Denialism Blog

Month: March 2008

  • Wifi Woo Strikes in Sebastopol

    By way of AP and BoingBoing, one can find this post by Dale Daugherty on O’Reilly Radar about the newest attack of the tinfoil-hat-wifi-radiation brigade:

    Our town, Sebastopol, had passed a resolution in November to permit a local Internet provider to provide public wireless access. This week, fourteen people showed up at a City Council meeting to make the claim that wireless caused health problems in general and to them specifically. These emotional pleas made the Council rescind its previous resolution.

    Ah, California! There’s good stuff out there explaining this breed of woo, but these activists still have traction because they’re very good at spreading fear and uncertainty. For instance, what do you do as a county supervisor (perhaps with no education in science since college) and a mob shows up at the meeting with signs that say “Just Say No to Radiation”?

    Or “Money Talks, We Get CANCER.”

    Strongly motivated, vocal, organized minority groups can have a powerful effect on politics. And this is irresponsible for several reasons–this anti-antenna movement has grabbed on to health and safety issues to mask their underlying goal: to make the neighborhoods more beautiful by removing antennae!

    As such, it is great example of how health and safety concerns and the precautionary principle can be used to simply push other political motivations. Cato and AEI could use this post as footnote 1 in any argument against health and safety legislation.

  • Quack Miranda Warning

    “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”

    This “Quack Miranda Warning” is on every just about every woo-meister’s website. I see dozens of patients every day, and I never Mirandize them, so whats the deal?

    There are three ways to look at this: the truthful way, the sinister way, and the bat-shit insane way.

  • Truth: Anyone who wants to sell you something that’s a load of crap must use this statement to cover themselves legally.
  • Sinister: Variation of above–someone wants to sell you something that you are supposed to believe is medically useful, but at the same time they tell you in fine print that it is not medically useful. When it doesn’t work, they don’t get sued. I wonder why anyone would buy something with that disclaimer attatched to it? When I treat someone for a medical problem, I pretty much say that I intend to diagnose, treat, cure, or prevent a disease. Why would I say otherwise? It would be a lie. Also, who would go to see a doctor that told you that they didn’t intend to diagnose or treat disease. The whole thing is bizarre.
  • Bat-shit insane: The FDA and Big Pharma are in cahoots with the AMA to keep you from learning all the simple ways to treat diseases. They want your money, and they’ll do anything they can to get it from you, including suppressing the knowledge that anyone can learn to heal cancer.

    • I can’t really help the people who believe #3, but people who are willing to suspend their paranoia should read #’s 1 and 2 a few times. Unless you’re being arrested, no one should be reading you your rights. The Quack Miranda Statement is the red flag that should send you running.

  • Some skills in medicine are harder to teach

    Teaching facts is easy. Medical students eat facts like Cheetos, and regurgitate them like…well, use your imagination. Ask them the details of the Krebs cycle, they deliver. Ask them the attachments of the extensor pollicis brevis, and they’re likely to describe the entire hand to you. Facts, and the learning of them, has traditionally been the focus of the first two years of medical school. The second two years deals with putting facts into action. Teaching medical students and residents is very different from being a school teacher, something with which I have first-hand knowledge and experience. Fetal doctors want to learn…they’re too scared not to. In general, give a med student a book, and she’ll read three, and write a paper before you see her again. But some things in medicine are harder to teach.

    Medical education in America underwent a revolution at the beginning of the 20th century, when texts were written, schools formed, and methods standardized. Now, 20 some-odd years into the evidence-based medicine revolution, medical education is improving once again.

    MarkH describes a method being tested to teach doctors to think under pressure. The big difference between this and the way these things have traditionally been done is that people are measuring them. They are forming hypotheses about learning and testing them. And it’s about damned time.

    My current teaching responsibilities are primarily those of teaching nascent internists how to practice their profession. The facts are (usually) there, but the judgment is not. This is also a field ready for evidence-based evaluation, but some things really do require repetition and mentoring.

    I supervise residents at an outpatient clinic. They see their own patients, and they see patients who either walk in or make appointments for immediate problems. Treating patients you know is one thing—treating a complete stranger is another.

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  • A history of denialism – the ancients

    This week I think I’m going to spend some time discussing denialism throughout history. In part inspired by the recent attacks on some of the most effective scientific communicators we have by by Mooney and Matthew Nisbet, and PalMD’s post on some modern thinking by “ancients” I feel like it’s time to provide some more historical context to debunking bullshit, and the long and honorable tradition of debunking by the world’s greatest thinkers and communicators. We’re going to start a little bit light with my nomination of Plato as history’s first debunker.

