One of the benefits of blogging is that it's broadened my horizons. Although the vast majority of what I write about happens in my very own country, the United States, nonetheless I frequently learn about things happening in many other countries, some that I wouldn't necessarily pay a lot of attention to. But when something happens in a country, not matter how far away, that interests me, sometimes it'll interest me enough to write about it. This is particularly true when it's a story about how other countries deal with the pseudoscientific bunch of quackery that comprise most of the treatments that are commonly referred to as "complementary and alternative medicine" (CAM) or "integrative medicine."
I'm referring to South Africa.
Yesterday, my Google Alerts for CAM popped up a rant by a man named Leon Louw against a new policy regarding CAM in South Africa that he views as unduly restrictive. That, of course, means that it's almost certainly a good policy. Also, Louw's little opinion piece uses a lot of fallacious arguments for CAM that are useful to examine. Of course, I had no idea who Leon Louw is; so I had to Google his name, which lead me to learn that he's a South African intellectual, author, speaker and policy advisor and one of the co-founders of the Free Market Foundation. When coupled with his little rant, the name of this foundation tells me a lot about it. His reasoning ability is also rather lacking:
THE new complementary and alternative medicines (Cams) regulations are draconian, misleading and insulting. In the name of science, they might promote rather than curb scams and pseudoscience. Instead of protecting consumers, they erode access to products and information. They subject supposedly unscientific Cams to supposedly scientific allopathic standards. Notwithstanding the regulations and the pretentious explanatory memorandum, the difference between the two is smaller than protagonists of science assume.
Right off the bat, Louw is demonstrating a whole lot of special pleading, objecting to holding CAM treatments to the very same standards for efficacy and safety as "allopathic" treatments. After invoking that logical fallacy, he then argues that the "difference between" CAM and "allopathic medicine" is smaller than protagonists of science assume. Well, one might reasonably wonder, if the difference between the two is so small, as Louw argues, then why shouldn't they be subject to the same scientific standards? Obviously, they shouldn't. That doesn't stop him from burying himself deeper into a pile of stupid:
That Cams are "unscientific" simply means they have not yet passed tests applied to most, but not all, mainstream treatments. A leading authority, the US’s National Institutes of Health, explains that "the list of what is considered to be Cam changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health". Every mainstream treatment starts as someone’s alternative idea, including "natural", "holistic" and "traditional" healers. Unless treatments are shown to be dangerous, they should be allowed without false or misleading claims. Antagonists, such as CAMcheck, should be as free to denounce Cams as Cams folk are free to denounce both CAMcheck and aspects of mainstream medicine.
No, many CAMs are "unscientific" because not only haven't they passed tests applied to mainstream treatments but because many of them are based on prescientific vitalism, mystical concepts, and ideas that, for them to be true, would violate multiple laws of physics and chemistry, such as homeopathy or reiki. Some CAMs claim the existence of nonexistent anatomic structures or abnormalities, such as the meridians of acupuncture, the craniosacral rhythms of craniosacral therapy, the "subluxations" of chiropractic, or the links between locations on the tongue or on the hands and the feet and internal organs postulated in traditional Chinese medicine or reflexology, respectively. Moreover, such modalities have been tested and failed to be shown to be more efficacious than the placebo control. Louw is wrong on nearly every level.
However, I can see what he is about. He's obviously a hard core free market type, as his argument sounds very much like the arguments libertarians make against government regulation of medicine. Of course, there's a hole you can drive a truck through in Louw's argument. It's inconsistent. He says that it should be OK to allow treatments that haven't been shown to be dangerous, as long as the practitioners of these treatments don't make misleading claims. But who's going to regulate whether claims are misleading or false? The not-so-subtle implication of Louw's argument is that it shouldn't be the government. Rather, he thinks the free market should do it, with CAMCheck, a group I hadn't heard of, "denouncing" CAM just as CAM promoters denounce CAMCheck. Hmmm. Come to think of it, there's a false scientific equivalence there (between CAMCheck and CAM practitioners), as well as nonsensical radical free market ideology about medicine. Here in the States, we tried that kind of approach for the first 100+ years of our nation's existence. It didn't work so well, which is why the Pure Food and Drug Act was passed in 1906 and the FDA formed. When it was found not to be strict enough, the act was replaced by the Federal Food, Drug, and Cosmetic Act in 1938.
