The Enemies of Reason, part 2: The Irrational Health Service (with a review)

I must say, having watched both parts of this, that I'm truly amazed by how nice and patient the legendarily fire-breathing atheist is with these nutjobs. If it were me, I honestly don't think I could repress a massive outburst of ridicule (at the very least).

I'm only sorry that he didn't mention Andrew Wakefield by name and use some of Brian Deer's work describing how Wakefield had serious conflicts of interest or point out the testimony at the Autism Omnibus hearings that showed just how shoddy and sloppy the science and laboratory techniques used by Wakefield were. The addition of such information would have helped to show just how irrational the MMR scare was and how orchestrated. Maybe it's those British libel laws that are so favorable to the plaintiff, the same ones taken advantage of by David Irving when he sued Deborah Lipstadt, that held the tongue of even Richard Dawkins.

I think the above requires some comments to avoid the possibility of misunderstanding by readers without the necessary background information.

Firstly although Irvin did indeed sue Lipstadt under the English libel laws he in fact lost the case hands down and the court and legal costs he had to pay as a result bankrupted him.

Secondly as Wakefield is himself the subject of legal proceedings (about which the ever admirable Orac has already reported) Dawkins probably did not mention him by name for fear of breeching the English sub judice regulations.

I have watched both parts of "Enemies of Reason" and my respect and admiration for Dawkins are continue to grow. I agree that America needs a big dose of Dawkins's wake-up calls in order to have a real effect fighting ignorance of the average American. Maybe showing Dawkins program as part of science class in high schools around the country could achieve what PBS and the main networks won't.

Thanks for the link. I got slashdotted this morning, too, so hopefully my server won't melt. :-/

All in all, I agree with your evaluation. I envy Dawkins for his patience displayed in that Chopra interview!

Firstly although Irvin did indeed sue Lipstadt under the English libel laws he in fact lost the case hands down and the court and legal costs he had to pay as a result bankrupted him.

I'm well aware of the outcome of the David Irving case and linked to a website that tells the story My point was that, even though Irving ultimately lost bigtime, while suing Lipstadt, he nonetheless managed to waste two years of her life plus over a million dollars in legal fees spent by her book company and donors to her legal fund to pay for her defense.

The best part was hearing Chopra claim that the reason his use of the term "quantum" is so different than the way physicists use it is because physicists had hijacked the term "quantum"! (How dare they...)

Revealed: Hillary Clinton is Deepak's "follower".

Let's see, that's psychics, channelling, bio-electric shields, "energy" healing, and Deepak's quantum woo - that we know about. (Don't forget Bill's obsessions as well.)

Yep, she's perfectly qualified to "lead" the nation.

But can you lead and follow at the same time?

And, if she's following, who's really leading?

Laugh at DC, etc., all you want - woo's got this country's nuts in a vice.

"Firstly although Irvin did indeed sue Lipstadt under the English libel laws he in fact lost the case hands down and the court and legal costs he had to pay as a result bankrupted him. "

True, but I often wonder whether he might have won if she hadn't been able to prove he taught his daughter a song which went: "I am a baby Aryan / Not Jewish or sectarian / I have no plans to marry an / Ape or Rastafarian". That sort of thing sways juries far more than mountains of evidence directly relating to the "libel" itself.

Actually, there was no jury for the Lipstadt trial. As I recall, it was decided by a single judge.

You'll love this:

Fame homeopathy seized

Doh, "Fake" not "Fame".

Thanks for the links to this program. Excellent doco.

Some of the nonsense is almost painful to watch. Don't know how Dawkins managed to keep a straight face when his DNA was being "topped up". I was in serious danger of an hysterical laughter induced hernia.

I do wish Dawkins had chosen someone besides Michael Fitzpatrick from (so-called) Sense About Science to talk to about the MMR issue (or frankly any other issue).

As to the Irvin libel case, there was a stunning moment in the trial when he inadvertently referred to the judge as "Mein Fuhrer", before immediately correcting himself.

Then there is fake homeopathy. But I repeat myself.

