This space has often hosted musings on the nature of scientific knowledge, on how medical science is based in methodological naturalism (MN), rather than supernaturalism.  MN requires that our acquisition of knowledge about the natural world be based on natural phenomena.  The reason for this should be quite obvious:  the natural world is the only one that exists, for all intents and purposes, and explanations must be based on natural processes.  Can you name any supernatural processes?  Can you measure them?  Of course not.

This bothers adherents of alternative medical practices.   Since science doesn’t support their ideas, they would like to carve out exceptions to natural laws.   Remember, we know quite a bit about the universe.  We don’t understand exactly what matter is yet, but we can measure it and experience it without ambiguity.  We know the universe has matter/energy; we understand pretty well the primary forces of electromagentism, gravity, small and weak nuclear; and there are probably a few other things whose effects we can measure even if they aren’t completely understood (dark energy, dark matter).

All of modern medicine works in ways consistent with our understanding of the universe.  Even when we don’t completely understand something, it does not behave contrary to these laws.  A beta blocker has never caused someone to levitate.  No one has been revivified by electricity, a la Dr. Frankenstein (“That’s Frahnkensteen!“).  Human bodies follow natural laws, and natural explanations are the ones that have explanatory power.

Since these natural laws explain what we see in the clinic and lab, what are the altmed gurus to do?

They have three main strategies, each of which is conveniently described by a logical fallacy.


This might be called the Egnor Gambit, after Creationist neurosurgeon Dr. Michael Egnor. Reality has consistently belied his belief in mind-body dualism.  Why does he think that brain is insufficient to explain mind?  I don’t know.  I mean, I’ve read his writing, and I’ve critiqued it.  His response to my critique?  “PalMD (that’s me) writes anonymously, and so must have something to hide.” To Dr. Novella, he issued a less ad hominem although no less ridiculous charge: explain the subjective experience of color! (or, “WHY ARE THERE STILL MONKEYS!!!)

The non sequitur of challenging my identity is too weak to even attend to, but the question about color is interesting.  What he is really asking is, “what is subjective experience?”  Or more generally, “what is mind?”  The answer: an epiphenomenon of brain. Why? Well, we already know that the brain produces thought, and what is subjective experience other than thought? And if brain doesn’t do it all, what natural phenomenon does?  If it it’s supernatural, how will you show it?

It’s a distractor.  Saying that methodological naturalism has not explained everything yet and is therefore invalid is no more logical than saying, “I don’t like anonymous bloggers, therefore they are wrong.” Both rest on illogical premises and serve as irrelevant noise rather than genuine inquiry.

Deny the preeminence of the natural world

Nature bugging you?  Those natural laws in the way of your pet theory?  Well, maybe it’s the law’s fault.

Homeopaths love this one.  In fact, it should probably be called the Hahnemann Plea, in honor of the inventor of homeopathy. The plea goes like this: “Please, Nature, have mercy on us! We know that homeopathy works because some studies suggest it.  Since the preponderance of evidence is not favorable, since implausibility renders the evidence that we do have suspect, and since homeopathy cannot work by any real understanding of the universe, then nature must be wrong.”

Since homeopaths can’t seem to generate any real evidence for their type of voodoo,  they spend a lot of time with the above whine plea.

For example (and I can’t really stand to cite Homeopathy as a real journal, so I have them listed below somewhat less formally), one issue complains about Bayes. If you’ll recall from Dr. Atwood’s introduction, Bayesian analysis takes into account the likelihood of something being true based on prior probability, and on data obtained.  Here, let’s take a look:

Bayesian analysis of the proof for homeopathy explains why people don’t accept proof, but it complicates the discussion unnecessarily. It obscures the real issue: our first prior belief. This paradigmatic first prior belief influences numerous aspects of a large number of decisions that must be made in Bayesian analysis. The first prior belief should be discussed properly and after that, the whole problem might dissolve, because we start looking differently at the existing evidence. Overturning our first prior belief requires a turning point, such as the paradigmatic crisis described by Kuhn, that has not yet been translated into an algorithm, Bayesian or otherwise.

Of course, Bayesian analysis does no such thing.  It does not prevent us from developing Kuhnian paradigmatic crises.  It simply helps us analyze data.

Here’s another one for you:

The dominant paradigm can perhaps still be traced back to the conception of Laplace in the late 19th century, quoted by Polyani as ‘science pursuing the ideal of absolute detachment by representing the world in terms of its exactly determined particulars’. A reductionist, materialist and mechanistic vision of reality that still influences the contemporary medical paradigm.