Next up, a massive straw man:
Pretentious regulators want us to believe, and may themselves believe, that science proves things. It does not. Especially not health science. There is no such thing as "scientific proof". The father of the scientific method, Karl Popper, explained that science establishes degrees of probability, never absolutes except disproof. Scientific evidence ranges from overwhelming, such as the efficacy of anaesthetics, to virtually zero, such as the nature of consciousness, something as fundamental to medicine as life and death.
Of course regulators say nothing of the sort, usually. Scientists know that nothing in medicine can be "proven" conclusively. But they do know that there's a huge difference in the "degree of probability" that a medicine that has a reasonable mechanism of action and has passed randomized clinical trials is safe and effective and the "degree of probability" that a CAM remedy with no prior plausibility and no evidence that it is better than placebo actually is safe and effective. And, of course, that bit about the end is nothing more than an appeal to the unknown and an attempt, as Dara Ó Briain puts it, to insert into the gaps of our understanding "whatever fairy tale appeals to you."
Of course, according to this story, manufacturers of CAM products are outright disobeying the law, ignoring a February 15 deadline to put disclaimers on its products and continuing to sell products that are now illegal. Progress is being made, though. No doubt Louw approves such passive resistance to the jackbooted thugs of the South Africa version of the FDA.
Of course, having used straw men, special pleading, a misunderstanding of how science works, and a whole lot of appeal to free market mythology, there's only one thing left for Louw to resort to. What could that be? I bet you can guess, but if not here it is:
There is a flawed notion that mainstream medicine establishes safety and efficacy conclusively. Science is about uncertainty, as revealed by the new US Food and Drug Administration (FDA) warning for statins. Statins are among the commonest medicines, once thought to be so safe that healthy people were encouraged to take them. Having assured us they are safe, the FDA now warns of statins causing liver, cognitive, memory, concentration, blood sugar, diabetic and muscle damage. A local statin insert has been extended to include skeletal, neurological, hypersensitivity, skin, reproductive, eye and other "abnormalities".
Yup, it's the typical tu quoque argument; i.e., "you do it too!" He's claiming that because there are problems with science-based medicine and how drugs are approved for use, because the process is imperfect and sometimes there are issues, because real medicines have side effects and complications that can sometimes severe, then quackery must work. Or, at least, it must be treated as the equal of real medicine. Well, whenever I hear such an argument, I'm reminded of Ben Goldacre's famous retort (no pharma shill, he!) in which he says, "Just because there are problems in the airline industry does not mean that flying carpets work." Similarly, just because there are problems with "conventional" medicine and sometimes drugs are approved and later found to have unexpected adverse reactions does not mean that the "flying carpet" that is CAM works. It certainly doesn't imply that CAm should be treated as an equal, which is the main argument that Luow is making, when boiled down to its essence.
Reading this article was simultaneously depressing and uplifting. It was uplifting to see a country like South Africa cracking down on pseudoscience and fraudulent claims this way. Would that my own country would do the same! However, it's depressing in that it tells me that the bovine excrement reasons people use to defend CAM, including free market fundamentalist "health freedom" religion, are the same the world over.
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I googled the alleged quote from the NIH but to my vast surprise, the only source for it is a range of SCAMmers.
So there was no scientific method before the 1940s? The stupid is strong with this one.
This happened in South Africa, not New Zealand.
Countered quite nicely by Jacques Russouw http://synapses.co.za/cam-regulations-draconian-misleading-insulting-le…
Sorry, misspelled Jacques Rousseau.
Frank and I evidently typing simultaneously.
Brain fart fixed. I blame early onset Alzheimers' disease. Either that, or Orac needs to have his circuits cleaned, which I am proceeding to do.
