What Not To Write in an E-mail to SBM

When I started this blog 10 years ago part of the purpose was to create a venue where we could interact with the media and the public. Blogs have much more immediacy than a printed journal, can react much more quickly to the news cycle, and can form the basis of a real-time discussion.

Tracking feedback over a decade also allows us to see patterns in how the public thinks about certain topics. We frequently receive either comments here or e-mails to one or more of us, for example, that take exception to the SBM approach to medical topics. That’s fine, we are open to criticism, and welcome any opportunity to engage with the public.

There is one type of response, however, that has not really changed in the two decades that I have been doing this. Recently David Gorski shared an e-mail he received that followed this format exactly, and it struck me how many times I have read this exact e-mail, with only changes to the names and details involved. It is boiler plate, as if literally hundreds of e-mailers have been following the same template over the last 20 years.

In fact I think they have – the template is the alternative medicine narrative that has been aggressively marketed to the public.

Here is the template: You are mean and probably a shill for Big Pharma. You dismissed Dr. X’s miracle treatment, but he saved my life (long-winded anecdote to follow). You are killing people with your negativity.

Such e-mails, unfortunately, are all but worthless, except as further evidence for the Complementary and Alternative Medicine (CAM) narrative. All they demonstrate is that the e-mailer has drunk deep of the CAM Kool-Aid, has not really thought about their position, and is further not genuinely interested in engaging with us. In fact, when I do take the time to respond to such e-mails, they are often surprised, and sometimes even embarrassed. Often their e-mail was more of a catharsis than a genuine attempt at engagement.

Here are some excerpts from this recent e-mail, revealing the CAM narrative for what it is. I will also point out lessons for how not to engage with others with whom you disagree, assuming, of course, that it is not your goal to look like a mindless fanatic.

I think it’s funny that your website is the top listing for Dr. Neides on Google. I wonder how much you or your money source pays for that. I just read your hate article about about [sic] the Cleveland Clinic and Dr. Neides and Dr. Hutchins. To someone like me, you are the definition of why people are moving away from traditional medicine. I can only assume you are being paid by the drug companies to write an article with such a closed mind.

The Pharma Shill gambit is a ubiquitous component to these negative e-mails and comments. It is interesting how certain the e-mailers often are that we must be in league with Big Pharma. In this case they are not only paying us, but are paying to promote the blog and its articles.

Within the echochamber narrative of CAM, the e-mailer cannot conceive that a medical professional would have an honest opinion that differs from theirs, or that would dare to be critical of their hero maverick doctor.

Mistake #1 is to make an unsupported and unwarranted assumption that is convenient to your narrative. It is generally good advice to avoid making such assumptions, and to be especially careful about assuming premises that are in line with your existing beliefs.

Mistake #2 is to violate the principle of charity. If your purpose is to meaningful engage with someone else, it is good advice to follow the principle of charity, which means you give them the benefit of the doubt and the most charitable interpretation of what they said or wrote. This is good advice because any lack of charity is probably just a reflection of your own biases. This means that you are also probably wrong in your negative assumptions. Further, if your position is correct, then it should be able to stand up against even the best version of opposing opinions. Otherwise you risk attacking a straw man.

Mistake #3 is framing your criticism as a personal attack. The e-mails characterizes Dr. Gorski’s article as a “hate article.” They are assuming a negative motivation, rather than engaging with the evidence or logical points made in the article.

Mistake #4 is to equate disagreeing with your position to being closed-minded. The accusation of being closed-minded is so knee-jerk and old that skeptics have become inured to it. The assumption here is that being “open-minded” is a virtue. It is often treated the same as having the alleged virtue of faith. It is used as a substitute for actual facts and logic. This is also another personal attack – assuming that our position is due to a personal failure (being closed-minded) rather than a position we arrived at through careful thought and research.

Mistake #5 derives from 1-4, and also the rest of the e-mail – a failure to engage with the actual arguments in the article you are criticizing. As I said, we are open to feedback and criticism. Science and critical thinking require such openness, and valid criticism can only improve our thinking about a topic. Sometimes we miss important references, or important points, or confuse technical concepts. We welcome legitimate corrections. We also welcome discussing our position with someone willing to engage with our actual arguments and beliefs.

Further, if you fail to address actual points, it is reasonable to assume that this is partly because you cannot. If you had valid points to make, you probably would make them. I am often willing to give critical e-mailers the benefit of the doubt, however. When I do respond I always encourage them to give me specific criticisms, point out factual errors or invalid logic, or indicate any information I am missing in my analysis. We are happy to fix actual errors. My efforts rarely result in actual detailed criticism, however, further supporting the conclusion that the e-mailer doesn’t have any.

