
Science-Based Medicine Answering Our Critics - tokenadult
http://www.sciencebasedmedicine.org/answering-our-critics-part-1-of-2/
======
pradocchia
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?"

~~~
tokenadult
_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](http://briandeer.com/mmr/lancet-
summary.htm)

~~~
msandford
Well, certainly you don't let things like this happen:
[http://scienceblogs.com/insolence/2013/09/20/patients-
endang...](http://scienceblogs.com/insolence/2013/09/20/patients-endangered-
by-failure-of-medical-boards/)

~~~
tokenadult
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-...](http://www.sciencebasedmedicine.org/editorial-staff/david-
h-gorski-md-phd-managing-editor/)

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

~~~
msandford
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-...](http://www.skincancer.org/healthy-
lifestyle/vitamin-d/the-d-dilemma)

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.

------
ianstallings
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...](http://www.telegraph.co.uk/news/worldnews/northamerica/usa/10329520/No-
serious-person-should-doubt-man-behind-climate-change-says-Tony-Blair.html)

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...](http://blogs.scientificamerican.com/the-curious-
wavefunction/2013/09/06/scientific-american-comes-out-in-favor-of-gmos/)

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.

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

~~~
3am
People throw around "attacking a straw man" far too much, but it would be
completely appropriate in the grandparent post.

~~~
ianstallings
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.

~~~
3am
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.

~~~
ianstallings
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.

------
CaptainZapp
"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
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.

------
logicchains
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.

~~~
tokenadult
_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](https://news.ycombinator.com/item?id=4491460)

~~~
logicchains
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...](http://www.thedailybeast.com/newsweek/2010/01/28/the-depressing-
news-about-antidepressants.html), which seemed to suggest a legitimate use
case for placebo treatment.

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

~~~
protonfish
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.

~~~
tokenadult
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...](http://www.sciencebasedmedicine.org/bad-pharma-a-manifesto-to-
fix-the-pharmaceutical-industry/)

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.

------
evoloution
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.

~~~
cell303
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.

~~~
Nursie
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.

------
throwawayyyz
Because you all love data so much:
[http://childhealthsafety.wordpress.com/graphs/](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.

~~~
tokenadult
Better data on the issue you bring up:

"How vaccination saves lives"

[http://www.nhs.uk/conditions/vaccinations/pages/vaccination-...](http://www.nhs.uk/conditions/vaccinations/pages/vaccination-
saves-lives.aspx)

"How vaccines saved millions of lives"

[http://www.skepticalraptor.com/skepticalraptorblog.php/vacci...](http://www.skepticalraptor.com/skepticalraptorblog.php/vaccines-
saved-millions-lives/)

"Vaccines bring 7 diseases under control"

[http://www.unicef.org/pon96/hevaccin.htm](http://www.unicef.org/pon96/hevaccin.htm)

"Gates Foundation Annual Letter 2011"

[http://www.gatesfoundation.org/who-we-are/resources-and-
medi...](http://www.gatesfoundation.org/who-we-are/resources-and-media/annual-
letters-list/annual-letter-2011)

------
pella
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/](http://www.alltrials.net/2013/2338/)

~~~
pella
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/](http://www.alltrials.net/)

------
raverbashing
"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.

~~~
protonfish
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.

~~~
raverbashing
"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.

~~~
protonfish
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.

------
eloff
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
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
Puff Peace.

------
rorrr2
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.

~~~
cell303
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.

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

WFT are you on about?

~~~
cell303
it's not so much about the reproduction of the person as of the idea.

~~~
Nursie
Then it has little to do with evolution.

