Harriet Hall
Volume 38.6, November/December 2014
Original link: http://www.csicop.org/si/show/defending_science-based_medicine_44_doctor-bashing_arguments_and_rebuttals
Supporters of alternative medicine and purveyors of
quack remedies love to criticize conventional medicine and science. They
keep repeating the same tired arguments that are easily rebutted. This
handy guide will help skeptics answer common criticisms from
doctor-bashers.
Doctor-bashing is a popular sport practiced by believers in complementary and alternative medicine (CAM) and purveyors of quack remedies. Since they can’t compete in the arena of science, their only recourse is to criticize science-based medicine—as if pointing out its imperfections somehow proves their own methods are superior! It’s like creationists who imagine that controversies about small details of evolution somehow prove that “God did it.”
The sport of doctor-bashing involves A LOT OF CAPITALS, miz-speld wurds, egregious errors of grammar and usage, abuse of logic, misrepresenting the facts, rejecting the scientific method, gratuitously insulting individuals rather than grappling with the issues, and so on. If players can find a way to compare doctors to Nazis, they get extra points. They tediously repeat the same false accusations and flawed arguments that have been rebutted ad nauseam.
I thought skeptics might find it useful to have a list of some common CAM arguments along with their rebuttals. These are not meant as debating points, since trying to debate true believers is as useless and frustrating as trying to glue ice cubes to the ceiling. But these points might be useful in discussing the issues with people who have not yet donned the jersey of a doctor-bashing team.
1. Science doesn’t know everything.
Comedian Dara Ó Briain said it best: “Science knows it doesn’t know everything, otherwise, it’d stop. But just because science doesn’t know everything doesn’t mean you can fill in the gaps with whatever fairy tale most appeals to you.”
2. There are other ways of knowing.
Sure there are: intuition, imagination, dreams, revelation, tradition, speculation, the “stoned thinking” favored by integrative medicine guru Andrew Weil, anecdotes, and personal observations. All of these can lead people to strong beliefs, to the illusion of knowledge; but until those beliefs are tested, we can’t trust them to reflect reality. Only the scientific method can lead to the kind of reliable knowledge that took humans to the moon and transformed AIDS from a death sentence into a chronic disease with near-normal life expectancy.
3. Science is only a belief system, just another religion.
Science is founded on only two underlying premises: that there is a material world, and that we can learn about how that world works. Science doesn’t “believe” anything; it asks and verifies. It has an excellent track record of practical success. The scientific method unquestionably works.
4. Science keeps changing its mind.
Yes, and that’s a good thing. Scientific conclusions are always provisional. Scientists follow the evidence wherever it leads, and they often have to change course as new evidence becomes available. CAM refuses to change its mind even in the face of clear evidence. Scientific medicine stops using treatments if they are proven not to work; medical history is littered with discarded theories and practices. CAM never rejects any treatment and hardly ever tests one of its treatments against another to see which is superior.
5. Science is dogmatic.
Yes, they inconsistently argue that science is dogmatic while also arguing that science keeps changing its mind. Dogmatism is found in CAM, not in science.
6. You are just robotically supporting the official party line of mainstream medicine.
When a body of experts evaluates all the published research and issues evidence-based guidelines, it’s worth listening to what they have to say and trying to understand why they say it. Evidence-based guidelines are general guidelines, not cookbooks: doctors are meant to use judgment in applying them to individual patients. There is a difference between the appeal to authority (“He’s a professor at Harvard, so we should believe everything he says”) and accepting the consensus of experts who know more about the field than we do. If ten top mechanics agree that your carburetor needs replacing, it is reasonable to replace the carburetor. It is not reasonable to listen to your barber if he says you can fix the carburetor by sprinkling lemon juice on it. All too often, CAM advocates are the ones who are parroting unreliable “authorities” who don’t know what they’re talking about.
7. Doctors are afraid the AMA will take away their licenses if they support unapproved treatments.
This one is really silly, since the AMA has no regulatory authority and the majority of doctors don’t even belong to the AMA. Only state licensing boards can take away a medical license, and they seldom do that even when a doctor is using irrational treatments or outright quackery.
