A few years ago, at a skeptics conference in Los Angeles, Stephen Barrett of Quackwatch had just finished giving a talk and was fielding questions from the audience. Someone asked, “why don’t you ever talk about how dangerous regular medicine is?” Dr. Barrett, with a look of bewilderment in his face and a tone of exasperation in his voice, replied: “This is what I do.” That was his way of responding to a question that had nothing to do with his talk, as should have been obvious to both the questioner and the rest of the audience. The question might as well have been “why don’t you ever talk about global warming”?

If people are going to enter the fray of debate, at least they ought to play by the rules. One who doesn’t is the Intelligent Design apologist Michael Egnor, a nice counter-example to the popular myth that neurosurgeons are necessarily intelligent. I’m aware that Steve Novella posted the day before yesterday in response to Egnor’s recent lament about our close friend Orac and about Dr. Novella himself. I couldn’t help but stick in my two cents, however, because deconstructing Egnor’s essay is like shooting fish in a barrel, and it seemed appropriate for Boxing Day. I have avoided reading Dr. Novella’s piece so as not to color my own thinking, so please forgive any redundancies (speaking of that, I’m not the first to make the obvious pun of Egnor’s name). My post will be short and sweet and sour.

In his first paragraph, Egnor claims to agree with Dr. Novella and Orac that there is no scientific basis for most “alternative medicine” practices or for “the view that vaccines cause autism.” Other than his calling modern medicine “traditional medicine,” which means roughly the opposite of what Egnor must have intended, there is little to quibble with. So where’s the beef? Oh:

Yet there is an irony in the efforts of “defenders of science” to protect the public from treatments and theories that are outside of the mainstream of medical practice. The greatest iatrogenic danger to patients isn’t chiropractors or homeopaths or vaccine “deniers.” It’s the doctors, nurses, and other medical personnel working in the traditional medical paradigm.

Ho hum: we get a strawman (“defenders of science”), a false premise (“iatrogenic” referring to chiropractors, etc.), a code word (“paradigm”) for BS, and that Mother of all Annoying Fallacies, the tu quoque. Why, Dr. Egnor, would you change the subject? There are many things in this life that are dangerous and that deserve the attentions of thoughtful people—asteroids on collision courses with the Earth, for example, or whether Al Quaeda continues to pose a threat to US territory. You don’t ask Orac and Dr. Novella to address those. Why not?

That’s about all there is to it, for those of you who like to stick to the point.

For those who want to venture, Egnor style, there’s plenty. He asserts that “The data is [sic] uncontestable,” linking to an article by Gary Null posted on the website of Joseph Mercola (makes you think twice about whether Egnor was being honest in his first paragraph). This is the same article that Harriet Hall wrote about in June and that Peter Lipson and various commenters discussed a couple of days ago, so I’ve only a little to add. What are those uncontestable data?

Each year in the United States, errors of traditional science-based medical practice kill at least a hundred thousand people, probably substantially more.

The Null article puts the number at a minimum of >700K, based on flights of fancy (“malnutrition” is said to cause >100K deaths/year; it’s hard to imagine how medical doctors could be causing that). Even the numbers trumpeted by the famous 1999 IOM report—48K-98K deaths/yr—are far from uncontestable. Consider that the two extremes were extrapolations from the only two “studies” that the IOM considered: small, retrospective chart reviews, neither of which had even attempted to establish cause. A more honest summary would have been “48K or 98K deaths possibly associated with ‘adverse events’,” but that might have looked a little too contestable.

Others provided more reasonable interpretations of those data (here, here, and here), suggesting that a realistic number of preventable deaths due to medical misadventure was at least an order of magnitude lower than the IOM estimate. Those perspectives have been mostly forgotten in the wake of media sensationalism. Also usually forgotten, especially by advocates of implausible medical claims, is the issue of risk vs. benefit, which is only meaningful when benefit>0.

Egnor, therefore, makes the same unsupported claim that everyone from Mercola and Null to Newt Gingrich has gleefully made, echoed by self-flagellating, South Park voice-overs from many in medicine proper:

The harm done by traditional [sic] practitioners of medicine is one of the leading causes of death in the United States.

Then he calls Steve and Orac “hypocrites” for not being similarly whiny and for supposedly not caring about real medical errors. Not that any of this matters, of course, because it is irrelevant to the arguments against pseudomedicine.

Egnor builds more strawmen: that our protagonists “excoriate” people who genuinely, if mistakenly, believe in woo; that they have “no respect for the right of people to hold other views,” and so on. That such claims are false (and, if he really wants our heroes to get whiny, approach being actionable) is demonstrated here , among other places.

Near the end of his silly essay, Dr. Egnor reveals his real agenda:

We are beset by an arrogant medical and scientific priestcraft, eager to call ordinary people “idiots” or “anti-science” or “deniers” because they hold viewpoints with which these particular scientists and physicians disagree. I believe that much of the motivation for the “pro-science” priesthood isn’t patient safety or a genuine respect for scientific method but ideological hegemony. What bothers materialist ideologues like Novella and Orac is that there are people who challenge their materialist scientific worldview. There is a deep arrogance to the commentary and tactics of these defenders of science.

Hmmm. Which will it be, Dr. Egnor: science or religion? That question seems to have you chronically stumped, even if you aren’t aware of it.



Posted by Kimball Atwood