Shares

It is unfortunately a common human reaction to respond to criticism by attacking those leveling the criticism, rather than addressing the points being made. This is especially true if the criticism is legitimate and one cannot reasonably counter it.

Substantive criticism is also a central part of the scientific endeavor, and so the culture of science has developed a tolerance for harsh criticism and a general understanding that the only proper response is with logic and evidence. Examples of exceptions are legion, human frailty being what it is, but you cannot live in the world of science for long without learning the rules of the game. Peers are expected to pull no punches when criticizing the errors or countering the arguments of their colleagues. Everyone is expected to be their own harshest critic (criticize your own data before someone has a chance to). And when criticized yourself, acknowledge what is legitimate and make appropriate corrections, but feel free to defend yourself against weak criticisms by pointing out additional data, interpretations, or errors in the arguments of your critics.

This meat grinder approach to scientific discourse works. Slowly, bad ideas and claims are beaten down, and only good ideas have the stamina to persist.

But here at science-based medicine we engage not only with the scientific community, but also with the public, and with those on the fringes of science. This means we often engage with those who do not play by the rules of science. A recent example is that of J.B. Handley from Age of Autism. David Gorski and I (and later Mark Crislip) wrote blog entries criticizing their 14 studies website with a detailed analysis. Handley responded with a full frontal personal assault sprinkled with irrelevant accusations. He ignored the vast majority of our actual criticisms, and those few he took on he completely botched.

Sometimes the targets of scientific criticism respond with another tactic – the diversion. Rather than make an obvious ad hominem attack, they try to distract the public (often the real target of the exchange) from the points of the criticism with a series of non sequiturs. They try to “re-frame” the discussion to make it about something other than the scientific evidence.

Creationists recently have been masters of this latter tactic. On scientific grounds, there is no debate about evolution. The overwhelming majority of the scientific community agrees that evolution happened, there is common descent, and natural selection is a dominant mechanism. Creationists cannot win this fight scientifically (though they keep trying), and so they try to distract from the science by trying to make it a political debate. So they accuse scientists of being dogmatic, of trying to exclude creationists from the debate, or for unfairly eliminating supernatural explanations from consideration. First they tried “teach the (fake) controversy,” and now they are trying “teach the strengths and (fake) weaknesses” of evolution.

Those who promote unscientific claims in medicine are no different. When scientists bother to examine their claims and level the sort of criticism typical of the scientific community at them, they often respond with some combination of personal attacks and distraction. Last week I criticised the Huffington Post for running a series of blogs and articles that are promoting dangerously pseudoscientific medical claims. I specifically commented on an outrageous article by Kim Evans, promoting the absurd claim that all cancers are caused by fungal infections, which in turn are caused by antibiotics. Evans has responded (sort of) with this week’s column, in which she addresses her critics, without naming anyone in particular.

Her response is right out of the pseudoscientific health claim play book, under “how to distract from legitimate criticism with logical fallacies and misdirection.” We have literally heard it all before, and have even answered much of it in detail. I will therefore not reiterate points that have been made before but will link to them.

She begins:

In a recent post I got a lot of flack for not speaking like a scientist. Something in that rubs me the wrong way because it presumes that only by a very narrow method can we come to any valid conclusions or make any new discoveries about the world we live in – while also presuming that only a tiny portion of the population, with a very specific set of skills and communication methods, has the ability to do so.

Here she is combing two common tactics – the claim that her critics are being elitist and that science it too narrow to encompass her wisdom (and she goes much further on these themes in the following paragraphs). Rather, she was criticized for promoting a dangerous health scam and not even attempting to justify it with anything resembling acceptable scientific evidence. In response to this criticism she did not either acknowledge the lack of evidence or provide references to such evidence – instead she “reframed” the criticism as being equivalent to saying that she is not in the club – an obvious appeal to elitism. (Handley, by the way, pulled the exact same ploy.)

She might as well have written that we were trying to “expel” her from the scientific discussion, because what she is doing is exactly the same as the Intelligent Design proponents tactics used in the movie by that name.

First she states that she was criticized for not behaving like a scientist, then she states, essentially, that science is not all its cracked up to be anyway. At least she is being openly anti-science.

