A Perfect Storm of Anti-Science
Wallace Sampson, writing for Science-Based Medicine, gives an excellent overview of the last forty years of medicine and what went wrong. He points to several cultural trends that conspired together to allow the anti-scientific revolution to occur. These include political correctness – which has had the effect of rendering appropriate scientific criticism as impolite. The post-modernist influence in academia also played a major role, one aspect of which is the portrayal of science as just another narrative without any special relationship to the truth. In fact science, according to some post-modernists, is just a way for one group (in this case Western white males) to impose their power over minorities and the oppressed.
Add to this a general anti-establishment movement beginning in the 1960s. CAM proponents were successful in portraying scientific medicine as the Establishment – something that needed to be taken down. This evolved into the “health care freedom” movement, the ostensible purpose of which was to earn freedom for the public to access whatever health care they wanted. In reality the health care freedom movement is about earning freedom for practitioners to do whatever they want, free from any regulation meant to protect the public. I find it one of the greatest ironies of the CAM phenomenon that they have been able to pass laws that are overtly anti-consumer, in that they remove protection from fraud or incompetence, in the name of consumer freedom. Why hasn’t Ralph Nader noticed this? What if the auto industry promoted “automobile freedom” laws so that consumers could buy any vehicles they wanted, free from any government quality or safety regulation?
This brings up the political dimension of CAM. Proponents have been successful at working both sides of the aisle, appealing to anti-regulation sentiment on the right and anti-corporate/anti-establishment sentiment on the left. Unfortunately, science has no political party.
And of course all of this is happening in a generally scientifically illiterate society. In my experience most of the public does not understand why homeopathy cannot possibly work (it’s just water), why scientists are confident that there is no mysterious life force at work in the body, why chiropractic subluxations make no sense, and why megadosing vitamins or the latest fad tropical fruit juice cannot cure everything.
And yes, of course, there are legitimate criticisms of mainstream medicine. The system is under great financial strain. Technology, while extremely effective, is very expensive and may render some medical encounters very unpleasant and frightening. The ethical model in medicine has also shifted from a paternalistic model, where doctors just did what they thought was best, to a cooperative model that focuses on informed consent. This is a good thing, but it means that physicians are ethically obliged to tell patients the whole and unpleasant truth. We do not have the luxury of lying to patients to make them feel better. Charlatans have no such constraints.
More irony. Over the last couple of decades there has been a growing movement within mainstream medicine called evidence-based medicine (EBM). One might think that EBM would have worked to retard the advance of CAM but the opposite was true. It is an unfortunate happenstance of history that the minds behind EBM inadvertently played into the hands of CAM proponents.
The concept behind EBM is that medical modalities should be judged primarily by the empirical evidence, not by their plausibility. The reason for this was the perception that too many practices were being widely used because they made sense – they were plausible – despite a lack of evidence that they actually worked. Therefore EBM was constructed to eliminate the advantage of plausibility. Medical claims require evidence no matter how plausible they are.
But by eliminating plausibility (or prior probability) from consideration EBM also leveled the field for highly implausible claims, even though this was never the intent. EBM is not unreasonable in a world where it is assumed that treatments and claims make basic scientific sense, but it is not equipped to deal with a world in which highly implausible claims are being promoted. This had the effect of almost eliminating basic science from consideration. Under EBM claims that are highly implausible are treated the same as claims that are highly plausible. This approach exists no where else in science.
Therefore, CAM proponents just adopted the language of EBM. It did not take long for CAM modalities to have the EBM label slapped on them, whether or not they earned it even by the flawed methods of EBM. I see “evidence-based homeopathy” or “evidence-based acupuncture” promoted all the time, even though these terms are oxymorons. Even without consideration of prior plausibility CAM modalities do not fair well under EBM examination, so proponents simply lie. They claim their methods are EBM even when no formal EBM evaluation has validated them. They behave as if their personal assessment of the evidence is sufficient to support a claim of EBM, when in fact there are formal methods of systematic review that are required.
But the EBM infrastructure is vulnerable. They already fail to put CAM modalities in their proper scientific perspective by considering prior probability. And now they too are putting the foxes in charge of the hen house – allowing CAM proponents to perform and publish biased EBM reviews.