SGU Episode 21
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|SGU Episode 21|
|7th December 2005|
|SGU 20||SGU 22|
|S: Steven Novella|
|B: Bob Novella|
|E: Evan Bernstein|
|P: Perry DeAngelis|
|WS: Wallace Sampson|
- 1 Introduction
- 2 News Items
- 3 Interview with "Wallace Sampson, MD" (8:20)
- 4 References
S: Hello and welcome to The Skeptics' Guide to the Universe. This is your host, Steven Novella, President of the New England Skeptical Society. Today is December 7th, 2005. With me today as always are Bob Novella ...
S: ... Perry DeAngelis
P: I'll have to put down my copy of the Psychic Sasquatch to join you, but I shall.
S: Oh, thanks for the sacrifice. You can get back to it later. And again as always Evan Bernstein.
E: Hello everyone
S: Guys, thanks for joining me tonight.
E: Thank you, Steve.
S: So today is December 7th, a day that will live in infamy, right? The Pearl Harbor Day.
B: That's right.
E: Pearl Harbor Day
B: I remember that, yeah.
E: I'll never forget that.
S: We will remember all of the Americans who lost their lives and limbs on that infamous day in 1941.
E: Changed the world. Changed the world forever.
S: When the Germans bombed Pearl Harbor
E: When the Germans bombed – yes, there's evidence to prove that.
S: So we have an excellent guest on our show tonight. Wallace Sampson ...
S: ... who will be joining us in just a few minutes.
Intelligent Design Course Withdrawn (1: 13)
But first there's just a couple of quick news items. First an update on our last show. We had reported that the University of Kansas was planning a course entitled Special Topics in Religion: Intelligent Design, Creationism and Other Religious Mythologies. The course was to be put on by Professor Paul Mirecki. We discussed the fact that the University, trying to retain some shred of scientific credibility and prestige is trying to do anything to counteract the fact that the Kansas State School Board for a second time is voting to either limit the teaching of evolution or promote the teaching of intelligent design in Kansas public schools.
Well, unfortunately the course has now been withdrawn by the University of Kansas. The apparent reason for doing this is the fact that Paul Mirecki, again the Professor who was going to run the course, made some indiscreet, anti-religious remarks. Actually, it was in an email to students. And he was slapped on the wrist by the University. He had to formally apologize. He said "I made a mistake in not leading by example in this student organisation email forum the importance of discussing differing view points in a civil and respectful manner," he said. The Chancellor, Robert Hemenway, referred to his comments as "repugnant and vile". Whenever you make any comment that is insensitive, it always seems that the University has to condemn it in the most extreme language they could possibly muster.
P: Do we have any idea of the nature of the comments?
S: Yeah, lets see. He said he was mocking Christian Fundamentalists.
P: Okay, that's pretty broad.
S: Yeah, I think he called them – referred to Religious Conservatives as "Fundies", and said ...
S: ... and said "a course depicting intelligent design as mythology would be a nice slap in their big fat face." That's it.
P: That's pretty horrific. I mean that's really, really (unintelligible).
S: Obviously he shouldn't of done that. He's a Professor, and ...
P: I agree
S: ... he's teaching a controversial course to specifically, to highlight the intellectual superiority of scientific honesty above religious fundamentalism masquerading as science. And he totally muddied it with these unnecessary comments.
P: It's true. I mean he shouldn't have done it.
S: It's just unfortunate. It's unfortunate.
P: He shouldn't have done it.
S: Although I have the sense that the University was happy to have an excuse to cancel it and get out of the controversy. They should have stuck to their guns. They should have made him apologize but not pull the course. I don't see why they had to do that.
E: Right, sounds like, I don't know, an excuse. Maybe they were never too hot on the course to begin with, and it's just a door that opened to allow it to be gone.
S: It's unfortunate. He should have known that by doing this he was putting himself in the limelight as it were, and he should have really been on his best behavior.
P: Cancelling the course still seems a little extreme.
S: I think so. I think it's a little excessive. So we'll keep you updated on this raging culture war. The judge has yet to make a decision in the case. You'll be sure to hear about it on the Skeptics' Guide when a decision comes down regarding the constitutionalilty of requiring teaching intelligent design in Dover Pennsylvania Public schools.
E: Hm, hm.
Weeping Icons (5: 00)
S: Another item that came to our attention this week was: there is a new sighting of a weeping Virgin Mary icon. Now Bob, you brought this article to our attention.
B: Yeah, I read a little bit about this. As reported in the Sacramento Bee there's a humble – described as a humble Vietnamese Catholic Martyr's Church. There's an outdoor statue of Mary that has become very popular with hundreds and hundreds of visitors coming by, rain or shine, since late November. Apparently there's a red streak running from the corner of her left eye, and that has been causing quite a stir. People have been coming and praying and thinking it's a miracle.
S: They think she's crying blood?
B: Yeah, essentially, I mean red streak, I mean you've got to think, oh yeah, it must be blood, miraculous bleeding.
E: Simple, simple test, simple test could...
B: It says here that the Priest wiped the streak away on November 9th but then it reappeared on November 20th, and many viewed it as tears of blood being shed, of course.
B: National media attention, many – lots of crowds, "I believe it's a miracle," said Florence Chempako. And I was very nicely surprised to see Joe Nickell quoted in this article. He said ...