Actually Dawkins does alot to bolster the historic superiority of relying on religion rather than medicine for health problems. What is deemed to be alternative medicine or woo today was the conventional medicine of 100 years ago. Relying on soley on prayer meant that one did not receive a medical treatment that was either ineffective or outright harmful and therefore was a much more rational choice than going to a physician.

That's why homeopathy seemed to work--200 years ago. Doing nothing back then was frequently better than the bleedings, treatments with arsenic or antimony, etc., particularly for self-limited diseases.

Dawkins is ... like a god to me :)

Ditto about Dawkins' patience and understanding. I've seen atheistic fire-breathers, but how did he get labeled as one?

This is just a nit, but I was a bit puzzled by the early pairing of narration about 'unproven therapies' with images of people working out in a gym and lifting weights. I've found exercise and strength training to be (for me) the only sustainable method for managing chronic pain - medications turned out rather badly. But perhaps that was an unintentional editing foible.

Could we lock all the presidential candidates in a room - and heck, all of Congress too - and make them watch the video?

I liked both parts of the documentary alot, but I felt that he was a little unfair in this treatment of the historical efficacy of outdated medicine systems (when he was saying that Ayurvedic medicine isn't automatically good just because it's centuries old). It's a good and important point to make, but by ignoring the kind of obvious fact that these ancient practices *did* occasionally manage to stumble upon herbs with physiologically active ingredients, and *did* actually heal people with non-placebo medicine, he makes it seem as though all evidence-based medicine sprang into existence with germ theory, like Athena from Zeus' head. And since it's rather easily proven that this isn't so, and that modern medicine gets lots of great ideas from the ancient traditions of cultures all over the world, alties could theoretically use this omission against him.

I just mean, in the spirit of fairness, he should have acknowledged that not every medicine prescribed before Louis Pasteur was a piece of crap. We stand on the shoulders of giants, etc.

Decrepitoldfool: I suspect Dawkins gets the firebrand reputation through small exerpts of his work (particularly The God Delusion) that are unfortunately phrased. Certainly if you read the book in its entirely he comes off as quite reasonable and calm.

Dawkins does a good job of outlining the main issues of concern about so-called alternative medical practices, but is simplistic and occasionally factually incorrect in his analysis.

Dawkins' approach to the problem presents alternative medicine in a stereotyped fashion and as though it were a homogeneous entity just like conventional medicine is alleged to be. But the reality is that there are countless practices, many of which are explicitly religious ceremonies adapted through market pressure for healing purposes in detachment from theit original ritualistic context.

When dealing with faith healers who present wacky theories about the universe Dawkins is flawless, instructive, and entertaining (in the best sense of the word): there is no doubt that much of what is grouped under alternative medicine is based on placebo, is performed by practitioners who are poorly trained even in their own disciplines (let alone scientific thought and medicine), and that some are truly malicious charlatans.

But when faced with more serious, level-minded exponents like Deepak Chopra and Peter Fisher Dawkins fails seriously to engage with their perspective which is fully aware of science, its triumphs, and its failings. Deepak Chopra is explicitly poetic and metaphorical -- in this mode he is acting as healer rather than scientist, and doesn't deny that the effects achieved by his approach are "placebo." It is jus that he doesn't stop the enquiry when this term is uttered, as is often done in conventional science: placebo should be the beginning of a quest to understand self-healing, rather than a terminal dismissal of all speculation.

Dawkins is at his weakest in his criticism of homeopathy:

- He presents Hahnemann as a faith healer instead of the polymathic scientist that he was -- not only a physician who railed against the superstitious practices of his day, but a leading-edge chemist and an early advocate of experimental method (such that it was in his day) in medicine -- simply due to disagreeing with the product of his searches. Hahnemann may have been dead-wrong about homeopathy, but to claim that he was irrational or not a scientist is ridiculous -- unless one likewise claims this about Newton due to his lifelong fascination with theology more wacky than homeopathy ever will be.

- Dawkins blatantly omits the fact that homeopathic dilutions undergo a specific process of shaking that plausibly can create some sort of "magnetization" (note: this is an analogy, not a claim of fact) that both imprints so-called "information" of the substance in question and "overwrites" pre-existing "information" (note: the preceding are metaphors, a permissible and unavoidable aspect of scientific theoretical reasoning).

