AI: To Quack or Not to Quack
Each Wednesday’s Afternoon Inquisition is provided by the previous week’s Comment o’ the Week winner. Today’s question comes courtesy of wet_bread:
Given the vested economic interests in modern medicine, especially
pharmaceuticals, are skeptics sometimes too quick to equate medical
practice with medical science and thereby dismiss as quackery
potentially criticism of status quo medical practice?
The Afternoon Inquisition (or AI) is a question posed to you, the Skepchick community. Look for it to appear daily at 3pm ET.
I don’t think so. I’m equally skeptical about new drugs they release without any studies comparing the effectiveness of new ones to older ones. I try not to take anything that hasn’t been on the market for 10+ years. Because lo! Economics takes precedence over safety. Same as in the pseudomedical world.
I’m not sure I understand the question.
I suppose “skeptics” “sometimes” jump to conclusions. But in general, legitimate critisism is recognisable as such.
Pharmaceuticals make shitloads of money and are in for shitloads of money if a drug fails. Based on that information, are we too quick to assume that they are right and is it a knee-jerk reaction to dismiss non-conventional medicine out of hand?
Are skeptics sometimes too quick to equate medical
practice with medical science?
If you mean that skeptics can be too quick to assume that medical practitioners understand or are aware of modern medical science, then yes. If you mean that some skeptics may not be as skeptical as they should be when being told about some new treatment, possibly. But if you’re wondering whether there is any grounds not to complete dismiss as bunk the world of naturopathy and homeopathy and so on, no.
I make an effort to try not to dismiss any claim without any evidence, and this applies to “non-conventional medicine”. I can only speak for myself and not for other skeptics though. If some robust studies showed acupuncture, chiropractic, herbal remedies, and even homeopathy to be more effective than placebo, I’d follow the evidence (although I’d really like to see a mechanism if homeopathy was shown to be effective).
However, I’m more trusting of pharmaceutical claims than OTC alt-med stuff, because I know that prescription drugs go through tons more testing to be approved. I know that doesn’t guarantee that the drug is safe or effective, but it’s a better shot than untested, non-FDA-approved alt-med products.
@Elyse: Pharmaceuticals make shitloads of money and are in for shitloads of money if a drug fails. Based on that information, are we too quick to assume that they are right and is it a knee-jerk reaction to dismiss non-conventional medicine out of hand?
To me there is a risk/reward every time we swallow something. The more something is researched the lower the risk harm and the greater chance of benefit. I wouldn’t say everything in the herbal supplement aisle is quackery, but I would say it is much less likely to do anything at all and more likely to do harm than FDA-approved drugs. I view this as a place where people who like to run uncompensated human clinical trials on themselves gather.
As MD’s Steve Novella and David Gorski at SBM all to often report; being a medical doctor does not mean you are good at science or have the initiative to exercise a science based approach and judgment when it comes to your practice. I often take a wait and see approach with new OTC medications and usually check into known side-effects or interaction issues.
As long as there is science behind it, research behind it, and sound scientific principles, then I will defer to the people with the expertise that I don’t have.
If there’s no science, bad research, and woo-woo involved, then I am skeptical. If people who are not experts in the field that they are speaking about (Jenny McCarthy, for example) then I am skeptical.
Basically, I try to defer to expert knowledge when the expert is appropriate, and to scientific consensus. It’s pretty easy to spot the woo.
As someone with several chronic illnesses, I have learned the very hard way and on more than one occasion that medical practice is more than fair game for criticism. Ranging from wrong-headed views that persist in some medical communities about my disability (mostly not in the U.S. anymore though) to doctors all too willing to chuck a “cookie-cutter” prescription at a patient who needs closer attention, I’ve found it perfectly clear that medical practice is not above reproach.
As James Fox notes, my readings of blogs like SBM and others don’t give me the impression that skeptics are giving bad conventional medicine a free ride. But as has just been illustrated by the foofaraw over James Randi’s position on AGW, criticism of science-based medicine can’t be done by, say, someone who’s read a few Google articles and considers herself an expert. (Not that I am comparing Randi to such a person, obviously.) Much criticism of conventional medicine is quackery in this sense, where the person doesn’t have the necessary background to contradict the consensus.
But I don’t see where economic interests have anything to do with this. Skeptics follow the evidence as catgirl said. Maybe this automatic rejection of medical practice criticism is happening in forums and blog comments, but personally I don’t see this from the “name” skeptics in the medical field.
I think it’s a fair question. I often feel we don’t always acknowledge the shortcomings of the medical profession.
But usually we are reacting to or pointing out ridiculous claims made by sham healthcare peddlers, not commenting on health care in general. The science based medicine industry already has establishments they need to answer to for efficacy and safety concerns, your local ear-candling homeopath does not. That leaves it to the public (us) to speak out about things that are factually incorrect.
Yesterdays ‘quickies’ post had a link to an article that touched on this a bit. Health care often fails when they cannot find a cause for the problem, especially if the problem is hard to measure. I’ve experienced this my self with a chronic pain condition I had for about 3 years. it was intensely frustrating to get no solution from every doctor I saw.
