are effective not only due to their medicine but also due to their effects on psychology but the important thing for doctors in society is not to be consultants of health but to prescribe proven medicine. .

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    1. Thanks for your comment. I actually disagree with you that ''the important thing for doctors in society is not to be consultants of health''. If you look up the root meanings of the words ''Doctor'' and ''Medicine'' this indicates that this is precisely what Doctors should be. Also - and related to this - I think there's a lot of misunderstanding about what ''medicine'' actually is. Aside from the management of infectious disease, the VAST majority of proven medicine prescribed in developed nations is merely to treat symptoms rather than heal the underlying condition. To me, this isn't medicine at all - only analogous to painting over rust without dealing with the underlying rust.

      When you mention 'witch doctors', I could imagine that people such as Ben Goldacre and DRG would take this as some indication of mockery. However, I don't think this - I think you're making a genuine and valid point. What you ascribe as the power of the witch doctor I call the power of the placebo effect - though, of course, they are exactly the same thing. Interestingly, the power of people like witch doctors in tribal societies becomes even more apparent when we consider the Nocebo Effect - the opposite of the Placebo. There have been cases reported in anthropological studies where a person is 'cursed' and cast out of a community by the witch doctor and dies from the belief and stress that he has been cursed.

      Note that the placebo effect is only one aspect of my article. Feel free to comment on the other points I make.

      Delete
  6. You are deeply misguided in the amount of time you've put into this. The misguidedness is here: you think that conventional medicine neglects the message about lifestyle. It doesn't.
    Five a day: promoted everywhere, and straight out of the conventional medicine playbook. Plenty of exercise: promoted everywhere (with dubious efficacy, I grant you), and straight out of conventional medicine.

    You think: conventional medicine neglects lifestyle; alt medicine fills the need.
    In fact: conventional medicine sends a simple, clear, proven message on lifestyle; alt medicine talks a load of unproven guff about lifestyle (just as it talks a load of unproven guff about drug effects).

    ReplyDelete
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    1. Thanks for your comment. Firstly, I don't understand your first sentence - are you saying that because I spent a lot of time on this it makes me misguided? I don't see the logical corollary. And isn't medicine one of the most important topics of all? It affects literally everyone. Secondly, I never said that conventional medicine neglects the message about lifestyle - what I did allude to is that most doctors and 'dogmatic' skeptics state a fairly bland and uncommitted prescription for health - i.e. balanced diet (expecting people to know what that even means). Like I say, most dietitians confuse 'balance' with a 'mixture of good and bad food'. Health is seen more as the ''absence of disease'' than as a positive thing. More specifically, if you'd like to prove your point - perhaps you could provide an example where Goldacre discusses the role of diet and exercise in the mitigation of Alzheimer's Disease (instead of drugs).

      In fact, your totally wrong when you say ''alt medicine talks a load of unproven guff about lifestyle''. You can go through the literature at your leisure - yoga, meditation, nutritional therapies (for type 2 diabetes), the healing effect of strong placebo response, effect of mood on epigenetic expression etc etc. And if you want to learn ore about the placebo response in the context of drug effects (i.e. comparison) feel free to listen to this:

      https://soundcloud.com/wsdiscovery/discovery-placebo-problem-02

      Delete
  7. Good article, and bravo to you for expressing this valid and pertinent critique!

    My background is in clinical psychology which generally requires ongoing self-evaluation in hopes of developing an increased awareness of one's own biases and judgments that shape a worldview of "right" and "wrong." You have addressed an often overlooked quality that one must possess if they wish to appropriately pursue evidence, objectivity. An impossible task I believe, but one which requires vigilance so that we can at least reduce the pollution of our subjectivity.

    Now, my own critique of your critique :)

    There have been several research projects and papers examining fundamental flaws in research, which I am sure you are aware (as you discuss some of this here), however, I am curious as to how you have come to the conclusion that vaccine research does not suffer due to many of the same flaws mentioned in this article? Similarly, it seems that that the right questions are not being answered regarding vaccination as a public health policy (i.e. does it make sense to vaccinate hundreds/thousands people to protect one vulnerable person? How can we determine safety of vaccines when we rely primarily on a passive reporting system and a populace told that vaccines don't have negative effects? What happens if we spend the money on improving health awareness, nutrition, hygiene rather than mass vaccination?)

