I have yet another grant deadline to deal with, this time for the Department of Defense Congressionally Directed Medical Research Programs, this time around its Breast Cancer Research Program. Unfortunately, that put a high degree of time pressure on me. Fortunately, there’s still stuff in the archives of my not-so-secret other blog that I deem quite appropriate for this blog and that can be updated with minimal effort. If you don’t know what I’m talking about when I refer to my not-so-secret other blog, then it’ll definitely be new to you. If you haven’t been reading that blog for at least four and a half years, it’ll be new to you as well. And even if you have seen it before, I think it’s worth revisiting.

Why? It came up because of an encounter I had on Twitter with Jane Orient, MD, who, as you might recall, is the executive director of the American Association of Physicians and Surgeons (AAPS). I’ve written about the AAPS before. You can get the details in the link, but if you don’t have time suffice to say that it is an entire organization of libertarian-leaning “brave maverick doctors” who think Medicare is unconstitutional, don’t believe that the government should have much, if anything, to do with regulating the practice of medicine, and reject evidence-based guidelines as an unholy affront to the independence of the physician. Along the way, the AAPS, through its journal, The Journal of American Association of Physicians and Surgeons (often abbreviated JPANDS), promoted antivaccine views, including the discredited concept that vaccines cause sudden infant death syndrome, HIV/AIDS denialism, and the scientifically unsupported idea that abortion causes breast cancer (a topic I might have to revisit, given the activity promoting it recently).

In any case, two or three weeks ago, I was having a bit of an exchange with Dr. Orient over anthropogenic global climate change (often abbreviated as AGW, for anthropogenic global warming, for short), the well-accepted science that concludes that CO2 generated by human activity is having a serious warming effect on the earth’s climate. As you might expect, she’s not big on this particular scientific consensus. I forgot about it, but then the other day saw this Tweet exchange between Dr. Orient and Ed Wiebe:


She’s referring to a project by AGW denialists that’s very much like the Perth Group when it comes to HIV/AIDS denialists and various lists of scientists who purported “dissent from Darwin.” It’s a common tactic used to try to give the appearance of an actual scientific controversy when in fact there isn’t one. Not surprisingly, similar efforts are taking place in the AGW community, and, also not particularly surprisingly, JPANDS has been linked to the Petition Project, which since 1998 has been trying to get signatures from scientists who don’t believe AGW is happening, while JPANDS itself has published some really bad papers on climate change. Later in the exchange, Dr. Orient Tweeted:


This reminded me of an earlier Tweet to me:


On the surface, Dr. Orient sounds so reasonable, doesn’t she? Isn’t it good for a scientist to be skeptical of everything, including existing scientific consensus? There’s just one problem. Dr. Orient completely misunderstands skepticism and science. Note her hostility at the very concept of that such a thing as a scientific consensus exists about anything, and you’ll be closer to seeing what her true agenda is.

It has often been written on this blog and elsewhere that the mark of a true crank is hatred of the scientific consensus, be it consensus regarding the theory of evolution; the science that says homeopathy is impossible; the scientific consensus among climate science that concludes that the earth is getting warmer due to human activity; various areas of science-based medicine; or the safety and efficacy of vaccines. Perhaps the most famous expression of distrust of a scientific consensus is the famous and widely quoted speech by Michael Crichton, in which he said:

Let’s be clear: the work of science has nothing whatever to do with consensus. Consensus is the business of politics. Science, on the contrary, requires only one investigator who happens to be right, which means that he or she has results that are verifiable by reference to the real world. In science consensus is irrelevant. What is relevant is reproducible results. The greatest scientists in history are great precisely because they broke with the consensus.

There is no such thing as consensus science. If it’s consensus, it isn’t science. If it’s science, it isn’t consensus. Period.

To which I (and many others) responded, “Bullshit!” (Seriously, anything less is not a strong enough rebuke.)