8. You skeptics are biased against CAM.
We are biased . . . in favor of science and reason. We are biased against claims that have been tested and disproven and that are incompatible with the rest of scientific knowledge. We are biased against health care providers telling patients things that are not true, presenting opinions as if they were facts. We are biased against using placebos because that constitutes lying, and lying is unethical. We are not biased against any CAM treatment just because it is CAM; we contend that there is only one medicine, that treatments have either been proven to work or they haven’t, and that all claims should be held to the same standard and tested by the same scientific methods.
9. Big Pharma is paying you to promote their products and discredit CAM. (The Pharma Shill gambit)
That accusation is unfounded. I don’t know of a single critic of CAM who is being paid by pharmaceutical companies for anything. We don’t accept gifts from drug companies. We don’t get kickbacks for prescribing certain drugs. We have no incentive to favor drugs over other treatments. For that matter, subsidiaries of pharmaceutical companies manufacture many of the diet supplements on the market, so we might just as well accuse you of being paid by Big Pharma to promote its products. What about Big Supplement?
10. Doctors are afraid of the competition.
Most doctors already have all the patients they can handle. CAM has only a very small share of the healthcare market. It’s not that doctors are afraid of competition, it’s that they are concerned for their patients’ welfare and don’t like to see them lied to, given ineffective treatments, persuaded to reject effective treatments, and persuaded to risk their health and their money.
11. Doctors only treat symptoms, not the underlying cause of disease.
Don’t be silly! Doctors treat the underlying cause whenever possible. If a patient has pneumonia, they don’t just treat the fever, pain, and cough; they figure out which microbe is responsible and provide the appropriate antibiotic. If a broken bone is painful, they don’t just treat the pain, they immobilize the fracture or insert a pin so it can heal. If a patient is in agony from pain in the right lower quadrant of the abdomen, they don’t just treat the pain, they try to figure out if the underlying cause is appendicitis, and if it is, they operate. The very people who accuse doctors of not treating “the underlying cause” are often the ones who think all disease is due to one bogus underlying cause (subluxations, disturbances of qi, poor diet, etc.). I once Googled for “the one true cause of all disease” and found sixty-three of them. (See SI 34(1), January/February 2010, available online at http://www.csicop.org/si/show/
12. Science-based medicine can’t explain why some people get a disease and others don’t, or why people get sick at a particular point in time.
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, chance, and so on. CAM proponents claim to fully understand why it happens, attributing it to some single cause that impairs optimum health (like a subluxation or a disturbance in qi or improper diet). But they have not been able to show they understand the answer to that question any better than conventional medicine does, or that their understanding leads to better patient outcomes.
13. Conventional medicine kills patients. (The “Death by Medicine” gambit)
Critics gleefully cite statistics for drug reactions, medical errors, and iatrogenic deaths; their numbers are usually wrong, but even when they are correct, it is irrational to look at those numbers in isolation. Harms must be weighed against benefits. Medicine saves far more people than it kills.
Many of those who develop treatment complications would have died even sooner without treatment. All effective treatments have side effects. Doctors look at the risk/benefit ratios and reject treatments where the risk is greater than the potential benefit. The risk/benefit ratio of CAM should be compared to that of conventional medicine; if there is no benefit, no degree of risk can be justified. There is no evidence that CAM saves lives, and it can kill if it is used in lieu of effective lifesaving treatments.
14. Doctors are only out to make money.
Most doctors go into medicine not because they want to get rich but because they want to help people. There are much better ways to get rich. Medical education is long (eleven or more years after high school), grueling, and expensive. Doctors typically work long hours and are on call for emergencies. They incur substantial debts for their education and need years to repay them. The nice houses and cars don’t come until long after graduation, and few doctors make really big bucks. A much easier way to make money is to market bogus remedies or spread misinformation (like Dr. Oz, Andrew Weil, Burzynski, Daniel Amen, Kevin Trudeau, and all the companies that sell diet supplements and miracle weight loss aids). Boiron sold 566 million Euros worth of homeopathic remedies (e.g., water or sugar pills) in 2012.
