History indicates that many people can be convinced of something completely nonsensical if it is packaged in an appealing narrative, one that stokes our emotional needs and resonates with our cognitive biases. That is the essence of effective propaganda.
So there are cohorts of people who believe fervently that the most effective public health intervention in human history (vaccines) is actually harming children and there is a massive conspiracy to cover up this fact. There is also the widespread belief that “they” have the cure for cancer but somehow vested interests are keeping it from the public. Under close scrutiny such beliefs collapse in a heap of poor evidence and worse logic, but they persist none-the-less.
An alluring narrative has also convinced much of the public that there are alternatives to science-based medicine. At its core SBM is very straight-forward – the medical profession should use the highest quality evidence available, in the context of a thorough scientific evaluation, to determine which medical interventions are likely to be safe and effective. There are only two real premises here, that treatments which work and are safe are better than treatments which don’t work or are unsafe, and that rigorous science is the best method for making such determinations.
When you strip it down these premises are not controversial. Yet amazingly proponents of interventions that 50 years ago were considered health fraud have managed to convince a large number of people that it is OK to use treatments that don’t work, or for which there is either no credible scientific evidence that they can or do work, or actually evidence that they don’t work.
Recently I and other proponents of SBM criticized UC Irvine for opening a center for integrative medicine, essentially becoming the standard bearer for pseudoscience and quackery in academic medicine. We correctly called them out for contributing to the anti-scientific and anti-intellectual narrative with which pseudoscience is promoted in medicine.
Predictably proponents of pseudoscience in medicine struck back. Specifically John Weeks, who is the Publisher-Editor of The Integrator Blog News & Reports, published a rant in the Huffington Post attacking UC Irvine’s critics. He specifically named myself, David Gorski and Timothy Caulfield. The piece is an excellent example of pseudoscientific propaganda, and exposes many of the strategies of integrative medicine proponents.
The response of the LA Times, STAT, Medpage, and most media to the visionary $200-million integrative health investment of Susan and Henry Samueli at UC Irvine has been a shameful display of media descent into Trump-like, polarizing tweets. Worse yet, the coverage has been a profoundly anti-science. These media, and others, have chosen to provide platforms to a small handful of individuals who for decades have denied the evidence of acupuncture, chiropractic, mind-body and multiple other integrative approaches.
I wonder if it’s time to extend Godwin’s law to include gratuitous references to Trump. What Week’s is doing here is framing the narrative for this issue. Integrative medicine is “visionary” and all those who oppose it must be anti-science. Further, they are just a “small” group of malcontents who deny the evidence. The media should ignore them, and focus only my perspective.
Part of this strategy is to flip the skeptical narrative on its head. Legitimate skepticism can always be unfairly portrayed as denial. You can them impugn the motives of the skeptics and compare them to some unsavory bogeyman.
He continues in this style:
From his LA Times podium, Michael Hiltzig first gives voice to David Gorski and then to Steven Novella, long-time colleagues and back-slapping companions as anti-integrative medicine vigilantes.
The approach was repeated at STAT by Usha Lee McFarling. Her post was bleated out again by Medpage Today. McFarling gives the honor of shaping her story to Novella: ” … putting an imprimatur of a university on things that have been discarded as medical fraud for 50 years.” She then turns to another lifer in anti-CAM activity, Timothy Caulfield. Caulfield doubles down against this “legitimization” message.
He criticizes McFarling for “shaping” her story a certain way, meanwhile is framing his own article in extreme and one-sided terms. We are deep into his article and Weeks so far has only engaged in personal attacks against the critics of his beloved integrative medicine, trying to marginalize and minimize them and their opinions. He has not yet actually engaged with any of our arguments.
After attacking the media for not being one-sided enough in his direction, he finally gets to something akin to an actual argument:
They promote this polarizing grandstanding rather than honor the emerging scientific consensus that is yet poorly integrated into health professional education and practice – and that utterly backs the Samuelis’ investment and direction at UC Irvine:
It really is amazing to read a screed that can only be characterized as polarizing grandstanding which criticizes others for polarizing grandstanding. But let’s address his kernel of a point here, which is really just a false argument from authority. He goes on to reference cases in which integrative medicine has managed to infiltrate legitimate medicine.
