Harriet has written some excellent recent posts about how to talk to CAM (complementary and alternative medicine) proponents, and answers to common CAM fallacies. I have written about this myself numerous times – we deal with the same logically-challenged claims so often that it’s useful to publish standard responses.
In fact, I often wonder about the seeming uniformity of poor arguments put forward by advocates of CAM and critics of SBM. Do their arguments represent common problems of thought, pathways of mental least resistance, or are we seeing the repetition of arguments resonating in the echochamber of a subculture? I suspect it’s all of those things, which all feed into a particular world-view.
Actually CAM proponents seem to fall into one of several common world views, or flavors, as I like to call them, ranging across the spectrum from pseudoscience to anti-science. There is substantial overlap, however, with common anti-scientific themes.
I recently had an exchange with an SBM reader who was demanding that a particular post be taken down, because “every single fact in the article is wrong.” I responded as I always do – please point out the factual errors, with proper references, and I will make sure that all appropriate corrections are made. This did not satisfy the e-mailer who insisted that the article was 100% false and libelous.
Eventually I did persuade them to give me specifics – the long response that resulted did not actually point out any errors in the article (surprise, surprise) but rather was a long and fairly typical anti-SBM rant. Here is the full response in pdf. I will pull out some specific claims, the ones that I encounter most often, and respond.
Buteyko breathing technique
For background, the article that the e-mailer was so upset about was this one by Joseph Albeitz about the Buteyko breathing technique. You should read the full article for details, but briefly, Buteyko was a Russian doctor who “discovered” that voluntarily slowing one’s breathing could cure asthma. Over the years he came to realize that slow breathing could cure scores of disorders – it seemed to work for everything. He believed, apparently, that humans evolved to chronically hyperventilate. (If you are basing your claims on anecdotal experience, then any treatment will seem to work for anything and everything.)
Joe nicely argued in his article that Buteyko’s original experience with slow breathing was likely just treating hyperventilation resulting from a panic attack. Buteyko extrapolated from this one experience into an entire form of medicine, all without doing any actual scientific research to substantiate his grandiose claims, which are physiologically implausible. Fifty years later, evidence for either a mechanism or to substantiate efficacy remain lacking.
This, of course, is a common story in the pages of SBM. The e-mailer is a Buteyko advocate who believes this technique saved their life. They “know” this to be true, and therefore take it as an iron-clad premise. If science disagrees with what they know to be true, then science must be wrong. If we are criticizing the treatment that saved their life, then we must be evil Pharma shills.
I do not think, however, that the e-mailer’s experience is enough to explain their opinions. They seem to be fueled by CAM propaganda. This is a consequence of CAM that is often overlooked – fomenting an anti-scientific and anti-mainstream medicine world view. This is an ugly fact that “integrators” willfully ignore.
The e-mailer opens with this:
Your article attempts a scientific analysis of the Buteyko Breathing Method (ie of ‘normal’ breathing or ‘correct’ breathing), in the form of a critique of Ira Packman’s explanation. In this analysis you are clearly unable to form a theoretical understanding of why the method works (indeed Buteyko himself may not have fully understood it), and thus finding it to make no sense within the realm of your own understanding, you respond like a chimpanzee who has just examined a modern tablet computer and, finding it to be useless, tosses it over their shoulder, declaring it to be worthless.
This is the, “Your science is too primitive to grasp the brilliance of my woo,” gambit. This is convenient, because you don’t have to actually engage with evidence, with a coherent explanation, or with specific criticism. You can simply dismiss criticism as being ignorant.
I half expected the e-mailer’s next paragraph to contain a hand-waving explanation for how they think Buteyko’s method works, but instead:
You completely fail to appreciate that no-one cares HOW the method works, only THAT it works. If you were honest for one moment you would admit that this is how ALL science works – as admitted by noted physicist Richard Feynman with regard to physics – ‘we do not understand it, nobody does’.
The most effective lies are wrapped around a kernel of truth. It is true that in medicine we do not need to know how a treatment works, if there is sufficient evidence for safety and efficacy. The problem here, of course, is that there is evidence for neither a mechanism nor efficacy. Also, this statement represents the common CAM confusion of lack of knowledge about mechanism vs. good scientific reasons to believe there is no plausible mechanism.
In this case the Buteyko method flies in the face of basic physiology. It’s not just mysterious, we have good reason to believe it is nonsensical.
The e-mailer also misunderstands Feynman (but it is rhetorically useful to throw around the names of famous scientists). This discussion is a bit out of the scope of this article, but in brief, while science is about forming predictive models, it also is based upon an understanding of how things work. Scientific models all have to work together in a coherent fashion, and the only way for that to be the case is if we try to understand the big picture, not just make narrow predictions.
You can already see, however, where the e-mailer is going – your science is too narrow and primitive to penetrate the brilliant mind of my guru. Next stop – conspiracy town.
Increasingly, in an age of much greater information flow, many people are beginning to question the credibility of scientific journals and publications which are under the complete control of powerful vested interests in pursuit of the three P’s – power, prestige, and profit – it is these same interests which suppress any studies reporting the carcinogenic properties of pesticides which affect virtually all of our food, and who produce grade A rated research recommendations for highly profitable yet completely ineffectual and highly dangerous drugs such as chemotherapy, and who have a long and utterly disgraceful history of hugely expensive legal campaigns to prohibit highly effective BUT UNPATENTABLE herbal medicines such as the Hoxsey cure for cancer.
