These days, it appears that pseudoscience in medicine, everything from homeopathy to anti-vaccine beliefs to cancer treatments to chiropractic to naturopathy, has taken hold of many people’s choices. It’s become so frustrating to read stories about people forsaking science-based medicine to use some quack treatment to treat their cancer.
I think there’s a basic reason for it — science is hard. Whether it results from the lack of education in science to a misunderstanding of science is irrelevant, too many people think that science-based medicine doesn’t work. Except it does.
I’ve written about pseudoscience over a hundred times, but I never answered the question of why it grabs the attention of people. I’m going to try to answer that here.
What is pseudoscience in medicine?
First, we need to identify pseudoscience in medicine.
Above, we talked about the scientific method. Next, in the pseudoscience vs science discussion, we need to list out the “pseudoscientific method.” It is the direct opposite in terms of logic and design.
- Use of vague, exaggerated or untestable claims. Pseudoscience tends to present claims that are imprecise and are unsupported by complex scrutiny, including statistical analyses. If we look at the anti-vaccine claims, this is precisely what they do – they rarely present unbiased data, preferring anecdotes and unsubstantiated information that is, of course, much easier to digest than science.
- Extreme reliance on confirmation rather than refutation. Pseudoscience looks for evidence that supports its pre-ordained conclusions. Real science looks at all the evidence, including evidence that might refute the hypothesis. That’s why falsifiability is the cornerstone of good science.
- Lack of openness to testing by other experts. Pseudoscience researchers evade peer review before publicizing results, occasionally using press conferences to share their ideas. These pseudoscientists will claim that their ideas contradict the scientific consensus, so they must avoid the peer review process because that process is biased towards the established paradigms and consensus. They will use special pleading to claim that their results cannot arrive from the scientific method. And if they do publish their “data,” it’s almost always in low-quality, predatory journals. Or their research is retracted!
- Absence of progress. Pseudoscience usually fails to progress towards providing or even searching for additional evidence of its claims. We have been discussing autism and vaccines for over 20 years – science has produced over 150 epidemiological and clinical studies that have conclusively established that there is no link. On the other hand, pseudoscience has never produced a single peer-reviewed article that supports these beliefs. Sure, there are opinion pieces in poorly ranked journals that lack any research that meets the standards of high-quality science, but that hardly meets the standards of real science.
- Personalization of issues. Pseudoscience is often composed of closely tied social groups, and usually includes an authoritarian personality, suppression of dissent, and groupthink. In an attempt to confirm their beliefs, the group tends to identify their critics as enemies (see everything that Del Bigtree and Robert F Kennedy Jr say).
- Conspiracies. Pseudoscience attempts to make claims of a conspiracy on the part of the scientific community to suppress results that support the pseudoscience. For example, the anti-vaccine crowd has invented numerous claims about Dr. Paul Offit in an attempt to discredit him. And any time anyone supports vaccines, they’re accused of being a Big Pharma Shill, called various racial epithets, or worse. Pseudoscience pushers love to call science-based medicine as “Western medicine” or “allopathy” in an attempt to make it appear to be part of some grand conspiracy of bad medicine. Or they claim that modern medicine “treats the symptoms not the disease” which isn’t true, except when you have to treat the symptoms first.
- Use of misleading language. Pseudoscience tries to create scientific-sounding terms to add weight to claims and persuade non-experts to believe statements that may be false or meaningless. They often use established technical terms in idiosyncratic ways, thereby demonstrating unfamiliarity with mainstream work in the discipline. They love to Gish gallop all the way to their pre-ordained conclusion.
There are so many areas of pseudoscience in medicine:
- Anti-vaccine rhetoric
- Cancer treatments
- Traditional Chinese Medicine
- Herbal treatments
Sometimes there might be an herb or Traditional Chinese Medicine that will work, but it’s real scientific research that shows that they work, not outrageous claims. Anything that works in medicine is just called medicine.
Science is hard
Science is an evidence-based systematic analysis without inherent opinion or emotion to answer questions about the natural world. In other words, it is a method to cut through opinions and anecdotal observations, so that one can have some reasonable expectation the proposed scientific principle can work as predicted.
This can be an issue when interpreting medical or scientific studies. Science tends to be written in nuanced, carefully supported statements. They often appear to be a bit indecisive, but it’s not.
Science is not dogmatic. Pseudoscience, religion, and alternative medicine are, by definition, dogmatic. Everything in science is provisional — we change our conclusions with new evidence when it becomes available.
Moreover, science is binary – either there is evidence to support a hypothesis or there is not. Let’s go back to the hypothesis that “vaccines are linked to autism.”