15. Your minds are closed.
We are open to any new treatment, no matter how implausible, if only it can be shown to be safe and effective. Before we can ask how it works, we must ask if it works. If homeopathy had shown the same spectacular degree of success as penicillin, everyone would be using it. When Helicobacter was proposed as the cause of ulcers, it only took a few years for the evidence to accumulate and for antibiotics to become the treatment of choice. When a treatment like acupuncture has been studied for decades and even for centuries and its effectiveness is still uncertain, it is only reasonable to stop studying it and spend our research money elsewhere. We don’t need to keep an open mind about perpetual motion or a flat Earth, and we don’t need to keep an open mind about homeopathy. CAM advocates are the ones whose minds are truly closed. Most of them hold their beliefs so firmly that they reject any evidence to the contrary. One practitioner told me he would keep using his pet method even if it were definitely proven not to work, because “his patients liked it.”
16. Doctors don’t do prevention.
They most certainly do! Who do you think invented vaccinations and preventive screening tests? Don’t you know about the U.S. Preventive Services Task Force? Medical doctors routinely advise patients about weight control, diet, seatbelts and other safety topics, alcohol, drugs, domestic violence, exercise, etc. Studies on these topics are constantly appearing in the major medical journals. And there’s no evidence that the preventive efforts of CAM providers result in any better health outcomes than those of MDs.
17. Doctors don’t know anything about nutrition.
They understand the science of nutrition, advise their patients based on the available scientific evidence, and refer to dietitians for specific diet plans. CAM providers claim to know more about nutrition, but they usually give pseudoscientific or unfounded diet advice.
18. CAM is better because it’s holistic.
CAM appropriated that idea from mainstream medicine. In medical school, doctors are taught that good medicine requires caring about the whole patient, not just treating the disease. Part of the standard medical history is a “social history.” Good clinicians consider the patient’s family, lifestyle, job, stresses, education, diet, socioeconomic status, beliefs, and everything about the individual that might have an impact on medical care.
19. Alternative treatments are individualized and can’t be subjected to the same tests as pharmaceuticals.
Any treatment can and should be tested by scientific methods. For instance, homeopaths could prescribe individually in whatever way they chose and the remedies they prescribed could then be randomized with placebo controls and dispensed by someone else with double-blinding. And the objective outcomes of individualized CAM treatments can be compared to those of standardized conventional treatments.
20. Natural remedies don’t get tested because they can’t be patented and there’s no profit in it.
Nonsense. About half of prescription drugs were developed from plants. The plant itself can’t be patented, but the drug company can isolate the active ingredient and patent that, or even improve on it with a synthetic version that is more effective, more consistent, and has fewer side effects. They can patent a unique method of converting a plant into a pill. There’s plenty of money to be made in herbal medicines, diet supplements, and even plain old vitamins: they generate billions of dollars in profits every year.
21. Treatment X worked for me.
Maybe, maybe not. You can only know that you improved after the treatment; you can’t know for sure that you improved because of the treatment. That could be a post hoc ergo propter hoc logical fallacy. You may not be able to imagine any other possible explanation, but that doesn’t mean there isn’t one. Barry Beyerstein explained some of the many ways people come to believe that a bogus therapy works: the disease ran its natural course, a severe phase of cyclic symptoms reverted to the mean, the original diagnosis or prognosis was wrong, more than one treatment was used and credit was given to the wrong one, there was a placebo effect, they confused temporary mood improvement with cure, and psychological needs can distort what people perceive and do. (See http://www.quackwatch.com/01QuackeryRelatedTopics/altbelief.html.)
22. You shouldn’t knock it if you haven’t tried it for yourself.
Trying it for yourself is not a reliable way to find out if a treatment works. Personal experience can be very compelling, but it is all too often misleading; in fact, it tends to interfere with one’s ability to objectively evaluate the scientific evidence. If the symptoms resolve, you have no way of knowing whether they resolved due to the treatment or whether they would have gone away anyway without treatment. Or whether some other factor caused the improvement. That’s why science uses control groups. If you try a remedy and get better, it’s reasonable on a practical basis to try it the next time you have the symptoms, but it’s not acceptable to cite your experience as proof that “it works.”
23. Huge numbers of people use X, and they couldn’t all be wrong.
Oh yes they could! The argument from popularity is a fallacy: popularity is no indication of truth. Just think of how many people believe their horoscopes or consult psychics. For centuries, everyone believed bloodletting was effective in balancing the humors to treat disease. Only when it was properly tested did doctors discover they’d been killing patients instead of helping them.