S: Of course
B: He says that he wrote "Looking for a miracle and the red streak as a hoax but not without possible value. Such events often can draw believers and non-believers to the church". Makes a lot of sense.
E: Huh, huh.
B: With national media attention and hundreds of people visiting everyday for weeks and weeks, I am sure they've seen a lot of new members.
S: Even if it turns out to be a hoax, the purpose was served.
B: Right. It's a win--win. It's a totally win--win situation for them. And it says here that he took issue with the church. He described it as a clumsy, obvious hoax and had issues with the church for not acting quickly to test the substance.
S: Hm, hm.
B: It says here that he's quoted as saying: "If the statue is a fraud or a hoax, or even just a mistake, it should be determined, and that should be that," Nickell said. "If it's a fake then it should be repudiated". And then, Steve, they actually had a quote from Lorrainne Warren.
S: Oh, really. They tracked her down.
B: Yeah, a Conneticut investigator of paranormal events for over 50 years admitted to a "believe first" approach. "Until you can disprove it, look at it as real," Warren said. Which I thought was ...
S: Yeah, that's about right.
B: ... not surprising but still an interesting perspective.
S: Now there have been cases similar to this in the past where they did test the blood, and they found it to match the type of blood and in fact DNA match to one of the people in the church or in the home.
S: And the comment was "Well, that just proves how miraculous it is. God can use any blood he wants to create this miracle".
E: That's right.
S: Again you can't falsify faith-based beliefs. Which, again, why these kind of things are a win-win. You know the church can never really lose, because the true believers will continue to believe regardless of whatever evidence comes down the pike later. So that was it, that was the only skeptical items that peeked above the radar this week. so we want to leave plenty of time for our guest. So we'll go to him now.
Interview with "Wallace Sampson, MD" (8:20)
S: So joining us tonight is Dr. Wallace Sampson. Dr. Sampson is an outspoken critic of unscientific, fringe, and bizarre health claims. He is the editor and chief of the Scientific Review of Alternative Medicine. And I, your host, is an associate editor of that journal with Dr. Sampson. He is also on the board of directors of the National Council against Health Fraud, the author of numerous articles and reviews dealing with a range of issues involving science and medicine. He's an Oncologist by training and is a clinical Professor Emeritus of Medicine at Stanford University. Wallace Sampson, thank you for joining us on the Skeptics' Guide to the Universe.
WS: My pleasure.
S: So, let's go ahead and just start talking about alternative medicine – complementary, alternative medicine. Give us your view of what this is all about, what role it's playing in modern health care, and what we as skeptical, concerned citizens should think about it.
WS: Well taking a somewhat historical view of this gives you some very surprising information. I am old enough that I have seen this thing grow, like weeds under my feet. When I first started in this, there were very few so-called alternatives, and we could keep track of them. We knew who the proponents were, we were – "we" meaning the people and my colleagues who taught me about this – were called in as consultants and witnesses in hearings and trials. And we were regarded as experts in this whole field. We held offices, official offices in the states' governments, ...
S: Hm, hm.
WS: ... and were witnesses for the federal attorneys general, and were held in fairly high regard within the scientific community. It was a little niche of interest for most of us, because we were a combination of PhD – usually bio-chemists – and MDs with an interest in Physiology and Biochemistry and Pharmacology.
WS: Well, when I first got interested in it, it was over a significant and obviously fraudulent material laetrile, ...
S: Hm, hm.
WS: ... and that was in the early 1970's.
S: That was the first issue that drew you into this?
WS: Right. I was trained as a hematologist and oncologist and was a practicing hemog, as we called ourselves, and had patients disappearing from my practice. A few of them ended up, I found out, in clinics across the border from San Diego in Tijuana getting laetrile.
S: Hm, hm.
WS: ... and that interested me, so I looked about and got some literature about it, and I tried to figure out what this stuff really was, and I became very confused, because the material I received had a degree of scientific panache and logic to it. So I really didn't know why it was not approved of ...
S: Hm, hm.
WS: ... because if everything the proponents said was true looked like it might be pretty good. Well, in fact, everything the proponents said was false. Not only was it a misinterpretation of things, they actually made it up in other words it was an intentional fraud.
S: Right. So just for some background, laetrile is a putative cancer cure that was studied for a time in the late sixties and seventies. Basically found to be completely ineffective – proven ineffective, discarded by ethical scientific medicine, but has had a life after that in these specialty clinics that offer laetrile and essentially claim that the medical establishment is lying to the public about the effectiveness of laetrile.
B: Did they find some other use for laetrile, completely unrelated to its original claims, something that "just, oh wow, it happens to have an effect on some unrelated condition," or am I just misremembering that?
S: Is there any legitimate medical use for laetrile, even outside the realm of cancer?
WS: Yeah. There's a legitimate use as a poison, as a matter of fact.
WS: It's a well known poison of domestic animals in Africa and in some other countries where these were the compounds in laetrile which come from various plants, including maize, and roots that out of which they make poi, casaba root, and a lot of other staples, because it contains twelve percent cyanide by weight.
E: But it's all natural, it must be good.
WS: It's all natural.
S: All natural poison.
