Testing remedies and trying arguments – 9 responses to claims by anti-FSM pseudoscience [Now with an added bonus 10th answer!]

Posted on 05/02/2012

10


Friends of Science in Medicine logo australia

FSM - someone should offer to design them a website and better logo!

Wow! Friends of Science in Medicine certainly got lots of people Googling for more information. FSM really should get their own website explaining their principles, so everyone who’s looking for information isn’t getting it from second-hand sources, such as the news, blogs, and their opponents. Plus then the public could go there to vent their spleen, rather than on my little blog! ;) [Update: they've created a website and there's a Facebook page]

I usually like to keep my posts varied, but since this has been such a big issue, I’m going to address a few points that arose underneath my previous articles on this topic (here, here, here and here).

  1. Prove it doesn’t work! – unless you do, we can include it science degrees
  2. They’re trying to ban us completely! We’re oppressed!! Totalitarianism!!!!!!
  3. You can’t reject all alternative medicines – some of them work!
  4. It’s a big pharma conspiracy because they make so much money out of patents
  5. Poor ickle wickle complementary and alternative remedies don’t have any money for research to show that they work
  6. You should, like, keep an open mind if you’re a scientist, even if they’ve been disproven they could still turn out to be right, y’know …
  7. Placebos and appropriate controls don’t apply to us
  8. It’s natural so it must be good for you and have no side effects
  9. Helicobacter pylori was ignored by the establishment for, like, decades and it was true
  10. Modern medicine doesn’t work and these remedies have been around for thousands of years so they must be right

1. Prove it doesn’t work! – unless you do, we can include it science degrees.

So you’ve waffled on about how homeopathy is wonderful (preferably with an anecdote) and haven’t actually provided any decent evidence (or provided the one small badly conducted study that appears to be positive, rather than the body of evidence as a whole), and then you turn around and say that the onus is on the people telling you to get out of taxpayer-funded science degrees to prove that you’re wrong.

Nup. You’ve got it the wrong way around (and fairly conclusively demonstrated you don’t have the first clue about science).

I need an imaginary example to help illustrate this.

Okay, say there are universities teaching a BHSc(Exorcism). You might think I’m being silly, but it’s currently a popular health remedy belief with a long history of apparently curing people of illnesses by realigning spirits, which apparently is less dangerous if performed by trained professionals. The leadership of the world’s largest branch of Christianity endorses it; Roman Catholicism has more than a billion followers so it would be politically expedient to be nice to them, let them into universities and fund their ‘research’ into exorcism.

So what if there were Catholic priests running publicly funded degrees in health sciences training up exorcism professionals? It’s no different from homeopathy practitioners in a BHSc training up true believers in homeopathy practice. And what if a group called Friends of Science in Medicine said there was no evidence that exorcisms worked and that as it’s all about spirit flows it has no plausible scientific grounding, and we should be getting it out of publicly funded science degrees?

Official Vatican exorcist. Image:telegraph.co.uk

The burden of proof would be on the Catholic exorcists to show they’re a science, and as they would inevitably fail to do so, they would be unceremoniously booted out of science degrees.

The Catholic exorcism priests would still be able to train students in their own non-taxpayer funded exorcism seminaries, and any one who wanted could spend their own time (and a small donation to the Church) getting an exorcism done. But it wouldn’t be subsidised by the taxpayer, or have faith taught in universities as science.

Yes, alt remedies should be discussed in a university health science courses. The  remedies with evidence for their efficacy should be taught in with the rest of the health science. And the remainder could be included in a few of lectures about popular folk remedies that either have no evidence that they work (and you’re welcome to conduct properly designed studies to find out more) or have been shown not to work and lead into a lovely discussion of all the ethical issues vs. health benefits arising from taking advantage of the placebo effect.

Anybody who wants to train as a therapist in a completely discredited area, like homeopathy, is welcome to go to a natural therapy college for training. But in terms of conducting taxpayer-funded ‘science’ courses that uncritically teach students to believe, and train them to become practitioners, in faith-based remedies – like exorcisms or homeopathy – the burden of proof is on the proponents to show that they work and are science, not on the people calling their bluff.

2. They’re trying to ban us completely! We’re oppressed!! Totalitarianism!!!!!!

No they are not. Check the evidence before you start claiming persecution. The FSM states:

We are not trying to stop public access to alternative therapies if they are fully informed about their lack of, or minimal evidence for, safety and efficacy.

We hope to … help the public make informed choices in medical care and not be subjected to false claims of efficacy nor take unnecessary risks of harm from unproven therapies or from delay in seeking proven treatment.

They’re not trying to stop you from practicing – people can pay for whatever sort of treatment they like – but what they are saying is that taxpayer funding should be directed towards remedies with evidence for their efficacy. And are you seriously suggesting that it’s okay to tell patients things that are demonstrably untrue?

