Chiropractic: Concussion Craziness – Skeptical Health : Skeptical Health

Chiropractic: Concussion Craziness – Skeptical Health : Skeptical Health.

Let me summarize what the article says:

  1. A concussion is serious, which usually, and I repeat usually, resolves itself.
  2. A real doctor (a DO or MD who actually has a degree and has trained in emergency medicine) should see the patient to rule out anything more serious.
  3. A chiropractor cannot do #2 by law, by training, or by knowledge.

If you want more information about “Chiropractic Neurology” (and if that’s not quack medicine trying to sound real by throwing in scientific terms, I don’t know what is), read what Steven Novella said about it at Science Based Medicine.

How pseudoscience makes its case. Part 3.

This is part of my ongoing discussion on how quacks use pseudoscience to push their myths and potions on the world.  Part 1 discussed the scientific method, which allows us to objectively analyze the natural world.  Part 2 discussed the best way for us to examine the difference between science and pseudoscience.

I just read an outstanding analysis, by Steven Novella, MD, a clinical neurologist at Yale University, of 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) to reject evidence-based medicine.

Dr. Novella clearly states how science in medicine works:

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.

Basically, science evolves over time.  A conclusion that lacks sufficient evidence may eventually be supported by better analysis or groundbreaking research.  You’ll notice that anti-science and pseudoscience pushers do not allow themselves to participate in the this continuum of research–they state emphatically that they are right.

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 it.  Simply put, science 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 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, 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.  Creationism is a perfect example.  It is based on a human text (the bible), so there is no experiment that could be designed to test the text, since it non-responsive in a natural sense.  It would be like trying to scientifically show that the muppets existed.

Two of the most misused and misunderstood terms in evaluating scientific evidence are correlation and causation, two powerful analytical tools that are critical to evidence based medicine.  Correlation is the grouping of variables that may occur together.  For example, smoking correlates with lung cancer in that those who smoke tend to develop lung cancer at a statistically significant rate.  It’s important to note that correlation does not prove causation.  However, once you have numerous well-designed studies that correlate lung cancer to smoking, along with adding in biological and physiological models that support the correlation, then we can arrive at a consensus that not only is smoking correlated with lung cancer, it causes it.

We observe correlations every day.  But they are subjective observations for which we cannot state a causal relationship without substantial research.  The anti-vaccination movement is rife with these observations which they use to “prove” a cause.  An anti-vaccine conspiracy website claims that pregnant women are miscarrying babies after getting the shot.  The fact is that there is a statistical chance that women will miscarry during any pregnancy.  This is random variability not a cause.  In fact, based on the rate of miscarriage, we could expect that thousands of women would miscarry within 24 hours of getting the H1N1 flu shot.  But it’s not correlation, unless significant studies show a causal relationship.  For example, I’m also sure that thousands of people broke a bone or had a desire to eat a burger after getting the shot, but that’s because in a large enough population of individuals, you can find literally millions of different actions after getting a shot.

So, the miscarriage rate after receiving the swine flu shot is not correlated.  It’s just a random observation.  And there is no biological cause that could be described.  Nevertheless, the “flu vaccine causes miscarriage” conspiracy has been thoroughly debunked by research, but still the internet meme continues.  Pseudoscience sometimes uses the same methodology (or lack of methodology) to make positive assertions.  Homeopaths will claim that their dilutions will cure whatever disease, yet they do not have scientific evidence supporting them, but there plenty of evidence that debunks what they practice.

As part of my analysis of medical claims of causation or “cures”, I often use this logic to test the possibility of the usefulness of any alternative medicine–is there any physical, chemical or biological mechanism that will allow the quack procedure to work?  If you cannot imagine it without violating some of the basic laws of science, then we should stand by Occam’s razor, which states often times the simplest solution is the best.  So, if there is no evidence of vaccinations being correlated, let alone causal, to autism, then that remains the simplest solution.  To explain a possible tie without any evidence would require us to suspend what we know of most biological processes.

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.  But that’s not science, that’s just a subjective observation.  Or even confirmation bias.

Once again, Dr. Novella says it perfectly:

In conclusion, correlation is an extremely valuable type of scientific evidence in medicine. But first correlations must be confirmed as real, and then every possible causational relationship must be systematically explored. In the end correlation can be used as powerful evidence for a cause and effect relationship between a treatment and benefit, or a risk factor and a disease. But it is also one of the most abused types of evidence, because it is easy and even tempting to come to premature conclusions based upon the preliminary appearance of a correlation.


How pseudoscience makes its case. Part 2.

Recently, I discussed how science works. It’s not a belief. It’s not a random set of rules. It is a rational and logical process to determine cause and effect in the natural world. Pseudoscience, by its very nature, ignores the scientific process; instead, it claims to come to conclusions through science, usually by using scientific sounding words, but actually avoids the scientific process.  They tend to use logical fallacies to make their case.  Just to be clear, logical fallacy is essentially an error of reasoning. When a pseudoscientist  makes a claim, or attempts to persuade the public of this claim, and it is based on a bad piece of reasoning, they commit a fallacy.

There are several types of logical fallacies that they employ.  My favorites are Appeals to Antiquity, 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; Appeals to Popularity, or everyone does it, so it must be useful; and the Genetic Fallacy, where the source is more matter than the merits of the evidence.  Logical fallacies are so prevalent in skeptical community, there are websites devoted to describing them.

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 (homeopathy, which is nothing but water, has magical properties to cure everything from cancer to male pattern baldness), or vaccine denialists (I’ve discussed this topic before, no need to belabor).  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.

So how can you tell the difference between science and pseudoscience in medicine? In medicine, we gather and analyze evidence in one of two ways.

Almost any medical product, device, drug or procedure must, by law, must studied in a Randomized Controlled Trial, which is sometimes called a clinical trial. Essentially, it is a scientific experiment, designed to test the hypothesis of whether the safety and efficacy of a particular medical product is better than a placebo. That is, does the medical product produce results better than doing nothing at all. This is 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 may be subject to argument). Alternative medicine just doesn’t do this (most of their reasoning is that their beliefs just doesn’t fit into the clinical trial model), so their is no proof that their products work. A 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.

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 is true 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. Once again, pushers of alternative medicine therapies have not published a study of all the patients who might have used their therapy and see the result. 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.

Remember, anecdotes (“my mother’s friend’s cousin’s daughter was cured by eating this leaf”) 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.

You might have heard that taking lots of Vitamin C helps prevent colds. It doesn’t. And that conclusions 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.