    I believe there are other "good questions" to ask, but I am sure you get the point.

    On a similar note, I would imagine you are familiar with the scandal involving William Thompson and the CDC, which suggests vaccine science may suffer from corruption/malfeasance rather than just simple/honest biases. I am curious to here your take on this issue if you are familiar, as my impression is that most who write on this topic (both sides) could do well to read you article and adopt it's recommendations.

    Enough with my derail, again, great article and keep up the good work!

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    1. Hey there,

      Thanks for your intelligent comments and questions. I agree with your sentiment about objectivity. It is a journey and discipline in and of itself, and absolutely vital in fields such as medicine.

      Regarding vaccines - yes, I am aware of the debate and also of the criticism that has been raised against scientific research in general by people such as Dr. Richard Horton (editor-in-chief of The Lancet), or against the peer-review process (BMJ), or against medicine more specifically (e.g. Arnold Seymour Relman (Harvard Professor of Medicine).

      In brief, the reasons I defend vaccines in my blog are two-fold:

      (a) For most ''safe'' vaccines, it's a probability game - i.e. the chance of an adverse reaction might be 1 in 100,000 but the chance of contracting a disease might be 1 in 1000, so you're still 100 times better off even if the vaccine isn't totally safe (if we assume the same severity for disease and the adverse reaction).

      (b) For the sake of credibility. It's a big enough of a headache trying to clarify the points I make without going into the vaccine controversy, where people will (falsely) accuse you of being anti-vaccine if you bring up the issue.

      But... you and I, and anyone else who is being objective, will have realised that the vaccine controversy is far from resolved. Three main points here - (1) Historically, vaccination programs have been full of problems, with several proved links to severe adverse reactions. Even today, vaccines are occasionally withdrawn due to adverse reactions. (2) Just going on first principles - as you allude to - the right questions aren't even being asked. What is the nature of these diseases we're being immunized against? Why don't we have natural immunity? Did we in the past? Can we improve our immunity through lifestyle? (3) Sure - research into vaccines is susceptible to the same scientific flaws present in other areas of research, perhaps even a hundredfold more likely given the ring-fencing on vaccine studies by Big Pharma or government agencies and the exemption from liability granted to vaccine companies (in the US, at least).

      I have been following the Andrew Wakefield / CDC whistle blower revelation and the backlash to the documentary 'Vaxxed'. This single topic alone proves the key idea of my blog - that there is a pernicious level of dogmatism and ideology in medicine. Read the mainstream media reviews of Vaxxed and repeated over and over again is the ''anti-vaccine'' meme. But Vaxxed is NOT anti-vaccine. And, more importantly, Andrew Wakefield was NEVER anti-vaccine – he was simply against the combined MMR vaccine (he called for single vaccines instead). If someone didn't do their research, they would never know that Wakefield is actually PRO-(safe) vaccine. Militant ideologues like David Robert Grimes still promulgate the idea that Wakefield is 'anti-vaccine' and that if you challenge the consensus on vaccination you are automatically anti-vaccine. Such idiocy. Either Grimes is ignorant or he's lying - either way, the way he broadcasts false information to the public is inexcusable.

      And, when science journalists like Ben Goldacre or David Robert Grimes state unequivocally that 'vaccines are safe' they are simply wrong - even if they only mean that specific vaccines are safe. No vaccine is 100% safe, but, on the balance on probabilities, some mass vaccinations are a good idea to develop herd immunity within the general population.

      (continued...)

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    2. The only plausible defence of making the blanket statement 'vaccines are safe' might be that if you hint at any potential risk then the public would blow this out of proportion. But that's still lying to the public. And it's so unnecessary - you could just give them an estimate of the balance of probabilities without arrogantly assuming they aren't logical enough to make the right decision.