This attitude derives from the premise that the methods of science are optional – just one way of knowing how nature works. This is, in my opinion, the core of the struggle between science-based medicine and everything else. But which rules of science, I wonder, would Evans recommend we abandon when it suits us? Should we ignore inconvenient evidence rather than take a systematic approach, use ambiguous criteria that are susceptible to bias, or not control for confounding variables?

There is nothing magical or arbitrary about the methods of science – they are merely careful observation and intellectual honesty rigorously applied. To say this is a “narrow” approach is to misunderstand science or a deliberate distraction.

Next she launches into the toxin gambit:

A study in 2005 found that newborns are being born with literally hundreds of chemicals in their bloodstream, many of them known to cause cancer. Most people eat pesticides and herbicides in their every meal. I don’t need to tell you that these substances are designed to kill living organisms, because you already know that, but might I remind you that you, too, are a living organism. Rocket fuel has been found in milk. Drugs and birth control have been found in the water.

The only evidence she provides to support her claims is a link to a Newsweek article. This is acceptable form in general for a blog, but does not do much to bolster her claims. The referenced article does site several studies that found detectable levels of various chemicals in the general population, but it also cites two NIH reviews of this data. The first found that there was little cause for concern, and the second that, based on animal data, there may be cause for concern and further study is necessary. This hardly supports the alarm bell Evans is ringing.

First, this does not have anything to do with the criticisms of her original article, which was about antibiotics and cancer. But that aside, her hysterical warnings about toxins, like most health care pseudoscience, has a kernel of truth. There are toxins in the environment, and it is plausible that some of them may reach levels that have health effects. We should be eternally vigilant about what substances we put into our environment and our bodies and monitor their health effects.

On the other hand – toxicity is always about dose. Most substances decried as toxins are in such low doses that they likely do not have any health effects. For some we do need more evidence, and maybe even changes in policy. This is likely to be forever a moving target as technology and industry advances. Policy should be based on evidence – not vague fears.

Also, her use of the word “chemical” is misleading. The environment is loaded with naturally-occurring chemicals. We are made of chemicals. It is not enough to say that chemicals exist in our environment.

And keep in mind all of this is to promote her health claims – that cleansing toxins has health benefits. That is an entirely separate claim that is not supported by evidence or much plausibility.

Next up is the claim that doctors and mainstream medicine kill patients.

So, while all of this looms and is largely unaccounted for in the standard health care equation, critics judge harshly alternative views and hail a system that’s been found to kill almost 200,000 people a year due to preventable errors. The same system has been found to kill another 100,000 annually with drugs, and seriously harm another 2.1 million each year by the same means. They hail “proven” methods for cancer that are known to cause significant damage to the immune system, and are even known to be carcinogenic, which means to cause cancer. So, I ask, “Is this rational?”

Harriet Hall has already dealt with this claim. First, it is a tu quoque logical fallacy. We all want better safer medicine. Failing to meet that goal in one arena does not justify pseudoscience in another. Further, these numbers are highly misleading (and almost certainly overstated) because they only consider the harm of intervention. But medical decision-making is about risk vs benefit. We need to know if the interventions in question save more people than they harm.

The standard in mainstream medicine is that each intervention should be backed by high quality evidence that its benefits outweigh its risks. Further, we are always trying to minimize risk whenever possible. And the principle of informed consent dictates that we give that information to patients and let them decide if the benefits outweigh the risks for them. Evan’s claimed treatments do not meet that standard, but she tries to distract from that criticism with the above non sequitur.

She concludes:

Oh wait, that’s exactly where we are now… So, in light of the numbers above and all of the proof that’s literally walking around next to us, maybe it’s time we started looking at and thinking about things a little differently. Because if a reliance on proven demonstrated science has gotten us exactly to the situation I describe above, perhaps a shift of focus to rational is the best move we can make.

Many of the commenters for this entry pointed out that science-based medicine has doubled the human life expectancy – that is also part of the situation. But again – at least she is flying her anti-scientific flag high and proud. Evans wants us to abandon science at our whim, certainly long enough to buy her book. She somehow twists logic to argue that this is “rational”, but she gets there only by abusing the evidence – by exaggerating risks and ignoring benefits.

Evan’s rant, typical of those in her camp, is once again just another long rationalization for not wanting to play by the fair and honest rules of science because logic and evidence does not support her claims.