At SBM our mission is to promote the highest standards of science in medicine, and to explore exactly what that means, both in the specific and the general. We do spend a lot of space criticizing so-called CAM (complementary and alternative medicine) because it represents a semi-organized attempt to reduce or even eliminate the science-based standard of care, and to sow confusion rather than clarity as to how science works and what the findings of medical science are.
CAM proponents tend to use the same bad arguments over and over again. They have no choice (other than deciding not to be CAM proponents) – if a treatment were backed by solid logic and evidence it would not be CAM, it would just be medicine. As SBM’s fourth year comes to a close I thought I would round up the most common bad arguments that CAM proponents put forward to defend their position. Like creationists, pointing out the errors in their facts and logic will not stop them from continuing to use these arguments. But this lack of imagination on their part makes it somewhat easy to counter their arguments, since the same ones will come up again and again.
The argument from antiquity
Our SBM colleagues in Australia have been critical of the incorporation of unscientific methods into academia. In defense of this practice:
Professor Iain Graham from Southern Cross University’s School of Health yesterday defended his university, saying the use of alternative therapies, such as homeopathy, can be traced as far back as ancient Greece.
This is a common claim – that some CAM modalities have been around for centuries, or even thousands of years, and so they must work. I am not sure if professor Graham intended to state that homeopathy can be traced back to ancient Greece, perhaps he just meant that some CAM therapies can, and chose homeopathy as a bad example. For the record, homeopathy was invented by Samuel Hahnemann about 200 years ago.
But I wonder what CAM modalities he had in mind. Chiropractic? About 100 years. Therapeutic touch? A few decades. Acupuncture is a complex question, but what passes for acupuncture today is less than 100 years old. Perhaps he was thinking about blood letting or trepanation.
It is true, however, that some basic concepts, like the notion of a life energy, can trace it roots to ancient Greece, and other ancient cultures. However, such notions are pre-scientific nonsense. Scientists abandoned the notion of life energy over a century ago because there was no evidence that such a force exists (and there still isn’t) and after figuring out all the basic processes of life there was essentially nothing left for the alleged life force to do.
For some reason, however, professor Graham believes that antiquity in science is a virtue – the “argument from antiquity” logical fallacy. The unstated assumption is that if an idea has survived for hundreds or thousands of years it must be legitimate. This is demonstrably false. Galenic medicine (blood letting, purging, etc. based on the notion of the four humours) survived for thousands of years, and yet it was based on complete and utter primitive nonsense. In fact its tendrils still exist – there is still blood letting, cupping (which is just another form of blood letting), and similar practices going on in the world. It was replaced in the West because of the advent of science in medicine – a trend that Graham and other CAM proponents apparently want to reverse.
The argument from popularity
Graham also states in the same article:
“Eighty per cent of Australians seek alternative therapies,” Prof Graham said.
“Obviously orthodox medicine is not working for everyone,” he said.
The argument from popularity is almost ubiquitous in CAM apologetics. We are constantly being told that CAM is popular and that its popularity is growing. This argument is used to justify incorporation of CAM into academia, spending research funds on CAM, and licensing CAM practitioners.
As with the argument from antiquity, the facts are often fudged. For example, I highly doubt that the 80% figure quoted for Australia is correct. Most such figures are highly inflated by including all sorts of practices in the CAM category, like exercise, eating organic food, and sometimes prayer is included. US surveys show the percentage of CAM use is around 1/3, but this is mostly things like massage and chiropractic manipulations. Homeopathy is around 3-4%, and acupuncture 6-7%. In fact, only manipulation and massage were in the double digits.
This is all marketing deception – create a false category (CAM), pad it out with commonly used methods, and then claim that the extreme fringes are therefore getting more popular. I don’t know how Graham got to 80% (I doubt such methods are that much more popular in Australia) but it is close to one survey from 2007 that found that 69% of Australians used one of the 17 most popular forms of CAM in the last year. However, they included in their list: martial arts, yoga, massage, meditation, and taking multivitamins. I am not sure what taking multivitamins says about the popularity of homeopathy, but apparently professor Graham thinks that is significant.