      Besides, this highlights a contradiction (dogmatic skeptics in medicine are walking contradictions) - Ben Goldacre stated that placebo medicine is wrong because it involves doctors lying to their patients. But apparently he's fine with lying to the public when he says 'MMR is safe'.

      The vaccine controversy is fascinating because it magnifies a lot of the distortions and biases which are present, but perhaps less conspicuous, in other areas of medicine.





      As an aside, a couple of things fascinate me about the way science journalists like Goldacre and Grimes report on ideas in medicine. Firstly, they rarely (if ever) argue from first principles, preferring instead to ‘’ask for evidence’’. Of course evidence is critical in science, but the ‘call for evidence’ can become such a red herring, especially in medicine where the epidemiological complexity of diseases is so complex. Thus, for example. Skeptics can ‘hide’ behind epidemiological complexity to deny pretty much any health claim. The nonsense surrounding cancer is a perfect example… I argue that it’s best to consider the issue from first principles as a basis for future understanding – thus, arguing from first principles, we could something like – ‘’biological cells have been around for 3.5 billion years, and it makes sense that cells should have developed powerful intrinsic mechanisms to protect against cancer’’…Then, you have a solid position to research from – rather than starting from the default position like David Robert Grimes does of ‘’we need evidence to show what are the factors which cause cancer’’ without even considering the topic from first principles. It would benefit every aspect of medicine to generate logical inferences from first principles.

      And secondly, it fascinates me how journalists like Goldacre and Grimes remain totally SILENT when studies emerge supporting alternative approaches to medicine - but are so vocal when bashing alternative medicine. For example, Grimes is a ‘cancer researcher’ and so I would have thought he would have been enormously excited when the article was published in Nature in 2015 stating that environmental factors are necessary to tip cells into a cancerous state in 70-90% of cases. This is one of the most important studies on cancer to be published in the past 50 years.

      But did Grimes post anything about this study? No, absolutely nothing.

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  8. I appreciate your honesty and candor in replying. For lack of a better system, I will quote your statements and add my responses.

    You wrote, "In brief, the reasons I defend vaccines in my blog are two-fold:

    (a) For most ''safe'' vaccines, it's a probability game - i.e. the chance of an adverse reaction might be 1 in 100,000 but the chance of contracting a disease might be 1 in 1000, so you're still 100 times better off even if the vaccine isn't totally safe (if we assume the same severity for disease and the adverse reaction)."

    I understand your rationale, however, the impasse I have come to relates to our monitoring (or lack thereof) of adverse events. Clinical trials can be notoriously short and limited in there generalizability, yet our primary means of monitoring long-term safety is a passive system KNOWN to suffer from severe under-reporting (VAERS). What's more, this system was implemented 30+ years after vaccination came into routine use.

    You mention fundamentals in science from which we can reliably anchor and explore from. I believe, this lack of understanding (or interest in understanding) of adverse events makes meaningful research on the "pros/cons" of vaccination near-impossible.

    You also wrote, "(b) For the sake of credibility. It's a big enough of a headache trying to clarify the points I make without going into the vaccine controversy, where people will (falsely) accuse you of being anti-vaccine if you bring up the issue."

    I understand 100%! I find it fascinating that this has become the climate, which obviously does more to stifle meaningful debate and scientific progress than anything. You are correct, "the vaccine debate" seems to evoke a primal response which I can't help but find fascinating.

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    1. Re "the headache of going in to the vaccine controversy". Really this climate is an enormous win for the pro-vaccine side and a huge loss for anyone who would have the question explored further, even on the basis of having an open mind.It is not in the interests of free enquiry or a democratic society.

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    2. Hi Andrew, thanks for your comment. Your point is a valid one. One can't even question the science surrounding vaccines without being labelled 'anti-vaccine' by people like David Robert Grimes. We know it's ridiculous, and anyone with a few brain cells on active duty knows it's ridiculous too. But this is the type of fascism we are confronted with, i.e. If you scientifically question consensus, you are 'anti-science'. Dogmatic skeptics don't seem to get the fact that they are stifling scientific progress.