After that introduction, and as with most of such e-mails, the e-mailer launches into a long and emotional anecdote. To them, this is their evidence, and it justifies everything else they say in the e-mail or comment. That is mistake #6 – failure to understand the nature of anecdotes.

We have discussed the limitations and deceptive nature of anecdotes at length already at SBM. The quick version is that anecdotes are not useful as confirmatory data. At best they can suggest a hypothesis, and they are useful for this purpose. But anecdotes by definition are uncontrolled, which means we cannot account for the many possible variables involved. Further, memory distorts anecdotes so that the details are not reliable.

I won’t go into the details of this case, but the e-mailer reports (missing the significance) that the doctor consulted said that the symptoms would likely improve on their own. They later did improve, but the various dubious treatments that were taken were credited with the improvement.

The personal anecdote is extremely common in feedback here and elsewhere. Whenever I post an SBM article to Facebook, for example, there are always dozens to hundreds of comments that attempt to contradict the careful analysis of systematic reviews of scientific evidence with a personal anecdote. This is understandable in that this appears to be baseline human psychology. We are wired to think that our personal experience is definitive.

This is why we have to write about anecdotal evidence so often. Anecdotes cannot be use to counter published scientific evidence – so don’t bother.

The e-mailer finishes:

I am so thankful that people are waking up and not listening to people like you and that our stories being are being shared through social media. Someone may not be able to turn their health around because of your message. Your scare tactics and closed minded thinking written in articles like this is sad and unnecessary.

Other than doubling down on her previous errors, the e-mailer adds the rebuke that our efforts to explain published science to the public are keeping people away from possibly effective alternative treatments. This is mistake #7, assuming your conclusion. Whether or not a particular treatment or approach is effective is the very question at issue.

There is also the assumption, which is often explicitly stated, that we do not have the moral (or sometimes even legal) right to engage with the public on issues of science and medicine. This comes from a childish or selfish desire to silence those with whom you disagree.

Again it is understandable that people do not like to be challenged in their strongly held beliefs, because this is basic human psychology. But we should resist the temptation to silence those challenges. This doesn’t mean that every idea should have access to every venue, with no quality control. What it means is that, again, you should engage with those ideas with which you disagree, and not try to shout or shame them into silence.

Everything above is a great example of what I think you should specifically avoid when giving critical feedback. This is assuming you are interested in the other person actually taking your feedback seriously, engaging with it, and perhaps even changing as a result. It seems to me that often such e-mailers do not think about what their purpose is. Sometimes they give this away when they respond to my reply, admitting they thought they were just sending their e-mail into the ether just to make themselves feel better.

I do think most people would likely be interested in how their e-mail will be perceived and received. Following the template above will not result in anything positive. The only thing you will accomplish is actually reinforcing our original position, and validating our attempts at public outreach (probably the opposite of what the e-mailers hope to accomplish, if anything).

Such e-mails essentially declare – “I am trapped in a CAM anti-scientific narrative. I do not understand or even care about scientific evidence. I have nothing useful to say, so I am going to rant about vague made-up accusations and then indulge in an unnecessarily long personal story.”

I will end with some advice on how one can engage with us, or anyone, about such topics. First, follow the principle of charity. Do not make negative self-serving and convenient assumptions about the other person. Try to look at their position in the best possible light, and make a genuine attempt to understand their position.

A good opener would be to find common ground, and acknowledge what you think the other person got right.

Assume the person to whom you are writing is reasonable, and that if you point out specific errors in fact or logic they will acknowledge and correct their error. If that assumption is wrong, then they will hang themselves.

Focus your feedback on facts and logic, not feelings, beliefs, assumptions, or personal attacks.

It may be helpful to frame your feedback as a question, showing some humility (especially if you are writing to someone who has genuine expertise). “You claim this, but I saw this study which appears to come to a different conclusion. Did you see this study, and how do you account for its findings?”

Finally – read your own e-mail before hitting send. Imagine yourself on the receiving end of that e-mail and the impression of yourself that you are creating with that e-mail. Think about your purpose in writing and sending the e-mail. Try to be brief and coherent, which shows respect for the other person’s time.

Oh – and don’t think that you are being clever. Anything you say in an attempt to be clever has almost certainly been said to that person hundreds of times. I know it’s tempting when you think you are the first person to come up with a clever barb – you aren’t.

This is part of my original observation, these e-mails are boiler plate. We read them hundreds of times. It’s really hard to take the next one seriously. Avoid falling into that trap.