WS: There's a significant public health problem, because the cattle in Africa are poisoned by it. They get thyroid poisoning, become hypothyroid. They get cyanide chronic poisoning with neurological changes and staggering that looks like mad cow disease, and a host of other problems. But these kinds of effects seem not to bother the proponents, and they didn't, of course, mention them in their ...
S: Hm, hm.
WS: ... advertisements and their claims. It bothered the state officials and the public health officials. Anyway, that's laetrile, and yes, it did develop a life of its own. It made the cover of Time, Newsweek, and Life magazines.
S: Hm, hm.
WS: It was a major scandal, because what it really was was a front for a fraudulent stock swindle on the Montreal and Toronto stock exchanges over which people were sentenced to long prison terms in Canada. And that's another aspect of the story ...
WS: ... which we don't have to deal with. But, nevertheless, it was recognized that this was never intended to be a real cure for cancer. It's just that some of the proponents began to believe their own stories, ...
WS: ... their own fairy stories. And a lot of other people fell in behind them so that it turned out to be hundreds of millions of dollars in the 1970s and early eighties for cancer patients. Here in the United States, in addition to what the Tijuana clinics were bringing in. It was legal here for awhile as long as a physician signed an affidavit saying that the person could bring in a certain amount for his own use.
S: Hm, hm.
WS: That is now run out, and it's illegal here now. But (unintelligible) started with that, and it was a good model for anyone starting in the field because it has all the characteristics of a pseudo-science and a swindle ...
S: Hm, hm.
WS: ... and a con. It is not a simple alternative. It has been falsified from the very beginning, and most of these are false from the beginning, if not intentionally so, then they are unintentionally false from the beginning. And what we are trying to do most recently here, and we'll get into this a little bit, is trying to find evidence that tells us with such certainty that the claims are false and the stuff cannot work and the method can't work. But doing clinical trials on this are unnecessary and a waste and lead to other secondary problems that are unexpected.
WS: So my major interest is to try a case for many of these alternatives in the same way that we finally made the case against laetrile.
National Center for Complementary Alternative Medicine(16:32)
S: Hm, hm. I read a recent article that you wrote called The Alternative Universe. This is on the Quack Files Blogspot. Who runs that site, by the way? It's a good website. You may not be aware of it, but there's a host of scientific, medical articles, medicine articles on there. But, anyway, the article that you wrote was specifically about research, the National Center for Complementary and Alternative Medicine, and why it is a waste to spend the hundreds of millions of dollars that are being spent to study modalities which we already know don't work. For example, acupuncture, chiropractic, homeopathy, and a slew of other ones that are still popular and in use these days.
S: That's basically what you are talking about, like laetrile's the same thing. We already know it doesn't work, so doing a clinical trial where we're giving it to patients who are sick, is unethical.
WS: Yeah. There are arguments all up the scale, from the very beginning of plausibility of it. For instance, with laetrile, it was implausible from the biochemical and pharmacological standpoint. It was impossible for it to work, and that's what the experts knew at the time, but no one believed them, except for other biochemists and pharmacologists.
WS: But the general public, the press wouldn't believe them. They couldn't even get quoted in articles in the press, because the experts were simply discarded. So you could start on that end of the scale, the very basic scale, and then you could take a look and say "What else is going on?" Take a look at the way they're being promoted. It's being promoted inappropriately and in the wrong places, and they're not able to back up their claims. That's the next level on the scale. And then you can just skip over anything else in between and get to the most ridiculous part of this, which is what this article that I wrote was about, I think, which is trying to put the burden of proof on the medical, scientific establishment to disprove the use of these things.
WS: And acupuncture's a very good case in point, because acupunture in traditional Chinese medicine was never used to treat a disease, because the Chinese never described diseases.
S: Right, that's a modern concept. People don't realize that ...
WS: That's right.
S: ... before really the scientific model of medicine, people didn't think in terms of specific patho-physiological diseases. They thought everyone had their own particular illness.
S: And usually conceived as being some life force or entity being out of balance.
S: But not diseases. So, of course, they couldn't frame their concept of how acupuncture might be working in terms of treating some specific biological disease.
WS: Right. And so few people recognize this. I had to point this out very basically to the California Legislature the year before last, and had a very hard time trying to get the point across. I spent two hours with what's called the Little Hoover Commission here, explaining this. And they were so fascinated by it, it was so new to them, and these were not unintelligent people, very intelligent people, who were assigned by the state legislature in California to come up with a solution to the education of acupuncturists.
S: Hm, hm.
WS: And they spent more time listening to me than they did listening to anybody else because no one else had ever brought this up.
WS: And I brought up all the material I had learned from our buddies, who are associate editors and people we associate with, but I learned a lot from them. The amazing thing was that none of the legislatures had ever come to terms with this.
S: Hm, hm.
WS: The consultants in the Little Hoover Commission had not. The California Medical Association had no one who had ever given this kind of testimony, and it's so very basic, what you just said, Steve, that's the basis of the objection to acupuncture in the first place. There was no system of science or observation in China, since sixty to eighty percent of the complaints that people have when they go to a doctor or healer are either self-limited or psychogenic, most of them get better with time.
WS: Every doctor knows this, and we all know this now, but no one ever put that together with traditional Chinese medicine, because that was the reason that they all became self-deluded.
S: Hm, hm.
WS: They thought that what they were doing was working sixty to eighty percent of the time, and they were impressed with themselves. So they kept doing it, and repeating and repeating the errors.