In fact science is all about coming to a consensus, but it’s about coming to a consensus based on data, experimentation, and evidence, a consensus that has reproducible results that are, as Crichton put it, verifiable by reference to the real world. After all, what is a scientific theory like the theory of evolution or Einstein’s theory of relativity but a statement of the current scientific consensus regarding a major scientific topic? What is peer review but quality control (making sure the scientific methodology is sound) coupled with testing new science against the current consensus to see where it fits in or where it exposes weaknesses? What is science but attempting to forge a consensus regarding theories and statements that most accurately describe the universe in a useful and predictable way?

Of course, questioning the consensus is often necessary in science. Indeed, it is critical to scientific advancement. However, there is a huge difference between questioning a current consensus and producing the data and experimental evidence to show that there is a real scientific reason to question it, and JAQing off about science. The latter, raising spurious or already answered questions about a scientific finding or theory one doesn’t like, belongs to the province of cranks and denialists, and it is what they are very good at. The problem is that they aren’t very good at realizing why their questions are not worthy of the attention that they think they are. A few years ago, a lovely example of this showed up in the Discovery Institute’s propaganda arm, its version of Age of Autism, so to speak, namely Evolution News and Views. In it, the Kent Heckenlively of the creationist set, the ever excitable Casey Luskin, penned a typical bit of silliness in which he asks the question, ‘When Is it Appropriate to Challenge the “Consensus”?

If Mr. Luskin had one clue about science, he could answer the question in two sentences and echo how scientists would answer the question: When you have an actual scientifically-valid reason, based on science, evidence, experimentation, and observational evidence, to think that the current scientific consensus about something is in error, then it is appropriate to challenge the scientific consensus. When you don’t, then it isn’t. Unfortunately, Casey didn’t; so he couldn’t. Instead, we were treated to a potpourri of pseudoscientific and denialist claptrap that was apparently based on an article in The American by Jay Richards entitled “When to Doubt a Scientific ‘Consensus’.” In the article, Richards postulates twelve “signs” that should lead one to doubt a scientific consensus, any scientific consensus—although he seemed most concerned with anthropogenic global warming in this particular article, while Luskin is, of course, concerned mostly with “intelligent design” creationism versus the hated (by Luskin) “Darwinism.” There’s just one problem. Not a single one of these “signs” had anything to do with a scientific argument. Richards started out with a reasonable enough introduction:

Anyone who has studied the history of science knows that scientists are not immune to the non-rational dynamics of the herd. Many false ideas enjoyed consensus opinion at one time. Indeed, the “power of the paradigm” often shapes the thinking of scientists so strongly that they become unable to accurately summarize, let alone evaluate, radical alternatives. Question the paradigm, and some respond with dogmatic fanaticism.

We shouldn’t, of course, forget the other side of the coin. There are always cranks and conspiracy theorists. No matter how well founded a scientific consensus, there’s someone somewhere–easily accessible online–that thinks it’s all hokum. Sometimes these folks turn out to be right. But often, they’re just cranks whose counsel is best disregarded.

So what’s a non-scientist citizen, without the time to study the scientific details, to do? How is the ordinary citizen to distinguish, as Andrew Coyne puts it, “between genuine authority and mere received wisdom? Conversely, how do we tell crankish imperviousness to evidence from legitimate skepticism?” Are we obligated to trust whatever we’re told is based on a scientific consensus unless we can study the science ourselves? When can you doubt a consensus? When should you doubt it?

Your best bet is to look at the process that produced, maintains, and communicates the ostensible consensus. I don’t know of any exhaustive list of signs of suspicion, but, using climate change as a test study, I propose this checklist as a rough-and-ready list of signs for when to consider doubting a scientific “consensus,” whatever the subject. One of these signs may be enough to give pause. If they start to pile up, then it’s wise to be suspicious.