24. It’s been used for centuries: it must work, or people wouldn’t have kept using it.
This is the argument from antiquity, the “ancient wisdom” fallacy. Our ancestors may have stumbled onto a few effective remedies by trial and error, but they didn’t have the advantage of scientific knowledge, and they didn’t know how to test remedies. It could be ancient wisdom, but it could just as well be ancient error carried over from a prescientific era.
25. It’s natural, therefore it’s safe.
Not necessarily. Many natural substances are deadly poisons. Any natural remedy must be tested for efficacy and safety by the same standards we use to test “unnatural” remedies like pharmaceuticals. Herbs are drugs too, and anything that has an effect can have a side effect. If presumably “safe” herbal remedies were tested as rigorously as prescription drugs, some of them would prove unsafe.
26. There is proof that X is correlated with Y (cites study).
Correlation does not prove causation. The rise in the number of diagnoses of autism correlates almost perfectly with the rise in the sales of organic food, but that doesn’t mean organic food causes autism. Apparent correlations can be due to chance, error, poor data collection, and many other things. There may not really be a true correlation, and even if there is, that doesn’t tell us whether X caused Y or Y caused X or whether X and Y were both caused by Z.
27. There are hundreds of studies that show X works.
Most of the studies cited by supporters are in animals or test tubes; others are opinion pieces, speculations, and irrelevant studies. They won’t tell you that there are other, better quality human clinical studies that show it doesn’t work. Studies can be found to support almost any claim. Half of all published studies are wrong, for a variety of reasons that were explained by Ioannidis. (See http://www.plosmedicine.org/
28. We don’t need studies; we have plenty of testimonials.
Ten anecdotes are no better than one; 100 are no better than ten. Anecdotal evidence is unreliable, no matter how many anecdotes you have accumulated. This lesson has had to be relearned over and over again throughout the history of medicine. Just think of how many testimonials there were for bloodletting throughout the Middle Ages and beyond. Anecdotes are useful, but only as a guide to what to investigate with scientific studies.
29. Are you accusing us of lying?
No. We believe you are sincerely telling the truth as you see it. We believe you had the experience you related. But that doesn’t mean your interpretation of your experience is true.
30. If you think X doesn’t work, why don’t you do a study to prove it?
It’s not that we think X doesn’t work, it’s that there is no evidence to make us think it does work. It is not up to us to prove a negative. The burden of proof is on the person making the claim. If I told you that putting a poker chip in your gas tank would give you better mileage, you should ask me to prove it. You are not obligated to design and conduct a controlled study to prove it doesn’t work.
31. The medical establishment would drum out any doctor who tried to publish studies going against the party line, showing that X worked or that condition Y was real.
Quite the contrary. Peer review would critique the study. If it was a good study, it would be published; then others would investigate. A doctor who discovered a new disease or treatment would be honored. The idea of treating ulcers with antibiotics instead of antacids went against the party line, but Drs. Marshall and Warren won a Nobel Prize for discovering the role of Helicobacter pyloris. Luc Montagnier was awarded a Nobel Prize for discovering the virus that causes AIDS only two years after the first reports of “gay-related immune deficiency syndrome.” Real diseases and new treatments are quickly recognized by the medical community.
32. You can’t know about it if you haven’t experienced it.
Yes you can. You don’t have to have been bitten by a snake to know how to treat a snakebite. Male obstetricians are proof that you can deliver babies without having been pregnant yourself. We can know that antibiotics work for pneumonia without having had pneumonia ourselves. We can read the medical literature and learn far more from it than we could ever hope to learn from personal experience.
33. They laughed at Galileo. (The Galileo gambit)
Or any other lone genius who was ignored in his time. Sure, any crank might turn out to be right, but most cranks don’t. If someone makes a questionable claim, we can look at his evidence. If he makes an idiotic claim without evidence, he deserves to be laughed at.
34. X is officially approved by . . . so it must work.
Proponents cite some organization or authority, such as Medicare, insurance companies, state licensing boards for acupuncture/chiropractic/ naturopathy, the WHO, the courts, some hospital or clinic. . . . These organizations are not authorities when it comes to scientific truth; often they are not even experts in science. They are influenced by factors like politics, expediency, customer demand, economics, lobbyists, legal maneuvering, etc. No matter how many authorities approve of a treatment, it must still be properly tested to determine safety and efficacy.