The institutions of science are far from perfect. In fact we spend a great deal of time at SBM pointing a critical eye to all of the components of science from funding to publication. You can look at any system and overhype the flaws into an argument that the entire system is fatally flawed, even when a more fair and balanced assessment would indicate that it is functional, if imperfect.
I recently wrote about this topic here – arguing that science is imperfect, but it is self-corrective. Despite its flaws, we can eventually mount sufficient evidence to form reliable conclusions based on repeatable evidence.
What the e-mailer does not do is question their own conclusions as strenuously as they do those of mainstream science. How do they know that chemotherapy does not work and that the Hoxsey cure does work? I guess science only works when you want it to. This, of course, is a classic denialist strategy. Whenever you encounter a bit of inconvenient scientific evidence, launch into an attack against the institutions of science.
The dangerous and wreckless treatments of allopathic medicine have a long and distinguished history, including the administration of toxic minerals such as lead, arsenic, antimony, and mercury, and the practice of ‘blood-letting’ (from which the ‘respected’ medical journal ‘The Lancet’ derives its name). George Washington founding father of the United States himself died promptly following treatment by blood-letting and fatal dosage of mercury for a minor illness.
I will compare the history of science-based medicine up against CAM any day. What the e-mailer is doing, however, is another common anti-scientific ploy, using historical examples that are no longer relevant to criticize modern medicine. In fact, the examples they give are from a distinctly pre-scientific era of medicine. We now know that humoral theory and mineral-based treatments are worthless to harmful because of science.
Of course, CAM retains the pre-scientific treatments of the past, so arguing against the pre-scientific treatment of the past does not really work in their favor.
A key element in the tyrannical monopoly of present-day allopathic medicine is the widespread practice of ‘clinical’ trials (its no accident that the word ‘clinical’ is a pejorative term in our common language – meaning devoid of emotion, analytical, unattractive, and soulless). Clinical trials deserve to have absolutely no place in medicine. They represent nothing more than a collosal waste of resources and systematic means of suppression of ‘alternative’ medicine and convenient means of manipulation of the truth to allow such scandalously ineffective and dangerous treatments as chemotherapy to gain acceptance in the mainstream.
Clinical trials are all a conspiracy, and you can dismiss them out-of-hand whenever they are inconvenient. This is quite a claim, of course completely unsubstantiated. This is also a common CAM position, although the e-mailer is being more candid and less nuanced than savvy CAM marketers, but the sentiment is the same.
If clinical trials are not to be trusted, then how do we know what works? The answer, of course, is anecdotal evidence. The e-mail actually directly advocated reliance on anecdotes over careful scientific evidence (sentences in quotations are from the original article, followed by the reply). They write:
“And finally, what evidence exists within the literature that BBT is an effective treatment for asthma?”
Why do you require evidence ‘from the literature’ ? When compelling evidence is available from real living people.
Who are you going to believe – soulless numbers on a page, or real living people?
I had to laugh at this next one:
Herbal medicines have been suppressed purely because they are UNPATENTABLE, NOT because they do not work. They are extremely cheap and generate virtually no profit.
The herbal remedy market is a multi-billion dollar market. Think of how effective the mom & pop marketing scam has worked, however. Herbal products are sold by big corporations, with significant overlap with the pharmaceutical industry. They generate billions of dollars in profit. They are drugs. They simply are poorly regulated drugs.
Tylenol, by the way, is long past its patent, and still generates hundreds of millions of dollars of profit.
“Buteyko himself never published a single paper”
It is most likely he was too busy trying to cure people.
This response is very common, and it’s a complete cop-out. Buteyko had 50 years to do research. If his claims are true, as the e-mailer believes, and it’s critically important to inform the world about this life-saving technique, then it is malfeasance not to do at least basic research to establish that his claims are valid. There is no excuse.
“but no improvement in pulmonary function tests” AND “Even more consistent however is the utter lack of any change in the participant’s pulmonary function tests.”
Frequently clinical trials of BBT asthma treatment report this as a finding. However pulmonary peak flow measurements are IRRELEVANT to asthmatics. EASE of breathing is all that is important to asthmatics. Fitness level or lung capacity are IRRELEVANT TO ASTHMA – asthma is constriction of airways – that is the problem we are trying to solve.
Pulmonary function is not irrelevant to asthmatics – it is life. Peak flow is a measure of the constriction of airways. The danger is in believing that a treatment works because of placebo effects when in fact lung function is not improved. This could delay effective treatment and even result in death with a severe asthmatic attack.
It is still amazing to me that someone can have a world view that is so divergent from my own, and that appears to be so discordant with reality. It should not be surprising, however, because everything we know about human psychology points to the fact that our cognitive functions conspire to build and maintain belief systems.
The hardest thing to do is to question the mental constructs we have erected. Open discussion, self-criticism, and external validation are important in this process. These principles are the core of the scientific method.
The world of CAM, however, wants you to believe in conspiracies, to reject science, to believe in the wisdom of gurus and the power of anecdotal experience and stories. They have created a nice narrative in which the promoters of science and standards of care are corporate villains, while the sellers of snake-oil and magic beans are saviors.
This is a destructive world view, and it cannot be separated from the nonsense that the world of CAM peddles.