Reading Wednesday 4/09

[liv]

Recently read: siderea made a post covering a topic I've been trying to articulate for a while, science fanboys who get all militant in the public sphere about the superior scientific virtue of modern, allopathic medicine over its supposed enemies of woo and superstition.

The focus of the post isn't quite where I would have put it. I don't think the main problem is putting medicine on a pedestal, exactly. And the connected post about pedestalization of teachers and school-based, institutional education I don't agree with nearly so much. But I do very heartily agree that there's a massive problem with rhetoric around science-based medicine. (We usually say "evidence-based medicine" this side of the pond.) Yes, actual medicine which has been rigorously proved to be effective is a thoroughly good idea, and yes, people selling woo and claiming that it's "alternative" medicine do a lot of harm. But there are also real problems in medicine and medical research, some due to error and some due to bias and abuse of power, and both of those classes of problems can be both systematic and individual.

(I would also add that it does a disservice to science to equate "scientific" with, always right and never to be questioned by non-experts. Because that's the opposite of science, that's dogma. The whole point of science is that you change your models in the light of new evidence, and empirical reality, not people who wield authority, is the arbiter of truth.)

Currently reading: Declare by Tim Powers. I'm about 2/3 of the way through, and it's suddenly switched viewpoint from a made-up protagonist to, er, Kim Philby who was an actual historical person. It's also gradually committed to unambiguously being set in a world where the supernatural is real and important in international affairs. I really like the portrayal of djinns, and the setting of a meta Great Game between humanity and the spirit world intertwined with the Cold War between different factions of humans. But it's a bit weird to have a real person as a viewpoint character in this AU. (I didn't mind when Philby was a minor character alongside TE Lawrence and Harold Macmillan.)

Up next: Not sure in terms of fiction, but definitely lots of course-related texts.

Comments

[lilysea]

Yes, actual medicine which has been rigorously proved to be effective is a thoroughly good idea, and yes, people selling woo and claiming that it's "alternative" medicine do a lot of harm. But there are also real problems in medicine and medical research, some due to error and some due to bias and abuse of power, and both of those classes of problems can be both systematic and individual.

One thing that comes to mind is cannabis for children with treatment-resistant epilepsy.

Lots of anecdata that it has helped a lot of people who weren't adequately helped by prescription anti-seizure meds,

but a lack of medical research into it due to legal issues.

Hopefully now that cannabis is being legalised research into its medical applications will ramp up.

[liv]

This is an instance of where the War on Drugs makes a lot of the things that are already problematic about the culture and practice of medicine substantially worse. It's really hard to research medical cannabis, it's really hard to prescribe medical cannabis, because of moral panic about Drugs. There have been high profile cases in the UK recently where children with epilepsy were denied cannabis based treatment that they need to avoid constant seizures, even though everybody involved agrees that it is perfectly legal to prescribe cannabis in this obviously medical situation. Not to mention that people like Prof Nutt being hounded out of their jobs for even researching drugs. And of course the damned War on Drugs was conceived as a racist project and continues to be racist in its application and just, argh.

[melannen]

Hmm. On the one hand, I agree with nearly every specific in siderea's post.

On the other hand, I don't like that she's dropping the problem on "skeptics". Maybe it's that my exposure to skeptics is largely through very carefully selected podcasts (because skepticism, like any movement, has its problem people and ideologies, and some of them are very loud), but most skeptics that I expose myself to are critical of establishment medicine as well as alternative. (In fact, one of my favorite skeptical podcasts has spent a significant amount of time in the past few years systematically criticizing organized skepticism for bad science, including not infrequently themselves.)

And often what skeptics are critical of in alternative medicine is the rhetoric siderea is criticizing in the post - the use of "science" as a defense for things that are not science, because a lot of the goop and anti-vaxxer crowd are saying "because SCIENCE!" just as loudly as the allopathic crowd - and most working skeptics will reply "if you said this works because magic, that's not our field, but you're saying it works because it does science-y things and you have research confirming that, which means we can criticize it on a scientific level."

Even the Flat Earthers, in general, aren't saying the Earth is flat because of magic; they're saying the Earth is flat because they have scientific proof thereof.

So I don't think the problem here is skeptics, or with pro-science vs. anti-science people; the problem is, as with many things, general poor communication around science and teaching of science in all communities (including, yes, the community of professional scientists, many of whom aren't as aware of things like basic philosophy of science and the nitty-gritty of statistics as organized skeptics are) and the fact that the loudmouth people who oversimplify are the ones who are easiest to quote in the press.

[(Anonymous)]

Anecdotally, most of the "look at me, I'm a skeptic, me" skepticism I see about medicine is really transphobia.

Naturally there are network effects involved in why that's my specific experience, but there have definitely been Movement Skeptics involved. Sooner or later, freedom of association vs no true scotsman gets pretty uncomfortable and you have to work out what you're doing to stop someone co-opting your movement on bigger platforms.

[melannen]

Oh, yes, definitely. And there's also a large element of "we have proof women are inferior" people saying "look at me, I'm a skeptic". And so many varieties of racists!