WS: So that's another level at which you can take a look at this whole situation and try to educate the public about it, which we are trying to do at the present time.
WS: As you work your way up the scale even further, there has been a development in medicine called evidence-based medicine. Evidenced-based medicine has developed clinical trials, randomized clinical trials to a degree that makes them much more – when they are done properly they are much more accurate and can much more accurately predict whether something really works or not.
WS: Or one thing works better than another. So evidence-based medicine has developed its own scale of rating various clinical trials to see how well the trial was done. And I won't go into that at the moment, but I think you could imagine how you could look at trial and were the patients randomized, were there blinds, blinding measures appropriate ...
S: Was the outcome measures appropriate? Right.
WS: Appropriate observations, appropriate statistics, and all these kinds of things that go into the analysis of a trial. So they've done pretty well with that. However, there are lots of holes, and what they don't have is any kind of a method for detecting fraud, or detecting fabrication. And so someone can make up a trial and publish it, and they have no way of knowing that it's made up. And, indeed, we have discovered some of these, and very few other people have. I must give credit to our crew of Steve and Bruce Lamm and Bob Emory and others who have been looking at these things and been able to detect where the frauds are. And the popular view is that we're not being listened to by University professors, because they have been deluded into thinking that the only way that you can really prove or disprove a method is by a clinical trial, and the only way they can improve is by tightening up the controls, and, still, there will be holes there and they can be defrauded. It's been going on today, and it's been going on for the past twenty years.
S: Right. Bob, you had a question?
B: Yeah. I was going to say that you said that there were holes, there's no way to detect fraud, but isn't it also one of the other hallmarks of evidence-based medicine is duplication, duplication of the experiments in the trials to see if you come up with similar results. Wouldn't that shed light on the fact if there was fraud or gross errors?
WS: It should. Ideally it does. There are two ways of tightening further. One is doing larger trials with larger numbers to increase the power of the study. The second is to have it reproduced by another group. But there are a couple of problems with this. Think about how long this would take. You spend say 30,000 dollars to 300,000 dollars doing a clinical trial with forty subjects and forty controls, which would give you an 85 percent power of being certain that your P-value will turn out to be correct. When you get a P-value of .05 or .01, which means chances are only one-in-twenty to one-in-a-hundred it could have been due to chance. Well suppose you made some systematic error in the setting up of the trial that you're unaware of. The first thing to do is for some other outfit to repeat the trial. While in the first place, most research grants are not given for specific repeats of someone else's work. They're mostly giving as grants for looking at in a different way or under different circumstances or for a different disorder. So you start to vary from that ideal repetition because of the way the granting agencies behave. I can only tell you that they think that the returns on the money that they will put into the grant will be much less if it's just for a repeat of something that's already in the literature. So a systematic error, unless it's repeated exactly the same way – unless its trial is repeated the same way, a systematic error can be repeated, and nobody even knows it's there. That's number one. Number two, it took six months to a year to write up the grant request in the first place. It took another year or two to gather the patients into the trial. Another year or two to observe them – maybe five years to observe them to see what the results are, and then another year to assimilate the data, write it up, and another six months to a year to get the paper accepted, because it goes through reviews, rejections, and the average rejection rate is two rejections per paper. So already you've got the work that's extended out from the ideal of about a year where you'd like to really know that's when you'd like to know what's really going on to five to maybe ten years before results are even published, and then start the repeats. And suppose you do get some outfit to repeat your work exactly the same way? Well, unless there's someone like our group out there looking for all these systematic errors and looking for something that could be wrong, you're going to have another five years to ten years before you have the answer. Now we're up to fifteen to twenty years. Meantime, these things are being marketed, and they're being talked up on websites and in books and on radio programs on anywhere else, and making their way into medical schools as part of alternative medicine instruction, and so forth, and some of these things get lives of their own, and it may be decades before they're disproved. That's the problem, and not only that, but it takes five or ten of these trials to be able to prove or disprove within some degree of certainty that something works or doesn't work, because each trial then is looking at a slightly different angle.
WS: And just not a true replication. That's the problem.
S: Now, of course, all of this, (unintelligible) for one second, all of this of course applies to any modality that we care to study, even legitimate scientific plausible modalities. But I think that the key difference is within conventional scientific medicine, practitioners tend to be much more conservative. We don't tend to jump on the bandwagon of one study, but rather wait for a consensus of a few trials to come out, wait for the replication. We take a more skeptical eye towards any new therapeutic claims. It's certainly true that sometimes modalities may become incorporated into our practice, and then later studies contradict or show that it does work, but then we abandoned them. We get rid of the ones that don't work. In the alternative medicine world, there is never, ever a case where an alternative medicine proponent will come to the conclusion that any modality doesn't work. It simply does not exist for them.
WS: That's right. I've never found one either.
S: Andrew Weil has never, ever, ever, condemned any alternative modality as not working.
E: And the media loves him. Loves him!
S: Oh they love him. He's the guru of the century. In your article you point out that the National Center after ten years and hundreds of millions of dollars has not proven anything to be ineffective, which is absurd in the scientific medical world.
WS: Yeah. There have been a few advances. We were making this point up until about a year ago. Within the past year or two there have been some exceptions to that, and one is Andrew Weil has condemned chelation therapy.
S: Oh, that's good.