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    3. What amazes me is that the very authoritarian "there is no evidence to support this" line is never questioned, not only in the media, but also by most people you discuss the issue with. People seem to be grateful to be told what to think :)

      It is worth reading the works of John Taylor Gatto "The Underground History of American Education". He documents the catastrophic collapse in literacy in the USA since the introduction of compulsory schooling in the 19th Century. He presents convincing evidence that the industrialists like the Carnegie's and Rockefellers who were pushing for this change were selling the advantages of a less literate population to the politicians at the time (The evidence is from letters and proceedings of Congress). Nowadays this is what we see--- many people have enormous difficulty in decoding public statements by politicians. That is great if you are a politician, or if you have the financial clout to influence politicians.


      Re consensus-- that always produces a dumbed down version of the truth- as everyone scrambles to find common ground what gets left out are the items raised by individuals which are actually correct.

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    4. You note, in your next reply, the similarity between the behaviour of the current elite (media/academics/medicine)has been described as Fascist. I can only agree, except that the more proper description of it would be "corporatist" as per the model described by John Ralston Saul in his books.The stifling of critical voices within the medical profession is a characteristic tool of control in corporatist societies. In that model ones position in one of the corporate "guilds" depends on adhering to the consensus in that guild, one is not able to comment even on another branch of medicine (an orthopedic surgeon, I think, in Australia was recently forbidden by the Australian Health Practitioners' Regulation Authority, to discuss nutrition with his patients! That is ridiculous- we should all be literate enough to discuss those sorts of things with our patients.
      Now the state " Big Brother" in Orwell's 1984 used to maintain control by re-writing and deleting information that became inconvenient when the party had had a change of policy.
      As I discussed above there is clear evidence, that especially in the United States, there has been a serious drop in literacy standards, and that this drop has been achieved as a desired end of public policy.

      This can be compared with the rewriting of history in "1984" - except that rewriting history is not needed when much of the population has such weak literacy skills.

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    5. Hey Andrew, thanks for your comments, and apologies for the delay in responding. Yes, the "there's no evidence to support this" meme is a curious one. Like we are both aware of, the call for evidence is good, in principle, but is often used by dogmatic skeptics as a strategy of ridicule or to discredit. I wonder what they would have said had the skecptic movement existed back in the 1960s when there was no good quality clinical data on the harmful effects of smoking? They could equally have said that the evidence for the harm of smoking was poor. It also boils down to burden of proof - people like Grimes and Goldacre don't seem to understand that burden of proof is related to the scientific plausibility of a claim, i.e. pesticides should be proved safe, rather than be allowed to be used until they manifest harmful effects.

      Thanks for introducing me to the book 'The Underground History of American Education'. This would certainly tie into the propagandists such as Edward Bernays. That's a fascinating idea about literacy. Even IF illiteracy wasn't being encouraged or pushed on purpose, there are many examples where governments fail to stop the public being negatively affected, even if the government doesn't directly perpetrate the problem. It's like saying - we're not going to harm you, but we won't stop you from getting harmed. This is where dogmatic skeptics who berate 'conspiratorial ideation' also get so confused, because they fail to see that *allowing* something to happen still counts as perpetrating that action, in many situations at least. As you suggest, literacy is important - not only to read, but also to decipher and unscramble the trickster language used by ideologues such as dogmatic skeptics. I suppose that, as well as literacy, it takes someone becoming acquainted with the Orwellian 'news speak' of certain science journalists. Perhaps everyone trying to understanding the promulgation of information in the media needs an Orwellian translation machine.

      Regarding consensus, that's a intelligent way of putting it; 'a dumbed down version of the truth'. I think people need to consider what 'consensus' actually means, and how the reliability of consensus varies dramatically across different fields, e.g. climate change .vs. mainstream medicine.