So far, there isn’t much here to disagree with. Scientists are human beings; scientific fads come and go. Ditto physicians. Medical fads come and go too. Some scientific consensuses ultimately turn out to be wrong. Virtually all of them undergo significant revisions as new evidence comes in. Moreover, not all consensuses are created equal. Depending upon the field, the strength of any one scientific consensus can vary quite markedly compared to others, depending upon the science, the topic within that science, or even the subtopic within the topic. For example, the scientific consensus supporting the theory of evolution, particularly common descent, is exceedingly strong. Based on multiple lines of converging evidence from many different disciplines, evolution is one of the strongest of all scientific consensuses. Similarly, the consensus that natural selection is one major driving force behind much of evolution is nearly as strong.

However, as the discussion devolves into more detailed, specialized areas, inevitably the consensus weakens. Eventually, subsidiary areas of a discipline are reached where the consensus is weak or where there is no consensus. Often these questions are at the frontiers of the science and, because there is not yet a consensus, they are the most heavily-researched and hotly-contested areas of the science. Denialists often attack science at the very edges of a field as a proxy for attacking the much more strongly supported core theory. Creationists like Casey Luskin are actually notorious for this, jumping on new findings about, for example, “junk DNA,” whether it has a function, whether it is subject to natural selection, and, if so, how much, as a bit of logical prestidigitation to hide the fact that the core theory of evolution is supported by mountains of evidence and not in doubt by scientists. Cancer quacks like to latch onto the newest findings to try to make it seem as though “everything you thought you knew about cancer is wrong.”

It is also true that peer pressure and groupthink can make persuading scientists that a particular scientific consensus is in error can be a disturbingly slow and messy process at times. However, in the end eventually science almost always wins out. One example (summarized very well by our very own Kimball Atwood IV, MD) is the discovery that most duodenal ulcers are actually caused by a bacterium, H. pylori. Barry Marshall and Robin Warren first reported a curious finding of what they described as “unidentified curved bacilli on gastric epithelium in active chronic gastritis” (not an ulcer) in two letters to The Lancet, published on June 4, 1983. They reported that it wasn’t seen using traditional staining methods and suggested that they might be associated with gastritis. By 1992, multiple studies had been published establishing the causative role of H. pylori in peptic ulcer disease, and medical practice rapidly changed. That’s less than ten years, which, given how long it takes to organize and carry out clinical trials, is amazingly fast. Yet somehow a favorite denialist myth is that “dogmatic,” “close-minded” scientists refused to accept Marshall and Warren’s findings. It’s an example of a scientific consensus that deserved to be questioned, was questioned in the right way, and was overthrown.

In other words, it was nothing like Richard’s twelve “signs”:

  1. When different claims get bundled together.
  2. When ad hominem attacks against dissenters predominate.
  3. When scientists are pressured to toe the party line.
  4. When publishing and peer review in the discipline is cliquish.
  5. When dissenting opinions are excluded from the relevant peer-reviewed literature not because of weak evidence or bad arguments but as part of a strategy to marginalize dissent.
  6. When the actual peer-reviewed literature is misrepresented.
  7. When consensus is declared hurriedly or before it even exists.
  8. When the subject matter seems, by its nature, to resist consensus.
  9. When “scientists say” or “science says” is a common locution.
  10. When it is being used to justify dramatic political or economic policies.
  11. When the “consensus” is maintained by an army of water-carrying journalists who defend it with uncritical and partisan zeal, and seem intent on helping certain scientists with their messaging rather than reporting on the field as objectively as possible.
  12. When we keep being told that there’s a scientific consensus.

Oddly enough, most, if not all, of these warning signs apply to denialists and cranks. Richards appeared to have been engaging in a massive case of projection. I’m not going to examine each of the twelve “signs” in detail (that will be left as an exercise for the interested reader), but I will examine a few of the most egregious “signs.” For example, when it comes to ad hominem attacks, Richards writes:

Personal attacks are common in any dispute simply because we’re human. It’s easier to insult than to the follow the thread of an argument. And just because someone makes an ad hominem argument, it doesn’t mean that their conclusion is wrong. But when the personal attacks are the first out of the gate, and when they seem to be growing in intensity and frequency, don your skeptic’s cap and look more closely at the evidence.