Still, Luow is a very silly man.
Damn. I was so excited at thinking Orac was highlighting NZ. Maybe next time!
"proven to be safe and effective" being the operative words, here. No putting the cart before the horse, Mr Leon Louw.
His prose is a pack of logical fallacies in condensed form. That part got me especially riled up:
Well, sorta yes. Where do your preferred CAM modalities fit on this range, boyo? Near the "overwhelming" part, or near the "pulled out of my @ss" part?
Surgeons use anaesthetics on a regular basis but usually don't try to move their patient's mind into a pot of petunia. The absence of a unified theory of consciousness supported by facts may explain this state of affairs.
That's the whole point of having evidence of efficacy, really.
I "googled" that same phrase “the list of what is considered to be Cam changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health”, and came up with this from the NIH-NCCAM (page 1)
http://cim.ucdavis.edu/clubs/camsig/whatiscam.pdf
Louw presents the case of statins and the warnings that are now incorporated into the Physicians' Prescribing Information package insert and provided to all patients. Hasn't he inadvertently made the case for licensing by the FDA, which monitors the safety profile of drugs after they are licensed and prescribed for millions of people?
Every mainstream treatment starts as someone’s alternative idea
But there is an established procedure for turning that alternative idea into an SBM treatment. The exact path may depend on some details, but roughly speaking: If it's a drug, you first do some biochemical research to establish that it might plausibly treat the condition you think it treats. Then you request IRB approval for experiments in animals or humans[1]. Then you apply for funding, either internally or externally (government, foundation, or pharmaceutical company), to do those experiments. Once you have both IRB approval and funding, you do those experiments. If they succeed, then you repeat the process for larger scale clinical trials (at least one iteration, and usually two or more). If the treatment is found effective, and side effects are rare enough or mild enough that the risk of suffering one is worth the benefit of the treatment, then it is approved for ordinary doctors to use. I have yet to hear of a CAM treatment that went through all of those steps (successfully or otherwise), and most of the ones I know of have been through at most one or two of the steps.
[1]If I'm reading correctly the form my employer uses for approvals to submit grant proposals, we don't actually have to have IRB approval before submitting the proposal, as long as we are able to say it's pending. But I don't know this firsthand (my own research doesn't involve anything that would require IRB approval), and it could well be different elsewhere.
I have to take issue with his assertion that “Pretentious regulators want us to believe, and may themselves believe, that science proves things. It does not. Especially not health science.”
Science is demonstrably capable of establishing fact, i.e. proving something to be true. That’s no less the case with health science than it is with respect to chemistry or physics.
OT - but are eConferences to promote 'energetic healing'** for autism EVER truly OT@ RI? I think not.
TMR's MacNeil announces that they will sponsor an eConference in which healers ( a few from AUS and Canada) will ply their trades both upon children and parents internationally via the net. You see, it can be done remotely. AND it's quantum.
TMs have applied these techniques on their children, on themselves and on other family members. Testimonials are presented. The ladies who provide these esoteric tune-ups include arcane techniques like reiki, vibrational something, mediumship, channelling, telepathy, accupressure, flower essences, Austrailan Bush flower essences, essential oils, intuitive work, shamanism, remote healing, EFT and much more!
If you recall, MacNeil has been a psychotherapist and has taken herself off of meds for depression: perhaps she has found a more resonant therapy?
You can register for 40 USD and view it live or at any time over the next year.
If I hadn't taken the Not one penny for woo (tm) pledge I just might sign up myself.
Oh wait, I can just view it remotely for free.
** does that mean that the healer puts on her exercise clothing and does calisthetics or aerobic dance routines whilst balancing your chakras?
And because reiki's healing energies can be sent freely backwards and forwards through time, viewing the tape later this year rather than viewing the eConference live is exactly the same as being there in person.
Denice @12
At least energetic therapy is mostly harmless although the acupressure could be a problem for someone with an aversion to be touched.
