Editor’s note: This article combines elements of several articles about pseudoscience published in 2012 and 2013. It’s been revised to include some newer information and split into several parts to improve readability. See Part 1 here.
This is part 2 of the Pseudoscience and science series.
Pseudoscience and science – the former is bullshit. And the latter is fact based on robust, unbiased evidence. Mostly pseudoscience can be ignored, even if it smells bad.
Pseudoscience is enticing because it’s easy to understand. It’s not nuanced, and it general speaks in black and white terms, often false dichotomies. That view is most prevalent in medicine.
Real doctors will say “this treatment for XYZ cancer is going to be difficult. You’ll lose your hair. You’ll feel sick all the time. You might be in pain. But it gives a 73% chance of putting the cancer into remission, and you have a reasonable chance of living at least five years.”
The pseudo-medicine pusher will say, “drink this juice and have a coffee enema. No side effects. And I guarantee that the cancer will disappear.”
The second choice is so enticing. So easy. But most of us know that treating most cancers is hard. We try to find another way, and hope for the best. Maybe you can choose the junk medicine approach, and get lucky with a spontaneous remission. Or maybe the real medicine worked well enough to cause the remission.
Of course, pseudoscience can make broad claims without the rigorous research required to make those claims. The charlatans who push junk medicine get to say whatever they want, with no consequences usually.
Alternative medicine is bullshit – it is firmly grounded in pseudoscience.
The pseudoscience of alternative medicine
Complementary and Alternative Medicine (called CAM) generally fails to utilize scientific method. Supporters of CAM usually perform experiments to confirm their hypotheses, never attempting to refute it. They rarely subject their results to internal review. They reject results from re-testing, especially if it’s negative, usually stating that it was done wrong.
When you speak to a believer of CAM, they almost never assume that their treatment cannot work–back to that black and white false dichotomy.
It’s interesting that CAM and pseudoscience start out with observations of the real world. For example, CAM therapies sometimes show positive results, not because of the therapies themselves, but because humans just get better from many diseases. Believe it or not, most colds resolve themselves in a set period of time.
Taking alternative medicines don’t reduce the severity or course of a cold. And echinacea doesn’t work. But people take them and say “my cold got better.” Yes. Because colds get better.
So, these CAM therapies rely upon confirmation bias, that is, the tendency to accept information that supports your beliefs, or even Post hoc ergo propter hoc, a logical fallacy which says “since that event followed this one, that event must have been caused by this one.”
Humans too often conflate correlation and causation. Just because events follow one another, that doesn’t mean one causes the other. I suppose that’s how superstitions arise.
Pseudoscience vs science based medicine
There are several types of logical fallacies that the pseudoscience crowd employs. My favorites are appeals to antiquity or tradition, or old ideas are somehow better than new ideas; appeals to authority, or someone who should know better supports the claim even if everyone else does not; bandwagon fallacy, or everyone does it, so it must be useful; and the genetic fallacy, where the source is matters more than the merits of the evidence. I’ve created my favorites list of logical fallacies on this website.
The typical pseudoscientist will use logical fallacies to state very definitively that “it’s proven.” It’s the same whether it’s creationism (the belief that some magical being created the world some small number of years ago), alternative medicine (for example, homeopathy, which is nothing but water, has magical properties to cure everything from cancer to male pattern baldness), or vaccine denialists.
The worst problem is that in the world of the internet, if you Google these beliefs, the number of websites and hits that seem to state that they are THE TRUTH™ overwhelm those that are more skeptical or critical.
However, Google is starting to rank websites based on the quality of their science. Pseudoscience pushers are crying.
So how can you tell the difference between science and pseudoscience in medicine? In real, evidence-based medicine, evidence is gathered and analyzed, published in real journals, repeated by other researchers, and then it’s incorporated into clinical decisions.