WS: That's one. But that's about it. Of all the hundreds of alternatives ...
WS: ... that's the only one I know that he won't say works. Or says doesn't work.
WS: The second exception is echinacea, and after the last two trials the National Center for Complementary Alternative Medicine head has finally made a statement that it shouldn't be used ...
WS: ... and stopped research on it. However, he got a letter from the industry. I forget which industrial group this was ...
S: "He" being Stephen Straus, the head of the National Center.
WS: Yeah. Right. He got a letter very recently from the supplement industry telling him he was wrong about this and should ...
S: Recant his ...
WS: ... reject what he said, because he did exactly that, and he took back what he said, and put in a specific statement saying "More studies are needed."
S: More studies.
WS: Because they didn't use the dose that was recommended. And for reasons like that. That's what the Council on Nutrition had claimed, and they sent a letter to the editor of the New England Journal, also, and our leader, Stephen Straus, of the National Center for Complementary Alternative Medicine actually bowed to these people in the industry and withdrew his previous statement saying that echinacea didn't work, and came out with this mealy-mouth statement. Now I might add that my article in the New England Journal that was regarding that last clinical trial, made the point that there was no historical reason that anyone can find to indicate that it should be used in colds and flus.
WS: In other words, Native Americans had used it for at least thirteen to twenty-one different uses, including an inhalation of its smoke, use of echinacea as a compress, and all sorts of other – and use as a local application for a painful tooth and a sore throat, but never was their use in a viral type illness or a feverish illness. And all the primary information that we consulted, and I consulted at least fifteen textbooks on this, and also the original text that related what the original Indians had told the traders.
S: Hm, hm.
WS: The American and French and Spanish traders. Never was there a claim for that. The claim came from one Swiss and one German homeopath and quack who saw this material. It's a long story and will be published in our journal, but what they did was they got somewhat deluded by one fellows' trip to South Dakota and a talk with a medicine man's son, and came back and made it up.
WS: He actually invented it in Germany, and marketed it as a cold cure.
WS: That's how it became popular in the United States. There was no basis for researching it at all!
WS: And of course that was completely ignored by the letters to the editor and ignored by National Center for Complementary Alternative Medicine.
WS: So this gives you a little idea of what we are up against here.
Alternative Medicine Culture (33:11)
S: Let me back up just a minute because, while I and my colleagues have been dealing with this issue for a long time, for many years, struggling really to find a way in my opinion to really get across to the public, to regulators, to educators, what it is we care about. I think that we get bogged down in terminology like "scientific medicine," "evidence-based medicine," et cetera. And the alternative medicine crowd I think have really learned over the years to expertly use terminology to their advantage. They really play that game very well. But honestly, when you break it down, I think what we're talking about is some very basic principles. The first being that medicine should be safe and effective. I think this is sort of a common ground that everyone can agree on. That it's inefficient, unethical, improper to use treatments which either don't work or which are unsafe. Although you'd be amazed at how difficult it is some times to get the alternative medicine people to agree to that. We further believe that over the last hundred, hundred and fifty years we've had some accumulative process of figuring out the best way to know what works and to know what is safe, and that these are really – again, there's no magic to this. I think people use the term "science" as if it's a magic wand. Basically, all we're talking about is intellectual integrity, fairly accounting for the evidence, using methods which are appropriate and legitimate, using valid logic in assessing claims, using appropriate statistics. That's it! That's all that we're really advocating. There's not really a big ideological or philosophical issue at stake here. It's really just an issue of quality. And when you dig down deep into any of these alternative modalities, what you find is that intellectually, they're extremely lacking. Either they're outright fraud, or they do not account for the evidence, or they are employing grossly invalid logic, or all of the above. Would you agree with the basic assessment?
WS: Very good! I sure do.
S: We say not that we're against all alternative or against some kind of artificial category, we think that "medicine is medicine". There is one medicine, and it should have the best quality possible. You brought up evidenced-based medicine. That is just I think is just the latest iteration of mainstream medicine's dedication to again this sort of excellence and quality in medicine, in health care. But you're right in that it has some holes in it, and I think the big one that we haven't talked about is the fact that it doesn't consider plausibility or prior probability.
S: So it assess empirical evidence essentially in an intellectual vacuum, as if we don't have a hundred and fifty years of biology and medicine behind us, which I think is just utter folly. Wouldn't you agree with that?
WS: Well I sure do. We've been bouncing this one back and forth for I think the past four years or five.
WS: And trying to figure out a good way to approach this so that the medical journals would accept what we had to say and not reject it off-hand ...
WS: ... as offensive as they so often do.
S: Right. The other thing that was sort of implied in what we've been talking about so far, but I think it's worth talking about for a few minutes, is what really is the size and scope of the alternative medicine phenomenon in our culture. Clearly it has risen to higher prominence in society, but my sense is that the public has been led to believe, essentially by a sensationalistic and credulous media, that there is a paradigm shift – I always hear that term being used – within scientific medicine, with science itself, and that it is being increasingly accepting of alternative modalities. But I just do not see that. I do not believe that that is the case. What I ...
P: You hear that about scientific community, not the public?
S: About both. About both.
P: Oh, okay.