JGC @12
I have seen a William Lee Rand DVD that includes him sending the viewer Reiki energy from his eyes. I am not sure what the consequences of holding a mirror in front of your face would be.
@ Militant Agnostic:
Much of this is done remotely.
Oh, I know.
MacNeil notes that eConferences are better than dragging a child to RL therapy sessions. Also in the RL woo, parents may serve as surrogates for chilldren.
Who would've thunk?
- as an aside Mama Mac uses the same graphic that gracious and inspired host does in his reiki post.
Synchronicity? or did she channel Orac?
If only. She might pick up a tad of common sense or reality orientation in the process.
I love how The Drinking Moms have plugged into bogus treatments for themselves and for their kids. Those "treatments" are so much better than the DIY fecal transplants, bleach enemas and stem cell transplants in filthy, unregulated offshore clinics.
Need I remind you all about the many posts by the science "journalists" at AoA about the prescribing of SSRIs for teens and young adults with major depression? According to them, mass murderer Adam Lanza must have been on prescribed antidepressant medication (he wasn't).
http://www.npr.org/blogs/health/2014/06/18/323329892/warnings-against-a…
"Government warnings that antidepressants may be risky for adolescents, and the ensuing media coverage, appear to have caused an increase in suicide attempts among young people, researchers reported Wednesday.
A study involving the health records of more than 7 million people between 2000 and 2010 found a sharp drop in antidepressant use among adolescents and young people and a significant increase in suicide attempts after the Food and Drug Administration issued its warnings.
"This was a huge worldwide event in terms of the mass media," says of the Harvard Medical School, a co-author of the study, which was in the journal BMJ. "Many of the media reports actually emphasized an exaggeration of the warnings."
Starting in 2003, the warned that popular antidepressants, such as Prozac, Zoloft and Paxil, might increase the risk that kids would think about killing themselves — or even actively attempt it.
In fact, no one knew for sure if the drugs were really dangerous. The idea was to get doctors and parents to keep a closer eye on kids taking them just in case it was true.
"The warnings were well-intentioned but people were concerned that the ferocity of the messages might affect clinicians, parents and young people in a way that would reduce needed medications," Soumerai says.
Antidepressant use nationally fell 31 percent among adolescents and 24 percent among young adults, the researchers reported. Suicide attempts increased by almost 22 percent among adolescents and 33 percent among young adults, they said...."
@ lilady:
Right. But that suicide/ violence meme has echoed about the woo-esphere for the past decade and seems to be getting louder.
MacNeil - who scoffs at most meds including antibiotics and SSRIs- should know better.
Energy healing is an imaginary solution ( non-homeopathic) to problems that are largely physiological.
I think JGC @11 is wrong and our author right.
Evidence for a model can be strong, but posterior probabilities never reach 1 unless there's goofy stuff going on with your prior (like having prior probability 1 for a model). There's also tricky stuff like the "true" model not having gotten any prior probability in a person's mind - Newton did not consider there might be special relativity.
(I think there's a word missing from the title of the post. It's likely a synonym for stupid. I was born curious.)
"Every mainstream treatment starts as someone’s alternative idea"
...but only a tiny fraction of someone's alternative ideas ever turns into mainstream therapy. And a vanishingly small fraction of alternative ideas that have been moldering for decades or even centuries ever morphs into something useful.
Actually there are four stages for ideas. First, they are mocked. Then a small number of people take them seriously. Then they are mocked again. Finally their supporters get butt-hurt and cry conspiracy or totalitarianism.
There may be a fifth stage:
the supporters inaugerate their own alternative journal.
"Statins are among the commonest medicines, once thought to be so safe that healthy people were encouraged to take them."
Then the FDA ( those jack booted thugs) found and responded to the problem.
Had it been a CAM therapy that was the problem and we were all living in his nonregulatory little paradise it would still be on the shelves. Sooooooo....how many own-goals can exist in one op-ed?
There’s also tricky stuff like the “true” model not having gotten any prior probability in a person’s mind – Newton did not consider there might be special relativity.