      Thanks for citing John Ralston Saul, and the idea of 'corporatist'. I will certainly check that out. Actually, it ties into something I heard once when an alternative medicine practitioner referred to some academics as 'corporate scientists'. This criticism is seems valid. Thanks for your feedback. It will be interesting to see how this era of dogmatic skepticism in science/academia/journalism metastasises in the coming years, or, hopefully (and perhaps inevitably) collapses in on itself under the weight of its own corruption and ignorance.

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  9. Continued...

    My background in psychology may predispose me to a unique conceptualization of how the debate around this topic has so deteriorated, but I can't help but see strong propaganda from both sides (although the "pro" side appears to be VERY adept). I am sure you are aware that the internet is full of "evidenced based skeptics" prowling the internet mud-slinging and presenting false narratives to naïve readers. That is what made my stumble onto your blog so great!

    To this point, I do believe that remaining silent on this issue represents an acquiescence of sorts, and tends to fulfill one of the goals that such propaganda tactics hope to achieve, which is to silence debate.

    You wrote, "The only plausible defence of making the blanket statement 'vaccines are safe' might be that if you hint at any potential risk then the public would blow this out of proportion. But that's still lying to the public. And it's so unnecessary - you could just give them an estimate of the balance of probabilities without arrogantly assuming they aren't logical enough to make the right decision."

    Again, I agree with you. A sort of placebo effect... I have considered this point and ultimately believe that this seems to be driving vaccine policy and an at times desperate protection of overall high vaccination rates. But think about it, vaccination is reliant on lying to the public in order to maintain supposed levels of herd immunity.

    This is scary to me because it obviously demonstrates a predisposition of the highest magnitude; what is it they say, "the road to hell is paved with good intentions." And now, suppose a study DID come out that vaccine policies have harmed kids, are they supposed to own up to it? They have already shown an unwillingness to disclose minute risk factors, much less something more serious.

    And here is my primary concern related to vaccine research, the bias is built in, "vaccines work and are safe" is the foundation from which most research into vaccines is conducted. And to be honest, this would be all great, and people could vaccinate to their hearts desire, however, I am not allowed to make that choice apparently...

    Oh man! Look at me, another rant!

    I do appreciate your contributions and would like to say that hearing/reading your reasoned assessment on these issues is refreshing and gives me hope that rational debate IS possible!

    Take care.

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  10. Hey again,

    Thanks for your reply. When I receive such intelligent comment it reinforces both my intuition and scientific opinion that it is of vital importance to critique, deconstruct and understand this topic - and the nature of dogmatism in science in general.

    Regrading vaccines - I agree with what you say. It sure does seem odd that vaccine medicine has been given a free pass and/or 'let off the hook' in so many ways... as you say - the passive system to report adverse effects, the under-reporting, skeptics in academic medicine disbelieving cases of parents who reported a dramatic change in their child's behaviour after being vaccinated(!) Andrew Wakefield is totally astonished by this last point, and raises it often - he states that nobody could be more perfectly positioned to observe change in a child than their parents. And, even if clinical studies on vaccine safety were rigorous and longitudinal - or if they existed at all - they would be just as prone to the distortions and fraud which is systemically and routinely perpetrated by Big Pharma.

    And yeh, like you allude to, just looking at the entire topic from first principles / fundamentals would help enormously with the pro/con debate. I mean, drop the ''evidence meme'' for a second, and simply intuit from a scientific mindset whether giving (as happens in the US) a child up to 24 vaccine injections before the age of 2 (many within the first 8 weeks after birth) can be a good idea.

    As you go on to concur with, the climate of militant skepticism is actually just stifling reasonable scientific debate and therefore scientific progress. Some have even suggested that an entire 'super-structure' has emerged within the triad of medicine/academia/media to thwart and ridicule dissent or challenge to the status-quo. This 'super-structure' has been described as Orwellian and fascist. (The paper in question is called ''Deconstructing the evidence-based discourse in health sciences: truth, power and fascism''.