Almost any medical product, device, drug or procedure must, by law, be tested in a Randomized Controlled Trial (RCT), sometimes called a clinical trial. Essentially, it is a scientific experiment, designed to test the hypothesis of whether the safety and effectiveness of a particular medical product is better than a placebo.
That is, a clinical trial ascertains whether the medical product produces results better than doing nothing at all. This is considered the “gold standard” of investigation, and if the study does confirm the hypothesis, you can be assured it has a benefit to your life (although the degree of benefit may be subject to further refinement).
Alternative medicine just doesn’t rely upon double-blind, randomized clinical trials. Much of their reasoning to avoid the RCT is that their “medicine” just doesn’t fit into the clinical trial model. That’s the point of RCT’s, they eliminate bias so that you might have a chance to ascertain whether the medication or device is superior to doing nothing.
Here’s the point – there is no proof that most alternative medicine therapies work. Oh sure, anecdotes about these therapies flood the internet. How many of you have a friend who says “that chiropractor fixed my back.” Yet, the evidence that chiropractic has any clinical benefit is nonexistent, except for maybe one or two therapies. And even there, a massage has the same effect.
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Remember, anecdotes are not reasons to accept alternative medicine. Even anecdotes that try to sound like science (“90 out of 100 people think this leaf does work”) aren’t a reason to “believe” in a pseudoscience. And having a high number of anecdotes does not equal “data.”
You might have heard that taking lots of Vitamin C helps prevent colds. It doesn’t–that conclusion is supported by large clinical trials. So unless you are afflicted by scurvy, there’s no reason to take large doses of the vitamin. And that’s the difference between real science and pseudoscience.
A randomized clinical trial usually has thousands of participants, and is done in a manner that the patient and the physician do not know who is and who is not receiving the treatment. The results are analyzed statistically and published in peer-reviewed journals.
Furthermore, the results are reviewed and investigated by the FDA (and legal bodies in other countries), before a drug or device can be used by a physician. This is an expensive and time-consuming process, in which alternative medicine hardly ever participates.
Epidemiology and evidence-based medicine
Now it’s not ethical to test every medical hypothesis with a clinical trial. For example, we know that smoking is bad for your health. Yet, tobacco manufacturers love to insist that there has never been a clinical trial that makes this conclusion.
The reason that there isn’t an RCT for smoking is that it would be unethical to give one group of adults cigarettes for 20 years and another group nothing to see if one would die at a higher rate. So we use epidemiological studies to determine if we can see in a population whether a cause has an effect. We can review records of thousands of smokers to see what the effect will be.
Epidemiology is a scientific process that is critical to preventative medicine–without it, we cannot know if some behavior or public health issue has a causal effect on health. Vaccine deniers also love to play with clinical trials by inventing outrageous and highly immoral clinical trials for vaccines. For example, they would like kids to be place in a placebo group vs a vaccine group to see if there are any adverse effects or if even if the vaccine works.
Pseudoscience pushers will criticize randomized clinical trials all the time. Unless it supports their a priori, or pre-established, beliefs. Then they love cherry picking that one piece of evidence as if it establishes
Homeopathy is pseudoscience
But sometimes alternative medicine hucksters just invent things. Homeopathy, the ridiculous belief that a tiny bit of something will cause water molecules to have a memory that tiny bit of something, which will cure anything from colds to cancers.
Homeopathy has invaded some medical school training, and too many well-trained physicians think it works. Only if you believe in wizards and warlocks and magical dragons–then I guess homeopathy is real.
But if you look at it scientifically and rationally, homeopathy is:
- just expensive water;
- violates every single principle of chemistry and quantum mechanics;
- and has never been shown to work in reals scientific studies.
What can we conclude? Homeopathy is nothing more than a pseudoscience looking to take money from gullible people.