As a physicist, I have to speak up about this bit of historical revisionism. We have every reason to think that Newton believed the laws of physics to be the same in all inertial frames of reference--the idea goes back to at least Galileo, and the concept is called Galilean relativity in his honor. What led to the development of special relativity was that Maxwell's equations are incompatible with Galilean relativity. Which is fine if electromagnetic waves propagate in a medium ("ether"), since that introduces a preferred frame. But that medium was found not to exist. The other way out, which Einstein gets credit for developing, is to assume that the speed of light is the same for all observers regardless of their relative motion. (The title of the paper in which he published this idea translates to English as "On the electrodynamics of moving bodies".) That's what we know as special relativity, and it differs from Galilean relativity because the speed of light is finite--a fact that was only discovered during Newton's lifetime.
To put it back in the Bayesian frame you are thinking of: The mathematical details of special relativity might not have been worked out until the end of the 19th century, but the fundamental principle behind it--that the laws of physics are the same to all observers--was the default prior until Maxwell's day. It was only for a few decades that serious physicists had good reason to doubt this prior.
Eric @23 -- A nice summary!
Special relativity is often touted by alternative types as a theory that overturned everything, when, as you point out, it actually preserved a centuries-old idea (reference frame invariance) by resolving the apparent contradictions raised by what was then "new physics". (electromagnetism).
Funny story. On a climate-change thread, I was having a bit of a back and forth with a climate denier who claimed to be a "research physicist". He (I assume, since most women are smarter than this) was using relativity as an example of how scientific consensus is often not reliable. I pointed out that special rel didn't overturn a consensus -- it reconciled E&M with other physics. The other poster asserted that relativity has "nothing to do with electromagnetism".
I felt like Thomas Huxley did at a key moment of his evolution debate with Bishop WIlberforce -- when Wilberforce said something especially stupid, Huxley is said to have muttered under his breath: "The Lord hath delivered him unto my hands". Because of course, it completely demolished his claim of being a "research physicist" -- at least his implicit claim of being a good "research physicist".
Good times.
Thankyou for physics lessons. Need a cleaner (and simpler) example for next time.
And to Dangerous Bacon: very nice.
Well, isn't this nice. It turns out that inside Big Pharma are a bunch of maverick executives and researchers who are unafraid to think outside the box, come up with something unique, and by golly follow it through till its adoption into the scientific mainstream. It's all dreams and hopes and lots of good hard work.
Frankly, I suspect that this particular scenario is probably a bit closer to the truth than the alternative altie conspiracy theory which has everyone associated with the pharmaceutical companies turn into discovery-adverse sociopaths who happily watch death tolls rise as they suppress any treatment which doesn't both comport with their hegemonic materialist worldview and put money in their pockets.
If you define "alternative medicine" so broadly it includes every single thing still being researched -- you're groping for respectability too obviously.
Rork, is it really your position that science cannot establish fact?
Is stating the half-life of P32 to be 14.3 days offering an opinion? Or that, at an atmospheric pressure of 101.3kPa, the boiling point of pure water boils may be something other than 100 degrees celsius?
Would I simply be be engaging in conjecture if I said that streptomycin inhibited protein synthesis, by binding to the 16S rRNA subunit of the 30S subunit of the bacterial ribosome, or that the B-lactam antibiotic penicillin inhibits the formation of peptidoglycan cross-links in bacterial cell walls by binding to the enzyme DD-transpeptidase?
Science can indeed establish fact--i.e., prove something to be true to as high a level of confidence as is humanly achievable--from which it proceeds from to derive the explanatory models, which are by defintion incapable of proof, you're speaking of in your post at 19.
That's the former definition of the scale.
palindrom:
"He (I assume, since most women are smarter than this)"
Uh oh. I believe that we are being buttered up like hot toast.
Not that's there's anything wrong with that.
"every mainstream treatment starts as someone's alternative idea"
No, just no. At least not in in the sense of CAM alternative, statins were firmly grounded in modern physiology, and our understanding of the role of cholesterol in disease. Imantinib and the related tyrosine kinase inhibitors were based on our understanding of the physiology of cancer, not mysterious energy flows unknown to science.
