It can be rather frustrating to refute the same old canards about alternative medicine.  There’s always been argument as to whether this is even useful.  Critics (some verging on “concern troll-ism”) argue that skeptics are convincing no one, others that we are too “dickish”. The first view is overly pessimistic (re: our impact), the second overly optimistic (re: the benign nature of our critics).   The truth always bears repeating, even at the risk of becoming the old guy at the end of the bar who always starts his stories off with, “Did I ever tell you…?”  The answer is always “yes” but if the story is good, and well-told, it may stand up to re-telling.

We tell many versions of the same story over and over, not just to entertain each other, but to refine our thinking, to convince those who can be convinced, and to point out the weakness in thinking apparent in others.  We do this not to be “dicks” but because repeated assaults on reason require repeated defense.   Scientific medicine gives us a powerful tool for analyzing new ideas and old ones dressed up in new clothes.  It allows us to find ourselves to be wrong in particular facts, if not in our overall approach.

A common theme in many of our writings at Science-Based Medicine is that science-based practitioners are willing to be proved wrong, and that altmed supporters are not.  The history of medicine is littered with the corpses of abandoned therapies, while altmed fetishizes the past, preferring to recycle old ideas rather than discard them in the face of overwhelming negative evidence.

This can be done in many ways.  I recently examined a paper that purported to support the use of a homeopathic preparation to treat sinus infections.  Leaving aside the nearly-miraculous reported results, there was a fundamental error in thinking at the very beginning of the paper.

The present trial was designed to demonstrate the efficacy and safety of Sinfrontal compared with placebo in patients with AMS confirmed by sinus radiography. As well as measuring the clinical efficacy of this homeopathic medication, the study also investigated the ability of subjects to work and/or to follow their usual activities of daily living—both during and following treatment with active medication compared with placebo—to assess the treatment success of this homeopathic medication as an integrated symptomatic therapy for AMS.

Compare this to another study on sinusitis treatment:

The value of antibiotics in acute rhinosinusitis is uncertain. Although maxillary sinusitis is commonly diagnosed and treated in general practice, no effectiveness studies have been done on unselected primary-care patients. We used a randomised, placebo-controlled design to test the hypothesis that there would be an improvement associated with amoxycillin treatment for acute maxillary sinusitis patients presenting to general practice.

The difference is dramatic.  All studies build on pre-existing knowledge, but good studies start with a question, not an answer.

Many in the altmed movement aren’t persuaded either by absence of evidence or evidence that directly refutes their hypotheses.  When that evidence is overwhelming, or when it is noted that their for their hypothesis to be true, we would have to toss out all we know of chemistry and physics, they fall back to one of their weakest arguments: “our magic is too clever for your science.”

This was demonstrated recently  in a blog post at the New York Times (and ably eviscerated by Orac). I wrote about it as well, especially regarding this particular complaint.   In the Times piece, an acupuncture supporter specifically complained that:

There is a body of literature that argues that the whole approach to studying acupuncture doesn’t lend itself to the Western reductionist scientific method.

What does that even mean?  We’ve seen this argument many times before, and what it usually means is, “we cannot prove our magic works, and rather than abandon it, we are going to abandon all of science, and we demand you do the same.”  That is obviously an untenable position, and to see why, one needs only to ask one question: are the altmed practitioners claiming it works?

If they are claiming their magic does something, then “something” can be measured.  If they are claiming that acupuncture treats arthritis, then we can ask patients if it is so, record their answers, and do some math.  That’s the Big Secret to “Western reductionist scientific method”.  If you are going to claim an effect on a subject, that effect can be recorded and measured.  Period.

Stepping back to examine basic principles and to critique basic errors is not some masturbatory exercise, and it does not have to descend into “dickishness”, but neither does it need to compromise or pull punches.  Some ideas are so laughably stupid that laugher is inevitable. Some are so demonstrably dangerous that scorn is not only appropriate but mandatory.

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.