S: But yes, the claim is absolutely being made about the scientific community. In fact what we see when we survey health-care professionals et cetera – and, again, I work inside an academic institution, so I can tell you from my direct experience is that ninety-five, ninety-six percent of scientists and health-care professionals think it's bunk. They just don't care about it. It's below their radar. They think it's a cultural pop fad that is not worthy of their time and attention. They may out of some misguided attempt at political correctness they may not condemn it in harsh terms, but they certainly don't think anything of it. There's only about four to five percent of practitioners who are really enamored of and dedicated – really on ideological and philosophical grounds – to these spiritual, new-age or anti-scientific or unscientific modalities, and they're the ones who are making all the noise. And they're trying to make it sound like there's a revolution going on inside medicine. It's really a false revolution, but the media is buying it, and they're selling this fiction to the public.
P: Why? What is the allure of the media? What attracts them to it so powerfully?
WS: "Man bites dog". Dog bites man is not news. Man bites dog is news. It's the unusual happening instead of the usual happening.
WS: That's what makes news.
S: It's a little also counter-culture and anti-establishment.
WS: I wish I had begun to tabulate the number of reporters I've talked to over the past ten or twenty years, who admitted to me that they thought that this whole thing was bunk, and yet wrote up their articles as if there's really something there.
WS: And I wish I could have just tabulated the number, because it just from my memory it's about ninety, ninety-five percent of them.
S: Yeah, that's my experience, too, although I will have to say that reporters I think tell you what they think you want to hear as a method of opening you up.
WS: That's true.
S: I don't know if that really reflects their views, or if they're just buttering us up, because they know they're interviewing "the skeptic." So "Oh, yeah, yeah, I'm skeptical, too." so, "Let me hear it, tell me what you really think."
WS: That's true.
S: I agree that in general I think I can get a sense when people are BSing me, or if they're genuinely skeptical. If they could really talk the talk. And I've had that experience, too, where you deal with either a producer or a reporter or whatever who appears to be by all accounts fairly skeptical, but they produce a credulous piece. It's usually out of naivety, just unfamiliarity with the topic at hand or because they believe that they're dealing with a "fluff piece", and therefore they don't have to.
P: But I'm sure there are a large number of people who author articles that they don't believe in just because they think ...
P: ... they look good in print that it'll please their editors ...
E: That's their job.
P: ... et cetera, et cetera. Right. It's their job. I believe that, a lot of them.
S: Right. Absolutely. My curiosity is: will the public acceptance of the presence of alternative medicine rise to the point where it will no longer be sensational, or will in fact we run through the cycle where the press will be interested in doing stories about the evils of alternative medicine? I don't know if that cycle is going to occur, but I'm watching and waiting to see if it does.
B: Steve, it will take a slew of deaths related to alternative medicine that might turn people against it.
S: Only celebrity deaths will help.
E: Like the baseball player that died.
S: You have to kill off famous people, otherwise the public won't care.
E: That baseball player that died, what was it, one year ago or two years ago. Ephedrin?
S: Of ephedra.
S: Definitely it was helpful. Although – and the FDA – this was the one and only "supplement" that the FDA was able to ban under the ridiculous dietary supplement and health education act of 1994. And in fact there are already calls to have that reversed because the industry is claiming that the FDA, even though it took them six years to compile the evidence that ephedra was unhealthy, was too risky to be marketed, the industry is now claiming that they didn't make their case. Again, they're using the dose issue, that the ...
S: ... marketing at a lower dose could potentially be safe.
P: Didn't Peter – sorry, Steve, I didn't mean to interrupt you.
S: Go ahead.
S: Hm, hm.
P: That didn't help them very much.
WS: They also went for laetrile.
P: Oh, really.
WS: Andy Kauffman did. Steve McQueen.
WS: Yeah. Down to the border clinics across the border in Mexico. Yeah.
S: And Peter Sellers had chelation therapy, in addition to the psychic surgery.
P: Oh, he did.
WS: That's right. That's right. Now I remember.
Chelation Therapy (42:50)
S: Chelation therapy, again, it's a legitimate treatment for heavy-metal poisoning, but there is a small subset of dedicated practitioners who are using it to treat – prevent heart attacks and strokes. Decades of evidence has shown that it doesn't work, and any putative mechanism by which it might work has been proven to be wrong. Again, really within ethical, scientific medicine, it's use for vascular diseases has been discarded. There are just some people who will not be persuaded by the evidence.
WS: Right. And there's a side issue here which is most important, and very difficult to gather data on this, but the doctors who use chelation are obviously – I think you have to invent a new term for it, and I call it intellectually with specific intellectual deficit. Intellectually deficient in specific areas. In other words they can function very well maintaining their bank accounts and even repair their cars and may even write glorious novels, but when it comes to this one specific area of chelation for cardiovascular disease, they completely lose their heads.
WS: These people are dangerous, and chelation has been a major reason for physicians having their licenses revoked or suspended ...
S: Hm, hm.
WS: ... over the past thirty, forty years. These are bad doctors.
WS: The best way the boards could catch them was to catch them giving chelation. Now, unfortunately, there've been some movements in the legal field which have defanged the boards, taken away their ability to prosecute these physicians on the basis of this one action.
S: Hm, hm.
WS: And these chelationists, it's practically all they do, so you can't catch them doing other things. You have to catch them ...