Crank movements, of course, excel at the ad hominem attack. Creationists like Casey Luskin, for instance, spit the term “Darwinist” at evolutionary biologists and frequently try to link evolution (and thus its defenders) Nazi-ism and the Holocaust, eugenics, social Darwinism, and all manner of evils. Above all, evolutionists must be atheists, which to many creationists is the worst thing a person can be, given the vehemence of the invective.

Speaking of invective, one crank in particular, J.B. Handley, has made a special study of seeing just how nasty his attacks can be. Generation Rescue and its propaganda arm Age of Autism specialize in “venomous invective,” particularly against Paul Offit and anyone else who opposes its anti-vaccine agenda. After all, this is the same man who launched personal attacks on Steve Novella that can only be viewed as more than venomous. This is the same man whose misogynistic attacks on Amy Wallace, a journalist who wrote an excellent article on the anti-vaccine movement, made him infamous throughout the science-based blogosphere. This the same man whose blog posted a Photoshopped picture of Steve Novella, Amy Wallace, Paul Offit, and Trine Tsouderos sitting around the table for a Thanksgiving feast, the main course of which was a baby.

If we look at the “case study” used by Richards, AGW denialists also excel at the same tactics, painting scientists as hopelessly politically motivated, corrupt, and lying. They hack e-mails looking for dirt and try to embarrass scientists by posting them. They attack Al Gore, the most famous advocate of political action to mitigate the effects of AGW, as fat, stupid, and corrupt, as though discrediting Al Gore would discredit AGW. (Hint: It won’t.) The list goes on.

By Richards’ criteria, the vaccine, evolution and AGW denialists send up huge red flags, as a major component of their message consists of ad hominem attacks on scientists. As for “misrepresenting the actual peer-reviewed scientific literature,” what are The Discovery Institute, Age of Autism, NaturalNews.com, and every other denialist website or blog but veritable fonts of misrepresenting scientific literature? Hardly a week goes by, it seems, that I’m not trying to refute some bit of nonsense or other about a scientific study laid down by the anti-vaccine movement or some quack or other. If you count my not-so-secret other blog, actually, hardly a day goes by without my having to do that.

It’s also hard not to note a distinct feeling of repetition in Richards’ list. For example “When ‘scientists say’ or ‘science says’ is a common locution” and “When we keep being told that there’s a scientific consensus” are more or less the same thing. Perhaps the silliest part of his list is this:

A scientific consensus should be based on scientific evidence. But a consensus is not itself the evidence. And with really well-established scientific theories, you never hear about consensus. No one talks about the consensus that the planets orbit the sun, that the hydrogen molecule is lighter than the oxygen molecule, that salt is sodium chloride, that light travels about 186,000 miles per second in a vacuum, that bacteria sometimes cause illness, or that blood carries oxygen to our organs. The very fact that we hear so much about a consensus on catastrophic, human-induced climate change is perhaps enough by itself to justify suspicion.

Now there’s some serious misunderstanding there.

Richards apparently doesn’t know the difference between scientific theory and scientific fact. That salt is sodium chloride is a fact. That light travels 186,000 miles per second in a vacuum is a measurement and a fact. That blood carries oxygen to our organs is a fact. Of course, no one argues about them; they are well-settled facts, not theories. They are trivially obvious. Arguing about them would be as trivial as arguing about what I had for breakfast this morning or whether the above paragraph by Richards represents the essence of scientific ignorance. A theory is a higher level construct supported by facts, experimentation, and evidence.