As a proposal for the discussion, debate and development of a new paradigm to stand alongside the vision summarised at the beginning of this paper, but with no expectation that it is adequate, I offer the following:

  1. Medical Science is concerned with the integrated constitution and function of the person as a whole, and all the contingent circumstances affecting his/her health.
  2. Healthcare, for all the importance and success of methods that control and manipulate body function, depends above all on maintaining and supporting (preventive medicine), enabling and mobilising (therapeutically) inherent self-regulating and self-healing processes.
  3. Many subtle therapeutic methods, specific and non-specific, and still poorly understood, are capable of stimulating these processes.
  4. Homeopathy is one such method, which also, together with others, provides insight into disease processes and healing processes that will richly augment conventional medical knowledge.

Notice the plea?  The cry for liberalizing some sort of oppressive dominant paradigm?  (Not to mention the excremental pile of begged questions).

Skeptics are mean

This is the “Gordon Gambit”, after Dr. Jay Gordon, anti-vaccinationist to the stars.   He hates being called “anti-vaccination”, despite his clear antivaccination views.   He also whines a lot.   His whines are a combination of “you guys are mean to me” and “you’re in the pocket of Big Pharma”.  This is a really, really pitiful.  It is sad that an educated physician has no better retort than, “reality is mean.”

All the whining  in the world is irrelevant.  It doesn’t help explain the natural world at all.  The thing is, to Gordon and his type, if something superficially makes sense, then it is so.  In his mind, if we were to just change the way we vaccinate, there would be less autism.  The only problem with this is that it doesn’t conform to reality.  There is no connection between autism and vaccines (except both occur in young children).  The Gordon Gambit wishes that reality were kind enough to cooperate with false beliefs, and that those who call you out on your idiocy should be nicer.  Sorry, Jay.  Whining about meanies doesn’t make one right.

Not-so-strange bedfellows

Finally, the Chopra Blunder:

In an argument regarding medical science, when a person cites Gary Null as a source, the argument is over, they have lost, and anything they say in the future may be safely ignored. And they may be laughed out of the room without guilt.

When your view of reality is twisted by ideology, it can be very lonely.  Reality, as Dr. Gordon discovered, can be mean.  What is one to do when your own profession has abandoned you as a hopeless crank?  Why,  make new friends, of course!  This is a more narrow case of what Dr. Mark Hoofnagle refers to as “crank magnetism”, or the tendency of people with poor reasoning skills to hang together, and to be susceptible to all sort of ideas.  When their pet ideas do not conform to reality, reality is defenestrated in favor of “other ways of knowing”, and HIV denialism and UFO encounters seem just as likely as the law of gravitation.

Reality is hard

The only way to understand the natural world is via natural explanations. When you cross the line, for example claiming that mind is some magical immaterial substance separate from brain, you might as well start choosing treatments by casting lots or reading Tarot.

My job isn’t always easy.  I have to tell people about horrible diseases that I can’t cure.  That’s my reality.   I just lost my father-in-law, and I cannot communicate with the dead.  That’s my reality.  It’s also yours.

But strangely, I don’t find this gloomy or hopeless.  After all, reality, good and bad,  is all we’ve got.

Rutten A.L.B.. How can we change beliefs? A Bayesian perspective. (2008) Homeopathy, 97 (4), pp. 214-219.

Swayne, Jeremy Truth, proof and evidence: Homeopathy and the medical paradigm
Homeopathy. Volume 97, Issue 2, April 2008, Pages 89-95

Posted by Peter Lipson

Peter A. Lipson, MD is a practicing internist and teaching physician in Southeast Michigan.  After graduating from Rush Medical College in Chicago, he completed his Internal Medicine residency at Northwestern Memorial Hospital. He currently maintains a private practice, and serves as a teaching physician at a large community hospital He also maintains appointments as a Clinical Assistant Professor of Medicine at Wayne State University School of Medicine and at Oakland University William Beaumont School of Medicine, the first being a large, established medical school, the latter being a newly-formed medical school which will soon be accepting its first class of students.  He blogs at White Coat Underground at the Scientopia blog network. A primary goal of his writing is to illuminate the differences between science-based medicine and everything else.  His perspective as a primary care physician and his daily interaction with real patients gives him what he hopes is special insight into the current "De-lightenment" in medicine.  As new media evolve, pseudo-scientific, deceptive, and immoral health practices become more and more available to patients, making his job all that much more difficult---and all that much more interesting. Disclaimer: The views in all of of Dr. Lipson's writing are his alone.  They do not represent in any way his practice, hospital, employers, or anyone else. Any medical information is general and should not be applied to specific personal medical decisions.  Any medical questions should be directed to your personal physician.  Dr. Lipson will not answer any specific medical questions, and any emails and comments should be assumed public. Dr. Lipson receives no compensation for his writing. Dr. Lipson's posts for Science-Based Medicine are archived here.