Science based medicine and quack medicine

 The CAM (complimentary and alternative medicine) industry lobbies in Washington and congress considers what it has to say. Most CAM products are scientifically unproven. My guess is that nearly all of the reported benefits arise from placebo effects. 

A couple of weeks ago, a science based medicine expert, Steven Novella, attended roundtable discussion a US senate healthcare committee held to consider what to do, if anything. Novella, a practicing neurologist, is a well-known skeptic of pseudo science, psi research and CAM. A new sales propaganda pitch to congress is to rebrand CAM as "integrative" medicine to make it sound like science-based medicine. 

Marketing propaganda

At Science Based Medicine Novella comments about that meeting:

Alternative, No – Complementary, No – Integrative

CAM proponents use a lot of bait-and-switch or what David Gorski has dubbed “Trojan Horse” strategies to push their treatments. Interestingly, it’s mostly the same exact treatments that have been around for 50 years or more.  When we talk of CAM we are still mostly referring to homeopathy, acupuncture, chiropractic manipulation, energy medicine, and herbal medicine. There are branding tweaks, or new versions of these things, but the core concepts are the same. It doesn’t matter if you call them alternative, complementary, or integrative. It’s the same stuff.

The evolution of the branding, however, is to reassure those who care about things such as the standard of care in medicine that they will not be replacing proven therapies, and are offered in addition to them. First, this is never entirely true. If a CAM method is being placed somewhere in the hierarchy of treatments, then it is displacing or delaying non-CAM therapies. Also, health care is often resource limited. If a patient is availing themselves of acupuncture, that is using up their limited resources of time and health-care dollars.

 

Further, the very concept of “integrative” medicine is flawed to its core. What, exactly, are they integrating into what? Try to answer this question without just referring to euphemisms – no alternative or complementary methods, traditional, non-mainstream, etc. None of these really work, nor can they be operationally defined. If, for example, you define it as integrating non-mainstream methods into mainstream medicine, that provokes the question of why they are non-mainstream in the first place.

All of this rhetorical dancing is to avoid the obvious answer – integrative medicine is all about creating a double standard (legally, academically, professionally) so that treatments and methods that are below the line of scientific medicine can be integrated with those that are above the line. That’s it, and the laws that are pushed to promote CAM explicitly carve out this double standard.

Integrative medicine is preventive medicine/health promotion

This is the most annoying aspect of the CAM propaganda – the retconning* CAM into preventive medicine. This is nothing short of gaslighting. The first piece of this strategy is to slander mainstream medicine by saying it is not about disease prevention, only disease intervention.

None of the CAM modalities I listed above have any preventive value (or arguably, any value).

But this line is rhetorically very powerful. If they can slip in this equivalency, then they have already won. To further support this approach CAM proponents are very liberal in defining what is CAM. They would love to include all nutrition and exercise – but again, this is anti-historical gaslighting.  

Appeal to anecdote**

I almost always hear the phrase, “I have seen it work in my practice” from CAM proponents justifying their non-science based interventions. Of course, this is anecdotal, it means close to nothing. Anecdotal evidence leads us to the conclusions we want to be true (quoting Barry Beyerstein), not the truth. Legions of patients swore by all kinds of nonsensical treatments throughout history, that we now know to be nothing but snake oil.  

The appeal to anecdote can also sometime be camouflaged with euphemisms. We see this treatment working individually, even if it cannot be demonstrated with group level data. Translation – this treatment does not work when studied scientifically, so I am going to refer to anecdotes instead.

* Retcon (retroactive continuity): changing an existing fictional narrative by introducing new information that recontextualizes previously established events, characters, etc.; a literary or rhetorical device or propaganda where asserted facts in a fictional narrative, e.g., a sales pitch, or work are adjusted, ignored, supplemented, or contradicted by a subsequently published work which recontextualizes or breaks continuity with the former; a form of gaslighting

** Appeal too anecdote (argument from anecdote): an informal logic fallacy, where anecdotal evidence is presented as an argument without other contributory evidence or reasoning. This type of argument is considered as an informal logical fallacy as it is unpersuasive – since the anecdote could be made up, misconstrued or be a statistical outlier which is insignificant when further evidence is considered

More marketing propaganda