    You see, Plato had to deal with some BS artists in his day. They were known as the sophists, traveling teachers of the youth who purported to teach the sons of the wealthy knowledge and virtue. However there was a problem. The sophists weren’t so much interested in teaching the kiddies philosophy, or how to find truth and improve human understanding of the world, they were only interested in winning arguments at any costs. In other words, they would teach the children of the wealthy how to use any dirty rhetorical trick they could think of to win people over and gain power. Charming group really.

    So along comes Plato, student of Socrates, and he’s not happy. He believed that people should be interested in seeking truth and understanding of the world. In his eyes the sloppy rhetoric and moral relativism of the sophists was ultimately corrupt and unworthy. His criticisms of the sophists are therefore a source of joy for any student of denialism. In particular, I believe that we should single out Plato’s dialogue Gorgias for an early discussion of denialist BS, and perhaps the earliest refutation of quackery that I’ve seen.

    Socrates: You were saying, in fact, that the rhetorician will have, greater powers of persuasion than the physician even in a matter of health?

    Gorgias: Yes, with the multitude-that is.

    Soc. You mean to say, with the ignorant; for with those who know he cannot be supposed to have greater powers of persuasion.

    Gor. Very true.

    Soc. But if he is to have more power of persuasion than the physician, he will have greater power than he who knows?

    Gor. Certainly.

    Soc. Although he is not a physician:-is he?

    Gor. No.

    Soc. And he who is not a physician must, obviously, be ignorant of what the physician knows.

    Gor. Clearly.

    Soc. Then, when the rhetorician is more persuasive than the physician, the ignorant is more persuasive with the ignorant than he who has knowledge?-is not that the inference?

    Gor. In the case supposed:-Yes.

    Soc. And the same holds of the relation of rhetoric to all the other arts; the rhetorician need not know the truth about things; he has only to discover some way of persuading the ignorant that he has more knowledge than those who know?

    Gor. Yes, Socrates, and is not this a great comfort?-not to have learned the other arts, but the art of rhetoric only, and yet to be in no way inferior to the professors of them?

    Ha! What does that sound like?

    The debunkers of the world are part of a long and noble history of those who wouldn’t tolerate BS and were willing to stand up against it in any form. Plato certainly won the historical fight. Today sophist is used as an epithet, and to say someone is just using rhetoric (although unfair to the legitimate study of rhetoric) is the same as calling someone a bullshitter. Therefore today I recognize Plato as a founding father of debunking denialism.

    GORGIAS by Plato translated by Benjamin Jowett, available at GreekTexts.com.

  • War Games!

    One of the problems with medical education is that while you are intellectually trained to deal with medical problems and emergencies, actual experience with how to respond to emergent clinical situations is difficult to teach and usually only comes with experience. Further, real clinical experts make medical decisions almost by reflex. You see this in medical school that while you as a medical student have to actively think about what is going on in any given situation, medical experts act more by pattern recognition and have an instant reflexive response to clinical situations. And how do you teach reflexes?

    Here at UVA, Jeff Young, a trauma surgeon and researcher in clinical decision making has published on a new strategy of assessing and improving the response of doctors in training to high-risk medical situations. His strategy is rather than stressing cognitive experience, which much of medical school and resident training emphasizes, the goal is to build reflexive responses to critical situations. In an emergency, the ability to generate differential diagnoses and recall complex information is secondary to knowing how to acutely assess patients, resuscitate and stabilize them. Clinical experts do this without even thinking about it. Young’s goal is to train medical students, interns and residents by simulation of critical care situations so that when they end up involved in charge of a critical patient they will reflexively perform the correct actions to resuscitate and stabilize patients. After all, practice makes perfect.

    The result is what Dr. Young calls “War Games” – simulations in which students and residents are drilled in their responses to medical emergencies. By putting students under some stress and making them think fast about critical care, reflexive responses to emergent situations are drilled into the subjects, and hopefully when the situations are encountered in real life they’ll know what to do without even thinking about it.

    So enough talking about it. Here’s what one looks like – me being drilled by the chief resident on a patient presenting with hypotension.

    You notice that rather than going for diagnosis the goal is to start with the basics. First you evaluate the airway, breathing, and circulatory status, resuscitate the patient as necessary, gain IV access, get basic vitals and check tests. Only after you’ve stabilized a patient should you start thinking about what the exact diagnosis is, whether you need to operate etc. It also emphasizes things you don’t necessarily learn in class, like the need to call the attending when some disaster has occurred. It seems like things like this should be obvious (they probably are to EMTs and paramedics), but the reality is that these kinds of practical skills are difficult to relate in a classroom setting. You also quickly realize that when you are under pressure, it’s completely different from all those sessions you remember from 2nd year where you sat around thinking about differential diagnosis with 5 other people in the room. I clearly screw up a few times during the simulation, but hey, that’s why I’m in training and why I appreciate these sessions.