In many ways I think that is part of what gives quacks so much power.
I think there may be some relegation of skepticism due to the differences of testing and hoops that pharmaceutical meds must go through vs. alternative meds.
However, there should be room for some more skepticism and criticism of the current drug industry. The excellent example is raised by Lilly suicides where medical practitioners pushed dangerous drugs onto individuals they were not tested for with some very sad results.
It’s always good to be skeptical of new drugs. But in particular I think it’s good to look at the interaction between regulating bodies and the drug companies as opposed to outright distrust. What exactly is the relationship between the APA/AMA and the drug companies? And how objective is the establishment of new mental and physical disorders that drug companies can then cater to? I know many women have been hesitant regarding the creation of new diseases based on PMS since they seem to be more focused on making a market to cater drugs to than to solve and actual need.
In the broader sceptical / rationalist community, the person I’m aware of who’s most sceptical of conventional medicine is economist Robin Hanson. He goes as far as to argue that the US could cut medical spending in half without reducing health.
Medicine will always be both an art and a science. But it should always be art founded on good science. As long as the science is good , it matters not if big pharma does the work or if it’s an independent study. Science can always be objectively evaluated – that’s its strength. The clinical application of that science takes into consideration many variables, from patient economics to patient fears, from physician’s compassion to physician’s need to be assertive, and on and on and on. The brushstrokes MUST differ from interaction to interaction, but never the goals, never the canvas, never the paint, unless the science dictates so.
One of my biggest beefs regarding medical research is that too much is made of a single study, by both my peers ANd by the media. Replication is a key aspect of science. Too often we fail to wait for additional studies before acting. The BODY of work is what is most important, not the newness alone.
It depends. I’ve encountered enough doctors, nurses, et al who were inept, ideological, or delusional that I do my own research rather than just listen to what they say. However once I’ve established that a particular health care professional is making statements consistent with the best available research then I tend to give their opinion much greater weight.
A lot of this seems to focus on medications, and while pharmaceuticals are a part of medicine they aren’t everything. Nor should they be. While I don’t trust anything I see in an ad, I do recognize that the pharm companies have a vested interest in offering products that have a net positive effect with minimal downsides. I question the relative efficacy of a pomo SSRI versus one that’s been around since the 60’s because I know that they aren’t making bank on the one with a cheap generic competitor available so they push the new one regardless.
I think as a general rule skeptics are less likely to have a knee-jerk antagonistic reaction to something coming from established medical practice than they are to something coming from outside of it. Historically the amount of garbage coming from within medicine (and there is certainly some) is far overshadowed by that coming from without.
Someone always “makes bank.” For example, with generic meds, it’s the pharmacist who makes more.
@Elyse: It’s not that we’re dismissive of alternative medicine because on economic knee-jerk in favour of BigPharma, it’s that we’re dismissive of alternative medicine because there’s no evidence to support it. For all it’s other faults, BigPharma is at least science-based medicine which homeopathy, naturopathy, accupuncture and all the rest of the alt-med group are not.
“I’d really like to see a mechanism if homeopathy was shown to be effective”
This is a big part of the problem. A reason why we can trust the pharmaceuticals more than alt-med is that they propose mechanisms understable from the point of view of chemistry and physics, which mean that in principle there are a lot of scientists that could validate it.
This fact by itself relaxes my suspicions. I would be very surprised if in the long process of testing a drug such a validation process wasn’t made.
If Homeopathy worked, then the drug companies would market their own homeopathic products. They would drive the small companies out of business, and then market more expensive “prescription grade” homeopathic cures.
@ Cygore … I have news for you … it doesn’t matter if they worked or not … some drug companies are indeed marketing homeopathy or herbal therapies – it may be a subdivision of the parent company … but everyone wants a piece of the pie if money is involved
“[…] are skeptics sometimes too quick to equate medical practice with medical science and thereby dismiss as quackery potentially criticism of status quo medical practice?”
Define “too” quick.
If Mr Abduction-conspiracy loon is claiming that the H1N1 vaccine is a secret government/BigPharma ploy to achieve mind control over the populace, then, is it “too quick” to dismiss this as the lunatic rantings of, well, a lunatic?
Likewise, if Jenny McCarthy is claiming that the MMR vaccine causes autism after numerous studies have shown no link and the goddamn MMR vaccine doesn’t even contain mercury any more anyway. Is that “too quick”?
I’d say “too quick” is when a legitimate concern is raised and it’s sumarily dismissed without even any further research into its validity.
Like the MMR vaccine scare when it first started, many, many years ago. But nobody dismissed it just like that. At the very least they questioned the correlation, or the modus operandi. And the fact the link was researched shows nobody was willing to dismiss it just like that anyway.
I think the definition of “too quick” might differ depending on whether you ask a skeptic or an alt-med enthousiast though (is 200 years “too quick” as far as homeopathy goes?) …
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