Casey Luskin’s and Jay Richard’s tag-team effort demonstrated to me a profound ignorance of science—even an anti-scientific bent. They don’t like science because it either doesn’t support their political beliefs (Jay Richards and AGW) or their religious beliefs (Casey Luskin and evolution). Sure, scientists can at times be as petty as any human being. They are as prone to groupthink and ideology as any group of people can be. But the wonderful thing about being a scientist is that science is a process. Although it is an activity of people it does not depend on any group of people. Eventually, even when scientists go down wrong alleys or succumb to fads, science wins out. It is self-correcting. The process may not be as fast as we like. It may not be as linear as we like. In fact, sometimes it’s damned messy and frustrating. However, it is the best process we have for finding out how our universe works.

Oh, and for building a consensus about how the universe works. It’s perfectly acceptable to challenge such a consensus, but if you don’t have the goods in the form of evidence, experimentation, and data to show that the consensus is in serious error, there is no reason for scientists to take your challenge seriously. As Joshua Rosenau put it:

But moving past those trivialities, Casey and Jay’s underlying point is catastrophically wrong. As John Ziman points out in Reliable Knowledge: “the goal of science is a consensus of rational opinion over the widest possible field” (emphasis original). The beauty of science is precisely that it is rooted in our shared reality, and as such it is subject to the formation of consensus on which new work can build.

Yep, that’s about right. Contrary to what Dr. Orient claims, consensus isn’t the death of science; rather, it’s what science strives to reach in all its argumentative, complicated, and, yes, messy glory. Indeed, I can’t resist asking again: What is a scientific theory but a scientific consensus about how one aspect of how the world works?

It should thus come as no surprise that the AAPS is not so fond of evidence-based medicine (EBM), in particular the treatment guidelines that flow from EBM. Indeed, JPANDS has published several articles with titles such as “Evidence-based Guidelines: Not Recommended“, “The Effect of Peer Review on Progress: Looking Back on 50 Years in Science” (featuring another scornful dismissal of the “herd instinct” and “conformity” and a fair amount of exaggeration of how much scientific progress is due to “violent confrontation” of old paradigms and how much is due to the slow accumulation of knowledge), and editorials attacking evidence-based medicine. To the AAPS, evidence-based guidelines are unacceptable limits on the autonomy of physicians.

I’d like to finish with an observation. Like Harriet Hall, Steve Novella, and Kimball Atwood, I’m a fellow of the Center for Inquiry, and I was happy to sign a statement from the Committee for Skeptical Inquiry entitled “Deniers are not Skeptics“. It’s a statement that asks the media to “please stop using the word ‘skeptic’ to describe deniers,” much as I’ve on occasion railed on descriptions of antivaccinationists as “vaccine skeptics” or cancer quacks as “chemotherapy” skeptics, or activists like Vani Hari (a.k.a. “The Food Babe”) as “skeptics” of the food industry. Here’s why:

As Fellows of the Committee for Skeptical Inquiry, we are concerned that the words “skeptic” and “denier” have been conflated by the popular media. Proper skepticism promotes scientific inquiry, critical investigation, and the use of reason in examining controversial and extraordinary claims. It is foundational to the scientific method. Denial, on the other hand, is the a priori rejection of ideas without objective consideration.

Real skepticism is summed up by a quote popularized by Carl Sagan, “Extraordinary claims require extraordinary evidence.” Inhofe’s belief that global warming is “the greatest hoax ever perpetrated on the American people” is an extraordinary claim indeed. He has never been able to provide evidence for this vast alleged conspiracy. That alone should disqualify him from using the title “skeptic.”

The same can be said of all manner of medical cranks, including antivaccinationists, cancer quacks, and the like, all of whom use the same techniques of false argumentation to attack medical consensuses they don’t like, such as the one that concludes vaccines are safe and effective. Unfortunately, physicians are no different. If there’s one thing that identifies a scientific crank or a medical quack, it’s hatred of the scientific consensus. I’m not just talking about questioning a consensus, which scientists and physicians do every day, but attacking the very concept of scientific consensus. Michael Crichton taught me that inadvertently, and Dr. Orient continues to do so. To overthrow an existing scientific consensus requires more than they can give: Lots of evidence and valid scientific reasons to do so.



Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.