    This also demonstrates something I think we can appreciate about evidence-based medicine. Not only do we emphasize a scientific basis for the treatments we use, but we also actively use science to figure out the best ways to train doctors to be better clinicians. I found this strategy to be incredibly useful, and I hope other medical schools around the country also adopt War Games to help train their students to be better docs.

  • Were the ancients fools?

    Often in the discussion of cult medicines such as homeopathy, acupuncture, and reiki, supporters fall back on “the wisdom of the ancients”. This raises a question. Since “the ancients” had it wrong (i.e. their belief systems could not effectively treat disease), were they just stupid?

    Any of my historian readers already know the answer, but it’s worth going over.

    Our forebears were neither more nor less intelligent that we (unless you go back about 3 or 4 million years—that gets rather dicey). They were literate, intelligent, and damn good thinkers. They just had limits to their ability to investigate their environments.

    Let’s take an example from an English physician living in Paris in the mid-18th century, during the time inoculation against smallpox was spreading, but vaccination had not yet been invented.

    i-aa5bcfa81eb6fcfe8c1013a6ec6a06d7-inoculation.jpg

    By way of background, this new (to Europe) practice actually comprised many different practices, but the basics were the same: take a bit of material from a smallpox pustule, and rub, snort, or inject it into the skin of a healthy person. The healthy person would then develop a (hopefully) mild case of smallpox that would protect them from epidemic smallpox, which had a high rate of mortality and disfigurement.

    Dr. Cantwell, an English physician in Paris, had some concerns about this procedure (translation unfortunately mine):

    It is facts, and not the promise of them, and reason, that must truly interest the public. If they respond to the promises of the Inoculators, inoculation will establish itself despite all that can be said to show the danger and inutility of it. If, on the contrary, the facts directly dispute their promises, the public will be disabused and inoculation fall by the wayside.

    As for my part, I would say that if among the Inoculators there is found even one who responds pertinently to the facts which I allege, I will be the first to swear to my defeat, and will side with these gentlemen. If not, justice demands that one always allow that new facts could be gathered against this method, and they must be rendered public with all pertinent arguments.

    It is not enough to say that of one hundred persons inoculated, only one or two perished in the first forty days. It is a question of knowing FIRST if Inoculation gives lifelong protection from smallpox, and if one can be killed by a natural smallpox infection which may follow the artificial one…. SECOND it is necessary to know, again, if inoculation might accidentally spread smallpox, in the right conditions causing more people to perish of this contagion than would be saved by its application…(emphasis mine)

    Dr. Cantwell was basically one of the earliest opponents of immunoprophylaxis (prevention of disease via inoculation or vaccine). Was he a crank?

    Well, not by this excerpt. He asks the same questions that we do today regarding a vaccine: what is the mortality from the procedure, does it actually protect, and could it possibly spread disease.

    This is very “modern” thinking. It turns out that Dr. Cantwell was both right and wrong in his apprehension about inoculation. There were, of course, no standard practices, and people were hurt, but in general, it tended to save lives during epidemics.

    Thankfully, the much safer practice of vaccination came along, largely building on the knowledge of inoculation, and the discovery of healthy milk maids. (What was Jenner doing hanging out with the milk maids?)

    So, the ancients did indeed possess wisdom; they just didn’t have all the tools to apply it, including statistics, microbiology, and a well-developed germ theory of disease.

    It would be wise to remember that our forebears, though smart, didn’t have the tools we have today. To rely on their intelligence but eschew modern knowledge makes us look like the fools.

  • Morgellons—cranks in search of a disease

    I’m trying to understand “morgellons syndrome”. Based on Morgellons Research Foundation reports, there are a lot of people out there who believe they have this so-called disease. But what is it? I decided to dig deeper on the research end of things. I went to the MRF website, and to MedLine, looking for something, anything, to help me find out more about this problem. I must report that the science doesn’t look good for the morgie boosters.

    First, there has been little legitimate research on morgellons as such. The CDC is doing an epidemiologic study to determine what, if anything, may actually exist.

    The medical consensus is that so-called morgellons is a variant of delusions of parasitosis. It may be, however no case definition exists, and no central registry exists. Each case is treated on its own (and probably should be).

    Since morgellons resembles in every way but name delusions of parasitosis, it is on the morgellons advocates that the burden of proof falls. If they wish to invoke a new diagnosis, they must have a definition, a way of distinguishing morgellons from DOP, and a reasonable hypothesis to investigate. So far, none of these has happened.

    The dermatology literature has treated this phenomenon is a very sensible way. It has been recommended that patients’ feelings and sensations be validated, but that they be told the truth—that there is no evidence of infectious or otherwise primary dermatologic disease. It is sometimes recommended that patients be told that they have a problem with the sensory apparatus in their skin and nervous system, and that medications that act on the nervous system be used. This approach is quite rational, and atypical antipsychotic medications have been used successfully.

