Science-Based Medicine Answering Our Critics

http://www.sciencebasedmedicine.org/answering-our-critics-part-1-of-2/

by tokenadult • 13 years ago

42 56 13 years ago

evoloution• 13 years ago

Taking the time to explain things that should be common sense shows to me that they somehow really care about people's health. Less empathic people would just let natural selection thin out the CAM user population.

cell3033• 13 years ago

Or is it the science based population that will be thinned out? Taking into account iatrogenesis (look it up) basically anything that takes you away from a doctor will be beneficial to you. However, this does not apply when dealing with servere diseases. In that case you no longer need to worry about side effects and this is where science-based medicine really shines.

fluidcruft2• 13 years ago

Lookout, thar be loons here.

Nursie3• 13 years ago

Nurse, he's escaped again!

What a load of old carp. Science based medicine has saved and prolonged so very many lives. Yup, some treatments have side effects. Sometimes these are fatal. However the balance is massively skewed in favour of SBM and getting more so all the time.

drharris• 13 years ago

I felt the same way (as a less empathic person). Things like this always make me think of that movie Idiocracy.

marksbrown• 13 years ago

On the same token, any reader interested in the topic should read `bad science' by Ben Goldacre.

protonfish3• 13 years ago

And the people at Science Based Medicine should address the legitimate criticisms in Ben's book Bad Pharma instead of focusing on the foolish woo from the alt health practitioners. I am sure its much easier to pretend that if the new age healers are wrong, then everything about the current use of pharmaceutical therapies is unquestioningly perfect.

The truth is there are serious problems with the current way drugs are researched and prescribed. So many people embracing non-standard therapies is a symptom of this, even though the average person may not be able to rationally articulate their concerns.

tokenadult7• 13 years ago

The people at Science-Based Medicine have written a favorable review of the book Bad Pharma:

http://www.sciencebasedmedicine.org/bad-pharma-a-manifesto-t...

They were aware of those issues and mentioning them before the book was published. Ben Goldacre and the joint editors of the Science-Based Medicine group blog are largely on the same page about how to investigate the safety and effectiveness of prescribed drugs.

pradocchia2• 13 years ago

I appreciate the appeal to reason and evidence, but these arguments miss the root: trust. Many people don't trust the medical establishment. If more people did trust the medical establishment to consistently provide optimal treatments and self-correct in case of error, the whole nonsense over vaccines would never have happened.

And if someone doesn't trust you, look in the mirror. I mean, look hard. The authors of TFA look in the mirror, love what they see, and ask the reader, "how can you not love me too?"

tokenadult7• 13 years ago

And if someone doesn't trust you, look in the mirror.

What do you do to gain trust if someone is continually spreading rumors about you behind your back?

http://briandeer.com/mmr/lancet-summary.htm

msandford2• 13 years ago

Well, certainly you don't let things like this happen: http://scienceblogs.com/insolence/2013/09/20/patients-endang...

pradocchia2• 13 years ago

The issue has been looked at by various think tanks. The question of trust is relevant to public health policy of course, but also to other areas of governance.

If the response is simply "better messaging", that will backfire eventually. Then again, there may be systemic constraints on a more substantive response. A major breakthrough in obesity, chronic disease and/or aging would reset public sentiment.

logicchains7• 13 years ago

Statistically speaking, people have reasons to distrust the competence of doctors. From the article here http://online.wsj.com/article/SB1000142412788732342380457902..., for instance:

"Both studies also found that about 25% of the time antibiotics were being prescribed for conditions in which they have no use, such as viral infections."

Anybody who's studied even high school level microbiology (or spent a minute on the Wikipedia article on antibiotics) knows that antibiotics only work on bacteria, not viruses. I imagine it's hard for people to trust doctors when they make basic mistakes like that. Even the CDC (http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-...) has stated that:

"Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe".

So if doctors can't even be trusted to not prescribe antibiotics as treatment for viral infections, why would people trust them regarding other more complex matters?

tokenadult7• 13 years ago

The issue you bring up is the topic of the recent Science-Based Medicine post, "The Overuse of Antibiotics for Viral Infections in Children" (2 August 2013),

http://www.sciencebasedmedicine.org/the-overuse-of-antibioti...

and that is far from the first time that the site has brought up that issue. Some doctors are rolling up their sleeves and taking personal time after work to inform other doctors about this issue and other issues for improving patient care.

3am4• 13 years ago

Doctors are overwhelmingly not the reason that this happens. Some are being risk averse (heading off unlikely 2ary bacterial infections to prevent lawsuites) and some are taking the path of least resistance with patients (who will doctor shop until they get some medicine).

This is just my firsthand experience with doctors and anecdotes. _Every single doctor_ is aware know the (lack of) efficacy of antibiotics against viral infections. I'm am completely comfortable with the blanket assertion, and I'm pretty sure you are wrong if you think otherwise.

raverbashing2• 13 years ago

"Only the scientific method can give us reliable knowledge"

Wrong. Math also gives reliable knowledge and has nothing to do with the scientific method.

Also remember that science had proved light was a wave and not a particle. Until it was disproved. (Amongst other examples). And several "scientists" forget that what's 'true' today for science is the best answer from what's know today, but that may change in the future.