Pseudoscience vs science based medicine
In an outstanding analysis of pseudoscience, Steven Novella, MD, a clinical neurologist at Yale University, illustrates how pseudoscience (those who pretend to praise the scientific method, yet do it in a way that is not actually science) and anti-science (those who repudiate science outright, or even undermine science, with subjective analysis and untestable spirituality) is used to reject evidence-based medicine:
[infobox icon=”quote-left”]This leads us to the final continuum – the consensus of expert opinion based upon systematic reviews can either result in a solid and confident unanimous opinion, a reliable opinion with serious minority objections, a genuine controversy with no objective resolution, or simply the conclusion that we currently lack sufficient evidence and do not know the answer. It can also lead, of course, to a solid consensus of expert opinion combined with a fake controversy manufactured by a group driven by ideology or greed and not science. The tobacco industry’s campaign of doubt against the conclusion that smoking is a risk factor for lung cancer is one example. The anti-vaccine movement’s fear-mongering about vaccines and autism is another.[/infobox]
Basically, science evolves over time. A conclusion that lacks sufficient evidence may eventually be supported by better analysis or groundbreaking research. I am a big fan of the scientific consensus, but getting to that consensus is very messy.
However, that’s the great thing about how science works. It starts with an idea, then there is lots of research that ends up in dead ends. But given enough time, robust evidence will eventually lead to a robust consensus.
On the other hand, anti-science and pseudoscience pushers do not allow themselves to participate in the this continuum of research–they state emphatically that they are right. Case closed. Move on. They are close minded, and they don’t allow their ideas to be tested over and over.
What if homeopathy would lead us to a new understanding of atoms and molecules? What if there was a paradigm-shifting theory about quantum mechanics, the field of science that describes how atoms and molecules interact? It’s doubtful that homeopathy represents a new understanding of subatomic particles, because it isn’t a field that is openminded to vigorous research.
When Mr. Andy Wakefield fraudulently alleged a connection between the MMR vaccine and autism, real scientists jumped on it. Even though there was a lot of skepticism about the plausibility of Wakefield’s claims, it had to be examined scientifically. And after wasting billions of dollars–real science found out that there is no link between vaccines and autism. Real science based medicine is openminded. It examine criticism. And if it’s real, then it changes. That’s a good thing.
Why alternative medicine is bullshit
As I’ve mentioned before, science, by its very nature, must be falsifiable, meaning that any hypothesis or theory has the logical possibility that it can be contradicted by an observation or the outcome of a physical experiment.
Just because a hypothesis or theory is “falsifiable,” we do not conclude that it is false. To the contrary, we understand that if it is false, then some observation or experiment will provide a reproducible result that is in conflict with our original hypothesis. Simply put, science actually generally assumes that it has it all wrong, and attempts to determine why a particular theory or hypothesis is wrong. Of course, in these attempts, usually more evidence is found to support the original hypothesis or consensus or theory. Just because science requires falsifiability, that does not mean that it will ever be falsified, but science is open to the possibility. In other words, science evolves.
Pseudoscience, represented by alternative medicine, by its very nature, is not falsifiable. It is mostly based on assertion rather than scientific observation, so it cannot be tested by experiment or observation. Acupuncture is a perfect example. The vast majority of real evidence says that acupuncture does not work, beyond minor placebo effects. Yet it persists, even some insurance plans will pay for it.
Clearly, science depends upon evidence, and in fact, values unbiased evidence above all other information. Alternative medicine depends upon faith or belief in what is being pushed. It actually devalues unbiased evidence, reciting a litany of excuses from “randomized clinical trials don’t work” to “Big Pharma hates us”.
As I’ve said in other posts, the internet gives us so much information, we tend to value it equally, as if every website provides accurate and logical data points. Maybe you have a friend who had a miscarriage 24 hours after receiving the swine flu vaccine. Maybe you’ve heard that many people have better health because of some alternative medicine treatment.
But stories from your friends, on the internet, or some celebrity aren’t evidence that it works. Maybe those telling the stories believe what they say, but that’s not how we use real science to find real clinical results.