    This is in marked contrast to the bizarre approach taken by the morgies. Their “research foundation” has preconceived notions of what is happening—they have formed a conclusion rather than a hypothesis. This is fatal to science.

    Read on….
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  • Why am I here? To bother you, of course

    When I use the word “scientist”, I mean something pretty specific—someone actually doing experiments and publishing the results. Some physicians are scientists. In fact, the MSTP that Mark H is a part of exists specifically to train doctors to do research and bring the results to the bedside.

    Most doctors aren’t scientists, by my definition. But good doctors these days have to be able to read and interpret scientific literature if the wish to practice science-based medicine.

    I think of ScienceBlogs as a community of scientists communicating with the lay-public and other scientists. I’m happy I’ve been allowed to contribute as well, and I think it’s justified. When I see patients, I do so with a head full of knowledge that is based on reading scientific literature. I then have to digest and regurgitate that literature in a form palatable to everyday folks.

    So, now that I’ve justified my existence, it’s time to get back to annoying people.

    Steve Novella over at NeuroLogica recently posted a piece on a new “mystery illness“. These are always fun. Epidemiology is a fascinating field, and has helped discover HIV, hanta virus, SARS, and many other emerging diseases.

    But there is the other kind of “emerging disease”: the folie à news. There have been many descriptions in the past of so-called folie à deux, a shared delusion. In the information age (God, I hate that phrase), the internet and television can bring people with similar delusions closer together to share their “folie”. One of the most recent examples is so-called Morgellons syndrome. This is a disease named by a woman who thought her child had parasites in his skin. The cause has been taken up by a “scientist” at the University of Oklahoma, and by several websites and support groups.

    This “syndrome” differs from emerging diseases such as West Nile Virus in several important ways. Over the next few days, I’ll examine some of the reasons that “Morgellons” is not a real illness. Some of the material will be familiar to readers of my old blog, but I’m buffing it up for a fresh discussion. For the first installment, go below the fold…
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  • Another victim of cult medicine

    This is another one migrated from my old blog. It is the first in a series that generated an unusually large number of comments. Thanks, PalMD

    This particular woo-encounter was non-fatal. A patient came to see me. He’s middle-aged, generally quite healthy, and physically active. After a recent return to physical activity, his elbow began to hurt, so rather than call his internist, he visited a chiropractor. Not surprisingly, the back-cracker was unable to effect a cure. What did he do next? Asked his friend for the name of a “better chiropractor” (which is a bit like trying to find a better wrench to turn a screw). This one took a totally different approach to not helping the patient, but that damned elbow still hurt.

    Like most cult medicine, there is little that chiropractic will not claim as their own. How tennis elbow could possibly be helped by back manipulation is beyond me. One website did, however, give some good insight:

    Not always thought of as a “chiropractic” condition by patients, chiropractic’s conservative approach to elbow pain is often very effective, avoiding more invasive, risky treatment options.

    An excellent example of “hurry up and do nothing”, which is not always bad advice, but is not unique to chiropractic. I guess when all you have is a hammer, and nails are notably absent, a wise chiropractor steps back and says, “abra cadabra!” I’m sure chiropractic cures the common cold as well—whereas the common cold, when left untreated, usually lasts a week to a week and a half, visit the chiropractor and your cold is gone in 7-10 days.

    Anyway, I gave the guy a tennis elbow strap, told him to rest and ice it, and take ibuprofen if he needed it. If he’s patient and follows my advice, he’ll probably save a few bucks. A strap is usually covered by insurance, but cheap anyway. Ice is basically free. And a visit to me is about sixty bucks—and if he gets better, he doesn’t have to return for multiple “manipulations”.

  • How listening to my wife CAN SAVE YOUR LIFE!!!!

    Most of us around here know about internet memes, hoax emails, and other sources of scientific and medical rumor. After all, we’re geeks (or at least, I am). My wife, however, is not. She is a typical (and wonderful) woman, from a particular ethnic group, and particular part of town (and well-educated). I’m a fairly well-known physician, but when we go out to dinner, everyone stops to say “hi” to her—and is introduced to “her husband” for the third time.

    So it isn’t really a surprise that she knows more about the “real world” than I do. I was sitting on the couch reading my feeds, and she was checking her email. She apparently belongs to a mailing list that “everybody” is on. I’m not sure how to reproduce the entire email, so I’ll describe it. It has pictures of an adorable child placing a Tupperware container in a microwave, a refreshing bottle of water, some chemical diagrams, and a headline that reads “Cancer update from Johns Hopkins”. It explains how plastic will poison you with dioxins and other nonsense.

    Now, to most folks reading this, it looks like the internet-equivalent of a cut-out newsprint ransom note. But to a suburban mom…
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