But more commonly, science is a concept. What we have contact with is the result of the application of that principle by researchers, which usually is close to the ideal thing, but sometimes is not.

"There is proof that X is correlated with Y (cites study).

Correlation does not prove causation"

This is important, and I would bet on a lot of studies implying the causation where there's none.

daemonk• 13 years ago

Science in its purest form is simply using our fundamental capacity for logic to, as objectively as possible, perceive the world through our senses and instruments. We make observations at low resolution to make correlations and at high resolution to deduce causation.

Do a lot people make wrong conclusions based on theirobservations? Yeah. But that doesn't make the scientific method wrong. It just mean it's very hard for scientists to completely remove themselves (to be objective) from their results sometimes.

fluidcruft2• 13 years ago

"Only the scientific method can give us reliable knowledge"

Did you read the topic sentence of the paragraph you excerpted that from? You're failing to address it in the context of "knowing whether a treatment is effective".

And several "scientists" forget that what's 'true' today for science is the best answer from what's know today, but that may change in the future.

Which was addressed in #18

protonfish3• 13 years ago

I don't think you have a clue what science is and I doubt I can thoroughly correct you in this short space but I'll give it a shot.

Math is a language - it has no inherent analogies to reality. It can be used to describe a natural phenomenon, but the validity of this description must be tested through experimentation. If it is not disproven, a mathematical (or other type) model can be a useful tool in simulating the observable world.

raverbashing2• 13 years ago

"Math is a language"

Beyond the fact that languages can be described in a mathematical way, yes.

And science is a philosophical concept. It also does not have any formal verification towards the validity of it. It has certainly has had a practical success, but one could say that is even anecdotal.

rorrr2• 13 years ago

I find it silly to try and disprove idiots who think some bogus alternative medicine works. Let the evolution take its course and weed out the morons.

NovemberWest2• 13 years ago

Wow. So much hostility.

Why? (Serious question. Not snark at all.)

saosebastiao• 13 years ago

I don't feel the same way as the person you are responding to, but I can empathize with his position. I left my religion of 29 years, and in the process I shattered connections with almost everybody in my life. They always try to bring up the religion and my beliefs, and I always cast aside the opportunity to try to convince them.

It isn't that I'm hostile or smug to them or their beliefs...it is just that arguing with them using reason and logic is so tiresome because we aren't arguing using the same language. We might as well be talking in Latin and Arabic.

cell3033• 13 years ago

Well, feel free to take any medicine you want, whenever something hurts or you feel depressed, basically every time you want to adjust any body function. Never mind side effects and let evolution take its course.

Nursie3• 13 years ago

Because anyone that ever takes any form of medication doesn't live long enough to reproduce?

WFT are you on about?

eloff• 13 years ago

Replace CAM with a religion of your choice and most of the page reads just fine. Irrational reasoning in the face of contradicting scientific evidence looks the same, no matter the subject it seems.

Ntrails• 13 years ago

The whole article kept reminding me of Tim Minchen's Poem "Storm". I think almost every point was covered, and it made me giggle :)

md2be• 13 years ago

Puff Peace.

logicchains7• 13 years ago

I would be interested to hear why they're "biased against using placebos because [they] consider it unethical". There is rigorous scientific support for the effectiveness of placebos in some situations, so by not supporting their uses they're effectively cutting patients off from a cheap, easy to produce treatment. Sure, lying isn't particularly ethical, but neither is denying a patient a valid treatment, so I wonder how they decided between the two.

tokenadult7• 13 years ago

I would be interested to hear why they're "biased against using placebos because [they] consider it unethical"

You quoted part of point 2 from the submitted article, and asked for more details. Point 30,

"30. If CAM makes people feel better, why deny them that? Even if it’s just a placebo, isn’t that a good thing?

"That merits its own post, which will appear as Part 2 next week."

suggests that we will hear more about the answer to your question. The preliminary answer I would give is that most claims of "placebo" medicine greatly overstate the benefits of placebos. I have written about this previously here on HN,[1] with plenty of links to research articles.

[1] https://news.ycombinator.com/item?id=4491460

logicchains7• 13 years ago

Thanks for pointing that out, I'll pay attention to their next post.

I skimmed over the content you linked, and it did suggest that placebo "can influence patient-reported outcomes, especially pain and nausea". It reminded me of this article: http://www.thedailybeast.com/newsweek/2010/01/28/the-depress..., which seemed to suggest a legitimate use case for placebo treatment.

CaptainZapp• 13 years ago

"Neither can CAM. But doctors do have some pretty good ideas why it happens: exposure to infections, number of organisms that get into the body, genetic factors, toxins, immune deficiency"

I would have preferred that they use the word poison instead of toxins. Not that it's factually wrong but a lot of woo treatments claim to flush the toxins out of the system.

Maybe I'm overly pedantic here, but a provider of dubious therapies can point to this very article and claim that "see, my mercury enema treatment flushes out the nasty toxins. Even scientists claim that this can be a problem".

criley2• 13 years ago

I agree, the word is tainted by the association with woo-peddling. It has a real use and when speaking technically, or writing scientifically, the correct term should be used, but when speaking colloquially, I think we should avoid those words.