[We seek to] reverse the currently trend which sees government-funded tertiary institutions offering health care ‘science’ courses not based on scientific principles nor supported by scientific evidence.

They’re not trying to stop the teaching of unproven alternative therapies at natural health colleges, as long as it’s not funded by taxpayer dollars which could more effectively spent elsewhere.

The remedies highlighted by FSM, such as homeopathy are iridology, are ones for which there is good evidence that they don’t work and/or they violate the evidence-based physical laws of the universe. And they’re saying we shouldn’t be teaching remedies that don’t work as ‘science’ degrees in taxpayer-funded universities. When they’re the total opposite of science. It’s the same reason priests, astrologers, and people who believe aliens landed in Area51 aren’t running entire university science courses teaching their evidence-free faith.

3. You can’t reject all alternative medicines – some of them work!

The FSM didn’t criticise all alternative remedies – just the ones that have been shown not to work, or make claims of efficacy without any evidence. Where there isn’t any evidence yet, they are “in favour of … the testing of these therapies in well-designed trials” to determine which ones work.

A ‘natural’ or ‘alternative’ remedy which has been shown to work simply becomes part of health science, and should be taught as medicine, for example, aspirin comes from willow bark. The big problem here is with people uncritically teaching things as real that have been shown not to work (and some have no plausible way they can work) in our universities as ‘science’. In science degrees, students should be taught to use research and evidence to separate fact from fantasy. Believing in something against all available evidence is the opposite of science.

If you want to check out the overall evidence for a particular alternative therapy before you claim that it works, a good place to start is here: NCCAM. Good luck.

The problem is that some CAM practitioners seem to ideologically cling on to all ‘alternative therapies’ (whatever than means) and won’t accept that some things get shown to work, and others get shown not to work or discredited and you need to let go of those discredited ideas if you want health science to continuing moving forward and improving.

It does seem that while some alternative remedy academics want to be taken as evidence-based researchers (e.g. making comments, like “CAM is not a “homogenous entity” … [t]here is a lot of crap, but there’s good stuff”), they don’t actually name what is crap compared to what is evidence-based. If they really do want to be a considered a health scientist (not an ideologue) establishing an evidence base for efficacy and better practice guidelines for alternative therapies, then they will have to be willing to delineate between, and publicly name, the things that: have good evidence that they work; that plausibly could work but do not yet have evidence; and the specific things that have been shown not to work time and time again.

Yet time and time again, the ‘academic’ defenders of CAM start by citing things that have some evidence for/against them, e.g. acupuncture, then show their true stripes by moving on to homeopathy (as I’ve already said, it does not work better than a placebo and is pseudoscience as it violates the evidence-based physical laws of the universe) – so they are incapable of differentiating between what does and doesn’t have evidence, yet hypocritically whinge that we’re the ones lumping all alt remedies into the same basket.

4. It’s a big pharma conspiracy because they make so much money

Yep, big pharmaceutical companies aren’t known for being paragons of virtue. But some of the biggest skeptics of pseudoscience are also some of the big critics of some of the dodgier practices of the medical/pharmaceutical industry.

Pointing at pharmaceutical companies is just trying to distract everyone from the problems in your own house. Stop changing the topic. And arguing that someone else is bad too doesn’t make you right.

If you’re criticising ‘big pharma’ for making money then you’re throwing stones from a glasshouse – CAM in Australia claims it has an industry turnover of AU$1.5-2.5 billion annually, and the global market is estimated to be US$ 83 billion annually. What should we call it? Big alter? Big quack?

And don’t start complaining there’s no research because it can’t be patented. Firstly, in some cases novel uses can be patented. Secondly, the CAM industry and all those supplement sellers, like Blackmore’s, are making billions of dollars without a patent in sight. The problem is that because they’re effectively unregulated and can sell billions of dollars of product without evidence, relying on the power of marketing and ideological faith/wishful thinking, there’s no financial incentive for them to spend money on research.

Also, I couldn’t care less about what irrelevant accusations you want to throw at medical practitioners – we’re talking about science here, and in our universities there are many, many scientists researching human health who have never received a dollar of pharmaceutical industry funding (I know of more who’ve received CAM industry funding than big pharma funding!).

5. Poor ickle wickle complementary and alternative remedies don’t have any money for research to show that they work

Firstly, the FSM do support research:

We are in favour of discussing the place of alternative therapies, their placebo effect and the testing of these therapies in well-designed trials. [emphasis added]

Secondly, see previous section. Annual turnover for CAM is billions nationally and US$83 billion internationally. Not so poor.

Thirdly, in terms of government funding for research, competitive proposals for research into natural remedies gets funded in mainstream grant schemes – lots of natural substances are being tested for medicinal properties all the time. There are scientists in universities all over the world (who have never received a dollar from ‘big pharma’ or a patent) who would love to research any breakthrough in disease treatment that looked genuinely promising (see point 9.).