That reminds me of a story. But it involves those mini-goudas and P. cubensis. Maybe some other time.
I advocate that we hold our next pharma shill soiree at Narad's place.
Phondue.
*Sigh* seems that we have our share of poepols here as well. Just one comment to add - notice how he refers to the FDA and NIH as authorities. OK, authorities to be shot down, but still, as big wheels. That is a reality around this part of the world. At the same time, I can't help remembering that American boytjie that convinced Pres Mbeki that HIV did not cause AIDS and therefore he should forbid hospitals and doctors to use antiretrovirals on those infected. And the enormous influence someone like Dr Oz has over people whose education, shall we say, leaves much to be desired. The US of A has status, cache, standing, in some other parts of the world, especially in scientific matters. Perhaps more than it deserves, but you'll know better than I do if that's so. What I want to say is, though, I'd love to see this status used responsibly, with careful control over the export of woo of all varieties, as these ideas often get more currency than real medicine prescribed by real but local doctors.
He (I assume, since most women are smarter than this)
It's not that women are immune to the Dunning-Kruger effect--Orac's archives include several examples of Dunning-Kruger afflicted women--but even the ones who are are smart enough not to try passing themselves off as research physicists. If you attempt to study physics but are not skilled at it, it's hard not to be aware of your lack of skill (but not impossible--I have run into a few cases myself, all of them male). In other fields, where experiments are harder to do (like medicine) or even impossible (like politics), it's easier to advance despite your lack of skill, and easier for you to ignore the people pointing out your lack of skill. See, e.g., Burzynski, Stan, or Palin, Sarah.
@Kathy, I thought Matthias Raath was a German.
@ Eric Lund:
Too true.
The Dunning-Kruger effect is failure to self-evaluate one's own abilities - which is part of executive functioning: abilities which develop over adolescence and young adulthood. For example, there's metacognition- knowledge about attention, memory and thought work: these skills enable a person to improve performance on important tasks through the development of strategies. Most people don't study this formally but learn through trial and error: good students learn how to study for tests and good speakers learn how to prepare in order to avoid common pitfalls and nervousness. D-K, I've learned, even occurs in tennis: people over-estimate their level of skill and get creamed or ridiculed: instructors know all about D-K.
I'd venture that there are fonts of D-K which enable the unschooled into thinking themselves expert- when they're not -through following their role models' illustrative example.
Of course, I'm talking about woo-centric websites/ media like NaturalNews, AoA, TMR, PRN.
This phenomenon is not limited to medical and health-oriented subjects unfortunately.
"Rork, is it really your position that science cannot establish fact? "
Fact is a fuzzy word, a term of convenience. Posterior probability of statement being true that is over around .999999 perhaps? Put in another dozen 9's for some of your examples perhaps. You'd find there'd be a debate about just how many 9's before we agree something is a fact. Even your facts are things that might actually require statements such as "so long as the rRNA doesn't have these alterations that we've recently found in a mutant strain" as we learn more.
"to as high a level of confidence as is humanly achievable" - that's downright funny, it admits confidence has degrees, has limits, but also like there's some wall where we can't learn more detail.
PS: Even my claims are subject to a problem - statistical decision theory as now developed may have flaws, and may be superseded by something better. But it's the only theory of learning I know of that makes any sense so far. The word fact does not appear in it. We've never had the silly dispute about how big posterior has to be to call something a fact - sue us.
@Julian - That's true that he is German, though I think it was during his time with Linus Pauling that he got hold of his ideas.
Julian, I presume Kathy was referring to Prof Duesberg, and not Mathias Raath. (But both are German, though Duesberg could be regarded as a Domiciled USian I suppose).
However it is interesting that Leon Louw ignores the realities of what people like Raath were able to do with their sCAM "Vitamins for AIDS" therapies. And let's not forget Mshabalala-Msimang's "Potato" cure, or the Virodene scandal.
Louw presumably want more of the same.