- Dawkins falsely describes the 2005 Lancet study as a comprehensive "meta-analysis of meta-analyses" when in fact it is a methodologically suspect comparison of an a tiny subset of placebo-controlled RCTs (not meta-analyses!) of conventional medicine (chosen through ad-hoc methods from the whole massive corpus of such studies) with an unreported subset of placebo-controlled RCTs (not meta-analyses!) of homeopathy, coupled with conclusions that do not follow from the (in-part positive) evidence. He fails to alert the viewer to the existence of truly comprehensive mata-analyses some of which conclude that there is some evidential basis for the reality of the homeopathic effect (even while lacking clinically useful guidance) sufficient to consider the phenomenon a possible anomaly vis-a-vis current scientific knowledge.

- Fisher is himself of a skeptical mindset, admits to doubt, and has performed research to address his concerns. He admits that he will not be swayed by evidence in the sense of abandoning his clinical practice, but doesn't claim blind belief in the reality of homeopathy above placebo and against experimental evidence, and continues in his research efforts accordingly. Dawkins fails to engage with this position, which combines concern for patients over-and-above scientific ideals (while continuing to uphold them) with rational skepticism identical to his own (in quality if not in degree).

Dawkins is highly critical of the lack of evidence base and of the profit motive of alternative practitioners, but fails to note that the same criticisms are highly applicable to many aspects of conventional medicine. For example, as a commenter on this blog I can point out the fact that modern surgery is a successful, scientific branch of medicine which is not grounded in double-blind placebo-controlled trials (the only trials which Dawkins regards as "proper") but on a rich tradition of anecdotal evidence and observational studies, and that Orac himself presents anecdotal evidence from his practice when detailing the horrors of alternative medicine.) As another example, it is not clear that the playing-field is uneven in favour of alternative practices (which are popular despite lack of evidence) vis-a-vis conventional practices. The opposite claim, that patentable medicines backed by lobbying power can fulfil the rigorous and exorbitantly expensive demands of RCTs as natural medicines and non-patentable practices cannot, is equally tenable.

Dawkins' critique is ultimately one-sided because his underlying belief is that "no matter how imperfect, modern medicine is fundamentally on good grounds and therefore its imperfections are something we just have to live with," whereas the same faults in alternative practices are damning. Yet scores of equally rational people submit to alternative treatments out of real despair arising from incurable conditions, and frequently they persist in their rational-skeptical world-view even after being helped (i.e., remaining agnostic about the explanation for their improvement). I therefore do not agree with Dawkins' overall concern that alternative medicine represents an abandonment of rationality, rather than a legitimate adjunct to conventional medicine, which it is rational to pursue at least once conventional methods have been exhausted.

Ultimately, I would expect Dawkins to be consistent in his argumentation and to evade hypocrisy by providing:

(i) evidence (rather than anecdote) that people who submit to alternative practices are less rational than those who don't;

(ii) evidence that reduced interest in science is harmful (and in what way) to modern society;

(iii) evidence that the modern world was built on reason alone and not also on patently theological elements of the Judeo-Christian religious/cultural tradition;

(iv) above all, an explanation of what exactly he means when he uses the word "evidence" in multiple contexts throughout the program, as though it were a simple term and not the one of the most laden terms in contemporary philosophy of science.

David,

It is exactly that "magnetization" process that makes homeopathy unscientific. There is NO evidence that water can do any such thing, and as Dawkins said in the episode - why doesn't someone show how it works? That would completely rewrite everything we know about matter and energy, and would surely win a Nobel Prize - not to mention changing the scientific world forever.

That's precisely it. It is not that scientists have some sort of inbuilt objection to *how* homeopathy works, it is just that no-one has ever demonstrated *that* homeopathy works. Prove the effect, then you can go back and dig around for the mechanism.

As it is, all the data are consistent with any "effect" of homeopathy being mediated *entirely* via the placebo route. In other words, the scientific model is already sufficient to account for the data; if they're proposing something above and beyond that, may we *please* have some evidence, instead of lame excuses about how it "might" work, *assuming* there is any effect left over that needs explained?

[Incidentally, where are the homeopathy trials testing 20C vs 30C preparations?]

