Monday, May 4, 2009

CAM, Anti-Vax loons and the Morons at Merck

I am more than a little pissed after reading this post, which I found through Greg Laden. I am pissed because I have become increasingly involved with fighting non-evidence based medicine, mostly with people around me. I don't really write about it much, though I have begun thinking that I should. I haven't really felt the need to, because there are a lot of great medical bloggers out there who do such a fantastic job of it - several of whom are linked in my sidebar. In particular, Orac, PalMD, Mark Hoofnagle and the great people at Science Based Medicine do one hell of a job tearing down the veneer of crap and exposing it for what it is.

Here's the issue I have. I'm a reasonably intelligent person, a bit above average even. Yet I am also what I like to call, pathologically credulous. I have fallen into remarkable amounts of magical thinking over the years and not because I'm dumb. In fact part of it is because I tend not to assume that something is true, just because everyone else says it is. And my relationship with non-evidence based "medicine" was largely grounded in the idea that evidence based medicine is largely profit based and therefore largely corrupt. What wasn't so apparent to me at the time, was that a lot of the bullshit that I was falling into was just as profit based and much of it was even more corrupt - though much of the corruption was a very different sort. I also fell into a lot of the bullshit because many of the claims were made by people who also made claims that were easily verifiable - they fostered my trust and I believed what they had to say about things that weren't so easily verifiable.

And that is the key to sucking people into so called alternative medicine. Efficacy by association. Throwing plant medicines that actually have some degree of efficacy (largely because many pharmaceuticals are derived from plant sources) into the mix, even though this can actually be quite dangerous in some cases (a whole post of its own sometime). Throwing legitimate medical treatments in, but using them for things they simply aren't called for - such as chelation therapy. It makes it easier to sell people on flat out bullshit. Things like osteopathy, homeopathy and energy medicine - things that are not only not supported by evidence, but which are flat out absurd on their face. Things that are based on nothing more than magical thinking.

It's bad enough that some of these "medicines" can be dangerous in and of themselves - either because the actual treatment is harmful, or more often, because the treatment is used in place of evidence based medicine. But it doesn't stop there. There is a very dark side to this, with insane and deadly notions like HIV/AIDS denialism, denial of the germ theory of disease, the anti-vaccine movement and anti-chemotherapy proponents. People actually die because of this complete and utter bullshit.

Another reason it is easy for some people to fall into magical thinking in regards to medicine, is because of the perception that evidence based medicine is mostly based on therapies developed by corrupt pharmaceutical companies. Most people don't start out believing that, but I think that most people do recognize that pharmaceutical companies and for that matter, medical science in general, is not immune to corruption. And I think that most people recognize that sometimes that corruption includes maliciously covering evidence that companies wish to avoid becoming public. This makes it rather easy for some people to buy the CAM line that critics of CAM and even fringe CAM ideas, are simply shills for Big Pharma - an evil bogyman that's out to addict people to their medicines and cast them aside when they've been poisoned by them. From there it isn't much of a trek to believing that all evidence based medicine is evile and that doctors are merely merchants of death, the death manufactured by Big Pharma.

This is why I am so very angry at Merck and the doctors that contributed to their advertising rag, disguised as a legitimate science journal*. The doctor involved should should face sanctions. And Merck should be fined heavily by the FDA. Things that would happen, if we lived in a reasonable world, in a reasonable country with reasonable oversight. There is something very wrong with a system where this can happen and the people involved don't even understand that they did something wrong. This is absolutely and categorically disgusting and unconscionable.

But the idea that this somehow validates the proponents of woo, the peddlers of magical thinking in the guise of medicine, is a logical fallacy and a rather obvious one - if not also one that is easy to accept. Just because another pharmaceutical company and some doctors were really damned stupid and highly unethical, does not mean that all of science based medicine is. And there are several doctors and scientists out there who would like to make sure you know that this is not the mainstream of science based medicine. Some of them have even written about this....

Respectful Insolence

Adventures in Ethics and Science

Dr. Isis

Stranger Fruit

Greg Laden

*I would also note that I am more disappointed in Elsevier for publishing this bullshit, than I am with Merck and the people involved from their end. That they would choose to put out this kind of garbage reflects poorly on them and while it may be a while yet before I am publishing papers, this will certainly reflect on my decisions about where to publish.


LostMarbles said...

I think another important thing to remember is that to many people science based medicine is pretty much as magical as alternative medicine. This isn't because these people are not intelligent. I think it's a product of people not being expected to understand how and why mainstream medicine accepts a treatment or diagnostic as useful.

As for the Merck bullshit, way to shit up the reputation of all the useful treatments you've produced with ethically corrupt practises.

DuWayne Brayton said...

LM -

Oh, I think that's important too. I am actually getting set to write a post about the arationality of many creationists and religious thinking in general. Something that I think is important to keep in mind with that discussion is that most people - even those who accept evolution, don't have the foggiest clue how it all works. And yes, the same is true of evidence based medicine...

Juniper Shoemaker said...

As I've said to you before, I'd describe myself as "(nigh on) pathologically credulous," too. Learining to shed the authoritarian morality that shamed me for my curiosity (about everything) and act on it instead has been quite a process. Naturally, it is far from over.

My authoritarian moral code gave authority to magical thinking over skepticism. I never want to live that way again. It seriously harms people, especially when it determines their choices regarding pharmaceuticals and drugs.

"Alternative medicine" has a tremendous foothold in CA. When my mother was diagnosed with stage 2B breast cancer, many people of varying professions rushed to offer her magic "mushroom shakes", acupuncture and "herbs and vitamins". Meanwhile, she was treated at UCLA, at which world-class oncologists reside, and yet at which alternative medicine is treated with too much respect for comfort. At least they didn't have the gall to suggest alternative remedies in place of the chemo that saved her life.