Plus CAM get their own special funding: the US National Center for Complementary and Alternative Medicine (NCCAM) has received billions in  funding since it was set up in the 90s (with little or no success – a very poor return on investment), and a quick Google search finds other special government funds, such as the £1.3 million fund in the UK and $7 million recently from Australia’s NHMRC.

Testing any remedy:

evidence based testing pseudoscience complementary alternative friends of science in medicine

It's not perfect, but creating it kept me amused during a day of advanced statistics lectures

Plus there is also an unclaimed million dollar prize available to anyone who can conclusively demonstrate that any of the magic remedies really work (note: I’m not saying all alt remedies break the laws of the physical universe – before you start complaining, learn to tell the difference between the ones that aren’t magic (eg. willow bark for pain) and the ones that are (homeopathy)).

6. You should, like, keep an open mind if you’re a scientist, even if they’ve been disproven they could still turn out to be right, y’know …

Then there’s practical reality. Do you worry if you take a plane flight to England that there’s a chance you could fall off a flat earth? Nup, because despite the beliefs of flat earthers, most of us regard it as ‘proven’ that the Earth is round. In real life, at some point you have to decide the evidence in conclusive enough to reject a theory (even if some people ‘believe’ in it) and move on – otherwise you’ll keep on believing every idea in history: an excellent treatment for most illnesses is blood letting, Iraq had WMDs, mental illness should be treated with trepanning, or the sun rises each day pushed by a dung beetle.

Things that violate the known laws of the physical universe (like homeopathy) are not very likely to be found to work. If you think homeopathy can work and science’s understand of the universe is wrong, then perhaps you should try this physics experiment: to check if gravity is working try jumping off the 2nd floor balcony of a building. If you’re right and science is wrong, you’ll float. Or if you’ve tried the experiment and failed, then, like a true homeopathy believer, just keep repeating it over and over again. You’re sure to prove science wrong sooner or later, right?

7. Placebos and appropriate controls don’t apply to us

So, you’re ‘special’ are you? Your magic doesn’t work if someone is looking?

Yes, finding appropriate controls can be hard sometimes, but there are ways to control for the placebo effect, for example, by sham needling for acupuncture.

The denial of the placebo effect leads to some really daft arguments, like in that acupuncture paper, where they’re using evidence of a placebo effect to argue that they don’t need a placebo:

In regard to scientific trials, there is the obvious difficulty of finding an appropriate placebo. To address this, some trials have used a sham needle (1).This is where a superficial needling technique is used at non-acupuncture points. The problem with this is that these non-acupuncture points may still lie on a channel and of course the sun luo and fen luo, the little capillary network of vessels of the jingluo, connect the surface to the interior jingluo/channels and this may indeed induce a response. Other researchers have used a sham needle that does not penetrate the skin at all, and although it is apparently realistic (for the patient), since some acupuncture techniques only lightly stimulate the point, even this might be enough to exert an effect.

So they agree it has the same effects whether or not you use acupuncture points or stick needles in. Wouldn’t any member of the reality-based community conclude this means you can have the same positive effect without sticking needles into people? Isn’t this a good thing?

Never mind that this screams placebo effect (again and again and again).  Pretend acupuncture has an even bigger placebo effect than a placebo pill.   And having a nice sympathetic chat with someone and telling them you’re going to treat them is the other main component of the placebo effect.

The placebo effect is incredibly well established and if you want anyone to take you seriously then you need to show that your remedy is more effective than the combined effects of having a nice chat and thinking it will work. And if every time something doesn’t work, instead of considering it disproven, you claim that you’re not bound by reality, then congratulations you’ve just proved FSM right and you don’t belong in university science courses.

8. It’s natural so it must be good for you and have no side effects

Please swallow this natural concoction I made containing cassava root extract and herbal leaf tea brewed from Atropa belladonna. I’ll enjoy collecting your Darwin Award.

If a remedy is biologically active then it’ll probably have side effects, such as stomach problems from willow bark extract.

It’s a bizarre distinction to call some therapies ‘natural’ and others not. If a herbal remedy has pills of Willow bark extract (ie aspirin of not so well regulated purity and dose) it’s natural, but if you get it in a pill packet that says ‘Aspirin’ (with a carefully controlled quality, purity and dose) then that’s unnatural? Is an osteopath giving you exercises ‘natural’, while a physio giving you exercises ‘unnatural’? What about once there’s some evidence that a particular osteopathy or chiropractic technique could help with lower back pain and a physio takes these bits (stripped of any pseudoscience ideology) and amalgamates them into mainstream evidence-based treatment for lower back pain – is that now unnatural because it’s evidence-based and being done by a physio?

This widespread belief that everything that can be claimed to be ‘natural’ is good for you is a marketer’s dream, both for remedies like herbal supplements and, as the belief has become pervasive, in other industries as well.