35. The NCCAM is studying it, so there must be something to it.
The National Center for Complementary and Alternative Medicine is strongly influenced by politics and has wasted millions of taxpayer dollars studying improbable treatments with no scientific merit. The studies they have funded have never proved that any CAM treatment was effective. (See “Measuring Mythology: Startling Concepts in NCCAM Grants,” SI, January/February 2012.)
36. Studies show it doesn’t work, but what if it only works for me and a small minority of people like me?
That’s possible, but not very probable. If it worked for a significant minority of people, it would have shown up in the data, would have affected the statistics, and would have changed the outcome of the study. If the minority was too small to affect the study outcome, what’s the likelihood that you would be one of the special few that it actually worked for? The odds are against it, and there is no rational way to choose the one treatment that might work for you out of all the various treatments that have been tested and shown to be ineffective.
37. I was misdiagnosed/mistreated by a doctor. I will never consult an MD again. Now I rely on my naturopath/chiropractor/acupuncturist/ homeopath (or on the testimonials of my friends).
If you get food poisoning, do you stop eating? If you get a bad batch of gasoline do you start putting water in the fuel tank instead? Anyone can make a mistake, and some doctors are incompetent. The rational solution is to find a more competent science-based doctor, not to switch to a less competent non-science-based source of advice.
38. I can’t afford conventional medicine; CAM costs less.
If it costs less but doesn’t work, that’s false economy. Water costs a lot less than gasoline, but it won’t run your car.
39. My doctor said nothing was wrong with me, but my CAM provider did a test conventional medicine doesn’t do and found a condition that needed to be treated.
If conventional doctors don’t do a test, didn’t you ever wonder why they don’t? Maybe they have a good reason. Has the test been validated? What is its specificity and sensitivity? Is a positive result more likely to be a false positive than a true positive? It may well be one of the many bogus tests and bogus diagnoses that abound in the world of CAM.
40. Conventional medicine doesn’t have an effective treatment for my disease.
CAM doesn’t either. They may tell you they do, but they will only offer false hope and waste your time and money. It might be wiser to accept that there is no effective treatment and concentrate on finding ways to cope with your illness and improve your quality of life.
41. Conventional medicine does some terrible things. Why don’t you put your own house in order before you criticize others?
Conventional medicine is flawed, but it is constantly criticizing and policing itself. Current practices are continually being reevaluated and discarded if they are found ineffective. CAM has no such tradition of self-criticism; CAM practitioners never reject any treatment even if the evidence clearly shows it doesn’t work.
42. Only 15 percent of mainstream medicine is based on evidence.
False. That estimate was based on a misunderstanding of a study from half a century ago that was never intended to estimate the percentage of treatments based on evidence. Bob Imrie reviewed the literature and found that 78 percent of treatments are based on compelling evidence, 38 percent on randomized controlled trials. (See http://www.veterinarywatch.com/CTiM.htm.) Academic neurologist Steven Novella estimates that nearly 100 percent of the treatments he recommends are based upon the best available evidence combined with plausible and rational extension of what is known, as well as adequate evidence for lack of harm (http://theness.com/
43. Why would so many doctors use CAM and recommend it if it didn’t work?
Medicine is an applied science, and doctors are not scientists. Medical students have to absorb vast amounts of information in a short time; they are unlikely to question their teachers, they don’t have the time to read the experimental evidence for what they are taught, they are not taught how to evaluate research studies, and they are not educated about the flaws of CAM. A lot of MDs know about science but don’t really understand the scientific method, and there are those who understand it but choose to ignore it. There are those who are “shruggies,” who think false claims from CAM don’t matter, and there are those who are too overworked to keep up with evolving knowledge.
And finally:
44. If CAM makes people feel better, why deny them that? Even if it’s just a placebo, isn’t that a good thing?
No. Placebos are unethical. Placebo effects tend to be small in magnitude and brief in duration, and disappointment soon ensues. Using a placebo may delay or replace effective treatment. Placebos can make asthma patients subjectively feel like they can breathe better when objectively their lung function is unimproved and they are still at risk—asthma attacks can be fatal.
As the T-shirt says, “Science: It works, bitches.” No other basis of medical care can begin to compete with it. The doctor-bashers are playing a losing game.