Scientific research, published in high-quality journals, is given much more weight as evidence in real science. Thus, if I propose the hypothesis that “vaccines are not linked to autism,” it is supported by a boatload of powerful evidence. On the other hand, the alternate hypothesis,” vaccines are linked to autism,” is not supported by any credible, peer-reviewed, high-quality published papers.
But all vaccine scientists are open-minded to the potential that evidence could be presented that establishes a link between vaccines and autism. But it cannot be done through a “vaccine debate,” it only can happen with real evidence.
When a pseudoscience supporter states that “it has been proven,” one must ask, “where is the evidence?” What is more troubling is that someone who believes in this pseudoscience, such as vaccines cause autism, cannot imagine that they are wrong. Ironically, those of us who study real science almost always assume that the conclusions could be shown to be false with more evidence.
Whenever I hear that a scientist says, “we were wrong, it doesn’t work,” my response is “excellent, good science.” Pseudoscience never admits it’s wrong, so the pseudoscientist can claim “science isn’t perfect, so it can’t be trusted.”
Lucky for us, science works despite the various tropes of the pseudoscience world.
Pseudoscience vs science – the scientific method
The underlying principle of science is the scientific method. If you ask how an anti-vaxxer or homeopath or naturopath reaches their conclusion, it never includes the scientific method.
The scientific method is an unbiased systematic approach to answer questions about the natural world, including medicine. People tend to think “science” is some magical way to explain things run by magicians called “scientists.” But real science is a rational methodology to uncover facts about the natural universe.
We didn’t conclude that vaccines are safe and effective because Paul Offit said it was so. It’s because he utilized mountains of evidence to come to that conclusion. And I mean a literal mountain (OK, maybe a small mountain) of evidence that supports the safety and effectiveness of vaccines.
The scientific method has several basic steps:
- Define the question – this could be anything from “does this compound have an effect on this disease?” or “how does this disease progress?”
- Observations – this is the subjective part of science. Do we observe trends or anomalies? Does a physician notice that every patient from a town or neighborhood exhibits the same disease? A lot of science arises from observations of the natural world, and yes, some of those observations can be anecdotes or personal observations. For example, one of the most famous stories in the early history of medicine is when Edward Jenner observed that milkmaids rarely were infected by smallpox because they were exposed to cowpox, a less virulent disease.
- Hypothesis – using the observations, create a hypothesis that can be tested. In Jenner’s case, he hypothesized that exposure to cowpox immunized individuals to smallpox.
- Experiment – simply, the scientist then tests the hypothesis with experiments and collects the data. The experiments are not designed to solely validate the hypothesis but may also attempt to refute it. In real science, attempting to nullify one’s own hypothesis is an honorable pursuit.
- Analyze – examining the results carefully, usually using acceptable statistical methods to determine if the hypothesis was supported or not.
- Interpret – sometimes the data leads to a revision of the hypothesis, which means the scientist has to return to steps 3-6. Or it confirms or supports the hypothesis, which means the researcher can move to Step 7.
- Publish – in today’s scientific community, scientific data and analysis is subject to the scrutiny of other scientists before it can be published, a process called “peer-review.” This is a critical step that ensures that the results can stand up to criticism of others.
- Retesting – many times the research is repeated by others, or the hypothesis may be slightly revised with additional data. Science is not static, it constantly revises theories as more data is gathered. For this reason alone, science is not an absolute, it is constantly seeking new data.
This is not an easy process. It requires years of study, research, and failure. And it’s really following the old instructions for shampoo – lather, rinse, and repeat, several times.
To think that anyone can do this process in a couple of hours of Google research, which is definitely not the scientific method, is arrogance. And it is not the basis of an evolution debate, a vaccine debate, or a climate change debate.
Pseudoscience is easy
And this is the crux of the issue. Science is difficult. It frequently hits dead ends and failure. It takes years of education and research to become an expert in just one tiny field of medicine. A vaccine expert spends years studying fields such as immunology, epidemiology, public health, and a lot more.
People seem to think scientific research is performed by some guy sitting alone in a lab, looking over a bunch of test tubes or into a microscope. He or she has bad hair, thick glasses, and no social skills. I read somewhere that our image of scientists is based on Albert Einstein.
But that’s not how biomedical research is done.
First of all, as I’ve written before, many scientists have had over 2500-3000 hours of classwork just in science relevant to their biomedical research. And these aren’t easy courses – immunology, biochemistry, statistics, physiology, cell biology, and so many others form the foundation of scientific research.