Funnily enough, you can even get side effects from remedies that work no better than a placebo. For example, I was criticising a terrible acupuncture study and someone in the comments tried arguing the whole ‘well alt remedies are good because they have no side effects’. Evidence? Well if you actually looked at the study you’d find there was the same number of adverse events in the acupuncture and control group – and the same occurred in this properly conducted study – it’s called the nocebo effect.

natural remedy homeopathy therapy

It's natural so it must be good for you and have no side-effects, like all natural products: arsenic, blue-green algae, ebola and tiger snakes.

9. Helicobacter pylori was ignored by the establishment for, like, decades and it was true

Don’t try to pull that myth on me – I’ve worked with Hp.  Why do you repeat myths without checking – and then put the onus on the person you’re talking to to waste time showing you’re wrong?

Go to Pubmed. Type in “Campylobacter pyloridis”. (H. pylori’s original name). Search. Click ‘Last’. You’ve now found the oldest studies.

Barry Marshall and Robin Warren first discovered it in 1982 and then worked on producing evidence that it caused stomach ulcers. Its first widespread dissemination within Australia was a presentation at the Gastroenterological Society of Australia conference in 1984. The world first saw it when it was published in the prestigious and selective medical journal The Lancet in June 1984. Yes it was controversial amongst medicos, but big claims require big proof and replication before being widely accepted, and being published in “one of the world’s best known, oldest, and most respected general medical journals”, hardly constitutes rejection by the establishment. And really, anyone who tries suggesting that bacteria can’t grow in any given extreme environment (as long as it’s not violating the laws of physics) is just being silly and asking to be proved wrong.

Now, if you look at the Pubmed search you prepared earlier, you’ll see lots of scientists from around the world investigating Campylobacter pyloridis from 1985 onwards.  I’ve just found that someone else investigating this myth has even produced a graph of the bucket loads of papers published on H. pylori in the 1980s.

So Nobel prize winners Marshall&Warren managed to produce enough evidence to begin getting mainstream scientific acceptance in just a couple of years.

In contrast, pseudoscience remedies like homeopathy have been around for hundreds of years, and no matter how much money and belief is wasted on them, the evidence shows time and time again that they work no better than a placebo.

helicobacter pylori

H. pylori

10. Modern medicine doesn’t work and these remedies have been around for thousands of years so they must be right.

Seriously? You actually want to live under medieval medicine when your life expectancy would have been decades younger? Died horrifically of a disease which modern medicine could cure? Do you want to die drowning in your own blood like your ancestors did, or would you like to be treated for tuberculosis? How about shitting yourself to death with one of the many gastrointestinal diseases, such as cholera, which can now be dealt with using antibiotics and/or oral rehydration therapy? Or perhaps you’d like to watch your child being paralysed by polio so that they can’t walk or breathe, which is getting closer to being eradicated from the planet thanks to massive vaccination drives.

We live lives that are decades longer and healthier thanks to health care which a couple of hundred years ago even Kings could only have dreamed of (and people in many third-world countries still dream of). The ultimate irony is having eradicated many of the deadliest diseases from the first world and living decades longer, thanks to evidence based treatments and public health measures, we now have people walking around claiming that we’re unhealthier and convincing us to buy useless medieval placebo remedies. And asking for taxpayer funding to do it. (Funnily enough it seems to be more romantic/exotic/exciting to embrace other cultures’ medieval remedies, like ‘Eastern medicine’.) Instead we could spend that money on quality research to improve our healthcare even more. Or even, for a wild suggestion, spend some of that wasted money on providing real health care with real remedies to treat deadly and debilitating diseases in third world countries.

polio

Polio before vaccination - iron lung to breathe

polio

60 years since the vaccine we're getting closer to eradicating polio, but not there yet. Worldwide it has decreased from an estimated 400,000 cases in 1980 (Unicef) to 1,294 cases in 2010.

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New links to news stories about FSM since I first posted on it:

Blogs:

Also some members on a National Herbalists Association of Australia forum discussing the “Campaign against uni courses in Australia” seem to be feeling a little worried (I only noticed because they link to a blogger – me (haha! ridiculous) – and keep visiting my post). What do I have to say to them? Herbs can be great sources of medication: digitalis (foxglove), quinine (Chinchona tree), morphine (poppy), qalantamine (daffodil), reserpine (Indian snakeroot), vincristine (periwinkle) and paclitaxel (Pacific yew). You won’t have a problem with FSM if you either: use remedies with evidence for their efficacy; for remedies where there is not yet good quality evidence for/against, then inform patients (or, in the case of FSM, university students) that there is no evidence; and do not promote the effectiveness of remedies for which there is evidence that they do not work any better than a placebo. What could there possibly be to feel worried about?

Posted in: science, skepticism