WS: ... from some patient who's died or had a bad complication. The problem is they give so little of the stuff that it can't possibly work, and it doesn't produce any side effects or toxicity in the highly dilute form that's given. So they get off doing it, and the quirks in the law and the quirks in the board policies that have been recently changed are responsible for its continuation, actually.
S: Right. Now ...
WS: The Doctors, the whole system has been changed around chelation therapy.
S: That's right. What you are basically talking about is a class of laws called the "health care freedom" laws, basically, and these kinds of things are regulated on a state by state basis. Each state has their own department of health or their health board that regulates licensing health care professionals and physicians and also disciplining them. And, traditionally, a state health board can discipline or even remove the license of a physician if they were practicing sub-standard medical care. The burden of proof was on the state, but if the state could prove through appropriate use of expert witnesses and evidence, et cetera, that a physician was practicing bad medicine, what we call sub-standard care, they could be disciplined. They could have their license taken away. This is a measure of protecting the public from fraudulent or just bad doctors, who are practicing bad medicine. Well, in the legal and cultural milieu that we find ourselves now, under the banner of "health care freedom", a number of states have passed health care freedom laws, which specifically state – there's different formulations, but the bottom line is that any practitioner who is practicing "alternative medicine", which is kind of an artificial category, but something similar to "complementary, alternative medicine" can not be disciplined for practicing sub-standard care. In other words, they are not held to any standard of care.
E: Freedom to commit fraud, basically.
S: Yes, absolutely. The state of Florida has this law – I was involved recently a couple of years ago in a case where there was a neurologist who was practising fraudulent, horribly bad medicine, and it's clear, to me, that he just made up his treatment, just designed to make money out of patients. We proved to a legal certainty, the judge decided that he was indeed practising sub-standard care, but then he appealed on the basis that what he was doing was alternative, and under the Florida statute got off scott-free, and is now free to commit quackery and fraud against patients because of this law. And this whole movement is very closely tied to the whole chelation therapy movement, the freedom for these doctors to prescribe their chelation therapy.
WS: Right. It is an aspect of this changing paradigm. That concept actually developed in the late nineteen-seventies that predicted the paradigm would change, so that all of these things would then become appropriate therapies has changed, but it's only changed within certain segments, including the legal part of societies. It certainly hasn't changed science, at all.
WS: Because, as you said before.
WS: But it has changed the practicalities of it, the practices, and some of the public perception.
S: Right. So what there is, is an increasing disparity, and increasing disconnect between science, what scientists and scientific practitioners believe and do, and what the law states the regulation of medicine and also what the public thinks is really going on.
S: A broadening gap between science and the public is always, always a bad thing. In this arena, we're talking about direct health effects, not some abstract, down-the-road danger of believing in silliness, but some decisions that are made directly and have an immediate impact on people's health. Sometimes even to the point of premature death. We see that all the time, certainly.
WS: Yup. Another aspect to this has been what I don't think the public has any recognition of this or realization of it, and very few people in the field of medicine recognize what's going on either is that when the claim is made that increasing numbers of people are going for alternative medicine, and it's being more and more accepted, the reaction of physicians is to say "What are we doing wrong?" ...
WS: ... number one, and number two is to come to an accomodation with it. Instead of opposing it, they say: well, we've done something wrong, it's our fault, and so what can we do? We must get along with the patients who believe in this ...
S: Hm, hm.
WS: ... and want to do it, and we must help them, and the interests of their lives and their happiness ...
WS: ... regardless of how we feel about it, and regardless of our consciences and what our rationality tells us. And you get the same reaction in medical literature among medical editors and journals. An article, for instance, that opposes, that presents information opposing the use of these unscientific methods will usually be rejected. There are very few articles in the literature that have been accepted that propose that physicians reject them as a group or as individuals or that try to work with a patient to discourage them from using these things.
S: Hm, hm.
WS: That fascinates me.
WS: Fascinates me greatly, as as matter of fact.
S: It's become politically incorrect.
S: Which is the enemy of reason, rationality, and science, and basically you're saying that you have some ideology or political concern which trumps evidence, reason, logic, and science. And, again, it has immediate and very severe detrimental effect on the public health.
P: To my lay mind the thing that would seem to have the most profound negative impact on these alternative modalities is simply their lack of efficacy, right? If it doesn't work, who's going to use it? Or more to the point, who's going to pay for it? And yet it doesn't seem to have any impact at all, and I guess that's because ...
B: Human psychology.
P: ... of placebo, self-limiting disease, and the fact that they're often taking these alternative modalities along with evidence-based medicine, I think.
WS: Well, that's interesting, because the perception of the patient shifts, but it starts out with this usually deluded or self-deluded recognition that I'm doing this for my cancer, say of the prostate, and I seem to be doing very well (I just got radiation of course, and my PSA level is going down), but I'm on all these supplements, and I intend to stay on the supplements because I want to cover all bases. And eventually I get to believe my PSA keeps going down, it must be the supplements. That's what I'm doing. This is very powerful. And then when the PSA starts to rise again, well the reason must be that I'm taking the wrong supplements, so I'll change. Or I'm not taking enough of it, or I skip too many doses. And that kind of rationalization comes in. The socking in of belief, the power of that belief, is such that people don't make the right decision. They don't make rational decisions ...
S: Hm, hm.
WS: ... based on what they truly have observed. They make the decision based on what they think they would want to have happened.