And the skeptics' movement in the US and UK has had an ongoing and loud problem with gender stuff especially, which they are working on but haven't solved any more than anyone else has (which is probably not also a loud race problem only because they are overwhelmingly White.) (This is largely why my only contact with them *is* through carefully selected podcasts.)

But lower-case skeptic doesn't belong to any organized movement, and people using the term (both in and outside the movement) are at least as likely to be pushing against the scientific establishment as for it - for example the most visible use of the term right now, "climate skeptics", who are yet another group misusing "scientific evidence" to push a harmful and counterfactual belief system. So using "skeptic" to mean "defenders of the scientific establishment" just doesn't clock either way, when it almost always means either "person outside the scientific mainstream trying to misuse science" or "person trying to reform it from within."

[liv]

There are certainly a lot of people lying about calling themselves skeptics who are in fact reactionaries and entirely anti-science, yeah. There are also lots of real skeptics who in fact do apply their skepticism to the scientific / medical establishment, and good for them. But there are also some people who claim to be skeptics, and are genuinely pro-science, but are pro-science in a pedestalizing and uncritical way. Those people might be open to being convinced that 'mainstream medicine is always right' is not an effective skeptical position to be taking.

[liv]

Yup. Transphobia is a specific problem with the capital-S Skeptic movement. Some of the specific proponents of U.K. skepticism in the noughties are implicated in the spread of transphobic thinking into the mainstream media in this country. I take the charitable view that the Skeptic movement had poor defences against entryism by trans-hating fascists, rather than that the movement was originally a fascist wedge project. And goodness knows there are a lot of organizations fascists have managed to infiltrate, from the Conservative party to the online gaming community, so it's not that organized Skeptics are uniquely awful, but there exists this weird correlation between ranting about homoeopathy and hating trans people and wanting to reestablish superior white culture under a strong authoritarian leader. (I don't think your experience is only bias due to a network effect, in other words.)

[liv]

What I took from siderea's post is not so much that the Skeptic movement is bad because members of it do this, but that if someone wishes to identify as a skeptic they should probably not do this.

You're right that there is a problem with woo-peddlars claiming their nonsense is based on science. And I don't think the issue here is pro-science people in general, it's the tendency of some people who identify as being pro-science but don't really understand the scientific method to use bad rhetoric. Science fanboys is Siderea's term, and I can immediately picture the sort of people she means by that.

I couldn't agree more that society as a whole needs better scientific and statistical literacy. Accepting anti-scientific (or para-scientific) constructions like antivax or homoeopathy is really harmful, we're presumed to be all in agreement about that. But taking a pro-science view that assumes mainstream medicine is always ideal and scientific and above criticism is also a problem.

[siderea]

We usually say "evidence-based medicine" this side of the pond.

I made a very deliberate decision not to use the expression "evidence-based medicine" because that actually means something else. It is simultaneously both vaguer and more specific than describing medicine as science-based.

I hope to write a thing at some point explaining that "evidence-based medicine" and "evidence-based practice" do not mean "evidence" "based" "medicine" or "practice". They function more like brand names, and they are political footballs - when you have official registries of "evidence-based practices" (which we do - in mental health, SAMHA had one and IIRC the APA had another), what evidence gets to count as "evidence", how much does it need to have, and whose products get included in the registry?

Part of the reason for the use of "evidence" is to weaken the standard from, say, "substantiated by an experimental test of efficacy". But at the same time, other parties are trying to push the throttle in the other direction.

And then there's other problems with what flies under the banner of "evidence-based practice" and omg I am going to stop myself before I write the whole post right here.

ETA: And if I could get everyone to understand one thing about healthcare it's that the expression "evidence-based medicine" does not mean what you think it does.

[liv]

Noted, and I look forward to your post explaining what's wrong with the evidence-based medicine label. I have mainly encountered the term in the context of explicitly teaching medical students how to understand and critically engage with research evidence, so I don't strongly associate it with making an exclusive list of treatments that count as "EBM".

I don't really like the term "allopathic" as I think it cedes rhetorical ground to the homoeopaths and woo merchants. But I'm happy to stick with contrasting "science-based medicine" to "alternative medicine".

[graydon2]

Re Declare: I kinda liked it! But Kim Philby is an extra special weird person: a real human named after a fictional spy character in a Rudyard Kipling novel who then grew up to be one of the actual highest ranking British spies but was also an honest to god double agent for the KGB the whole time, and who was eventually accused, then exonorated, reinstated, escaped to the Soviet Union, wrote his life up as a detailed autobiography about his lifelong double cross while living under house arrest in his retirement in Moscow, and who is subsequently the model for basically all double agents in fiction. I feel like his treatment in Declare is quite appropriately convoluted.

[liv]

Yeah, it's quite clear that the inspiration for the book is the ways that the historical Kim Philby was too weird to be a fictional character! Thanks for this summary, I'm wondering if I should in fact read his autobiography.

[finding_helena]

There's definitely shady stuff in science and medicine, but there's a lot of shady stuff and misunderstandings of science in the alternative stuff too.