Reminds me of the word "believe". It should mean "you think it's true", but it has so many supernatural/unscientific connotations that people start using it as a trap "do you believe in global warming" which is just becomes a minefield of misused language and gotchas.

throwawayyyz• 13 years ago

Because you all love data so much: http://childhealthsafety.wordpress.com/graphs/

It's funny to me how the HNers who question vaccines remain silent when these threads pop here. I know they're out there and I know they read them all the time, just are too scared to respond. Guess I am too, with this throwaway and all.

tokenadult7• 13 years ago

Better data on the issue you bring up:

"How vaccination saves lives"

http://www.nhs.uk/conditions/vaccinations/pages/vaccination-...

"How vaccines saved millions of lives"

http://www.skepticalraptor.com/skepticalraptorblog.php/vacci...

"Vaccines bring 7 diseases under control"

http://www.unicef.org/pon96/hevaccin.htm

"Gates Foundation Annual Letter 2011"

http://www.gatesfoundation.org/who-we-are/resources-and-medi...

ianstallings4• 13 years ago

Although I do like addressing critics, I don't like this recent trend where critics of a particular science are treated with complete disdain. Is calling someone "batshit crazy", in so many words, supposed to open a dialogue?

For instance, the recent IPCC's attempt to make their position unchallengeable, with Tony Blair claiming No 'serious person' should doubt man behind climate change, says Tony Blair.

http://www.telegraph.co.uk/news/worldnews/northamerica/usa/1...

So if you have any doubts or skepticism you are not a serious person.

Another example is the constant attack on anyone that claims GMO foods should probably be labeled and that they could lead to disaster if not treated with the proper scientific respect it deserves.

Here is an article from SciAm that claims basically that anything other than the status quo on GMOs is "hysteria": http://blogs.scientificamerican.com/the-curious-wavefunction...

I could go on and on listing public criticisms of science and their rebuttals, but my point is this - science is about challenge. We need to take a very careful approach when we're trying to convince hearts and minds of the public and address their skepticism not with disdain but with empathy and understanding. Instead of saying, in a very eloquent way, "oh well, that's because you're stupid", we should stick to our scientific guns and beat down ignorance with facts. Going down any other path leads into the realm of philosophy, where science has no teeth. We can't simply wave our hand and say "trust us". Trust is earned. Let's earn it with science.

tokenadult7• 13 years ago

You are not writing about the submitted article. The phrase you put in quotation marks is not found there.

3am4• 13 years ago

People throw around "attacking a straw man" far too much, but it would be completely appropriate in the grandparent post.

logicchains7• 13 years ago

A cynic might say "follow the money". There's an awful lot of money behind the push for GMO, and a powerful company with a reputation for doing unethical things (Monsanto). Many people are quite emotionally (and/or politically) invested in the concept of global warming. I'm not saying I disagree that GMOs are harmless or that global warming is occurring, only that often when people speak with such vitriol they're doing it in the name of money or emotion, not science.

ianstallings4• 13 years ago

Yeah that happens on both sides of some scientific debates these days. Ones that usually effect all of us, such as GMO or climate chance. I bet the guys over in doing astrophysics are very thankful no one is getting the pitch forks out because of dark matter claims. We'll work through it, as we always do. In the meantime we'll have to try and focus on thoughtful and healthy debate.

pella2• 13 years ago

Trust is important!

see :"AbbVie representative says info on adverse effects of drugs should be considered commercially confidential" ( 6th September 2013 )

" On the other hand, there are other companies suing the European Medicines Agency to prevent release of clinical trial information. One of those companies, AbbVie, has just argued that information about adverse effects of drugs “is confidential commercial information because if released other companies could use it to help them get products approved.” Watch Neal Parker of AbbVie say this at a meeting hosted by EFPIA, the European pharmaceutical industry body, in Brussels:

The Head of the Dutch medicines evaluation board asked Parker in response “You think that adverse events are commercially sensitive information? … You are aware that you are working in the healthcare industry, with patients and human beings?”

Hans Georg Eichler, the EMA’s senior medical officer, said “I have been a regulator for many years and I am totally flabbergasted.”

AbbVie representative Neal Parker went on to say that AbbVie will release information on adverse events to researchers who request it and who promise not to share it with competitors, on a case by case basis. This is what other companies do too. Other companies are not claiming that this is commercially confidential information.

If the views of those like AbbVie prevail and information from drug trials is kept behind closed doors doctors won’t know it, researchers won’t know it and patients will suffer. Sign the petition calling for all clinical trials to be registered and results reported and help us by donating to the AllTrials campaign."

http://www.alltrials.net/2013/2338/

pella2• 13 years ago

please sign the petiton :

"Around half of all clinical trials have not been published; some trials have not even been registered. If action is not taken urgently, information on what was done and what was found in trials could be lost forever, leading to bad treatment decisions, missed opportunities for good medicine, and trials being repeated unnecessarily."

---> http://www.alltrials.net/

Science-Based Medicine Answering Our Critics

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