But when faced with more serious, level-minded exponents like Deepak Chopra and Peter Fisher Dawkins fails seriously to engage with their perspective which is fully aware of science, its triumphs, and its failings. Deepak Chopra is explicitly poetic and metaphorical

Deepak Chopra "serious" or "level-minded"? That's the funniest thing I've read all day! Chopra routinely mangles quantum theory, misrepresents evolution, and sometimes seems as though he doesn't understand even very basic aspects of medicine, as I've documented time and time again. Indeed, he is so full of it that I coined a new word for the sort of blather he routinely spews: Choprawoo.

Dawkins blatantly omits the fact that homeopathic dilutions undergo a specific process of shaking that plausibly can create some sort of "magnetization" (note: this is an analogy, not a claim of fact) that both imprints so-called "information" of the substance in question and "overwrites" pre-existing "information" (note: the preceding are metaphors, a permissible and unavoidable aspect of scientific theoretical reasoning).

This is the second most pseudoscientific thing about homeopathy after its very concept that "like cures like" and solutions of "like" diluted away to the point where not a single molecule remains can do anything. There's no evidence for "magnetization" or that "succussation" does anything.

As for Dawkins' description of the trials for homeopathy, he was a bit simplistic, but basically correct. The larger and better designed the trial, the less likely it is to find any "effect" from homeopathy, whereas the only trials that do find an "effect" generally are small and not as well-designed. Also remember that, using a p value of 0.05 as the cutoff, one would not be surprised if one out of every 20 trials of homeopathy would be "positive" by random chance alone.

Of course, if homeopathy did work as well as most of its promoters claim, there wouldn't be any questions about statistical significance - it would be blatantly obvious and unquestionable.

I have quite a good write-up which explains the physiology of the placebo effect. It is quite real and relates to neurogenic production of nitric oxide.

http://daedalus2u.blogspot.com/2007/04/placebo-and-nocebo-effects.html

In that context, blood letting is a treatment that works via the "placebo" like effect because it reduces hematocrit. Hemoglobin is the sink for NO, so when you reduce hematocrit, you increase NO levels.

I finally watched the video an then read the rest of the post.I have noted the marked proliferation of alternative medicine offerings complete with the offerings of phony credentials. As Dawkins points out it seems to appeal to people with money. This is of concern because these people are supposedly educated (years in school and the ability to think may not correlate)and they are often politically active.

I recently discovered that some hospitals in this state offer Therapeutic Touch or Reiki (manipulation of imaginary energy fields). These are offered through nursing departments and complaints risk being considered sexual discrimination. Once again woo-woo treatment sets itself up for special protection.

The problem with this documentary and this blog and several other attacks on alternative medicine (or the distrust of regular medicine/science) is that it is more or less preaching to the choir. What I would be much more interested in is how to "deprogram" someone who believes in all this mumbo jumbo, and has become afraid of regular medication ("the list of side effects is as long as my arm, this stuff is dangerous"). The odd thing is that some people go to a real doctor, and then refuse to take the prescription, go back because the problem does not go away (and do not tell the doctor they did not take their medicine), and subsequently claim that real medicine doesn't work!
Is it that there is a credibility problem here? Is it because people are afraid? Is it because people do not understand statistics, and think they will experience all of the side-effects? Is it because taking medication requires to some degree acceptance of the fact you are no longer a "normal" healthy person?

- Dawkins blatantly omits the fact that homeopathic dilutions undergo a specific process of shaking that plausibly can create some sort of "magnetization" (note: this is an analogy, not a claim of fact) that both imprints so-called "information" of the substance in question and "overwrites" pre-existing "information" (note: the preceding are metaphors, a permissible and unavoidable aspect of scientific theoretical reasoning).

This is testable. It has been tested. Lo and behold, it does not work.

(No surprise. That's the difference between liquid water and ice: the molecules don't stay in the same place and the same orientation.)

Benveniste got two IgNobel Prizes for this. That makes him the only person to ever have received two IgNobel Prizes.

Oh, and, the low dilutions in homeopathy (such as D12) may well work. They are powerful poisons (platinum complexes, for example) in very high dilutions. It is easy to imagine that such preparations have an effect. But the high dilutions are unambiguously woo.