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    1. It might sound dramatic to raise the idea of 'fascism' in science, but that's only because we generally associate fascism with violence, whereas, in truth, it's only a word that denotes a type or system of operation.

      I am well aware of the "evidenced based skeptics" prowling the internet, and the newspapers! One of them is David Robert Grimes (and Ben Goldacre - but to a lesser extent). You just need to examine the language Grimes uses, and the method and context in which he uses it - such as as repeating Ad Nauseam ''anti-science'', ''fraud'', ''conspiracy nut'', ''no evidence whatsoever''...the list goes on. And all this from a journalist who accepted the Sense About Science's (SAS) John Maddox Prize for ''standing up for science'' even though (a) SAS is, and has historically been, partly funded by major pharmaceutical companies (b) Grimes's condescending and vitriolic approach to science journalism is actually more likely to put people OFF science. It's easy to 'stand up for science' when all he does is un-critically regurgitate pro-establishment consensus positions.

      As you say, mass acquiescence is one of the goals and, as I say, one of the deadliest tools in a dogmatic skeptic's toolbox is also silence, i.e. to remain selectively silent on important discoveries and evidence when they are in the privileged position to promulgate such information to mass audiences (e.g. journalists).

      Just to pick up on a couple of your other points on vaccines... sure, vaccine policy is based on lying but, like I say previously, it's more the double standard here which I find disgraceful...apparently lying is OK to push vaccines ''in the public interest'' but is ''unethical'' when it comes to prescribing patients placebo medicine. It's utter stupidity. The main driving force is economical, thus the truth is closer to ''it's un-economical to prescribe patients placebo medicine''. It will be interesting to see what transpires out of this CDC / William Thompson case - then you will perhaps have an answer to your last question. Luckily, we still have a choice here in the UK, not so in the USA where vaccinations are becoming mandatory - refusal will be punishable. 1984.

      Anyway, there are some amazing scientists out there - my favourites are Dr. Rhonda Patrick (Nature-published biochemist who's super-interested in nutrition), Dr. Andrew Weil (most respected doctor of Integrative Medicine and author of the Integrative Medicine series). Also, check out Rupert Sheldrake's website 'Skeptical About Skeptics', some informative articles. I'm sure you have your heroes in psychology too :o). Feel free to get in touch again with any other ideas, my email is yodaknight10@gmail.com or matthewlundquist81@hotmail.co.uk.

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  11. This article is interesting and useful, but there are some serious errors. Perhaps the most serious, is the discussion of placebo effect.

    Placebo Effect: We can pull out any dictionary to learn that:
    a) Placebo effect is a real positive effect - not imaginary.
    b) Placebo effect is NOT caused by the treatment it is attributed to.

    If a placebo effect is a real effect, then it has a real cause.

    Once we identify the real cause, it is no longer a placebo effect. Therefore, placebo effects do not exist. Using the phrase placebo effect is simply an excuse for not investigating, for not being truly skeptical. "Undervaluing and misunderstanding the role of placebo effects in medicine" - is nonsense. The only true role placebo effects have in medicine is to create confused excuses.

    The statement "Of course, the placebo effect must be used wisely and ethically in medicine, and any reasonable and sensible person would consider this." is nonsense. If you can 'make use of it' it is a real effect, not a placebo effect. "Placebo effect" should be viewed as a reason to investigate what actually happened, so that we can understand and use the 'real effect' appropriately.

    RE: RTC and EBM "Obsession with RCTs as the foundation of Evidence Based Medicine (EBM)"
    You might check out a few RTCs. They're not hard to find. But try this trick. Find an RTC that
    a) tests a medical treatment for an illness not caused by a parasite.
    b) clearly defines and tests for 'cured'.

    RTCs are a technique used to test medicines that don't cure, against medicines, or placebos, that don't cure. Because 'cured' is not defined for most RTCs, if a cure is encountered, it cannot be documented.