I don’t care how smart some anti-vax mom claims she is just because she has a college degree. Just to understand the immune system and how it reacts to antigens takes years. Many times I read posts from anti-vaxxers that get basic infant immunology so wrong that it’s clear that they are amateurs in science.
Second, scientific research is not a lonely, one-person pursuit. A research leader has a team that helps get the research done. There are post-docs and graduate students who are pursuing lines of research that are related to the overall goals of the lab where they are located. There are lab techs who do much of the hands-on work. There are data entry experts who make sure what was gathered can be analyzed There are computer programmers who help construct complex models. There are statisticians who analyze the data.
When I did my graduate work in cell biology, my lab was run by a senior professor and included five doctoral students, four Master’s students, five lab techs, two administrative assistants, and the assistance of the school’s statistics and computer science departments. Although some of us had our own research directions, we frequently had to assist in developing new techniques (I will never want to fractionate proteins again in my life) or performing experiments.
Third, education and training never cease for most scientists. I find it hysterical and troubling when an anti-vaxxer says that a physician never learns about vaccines. Nothing could be further from the truth. A pediatrician, usually the point person for vaccines, has at least eight years of formal science education, along with three or more years of clinical experience with vaccines.
Not only do they read about the safety and effectiveness of vaccines during high-level courses, but they also observe and examine patients who have and have not received vaccines. They see children who have been vaccinated, and they can separate fact from fiction. They also see children who have not been vaccinated and succumb to deadly diseases.
Vaccine scientists are constantly reading newly published studies. They attend several meetings a year where research data and conclusions are freely shared. They discuss current research with colleagues.
Fourth, scientific research is a lifelong pursuit. It is not an hour or two on Google University. As arrogant as the anti-vaxxers want to be, it is nearly impossible to become an expert in science in just a day or two.
Does this all mean that science should be unapproachable? No, but it is not easy. The anti-vaxxers dismiss the expertise and knowledge because that expertise and knowledge contradict their beliefs.
Does it mean that science shouldn’t be criticized? No, but it should be criticized on the science itself, not because of beliefs, logical fallacies, and political expediency. It must be challenged with scientific evidence, which is what science does well. Science is self-critical, despite the beliefs of the science deniers.
So why is pseudoscience in medicine so popular?
I think I wrote it above — it’s so easy and real science is so damn hard.
Pseudoscience in medicine provides easy answers to hard questions and makes them easy to understand. Although I am not an oncologist (nor do I play one on the internet), I see so many people say that cancer treatments are hard, but they know of the secret herb that will cure all cancer without any side effects. That’s so much easier than surgery and chemotherapy.
Of course, we know it’s pseudoscience because cancer isn’t one disease, it’s literally hundreds of different diseases with different etiologies and pathophysiologies. And they require hundreds, if not thousands, of different treatment strategies. That sounds hard.
My good friend and fellow zombie aficionado, David Gorski MD Ph.D., has written numerous stories about cancer patients who were sucked into the lure of the easy fix for their cancer, but by the time they realized they needed a real oncologist, they are past saving. Steve Jobs is a perfect example of someone buying into pseudoscience in medicine and paying for it with his life.
Anti-vaxxers like to use the Vaccine Adverse Event Reporting System (VAERS) to make false claims about vaccines. Why do they use it? Because it’s easy, despite the fact that VAERS does not establish causality in any way.
The better database to use is the Vaccine Safety Datalink (VSD) is a much better database because it provides full medical records of a large population of adults and children along with their vaccine status. You can do powerful, and publishable, case-control and cohort studies that are almost as good as a double-blind, randomized clinical trial. The database is available for anyone to use, although you have to agree to certain conditions on its use. But, it takes hard work to establish correlation — you don’t use it by searching for every case of autism after vaccination and say “ah-ha!!!” You have to compare that to the unvaccinated cohort and what you will find is that there is no difference between the groups.
Pseudoscience is easy because it doesn’t have to provide robust, repeated, and reliable evidence to support its claims. That takes work.
Pseudoscience in medicine, especially recently with the COVID-19 vaccines, doesn’t require hard research and education. It just requires making claims and then telling the rest of us to “prove them wrong.” That’s not science. It’s the job of those who make the claims to provide the evidence. And let me remind you that extraordinary claims demand extraordinary evidence.
I wish I could make science easy. I try to do it with many of my articles here — I try to explain the methods as easily as I can and bullet point the results. And then criticize where it’s necessary. But I assume that my audience knows how to dig into the published paper themselves because I always link to high-quality peer-reviewed papers.