In any case – I will grant that CAM as a marketing concept has been somewhat successful, and even that it has gained popularity recently (although not as much as advocates would have you think). That is entirely irrelevant, however, to the question of whether or not any particular CAM modality is science-based and appropriate for a university curriculum.
Universities are supposed to be thought-leaders, to have intellectual standards that rise above the mere notion of popularity. They are supposed to uphold academic standards of scholarship, and in scientific disciplines high standards in science. The medical profession should be science-based and have high professional standards – not cater to the latest fad. It is therefore very odd and disturbing to defend a university policy or professional conduct based upon popularity. Should we allow surveys of public opinion to determine whether or not we teach creationism or astrology in our universities?
The second part of Graham’s quote was:
“Obviously orthodox medicine is not working for everyone,” he said.
This is a common assumption, even among CAM critics. If people are choosing to use CAM then they must be dissatisfied with mainstream medicine. This is a way of providing a false choice – if there are deficiencies in science-based medicine, then CAM is an appropriate “alternative.” Again – this is a similar strategy to the creationists, whose main style of argument is to attempt to poke holes in evolutionary theory, then propose creationism as the only alternative, without ever providing actual evidence for creation. CAM proponents therefore spend a lot of time criticizing mainstream medicine, and then present CAM as the only alternative.
The claim that people are using CAM because they are not satisfied with science-based medicine, however, is not based upon any evidence. In fact, what evidence we have strongly suggests this is wrong. Surveys show that people use CAM because they want to increase their options, or because they are philosophically aligned with the marketing image created for CAM (holistic, etc.). CAM users, however, do not turn to CAM because they are dissatisfied with their doctors or mainstream medicine. In fact in one survey CAM users were more satisfied with their primary care doctors.
No one claims that mainstream medicine is perfect, or that science-based medicine has all the answers. As with science in general – medicine is a flawed human endeavor. The rational response to the deficiencies in medicine, however, is to strive to improve our knowledge and practice, not to turn to an alternative simply because it’s there. CAM therapies need to stand on their own merits (which they can’t – that’s why they are not accepted as science-based). Proponents, however, promote CAM therapies as if they are the default choice when SBM is imperfect.
A similar strategy to the false choice is to justify the failings of CAM by pointing out the failings in mainstream medicine – the tu quoque logical fallacy.
In the comments to the above article commenter “shotinfo” (which, I am told, is a common pseudonym for Meryl Dorey, who heads an anti-vaccine organization in Australia) wrote:
According to articles published in both the British Medical Journal and the New England Journal of Medicine, between 85% and 90% of all mainstream medical drugs and procedures have never been scientifically proven to either work or be effective.
I love the fake references – of course no such articles in BMJ or NEJM exist, and no references were offered, but it certainly makes the fake factoid sound legitimate. I have already discussed this issue in detail. The bottom line is that surveys of medical practice find that about 78% of them are reasonably evidence-based. Yet again we have a factual misstatement used to support a logical fallacy (tu quoque). All medical practice should strive to be more science and evidence-based. Pointing out the deficiencies in one discipline does not justify deficiencies in another.
The commenter, however, also misses the real point of criticism of CAM. Mainstream medicine is based upon a culture and institution of science, and a science-based standard of care. The execution of this standard is flawed, but the principle is clear. CAM is not based on a science-based standard. It, in fact, seeks to subvert and even remove the science-based standard of care. And CAM proponents live in a culture of pseudoscience, not legitimate science.
To the extent that the science-base of modern medicine is not adequate the proper response is to improve the science (a never ending task), not to use methods that are even less science-based. CAM is largely devoid of science. CAM proponents, to borrow an excellent turn of phrase, use science as a drunk uses a lamppost – for support rather than illumination. Tom Harkin gives us the best evidence for this when he stated (talking about the NCCAM):
One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.
The purpose of science is to validate, not disprove, according to Harkin. This, of course, is the opposite of the truth, but reveals a key logical failing of the CAM community.
There are many more examples of poor logic and dubious facts common to the CAM community (“what’s the harm,” for example), but the above arguments are the most common in my experience. After discussing and debating this issue for years it is clear to me that the above arguments will not go away simply because we point out that they are false and logically invalid. So we will have to keep pointing it out, over and over again.