    This also applies to the section about "The Nature of Evidence". RTC evidence is evidence of failure to cure, and in most cases, the product that performs better is simply the one that "does not cure" better. If we are to study evidence in medicine, we must define and study cure, cures and cured. Until then, so called 'evidence' is simply an argument about who can "treat but not cure" better.

    re: "Misrepresenting 'alternative' / complimentary medicine"

    First of all, '/' is not in the dictionary. Generally, when people use the slash in this fashion, their thinking is weak and they are forcing the reader to (correctly or otherwise) figure out what was meant. Does the slash mean?

    - misrepresenting alternative medicine AND complimentary medicine? If so, use AND.
    - misrepresenting alternative medicine or complimentary medicine? (inclusive or, or exclusive or)?
    - misrepresenting alternative' or (AKA) complimentary medicine?

    So. Let's be clear. Officially, in the USA, there is one type of medicine. Approved medicine. Approved by the US FDA. The US FDA does not approve 'alternative' medicines nor does it approve 'complimentary' medicines (whatever that means). These terms are, frankly, loosely defined and arguments could be made that any medicine, and every medical treatment is an 'alternative', and any medicine or treatment that is prescribed or used in concert with another is a 'complimentary' medicine. You might think that the term alternative medicine is well defined. It simply is not, not in any way that is clearly recognized by the medical or scientific professions.

    Therefore: If you are speaking about 'alternative medicine', and you don't define what you mean by 'alternative medicine'. There is no "alternative medicine camp". sorry.... There are people who believe in medicines and medical treatments that are not approved by the USFDA. Who? Well, to be frank, everyone, because the US FDA only approves drugs, when requested to do so by a marketer or manufacturer.

    to your health, tracy

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    1. Thanks for your comments. I have considered your ideas, and I largely disagree with your points.

       You say that, once we identify a real cause, it is no longer a placebo effect. You're confusing the issue here by implying that ‘real cause’ is synonymous with ‘external’. The placebo effect – as most academics and doctors use the word – is simply the endogenous production of compounds in response to a change in our state of consciousness. The placebo effect is sometimes confused with regression to the mean. Consider the thought experiment of thinking of biting into a lemon. Your body will undergo real, significant and observable physiological changes, due simply to a change in your thoughts. This is the placebo effect. Similarly, it's why people feel better after having gone to the doctor even when they received no physical intervention. Thus, the placebo effect DOES exist – it is real, and it can be used in medicine to elicit healing responses without the need for physical interventions, in some cases. I agree that placebo effect should be viewed as a reason to investigate what actually happened – but we know that what *actually* happened is a physiological change in the body caused by the endogenous release of compounds following a shift in consciousness.

       Regarding EMB and RCTs, your point is unclear because you’re juggling around with semantics. I would be grateful if you could clarify the point you are trying to make.

       The slash (/) isn't indicative that my thinking is unclear – it actually purposefully reflects the muddled thinking and misinformation promulgated by a lot of dogmatic skeptics. The fact is, many dogmatic skeptics, such as Ben Goldacre and David Robert Grimes, consistently fail to differentiate between (a) alternative approaches to medicine and ‘alternative medicine’ – i.e. there is a wide spectrum of alternative practices, some of which have a strong evidence base and others have a weak evidence base; (b) related to the first point, the favourite saying of dogmatic skeptics that “alternative medicine that has been proved to work is just called medicine” is a totally misleading and dishonest meme. Yoga or nutritional interventions will never be called medicine by the orthodoxy, even though they have a medicinal effect in specific cases. My point is this – alternative simply means alternative to consensus. So, for example, treating type 2 diabetes with nutrition is ‘alternative’, and yet it works wonders for the condition. Thus, we have an alternative treatment which works better than the consensus treatment (drugs). This just proves the original point that these words ‘alternative’ and ‘complimentary’ are fairly meaningless when used by dogmatic skeptics.

       I agree with your sentiment toward the FDA, but I just don't agree with you on the supposed ambiguity about the words ‘alternative’ and complimentary’ in the sense you talk about in the final couple of paragraphs. When talking about cancer, for example, it seems obvious that alternative is anything which isn't chemo, radiotherapy or surgery.

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