WS: And what they want to have happened.
WS: And the psychologists have studied this phenomenon for many years, and that's why Steve and I are enthralled with psychology brethren ...
WS: ... who have laid these things out. And there's book after book that there must be five or ten at least well-written textbooks on this matter that are taught in advanced and upper-division psychology classes, and that we use all the time in our teaching. The psychologists have figure all this stuff out. But even though you can deal with it intellectually, individual patients, when they are faced with these personal problems, fail to recognize that what they even may have learned through a textbook and through a course and lecture, they fail to be able to apply it to themselves.
S: Right. The bottom line is, and again this is well, well described and very thoroughly understood, is that there is always an almost complete disconnect between what patients, what the public perceives and what's really going on in terms of their illness or their response to treatment. There's a host of psychological mechanisms at work that overwhelm any perception of reality. Scientists know this. We all know this. That's why you need to do carefully designed studies. Studies, when a study is "carefully designed", what that means is it is designed to eliminate the effect of all of these biases that we know are there. Anecdotal evidence, the reason why anecdotal evidence is pejorative, is because it's not controlling for all of this variety, this host of psychological and biasing factors. Anecdotal evidence is worse than worthless, because it tends to lead one to conclusions they wish to be true. It has almost no relationship to the actual truth. And that's really a critical point of understanding between our position, the scientific and rational position, and alternative medicine proponents, is they just don't get that. They don't want to get that. They're happy to rely on anecdotal evidence because you can prove anything with it, because, again, it leads you happily to whatever conclusions you wish to be true.
WS: That's so right.
S: It's critical for us to make that point to the public, that the fact that something seem to work is meaningless. It's absolutely meaningless. I can't tell you how many times people come to me – and we hear this, too, in all areas of skepticism, "Well how do you explain this? A friend of mine had this disease and he took this bizarre treatment, and he got better. How do you explain that?" Well, that's anecdotal; it can't be explained. But it's worthless as evidence. It just runs totally contrary to basic human psychology, I guess.
B: And Steve, don't forget, and I'm sure you didn't forget, but also it's worth pointing out that science-based medicine also helps prevent biases on the part not only of the patient but of the experimenter, the scientists themselves.
S: Right. Absolutely. Everyone involved needs to be – there needs to be precautions taken against bias. The observer, the person conducting the trial, the subject, and the analysis of the data at the back end. Any time there is a potential for bias to get into the final analysis of the data, it will be there, so you have to design it in such a way either that it can't influence the results or are averaged out over large numbers of subjects.
WS: We want to both praise the doing of appropriate randomized clinical trials, while at the same time try to point out the defects.
S: Hm, hm.
WS: The things they can't really cover, at least not yet been designed to cover.
WS: But we think that's correctable.
WS: I'm convinced that bringing in, as you've said, prior probability, which we haven't talked about much, ...
WS: ... but that can actually be factored in quantitatively as a choice of numbers ...
S: Hm, hm.
WS: ... and plausibility, and factor in considerations for the possibility of fabrication and fraud. We have a list of things to look for that simply haven't been incorporated yet.
WS: We're all for evidenced-based medicine or for sure tightening it up and recognizing its limitations, as well.
S: Absolutely. In fact, again, scientist practitioners consider prior plausibility on a day-to-day basis.
S: We know biology. We know how things work, basically. We know the limitations on our knowledge of how things work, and whenever a new treatment comes down the pike, the instinct of the scientists or the clinician is to think "How could that work?" Does that make any sense given everything else that we think we know about biology and medicine. That's the consilience of medicine. And I think that would solve the problem to a large degree if any claim to knowledge has to be accounted for within the framework of everything that's already been established to whatever degree it has been established. You can't take some new idea in an absolute vacuum as if we don't know anything.
WS: Sure. As a matter of fact it comes into play the moment you start to make up a clinical trial or apply for a grant.
WS: Because you can't make up a study of intestinal flu in ants ...
S: Hm, hm.
WS: ... and try apply it to humans.
WS: What on earth are you talking about?
WS: Because there is no plausibility there. So it's actually done repeatedly. The problem in alternative medicine is that almost all claims in humans are now plausibile. That's the problem.
S: Right. They want to change the rules. They want to change the rules.
WS: They are changing them, that's right. They are changing the rules.
S: Plausibility is equated to closed mindedness.
S: They dismiss all of it. You make any kind of assessment of prior probability or plausibility, they interpret that as being close-minded and dismissive.
WS: Exactly. It's up to us to make the case to bring it in in a convincing way.
S: Well, it's an uphill battle.
WS: It sure is.
S: We'll keep plugging away. Well I hate to say this but our time once again is up. It always goes by so quickly. Dr. Sampson, again, we appreciate having you on the Skeptic's Guide. Thanks for joining us.
B: Thank you.
WS: It was my pleasure. I appreciate the opportunity.
S: Great! I hope to have you back again in the future. We just barely scratched the surface. There's so much more.
E: There's so much. Yeah.
S: Perry, Evan, Bob – thanks again for joining me.
E: Thanks, Steve.
S: Until next week, this is your Skeptics' Guide to the Universe.
S: The Skeptics' Guide to the Universe is a production of the New England Skeptical Society. For information about this and other episodes, visit our website at www.theness.com. 'Theorem' is produced by Kineto and is used with permission.