Science-Based Medicine Answering Our Critics | Hacker News Reader

Science-Based Medicine Answering Our Critics

sciencebasedmedicine.org

42 pointstokenadult56 comments

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?"

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

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

The author of that thoughtful blog post is, of course, one of the editors at Science-Based Medicine.

http://www.sciencebasedmedicine.org/editorial-staff/david-h-...

On his personal blog he uses the screen name "Orac," but he is the same person.

I guess the problem is that on the one hand he's imploring people to trust the science and those performing it, and on the other hand he's showing that those performing it aren't necessarily trustworthy.

It's hard for me to look at those two articles and reconcile the information from one of them with the information from the other.

Furthermore I have HUGE problems with people saying "LOOK SCIENCE!!" with anything other than physics or chemistry. In those areas where the interactions take place incredibly quickly and there are few compounding variables I love me some science just as much as the next guy.

When you start talking about organisms where everything is potentially a confounding variable it's a lot harder for me to excited about things being "proven" via science.

For example, fat used to be fine, then in the 80s and 90s it wasn't, now in the aughts and teens it might be again depending on which doctors you talk to.

I mean, right now you can't even tell if it's better to get small infrequent doses of no-sunscreen daylight (for the vitamin D) or not. The doctors and scientists are split on this one and there's no real discernable pattern as to which goes on which side. http://www.skincancer.org/healthy-lifestyle/vitamin-d/the-d-...

Given that 10 years ago there was no debate whatsoever and now there's a huge debate raging it makes a person a bit circumspect when taking the advice of those who purport to "know" something.

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.

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?

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.

Well then maybe if there was some kind of register of the doctors that did in fact practice science based medicine, public trust would be improved, although I imagine there's probably some legal or political obstacle standing in the way of that.

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.

Well if they're all aware of that yet some still prescribe antibiotics for viral infections due to pressure from patients, isn't that an ethical issue? If for some reason bloodletting came into fashion again among the populace, would doctors be acting ethically if they caved into patients' demands to give them that therapy? Doctors won't prescribe useless treatments like homeopathics to patients, so why can't they say no to patients asking for antibiotics when antibiotics would be ineffective?

Yes it is an ethical issue, for the doctors and the patients. I just feel like you're giving a free pass to patients that lack expertise demanding particular treatments from experts. I think they are more culpable than the doctors.

Well if patients are the problem then the whole thing's a moot point; patients are just getting what they deserve for refusing not only to trust doctors but also to do even a tiny bit of research for themselves. The problem is that such things can harm the whole population, even those who make sensible health decisions, due to how antibiotics overuse encourages the development of antibiotics-resistant superbugs. If doctors can't stop this, then who can?

Many doctors have given placebos to patients. Actual placebo pills, with no active ingredient.

The problem with prescribing antibiotics for a viral infection is not that it is useless -- it is no less effective than a placebo. The problem is that it contributes to drug resistance, while a placebo doesn't.

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.

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

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

I was trying to make a point that I summarized in the ending paragraph. I'm sorry you thought it was a straw man. My main point, if I can drill it further home, is not to attack anyone in debate and instead use empathy to lead to a dialogue. For instance, say you meet someone that is against vaccines because of their supposed link to autism. Would it be better to talk to them rationally about the subject, figuring out why there is a lack of trust, while sticking to the facts, or is it better to call them out in public in a retort that makes them look childish? If you want to be right then by all means, do the public retort. But if you want to convince them, then address them directly and stick to science.

Okay, on that point, I think it's fine to attack debate opponents as long as your are attacking them 1) on the merits of their points or 2) personal traits that are germane to the discussion.

The autism/vaccine link has been studied to death, far more than it should have been. It doesn't exist. But people still bring it up. Is that a good faith debate? I feel like the anti-vaccine discussion wants to be treated as an equal on a scientific basis, but is unwilling to do the hard work being aware of and understanding the research on the topic. I think they deserve to be treated with scorn, because a good faith effort to educate them has been happening for the better part of a decade and it has had little effect. Science is a bitch. If you don't get the answer you like, you don't get an unlimited number of do-overs.

EDIT: though, I think you have a legit gripe on GMOs.

Yeah, even the most compassionate person on the planet has limits to what debate it wants to entertain. I think we should stick to people that truly want to learn the truth and ignore the ones that simply want to muckrake. Unfortunately a lot of people "learn" from pictures with quotes on them posted on a social network, and it just wastes everyone's time. It's up to us to either address it or ignore it. I'd rather ignore it and reach those that can be reached. Because unfortunately I've found that digging into a topic with people that parrot statements without much basis in fact that they lose all interest. How can you convince someone that philosophically believes that the world is out to get them, that they should stop talking and listen? This is the great challenge of science, as always.

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.

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.

"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".

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.

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.

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

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.

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

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.

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.

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.

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.

Lookout, thar be loons here.

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.

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

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.

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...

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/

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/

"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.

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.

> "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

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.

"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.

A better way to say it is that math is a formal system - It is a set of symbols and rules for transforming those symbols. It is often mistakenly believed that it is the one and only universal system. But not long ago we used Roman numerals and did not even have calculus. (How Archimedes did his work I can't imagine.) What we consider modern formal mathematics is only one possible system and there is no reason to think that a completely different one would not do the same job just as well.

You use the terms "verification" and validity." These terms are used in symbolic systems to describe formulas that are well-formed (follow all the rules of their formal system) or equivalent to another formula (derivation) or a legitimate combination of multiple formulas (proofs.) Unfortunately, no matter how much you "prove" a pure mathematical theorem, it will never mean a darn thing about our observable universe. That is a job only science can do.

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.

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

Puff Peace.

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.

Wow. So much hostility.

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

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.

Thanks, though I think the comparison to religion is probably a lot more accurate than the comparison to language. Wishing for someone to die is generally a level of hostility rooted in something deeper and uglier than communication challenges. If that was all it was, translators could end all wars and the world doesn't really work that way.

Have a great day.

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.

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

WFT are you on about?

it's not so much about the reproduction of the person as of the idea.

Then it has little to do with evolution.

Reply on news.ycombinator.com