He cites four reviews and reports on pain management that recommend non-pharmacological approaches, including chiropractic and acupuncture. As we have pointed out before, part of the con of integrative medicine is to rebrand science-based interventions as alternative. Their false premise is that science-based medicine includes only drugs and surgery, and therefore everything else is “alternative.” This is demonstrably false – nothing but historical revisionism. Exercise, relaxation therapy, massage, and proper nutrition (when kept within the scientific evidence) are all part of mainstream medicine.
This is all part of the broader narrative that derives from creating these false categories in the first place – alternative, complementary, or integrative medicine. These categories exist only to create a double standard of lower scientific evidence, and to create an umbrella under which real treatments can be used to lend legitimacy to quackery. So if yoga is useful in certain conditions, because it is exercise and stretching, then, they argue, that legitimizes the entire category of “integrative” medicine, and therefore other things which are pure quackery, like homeopathy, must also be legitimate.
How do things like acupuncture and homeopathy slip onto these lists of recommended interventions by legitimate organizations? That’s a good question. It is not because of the evidence. What tends to happen is that clueless academics put proponents in charge of reviewing the evidence for “alternative” therapies (because they are the alleged experts).
Acupuncture is a great example. After thousands of studies the only sensible scientific conclusion is that acupuncture does not work. The evidence clearly shows that it does not matter where you stick the needles, or if you stick the needles, and that chi and acupuncture points do not exist. Acupuncture is nothing but a theatrical placebo.
Yet proponents have been surprisingly successful in willfully misinterpreting the scientific evidence – interpreting negative studies as if they are positive for example. Many studies of acupuncture show a difference when comparing a non-intervention group to an acupuncture group, but no difference between true acupuncture and sham or placebo acupuncture. Proponents have actually interpreted these clearly negative studies as “acupuncture works, we’re just not sure how it works.” These same proponents find their way onto committee and panels who shape recommendations that include acupuncture, while academics are asleep at the switch.
This is a great example of pseudoscience justifying itself. Proponents do poor studies or misinterpret negative studies, then use their own misinterpretations as if it legitimizes their claims. Integrative medicine is a beast feeding on itself. Favorable news coverage is evidence that it is legitimate and popular. Negative news coverage is evidence that its critics are biased and must be worried. Any infiltration into legitimate medicine is used to promote further infiltration into medicine. The public wants it, they argue, therefore we should promote it. But they only want it because it is being promoted.
What they don’t have is external scientific legitimacy – which is all that matters.
After doubling down on his anti-science denial stance, Weeks then goes off the rails with this statement:
And while the scale is different, both forms of science denial have blood on their hands. The residual, reactive, medical ideology of these anti-integrative careerists to which the LA Times and others give a platform is a barrier to potentially lifesaving directions toward which the Joint Commission-Mayo/NIH-American College of Physicians-NAM-Attorneys General jointly urge us – and the Samueli investment would propel us.
This is the ultimate emotional appeal of the integrative crowd – but what if this nonsense we are promoting actually works? Then those calling for scientific evidence might be delaying or denying treatments to people. This, of course, puts the entire logic of modern medicine on its head. The whole point of using careful rigorous science is to determine which treatments are safe and effective. We need to be able to make evidence-based risk vs benefit decisions.
This is not a “barrier” to effective treatments, it is the only road to effective treatments. Without solid science, medicine tends to drift off into fantasy land. We literally have thousands of years of experience to validate this view.
Proponents of science-based medicine spend their time and energy doing what we do for one reason – to protect patients from fraud and abuse. To protect the public from medical services and products that are worthless or harmful. To inform the public and our fellow professionals about the often complex relationship between science and medicine.
If anyone thinks they have a life-saving medical intervention, there is a well-established route to making this intervention widely available. Do the science, and convince your colleagues. Proponents of real quackery can’t do this, because the science is not on their side. So instead they make progressively more shrill arguments, attack their critics, distort the science, lobby the courts, and try to carve out a double standard for their treatments.
As an example, the Samueli’s that Weeks thinks are so “visionary” are big believers in homeopthy. Homeopathy is pure pseudoscience, and only causes waste and harm through delayed treatment and diverted resources. That is what the Samueli’s want to promote. That is what Weeks is defending. We are just pointing out the scientific evidence. Weeks doesn’t like that, so he is essentially arguing for us to shut up, and for the media to ignore us.
Sorry, Weeks, that’s not going to happen. Your emperor has no clothes and we are never going to stop pointing it out.